Family psychoeducation and schizophrenia: A review of the literature

Journal of Marital and Family Therapy, Apr 2003 by McFarlane, William R, Dixon, Lisa, Lukens, Ellen, Lucksted, Alicia

Research conducted over the last decade has supported the development of evidence-based practice guidelines for addressing family-members' needs for information, clinical guidance, and ongoing support. This research has demonstrated that meeting the needs of family members also dramatically improves patient outcomes, while improving family well-being. Several models have evolved to address the needs of family members: individual family consultation; professionally-led family psychoeducation (Anderson et al., 1980; Falloon et al., 1984), in single-family and multifamily group formats (McFarlane, 2002): various forms of more traditional family therapies (see Marsh, 2001); and a range of professionally-led models of short-term family education-sometimes referred to as therapeutic education (Amenson, 1998; Marsh, 2001). There are also family-led information and support classes or groups such as those of the National Alliance for the Mentally Ill (NAME Burland, 1998; PickettSchenk, Cook, & Laris, 2000). Of these models, family psychoeducation has a deep enough research and dissemination base to be considered an evidence-based practice. The descriptor "psychoeducation" can be misleading; family psychoeducation includes many cognitive, behavioral, and supportive therapeutic elements, often utilizes a consultative framework, and shares key characteristics with other types of family interventions.

A variety of family psychoeducation programs have been developed over the past two decades (Anderson, Reiss, & Hogarty, 1986; Falloon et al., 1984). These programs are professionally created and led, offered as part of a treatment plan for the consumer, and are usually diagnosis-specific. The models differ significantly in format (multiple-family, single-family, relatives only, combined), structure (involvement or exclusion of consumer), duration and intensity of treatment, and setting (hospital or clinic, home). They place variable emphasis on didactic, emotional, cognitive behavioral, clinical, rehabilitative, and systemic techniques. Most have focused first on consumer outcomes, although family understanding and well-being are assumed necessary to achieve those outcomes. All focus on family resiliency and strengths.

Although the existing models of family intervention may appear to have substantial differences, a significant consensus about critical elements of this kind of treatment emerged in 1999, under the encouragement of the leaders of the World Schizophrenia Fellowship (1998). Leff, Falloon, and McFarlane (World Schizophrenia Fellowship, 1998) developed the original consensus, which was then refined and ratified by many recognized clinical researchers working in this field. The process involved selection of the key components, developing a consensus based first on empirical evidence and then on a consensus as to what each component actually represented. The final step was further refinement based on feedback from, and iterative reworking with, nearly all of the principal psychoeducation researchers in the world. Parenthetically, this process led to convergence of concept rather than the usual process of the field splitting into competing schools. The resulting consensus regarding goals, principles and methods, i.e., elements of family intervention that are critical to achieving the empirically validated outcomes reported, was summarized as follows.