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Family interventions for psychosis

10 June 2021 | by Guest

The following article was co-written by Jo Allen and Steven Livingstone, authors of our recently-published guidelines on 'Family Interventions for Psychosis'.

We are pleased to announce the publication of ‘Family Interventions for Psychosis: Guidelines for psychologists and practitioners supporting families and social networks’.

The document has been produced through a collaboration between family members and carers, experts by experience, psychologists and other mental health professionals, brought together by the BPS Psychosis and Complex Mental Health Faculty. The document is published to coincide with Carer’s Week.

When someone is affected by psychosis, they will often turn to those closest to them. Supporting family when their loved one becomes unwell means they are better able to cope with the multiple challenges of this difficult journey. It is also thought that family work can support better understanding of the identified persons problems and mean support can be better tailored to them.

Family Interventions are recommended in decades of research and supported by a range of policies and guidelines – yet in practice, service provision often falls short of what is recommended. Part of the reason for this may be the lack of clarity around the structures necessary for family interventions, what intervention is best when, who should be providing what intervention, and what role psychologists and others can take in this.

It is hoped that the document will address these issues through providing useful guidelines for professionals, while also providing service users and carers with a framework for understanding what services could and should be providing. The document shows that working with families and networks is essential for good practice in services. All mental health professionals have a role in supporting family inclusive practice and increasing availability and quality of family interventions.

The document represents all the major approaches to family work in psychosis, and we were particularly pleased to have had contributions from experts associated with each of the main modalities. We have chosen not to represent the main approaches hierarchically, on the basis of length of training or assumed level of complexity.

The approaches are instead represented as different, having different training routes and techniques, but also as having common processes, such as attending to the therapeutic relationship, contracting of goals and supporting change through conversations around understanding experiences, improving communication and supporting recovery.

The document emphasises that choice, both for families and practitioners, should be supported. Some families prefer a more psychoeducational approach and learning structured communication skills. Others value open-ended questions, attention to the wider context and a focus on trans-generational issues, as more often used in systemic practice.

Additionally, practitioners should be encouraged to pursue the approach which makes sense to them, as there is evidence that therapist conviction in the approach is an important predictor of progress in therapy. Ultimately, the different ways of working and different approaches described in this document all offer something helpful to families. Commitment to offering different approaches should be sought, and choice should be available to families in the approach they take up.

The multiple health inequalities experiences by ethnic minorities are well known. The increased incidence of psychosis, especially within Black groups, highlights the critical need for family interventions that are accessible and acceptable to people from diverse racial backgrounds.

All families are different and attention to difference should be central to family interventions. A wide view of family should always be taken, asking service users and families who should be included in any intervention. Family Interventions training must equip practitioners to work with diversity and to

practice in an anti-racist and anti-oppressive manner. Practitioners should commit to ongoing self-reflexivity and curiosity about their own and families’ socio-historical context and develop competencies in bringing this into their work with families.

Supporting families throughout their journey in services is important, and practitioners should offer family interventions multiple times in each service. Families might require different things at different times in their journey and different conversations and support might be necessary depending on the situation.

Attention needs to be given to the trauma experienced in crisis, the shock and trauma of first episodes and the burn-out after multiple years of caring, which can lead to loss of hope and feelings of grief. Different family members may want to be included at different times, hence flexibility in supporting work with different groups of family members is important.

A clear implementation strategy with support at all levels of the organisation is important to providing sustained delivery of family inclusive practice and family interventions. Training and supervision should always be included in these plans, including the need for clinicians to have the time to not just to attend training but also to deliver interventions and attend on-going supervision.

Different approaches should be supported and differing lengths of training to support the development of expertise in services. All staff should be trained in family-inclusive practice.

Training needs to follow guidelines and be supported by co-working and supervision by experienced family intervention practitioners.

Psychologists, along with other professionals, have a role to play in the development of family interventions in services, particularly in supervision and training. Support is required in organisations and professional groups to help them achieve this, and doctorate psychology training should equip all trainees with the skills to work with families and networks.

This guidance is specifically focused on family interventions for psychosis. The recommendations apply equally however to many if not all mental health difficulties. It is hoped that family interventions will become readily available for all families regardless of diagnosis.

We hope that in the future no family should go through supporting a loved one in their journey through mental health services without being included in their care and being offered family interventions as well as their own individualised support. As one of the carers who contributed to the document put it:

"My hope is that every family can be supported to access provision like this. It is empowering and has given each member of my family tools to go forwards, and we feel we can support each other better.

I realise that resources are limited but I am sure that the longer-term benefits in cost reduction, brought about through developing families’ resilience and coping strategies, alongside co-production of care planning is the only way to develop a meaningful approach to mental health support."

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