Family work for schizophrenia : a practical guide

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