Family Therapy in Trouble: Psychoeducation as Solution and as Problem

Abstract

The authors cite clinical literature attesting to the importance of recognizing the family, rather than the individual, as the proper locus of conceptualizing, diagnosing, and treating mental illnesses. Specifically with regard to severe psychiatric illnesses, in particular schizophrenia, family dysfunction contributes to the emergence of the illness, significantly affects its course, and strongly influences the achievement and maintenance of treatment gains. Currently, a movement is afoot to limit sharply the amount and kind of treatment offered to schizophrenic patients and their families. Rooted in a "medical model" or "biogenic" view of the etiology of schizophrenia, this school of thought prescribes psychoeducation as the family treatment of choice. The present article looks at some misconceptions regarding treatment that prompted a widespread turning away from psychoanalytically oriented family psychotherapy for schizophrenic patients and their families, examines the reductionism (biological and behavioral) inhering in the exclusive use of psychoeducation, and looks at the clinical dangers of such reductionism. Finally, it proposes that family psychotherapists should not abandon a concern with the inner lives of severely ill patients and their families in the face of spuriously generalized claims made by reductionist researchers.

Hope‐Focused and Forgiveness‐Based Group Interventions to Promote Marital Enrichment

“…Psychoeducational groups have historically been a component of graduate training for mental health professionals (Wilson, Coyne, & Ward, 1994). Across time, the topics that have been addressed in psychoeducational groups have been wide-ranging, including promoting marriages (Kaiser, Hahlweg, Fehm-Wolfsdorf, & Groth, 1998;Long, Angera, Carter, Nakamoto, & Kalso, 1999;Zimpfer, 1990), supporting families (Hunter, Hoffnung, & Ferholt, 1988), training parents (Cwiakala & Mordock, 1996;Kiselica, Rotzien, & Doms, 1994), supporting adolescents (Kiselica et al, 1994;Rice & Meyer, 1994;Yoshikawa, 1994), caretaking for elderly family members (Schwiebert & Myers, 1994), coping with psychological disorders (Fristad, Gavazzi, Centolella, & Soldano, 1996;Twoey, 1997), promoting forgiveness (McCullough & Worthington, 1994, 1995Worthington, Sandage, & Berry, 2000), and coping with substance abuse problems (Stanton & Shadish, 1997).…”

Systemic Approaches to Psychosis Part I — The Systemic Context

“…They caution family therapists against "abandon(ing) a concern with the inner lives (feelings and thoughts) of severely ill patients and their families in the face of spur iously generalised claims made by reductionist researchers" (page 327). The authors further suggest that psychoeducational approaches avoid the resolution of inevitable guilt and blame, driving it underground and engendering denial and pseudo-mutuality (Hunter et al, 1988).…”

“…Although the above studies have been invaluable in estab lishing the efficacy of family and context based interventions, they have not been without criticism (Haley, 1989;Hunter et al, 1988).…”

“…Given that psychoeducational approaches aim to educate families and individuals regarding the nature, management and outcome of 'schizophrenia', it is reasonable to examine what 'knowledge' is being imparted. Hunter et al (1988) argue that at the core of the psychoeducation approach is the belief that 'schizophrenia' is simply a brain disease, and that such a biologically reductionist view is untenable in the light of current research and is a flight from complexity. In particular, they reject the reductionist philosophy and practice implied by the exclusive use of psychoeducation.…”