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Working with Families

Working with Families . Linda May, PhD, MFT – Case Manager, PART. The experience of working with families. What would you want if you or a loved one developed a high risk or psychotic illness? What would you expect would be the stressors, skill deficits, AND Areas of strength.

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Working with Families

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  1. Working with Families

  2. Linda May, PhD, MFT – Case Manager, PART

  3. The experience of working with families • What would you want if you or a loved one developed a high risk or psychotic illness? • What would you expect would be the stressors, skill deficits, AND Areas of strength

  4. Systems - homeostasis

  5. Organizational Homeostasis

  6. Genogram

  7. Family therapy – then and now • Dysfunctionality based approaches • Best possible outcome for consumer and family thru collaboration • Evidence-based family intervention

  8. Functional & Problem Behaviors

  9. Family work in prodrome, and early psychosis • Research supports need for comprehensive txt – meds, family wk, milieu/occupational, & psychosocial • Earlier treatment improves prognosis • Support and education of individual and family • Family may be main caregiver

  10. Ultra High Risk & Psychosis in Developmental Perspective • Normal development individuation, formal operations, identify formation, family system temperaments, significant life events • Ultra High Risk & Psychotic symptoms – impact on communication, expectations

  11. Family as support vs. stressor • Family style (EE research) pre, post symptoms • Stigma impact • Lack of comprehensive support network • “Warm, positive” versus “critical, overprotective”

  12. Components of expressed emotion: Prodromal vs. chronic phase SAS-III, Rejection and Emotional Over-involvement subscales All differences, prodromal vs. chronic: p<0.01

  13. Effects of EE and contact on relapse in schizophrenia Bebbington and Kuipers, 1994

  14. Family Guidelines • System changes, sib realignment, need for family support • Grief, loss regarding “former child” • Impact on parental identification • Impact on “launching” plans • Impact on child’s individuation, identity with adolescent, young adult peers

  15. Social networks in schizophrenia • Family network size • diminishes with length of illness • decreases in the period immediately following a first episode • is smaller at the time of first admission • Networks • buffer stress and adverse events • determine treatment compliance • predict relapse rate • correlate with coping skills and burden.

  16. Key family interventions specific to prodromal psychosis • Strengthening relationships and creating an optimal, protective home environment • Preventing onset of negativity and criticism • Reducing intensity, anxiety and over involvement • Adjusting expectations and performance demands • Minimizing internal family stressors as marital stress, sibling conflict/concerns, conceptual and attributional confusions and disagreement

  17. References • Family Guidelines – Sources: Carol Anderson, Schizophrenia and the Family (Guilford Press, 1986); Dr. William McFarlane, Multi-Family Groups in the Treatment of Severe Psychiatric Disorders (Guilford Press, September 2004). • Concepts & Recommendations for clinicians Who Teach Families How to Manage Schizophrenia by Carole M. Anderson, Douglas J. Reiss, William R. McFarlane, MD • Family Expressed Emotion Prior to Onset of Psychosis – William R. McFarlane, MD, William L. Cook, PhD • Family Psychoeducation and Schizophrenia: A Review of the Literature – William R. McFarlane, Lisa Dixon, Ellen Lukens, Alicia Lucksted • Multifamily Groups in the Treatment of Severe Psychiatric Disorders by William R. McFarlane

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