Reply To: What challenges have you experienced when involving families?

Home – NEW Forums Module 2 – Care for Early Psychosis Fall 2023 What challenges have you experienced when involving families? Reply To: What challenges have you experienced when involving families?



Thank you for bringing up the challenges w/ involving family when there is intergenerational trauma, and as well as the right for individuals to live at risk. I work as a harm-reduction based MHSU clinician on an ICMT team locally. Many of my clients who experience psychosis and have related dx disorders are picked up by the team well-after a breakdown of family relations and support network. For many, this often includes early MCFD involvement during which the client had already been removed from their familial context and support. For one client, he was put into an abusive foster home for many years resulting in chronic adverse childhood experiences and PTSD. This client has struggled with positive symptoms related to his experience of schizophrenia, for which he had learned to self-medicate w/ illicit substances during a prolonged period of homelessness after aging out. The familial challenges of intergenerational trauma in this case plays out in his relationship with both his mother, grandmother, and younger siblings. The grandmother is his main connection to the family, and she is the main caretaker therein; the siblings live with the grandmother. The family is from a small town on Vancouver Island, but d/t the lack of resources in rural settings, the client wounded up in the Victoria shelter system after aging out of MCFD care. While the reuniting with family is one of the client’s main motivation, the grandmother had kept him at arms length from herself and siblings for many years, refusing to support any visits or moves back to the hometown. This stems from her experiences with the client’s mother who also struggles with positive symptoms relayed to schizophrenia, substance abuse, and homelessness. Indeed, the client was placed into MCFD care d/t the mother’s struggles with substance abuse, lack of housing, and psychosis; the mother still struggles with these challenges sleeping rough in the local home town. The grandmother is very protective of the siblings and sees the mother around town as a daily reminder of their family trauma. While the grandmother has “seen” what psychosis looks like, she very much associates these s/s as a function of substance abuse, which has been a common issue in the town. Despite the client completing a comprehensive mhsu residential treatment program, the family cannot see past the stigma toward substance use and psychosis. The client is in recovery from substance abuse but still experiences both positive and negative symptoms, as well as motor s/s of antipsych meds. The grandmother continues to gate-keep the client from reconnecting with his siblings d/t his presentation. She has seen the mother go through many cycles of recovery and relapse for both psychosis and substance use, so through this lens, she feels like nothing has changed. To the extent that “burn out” is appropriate, intergenerational trauma instills a sense of pessimism and reluctance to “get involved” to support the client through his current recovery. It’s challenging when family reunfiication is the client’s main motivation but family continues to be his main source of perceived rejection.