Family psychoeducation is a method for training families to work together with mental health professionals as part of a team to help family members with psychiatric disorders recover and maintain psychological health. Family psychoeducation has been shown to improve patient outcomes for people with schizophrenia , bipolar disorders, depression , and other major mental illnesses.
The goal of family psychoeducation is to prevent patients with severe mental illnesses from relapsing, and to promote their reentry into their home communities, with particular regard for their social and occupational functioning. To achieve this goal, family psychoeducation programs seek to provide families with the information they need about mental illness and give them the coping skills to deal with their family members’ psychiatric disorders.
An associated goal of family psychoeducation is to provide support for the patients’ families. Families experience many burdens (financial, social, and psychological) in serving as long-term caregivers for their loved ones. Although the primary focus of family psychoeducation groups is improved patient outcomes, an essential intermediate goal is to promote the well-being of the family.
There are several different models of family psychoeducation. Although they include many common elements, these different models are: single- and multiple-family groups; mixed groups that include family members and consumers (patients); groups of varying duration ranging from nine months to more than five years; and groups that focus on patients and families at different phases in the illness. Family psychoeducation programs have been studied extensively and refined by a number of researchers, including Drs. Ian Falloon, Gerald Hogarty, William McFarlane, and Lisa Dixon.
The evidence suggests that multifamily groups, which bring together several patients and their families, lead to better outcomes than single-family psychoeducation groups. The origins of multiple-family group therapy go back as far as 1960, when these groups were first assembled to solve ward-management problems in a psychiatric hospital. Lasting a minimum of nine months, the programs provided their participants with information about mental illness, its symptoms and treatment; medication and its side effects; how to communicate with a person with mental illness; and techniques for crisis intervention and mutual problem solving.
Dr. Dixon recently outlined the characteristics of successful family psychoeducation programs. They include:
- the programs consider schizophrenia an illness like any other.
- they are led by mental health professionals.
- they are part of a total treatment plan that includes medication.
- families are treated as partners rather than patients.
- the programs focus primarily on patient outcomes, and secondarily on family outcomes.
- the programs differ from traditional family therapy in that they do not treat families as part of the problem; they see them as part of the solution.
It is also important that family education programs take into account the phase of the patient’s illness, the life cycle of both the patient and the family, and the family’s cultural context.
Burden —First described by M. B. Treudley in 1946, this term generally refers to the consequences for the family of close contact with people who have severe mentally illnesses.
Meta-analysis —The statistical analysis of a large collection of analyses from individual studies for the purpose of integrating the findings.
A large body of evidence supports the use of family psychoeducation as a “best practice” for young adults with schizophrenia and their families. Because of this compelling evidence, researchers at the University of Maryland, as part of the Schizophrenia Patient Outcomes Research Team (PORT), identified family psychoeducation as an evidence-based practice that should be offered to all families. This and other research studies have shown reduced rates of relapse and lower rates of hospitalization among patients and families involved in these programs. Other outcomes included increased rates of patient participation in vocational rehabilitation programs and employment, decreased costs of care, and improved well-being of family members.
A meta-analysis of 16 individual studies found that family interventions of fewer than 10 sessions have no effect on the reduction of family burden. There are also several controlled studies that support the effectiveness of single- and multiple-family interventions for bipolar disorder , major depression, obsessive-compulsive disorder, anorexia nervosa , and borderline personality disorder. Studies of family psychoeducation have been conducted with a Hispanic population in Los Angeles, California, and outside the United States in China, Norway, and the Netherlands.
Unfortunately, putting family psychoeducation into effect in clinical settings has not kept pace with research. The PORT study found that only 31% of patients studied reported that their families received information about their illness. One recent strategy to expand these programs includes integrating family psychoeducation into assertive community treatment (ACT) programs.
See alsoCase management.
Lefley, Harriet P., and Dale L. Johnson, eds. Family Interventions in Mental Illness: International Perspectives. Westport, CT: Praeger Publishers, 2002.
Klaus, Nicole, and Mary A. Fristad. “Family Psychoeducation as a Valuable Adjunctive Intervention for Children With Bipolar Disorder.” Directions in Psychiatry 25.3 (2005): 217–30.
Lopez, Molly A, and others. “A Psychoeducational Program for Children with ADHD or Depression and their Families: Results from the CMAP Feasibility Study.” Community Mental Health Journal 41.1 (Feb. 2005): 51–66.
Mino, Yoshio, and others. “Medical Cost Analysis of Family Psychoeducation for Schizophrenia.” Psychiatry and Clinical Neurosciences 61.1 (Feb. 2007): 20–24.
Motlova, Lucie, and others. “Relapse Prevention in Schizophrenia: Does Group Family Psychoeducation Matter? One-Year Prospective Follow-Up Field Study.” International Journal of Psychiatry in Clinical Practice 10.1 (Mar. 2006): 38–44.
Sanford, Mark, and others. “A Pilot Study of Adjunctive Family Psychoeducation in Adolescent Major Depression: Feasibility and Treatment Effect.” Journal of the American Academy of Child & Adolescent Psychiatry 45.4 (Apr. 2006): 386–95.
National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Boulevard, Suite 300, Arlington, VA 22201-3042. Telephone: (800) 950-NAMI (6264) or (703) 524-7600. <http://www.nami.org>.
National Mental Health Association (NMHA). 1021 Prince Street, Alexandria, VA 22314-2971. Telephone: (800) 969-6642 or (703) 684-7722. <http://www.nmha.org>.
National Institute of Mental Health. “Schizophrenia”. <http://www.nimh.nih.gov/publicat/schizoph.htm>.
Irene S. Levine, PhD
Ruth A. Wienclaw, PhD