Psykoeducational family work

1. Psykoeducational family work Åse Sviland Clinical spesialist psychiatric nurse Anvor Lothe Clinical social worker/ family therapist Family department Psychiatric division Stavanger University Hospital Norway

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10. Plan for the Presentation • Schizophrenia and optimal treatment • Background for familywork in Norway • National guidelines • Main tasks of family work • Guiding principles for family work • History and research • Familys encounter, challenge and role • Psycho educational mulitfamily group • Recovery • Organizing of familywork in Stavanger

11. Schizophrenia • Schizofrenia is one of the most serious of the mental illnesses • It has a great impact on the life of both patient and the patient`s family • It strokes mostly young people between the ages of 15 and 25 • And the treatment of schizophrenia has had a difficult history.

12. Optimal treatment • Treatment with antipsychotic medicasion. • Psychotherapeutic treatment from an experienced therapist • Hospitaliaized within an appropriate therapautic environment • Psychoeducational family approach

13. Background • Patient`s relatives appreciated meeting other relatives • Multifamily- group with the patient • The modell of William Mcfarlane • Weekend seminar • Roleplay • 1 year before pilot-groups

14. National guidelines for the treatment of psychosis • All families will be offered contact within three days after starting treatment. • All families will be offered calls for their own benefit, education, aid to problem solving and effective communication. • Siblings and children are invited into their own conversations. • Services to families should be needs-oriented

15. General guidelines for family work • To ensure an effectivetreatment for thepatient • Relating to familymembers' needs in relation to theaffectedfamilymember'spsychoticcondition Burbach, Fadden og Smith 2008

16. The main tasks of family work in psychosis • To engage the family in a therapeutic adapted collaboration with professionals. • To offer family members the time to talk about what has happened. • To normalize the reactions and offer emotional support. • To talk with each family member separately, in order to gain an understanding of each individual's situation, how they are affected by development.

17. The main tasks of family work continue… • An overview of how family members relate to each other and • how those systems relate to their experiences. • To convey understanding and help them to deal with the situation they are experiencing as a result of psychosis development. • Helping them to make contact with other family members who are in a comparable situation to reduce the experience of isolation and stigma

18. Conclusion The best results are when the family participates in the treatment

19. Guiding principles for family work • Collaboration between patient, family and the professionals who work with them. • Challenges that arise, meet on an objective basis and the solution that is developed between the parties forming the basis for problem-solving efforts. • Methodology in family work is based on a non-judgmental attitude towards family members. • Focus of the work is here and now oriented and forward looking. • The emphasis on an honest and open exchange of information with all family members where the patient is included

20. 3 claims • Treatment works best when the patient knows how to work, and how patient themselves can contribute • Patient knows best how he can collaborate and contribute when he knows what the disease is and what the treatment involves • The environment knows best how patient can be helped when they know how the disease is

21. What is communicated • Actual knowledge • Attitudes • Seriousness • Activity • Safety • Confidence • Community

22. History 1950 Neuroleptica is introduced in the treatment of serious mental illnesses. Optimism is high. Many patients are being dismissed from the hospitals, but unfortunately a large percentage return after a short time George Brown (England) examines 229 patients after their dismission from hospital. He identifies two types of families: (Leff and Vaughn, 1985) 1968

23. History 1972 The Camberwell – interview ”made to measure” EE • Methods oftreatment to lower EE in thefamilyareintroduced. Relapse is reduced from 60 % to 20 % in oneyear. (Borchgrevink 1999, Kavanagh 1992, Leff and Vaughn 1985) • Main elements are Education Communication Problem solving

24. ResearchHogarty et al.(1986) Mc Farlane et al. (1990)Relapse after one year (%) 41 Outpatient treatment 42,9 Dynamically oriented multifamily work 23,5 Single family work Familywork including 19 education and problem solving 20 Social skills training 12,5 Multifamily educational groups Familywork including 0 social skills training

25. Recent Research Psykoeducational terapy give better results • reduce relapse • reduce symptoms • better psykososial function • more knowledge about psychoses • better coopertion about medication (Pitchel-Waltz et al, 2001, Pekkala & Merinder 2002, Bentsen 2003, Murray-Swank & Dixon, 2004)

26. The family's encounter with psychosis • Sadness - despair – crisis Shame and stigma • Isolation Economic problems

27. The family's challenge • Understand the incomprehensible behavior • Maintain a dialogue • Provide assistance • Take care of the rest of the family • Fulfill their own needs

28. The family's role Family is not responsible for the development of psychotic disorders Family members are doing the best they can in relation to the help they get to understand the disease and what they can do to help

29. Effective psychosocial treatments • Emphasizes education about the disease • Based in the stress / vulnerability model • Works to enhance natural coping mechanisms • Mobilize all available support

30. One family Multifamily With patient Without patient The groupleader gets a different relation to the patient The relatives get a different relation to the patient The patient changes attitude/behaviour Familywork

31. Better cooperation bethween patient, relatives and professionals Reduce the risk of relapse By giving the family Knowledge Support and advice By helping the family Better manage living with the patient Better handling difficult situations Ease the burden Goals

32. Multifamilygroups Focus on the family work is Problem solving Education Communication

33. Relatives Introducing the family-work program, contents and goals Crisis concerning the illness Draw a geneogram (family tree) Learning about warning signs and possible signs of relapse Patient Introducing the family-work program, contents and goals The groupleaders and the patient is getting to know each other Draw a genogram (family tree) Learning about warning signs and signs of possible relapse Family-work structurealliance talks

34. Educasion - seminar Program • Understanding psychoses • Expressed Emotion • Stress- vulnerability model • Different symptoms • Drugs / psychoses • Treatment: milieu therapy, medication, rehabilitation, psychotherapy • Crisis theory • The Law concerning mental health service

35. Multifamily groups-structure • First meeting: Presentation of all the group-members • Second meeting: the group members talk about how the illnes have affected their lives. • Following meetings: Problem solving method • McFarlane • First year • Avoiding relapse • Gradually reestablishing normal • functioning within the family • and amongst friends • Second year • Rehabilitation • Education / Work planning • Reestablishing normal social • functioning

36. Meeting structure

37. Problem solving / choosing a problem Two main areas of concern • Factors that can lead to relapse • Factors involving the next step in getting better Priorities • Safety at home • Medication • Drugs and alcohol • Life events • Experiences beyond one’s influence • Disagreement between family members

38. Solution Plan Define a problem or a preferredactivity Make a list of all possiblesolutions Discuss all possiblesolutions Make a detailed plan: How to get started? • When do you want • to start? • What resources • will you need?

39. Solutions in practice • All successfull solutions are credited the family. • The failures are put on the shoulders of the group leaders

40. When a certain problem is not solved • Give a suggestion to the solution and ask for a response on the next group meeting • Refer to earlier similar problem solution

41. Communication rules • No mind reading • Talk for yourself • Respect the views of others • No ”deep” discussions • Help each other with explanations • Give positive feedback and support

42. Advice to relatives during patient’s psychosis

43. RecoveryPhases in the improvement process: • improvement is a gradual process • often go in waves • need rest periods to be stable • pressure for change in these periods causes stress • pace of change is individually • TAKE ONE STEP AT A TIME !!!!

44. How we organize familywork in Stavanger? • In Norway, we have a common national educational programme consist of 60 hours of theori. • Participants in the training engage in role play • there is monthly supervision for groupleaders • In Stavanger 2012: 20 multifamiliegroup and 40 group leaders in activity

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