Integrating the Family in the Treatment of Psychotic Disorders
Maine Medical Center, University of Vermont
The multifamily group approach often provides opportunities for patients to break through problems that are limiting their options in living. Described here are the theoretical background for this treatment model, evidence of its effectiveness and its major components.
The early stages of onset of a psychotic disorder include the cardinal symptoms of all psychoses – major alterations of cognition, affect, sensation and behavior. These are most serious in schizophrenia. However, especially in that disorder, it has become clear that the accompanying deficit syndrome is the source of the most severe disability, lasting for a lifetime in the majority of cases. Both aspects – psychotic symptoms and functional disability – make these devastating disorders for families, who often assume major caretaking and psychological burdens secondary to the functional deficits that this and other psychotic disorders impose. These deficit processes usually begin prior to the psychotic symptoms, often persist in spite of treatment, and usually get worse with time and with each subsequent episode. These deficits are often the most confusing and burdensome for fam-ily members, because they usually do not identify them as part of the disorder, but nevertheless find themselves supporting the affected member to compensate for those deficits. The resulting stresses on families lead to interactions and persisting patterns of interaction that can have equally devastating effects on the patient with the disorder and its course over time. Family psychoeducation has been developed and shown to be remarkably effective in counteracting these processes and in improving family functioning and coping skills, leading to greatly improved clinical and functional outcomes. Described here are the theoretical background for this treatment model, evidence of its effectiveness, and its major components and technical features.
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