Family Work for Schizophrenia (Second edition)
Julian Leff, Elizabeth Kuipers and Dominic Lam
The relapse rate of schizophrenia can be substantially reduced
by working with the families of sufferers on the everyday problems
generated by the illness. This book is a detailed practical guide
to intervention. The approach to working with families has been
used by hundreds of community staff and has proved helpful with a
range of clients in addition to those with a diagnosis of
schizophrenia. The techniques and strategies included in the guide
are clearly described for use by clinical practitioners and are
illustrated by case examples.
The second edition retains the original sections, including
the engaging the family, treading the fine line between working as
a therapist and being a guest in the family's home, improving
communication, teaching problem-solving and cultural issues.
Material has been added on the evidence base for family work for
schizophrenia and on the emotional responses of siblings. The guide
has been further enriched with the authors' experience of working
with families over the ten years since the first edition was
published.
Contents
Acknowledgements
Part I. Introduction
1. Introduction to our approach
What are the emotions measured by EE? · Low-EE relatives and
the importance of warmth · Low-EE relatives are not simply neutral
· Targeting interventions · The treatment model · Differences
between our approach to work with families and that of others ·
General interpersonal effectiveness · Support group for therapists
· Summary
Part II. Practical issues in family
work
2. Engaging the family
Strategies · Families who refuse · Maintaining families in
treatment · Summary
3. Being a therapist, not a guest
Social pressures · Forms of address · Greeting and parting ·
Turning off the television · Tea and biscuits · Personal
questions · Taking control · Summary
4. Co-therapy
Modelling · Trust · Forming alliances · Working on separate
tasks · Planning sessions · Support during the session · Debriefing
· Summary
5. Offering education
The education programme · The long-term process of education ·
The main topics · Summary
6. Family sessions
Aims · Achieving the aims · Briefing and debriefing ·
Summary
7. Improving communication
The problems · Establishing the ground rules · Listening skills
· Summary
8. Task setting
Setting a realistic list of goals · Setting an agenda and
prioritising · Negotiating solutions and agreeing on homework ·
Checking up on homework · Summary
9. Dealing with emotional upset: general issues
The variety of emotional responses · Normalising emotional
responses · Positive reframing · Seeing family members separately ·
The use of relatives' groups and role play · Summary
10. How families affect professionals
The spread of conflict · Doom and gloom · Guilt and anger ·
Summary
11. Leaving
Establishing a lifeline · Reviewing the family work ·
Summary
Part III. Emotional issues, problems of individuals
and groups
12. Anger, conflict, rejection
Defusing anger · Keeping control · Model positive negotiation ·
Look at the positive aspects · Limit setting · Unpacking a violent
incident within the family · Prevention · Summary
13. Dealing with overinvolvement
General considerations · Relative's guilt · Finding a lever ·
Exploring anxieties about separation · Replacing the role of carer
· Limit setting · Achieving independence · Strategic moves ·
Summary
14. Grief
Summary
15. The vulnerability of adult patients
Sexuality · Social competence · Summary
16. Stigma
Intervention · Summary
17. Absent family members
How to get everyone in the family involved · Involving the
'peripheral' family network for support · Coping with
non-attendance · Coping with lack of interest in meetings ·
Summary
18. Helping marital families
Task sharing · Loss of a confidante · Re-establishing a warm
relationship · Sexuality · Separation · Summary
19. Children in the household
Timing of parents' marriage · Exposure of the child to symptoms
· Factors influencing the child's response to a parent with
schizophrenia · Specific problems · Summary
20. Carers who are siblings or children
Siblings · Children · Summary
21. Employment
Helping patients to gain outside employment or return to
education · Preparation of patients · Summary
22. Cultural issues
Language · Ethnic matching of therapists with clients · Family
structure · Maintaining 'face' · Beliefs about the causes and
treatment of illness · The advantages · Summary
23. Special problems complicating family work
Alcohol and substance misuse · Child physical and sexual abuse
· Suicide · Physical disabilities · More than one person in the
family with schizophrenia · Working with several other agencies ·
Families who reject therapists · Summary
24. Running a relatives' group. I
Advantages of relatives' groups · Disadvantages of relatives'
groups · General issues · Venue · Timing · Selection · Size · Open
or closed groups? · Aims of a relatives' group · Therapists' role ·
Summary
25. Running a relatives' group. II
The first group meeting · Subsequent meetings · Themes ·
Problem solving · Emotional processing · Maintaining attendance ·
Ending a group · Summary
Part IV. Conclusion
26. Conclusion
Effect of education · Effect of family sessions
Bibliography
Appendix 1. Education booklet
Appendix 2. Helpful Aspects of Therapy form