OASIS PDP
News
Family Support and Collaboration on a Treatment Plan
25 March 2024
Psychiatric care has evolved from asylum care or therapist counselling to encompass family and community support as part of the treatment plan. This involves engaging patients, their families and caregivers in the management and treatment of their mental health.
The objective behind family engagement in mental health treatment is to alter the family’s approach and response to the mental disorder and towards one other, and to achieve superior treatment outcome. This is done by exploring beliefs, patterns of interaction and behaviour within the family to avoid unhelpful (vicious) cycles of interaction and to promote helpful (virtuous) cycles (Burbach1996; Farhall, Harvey, Kazantzis, Meadows, Farhall and Fossey2012).
Goals of Family Intervention
To understand the family’s interactive patterns and it’s psychopathological ramifications
To identify and restructure maladaptive interactive family patterns
To activate the family's strengths and functional resources
To strengthen the family's communication and problem-solving behaviour
To create an effective treatment plan with family support
Process of Family Engagement
Family assessment is the first step in evaluating what the family knows and understands about the patient’s problem. It involves interviewing the patient and family, separately and together, conducting the patient’s mental status examination, retrieving patient history, family history, symptoms of mental illness, history of illness, diagnosis of mental illness, determining treatment plan, addressing familial issues, identifying family strengths, understanding family dynamics, maladaptive interactive patterns within the family, providing psychoeducation to client and family, creating a treatment plan, and collaborating with family on treatment.
The clinician first establishes a rapport with the client and family, wherein they feel comfortable, understood, respected, validated, not judged or blamed, and feel able to openly participate in the assessment process.
Family assessment aims to orient the family to the interview process and establish a comfortable, collaborative relationship, help the family identify all previous and current problems that led to the need for treatment, and the family’s transactional style (communication, interaction, dynamics) which analyses their interaction and functioning(functional or dysfunctional). Dysfunctional transactional patterns are repetitive interactive behaviour that limit resolution of, and alleviate interpersonal issues, within the family. These need to be identified and rectified for effective treatment.
Family therapies include psycho-educational interventions and relationship-focused interventions. These interventions educate the client and family about psychological concepts, their specific issues, and the relationship between thinking, emotion, and behaviour. They addresses relationship skill deficits and acts as preventive function by supporting the client’s and family’s acquisition of the skills required to live a meaningful life.
These interventions work by empowering the family, by helping them understand and gain knowledge of the illness, dissipate related guilt, redefine the problems for clearer perspective, teach and model adaptive coping techniques, life skills, set clear boundaries, learn and apply communication skills, foster listening, patience, acceptance of the problem, problem solving skills, decision-making, emotional awareness, parenting skills, positivity, conflict resolution, so as to move from conflict to collaboration.
Psychoeducation also involves educating the family about the illness, its course, causes, treatment, and prognosis, covered in two to six sessions. Additional family interventions focus on specific aspects such as career, future plans, job prospects, medication supervision, marriage and pregnancy (in women), behavioural management, improving communication, and so on, requiring 2 and 6 sessions.
Psychoeducation and relationship interventions apply cognitive behavioural therapy (CBT) with the client and family to help them understand how their mind and emotions work, creating stressors and responses, leading to dysfunctional behaviour and thought patterns. Core beliefs which result in faulty thinking and cognitive distortions, and lead to stressors, anxiety, depression and interpersonal or behavioural issues, are examined and identified. The therapist helps the client and family learn and practice techniques and skills to restructure these thought and response patterns, within themselves and towards each other, communicate positively, and transform negative thinking and responses to more positive ones.
BENEFITS OF FAMILY COLLABORATION
Family engagement has short-term and long-term benefits, resulting in better patient outcomes, such as- fewer relapses, greater intervals between relapses, reduced hospital admissions, shorter inpatient stays, and improved compliance to medication and treatment plans. Family engagement in schizophrenia patients has resulted in lower residual psychotic and deficit symptoms, and also helped in early detection of signs of relapse. Early family intervention in depression helps reduce the severity. Patients report better quality of life and reduced general social-impairment with family engagement. Family involvement helps in faster access to mental health services, eases family burden and caregiver stress, and improves emotional expression among family members and carers. The benefits endure over time when family engagement is actively maintained.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8801858/
https://www.psychiatryadvisor.com/home/practice-management/involve-families-in-patient-treatment/