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

Short-term models. In work that focused particularly on family rather than patient outcomes, Solomon, Draine, Mannion, and Meisel (1996, 1997) compared two short-term models of family intervention, either family group education or individualized family consultation, with a waitlist control group. About half of the participants were members of family support groups such as NAMI. For the active treatments, patients were invited. The group education model was well defined and included 10 weekly sessions focusing on education and development of coping skills. To facilitate collaboration between professionals and families, the groups were co-led by a professional and a peer consultant. The families were involved in designing the psychoeducational and problem-solving agenda and could obtain as-needed professional consultation following the conclusion of the group. In contrast, the consultation sessions were individualized, conducted in person or by telephone. Improved self-efficacy, defined as confidence in one's ability to understand and cope with the mental illness of a relative, was the only significantly improved outcome at the conclusion of the interventions. Among those who received individual consultation, self-efficacy improved regardless of prior membership in a self-help group. For those attending the family groups, participants showed significantly increased self-efficacy only if they had never participated in a self-help group. A more recent study assessed the efficacy of the Family-toFamily Education Program, a structured 12-week program developed by the National Alliance for the Mentally Ill (Dixon, Stewart, et al., 2001). After completing the program, the participants demonstrated significantly greater family, community, and service system empowerment, and reduced displeasure and worry about the family member who had a mental illness. These benefits were sustained at 6 months. It is noteworthy that these interventions were short-term in nature and that effects on patients were not assessed. Given recent practice guidelines that emphasize duration of at least 6 months and that the core elements of coping skill training and problem solving were lacking, an extension of these models may or may not have produced improved patient outcomes.

RESEARCH OVERVIEW

In the preceding Journal of Marital and Family Therapy research review in 1995, Goldstein and Miklowitz concluded that family psychoeducation for people afflicted with schizophrenia was highly effective when compared to standard care or medication alone. Going beyond basic efficacy, they described a number of studies in progress or very recently published that addressed the question as to whether there were technical variants that were more or less effective and/or specific subpopulations of patients with schizophrenia for which a given approach was superior. They went on to note that in the U.S., where the bulk of the research had been done, there was little application in routine clinical practice. In the U.K., by contrast, there was at least one national and one major large urban initiative to implement the approach. Finally, they noted that the approach had begun to be tested in other disorders, beginning with bipolar disorder. Each of those themes is reflected in the research reviewed here, although one of them, dissemination and implementation, is in nearly the same discouraging state that it was in 1995.