Benefits of Psychoeducation Copy

Client and family psychoeducation are essential to achieving good outcome. Psychoeducation needs to empower clients and families to become involved with treatment planning and management. Appropriate and intensive psychoeducation leads to:

  1. Improved relationships (therapeutic alliances) among the clients, families, physicians and other clinicians
  2. More active and full participation of clients and families in treatment, including better self-management of symptoms and side effects
  3. Improved adherence to the prescribed treatment regimen
  4. Improved client and family skills in management of psychosis
  5. Better understanding of the developmental needs of clients

Educating clients and families will also lead to clinicians making better informed clinical decisions due to the improvements in communication with clients and families about illness status and treatment needs.

Going beyond didatic education has proven to be the most relevant for first episode clients and their families. The use of psychoeducation whereby information is delivered using therapeutic strategies for enhancing coping, communication and stress management. The components of greatest utility to your clients and their families will depend on their explanatory model of illness and their willingness to engage in treatment.

Psychoeducation Improves Outcomes

Research has shown that intensive and ongoing psychoeducation to both client and family leads to many benefits including:

  • Improved knowledge
  • Decreased negative symptoms
  • Improved interpersonal skills
  • Decreased relapse rates
  • Shorter hospital stays

These benefits are more pronounced with the increased reliance on community care, limited success of pharmacological treatments and impaired social functioning experienced by young people coping with psychosis.

Psychoeducation must be Intensive and Ongoing and provided to Both Client and Family

The full benefits of psychoeducation will not be achieved if it is limited to only a few sessions. The best results are achieved when psychoeducation is provided intensively for a long period of time (every couple of weeks over at least 6-9 months and including a range of psychosocial interventions) to both the client and family. While studies on the impact on family members of the onset of psychosis are limited, research on family coping with schizophrenia can provide some insight as to the responses and needs of all family members.

Oversimplifying family members responses undermines the possible assistance a clinician can offer to the family and client. While most literature suggests that family members are best viewed as those experiencing a sense of loss and grief, this may not be a helpful paradigm in appreciating the complexities of viewing one’s adolescent as mentally ill. Family members often describe the experience of psychosis as a nightmare as they are ill-prepared to view their child or sibling as someone who is unwell. An initial response of rational questioning is commonplace with parents and siblings looking for a reasonable explanation for the changes in behaviour and sociability of their young person. Acknowledging that adolescence is a period of a wide range of adaptive behaviours and coping strategies is often the first stance chosen by family members. Looking to normative individuation behaviours is comforting and reinforced by society’s view of teenagers. “It’s just a phase” is the common refrain provided by family members as they try to understand their experiences. When the behaviours persist, family members begin to acknowledge that something unusual or abnormal is occurring. Some families begin to ascribe blame to the young person, their friends, themselves or to outside forces such as stress or drugs. This shift in thinking may be the first contact the family begins to have with outside professionals or agencies. Help seeking may take the form of searching the internet, calling crisis lines, asking school officials or their family physician for assistance in understanding the adolescent’s changed presentation. This proactive stance should be viewed as important by the clinician but not misunderstood as a sign of acceptance that mental illness is the issue or that this is a situation beyond the control of the young person.

Experiences of the Fraser South EPI Program with family members supports this exploratory stage as most families have gone to the web for an understanding of issues such as depression, anxiety, mental illness and substance misuse. They arrive at the initial sessions with a clinician with considerable information about the possible explanations for their son’s or daughter’s behaviour. Families from varied cultural groups have reported that the anonymity of the internet is helpful given the shame associated with their child being ill.

The realization that their child’s illness may in fact be an indicator of a serious mental illness elicits the anticipated stages of loss and grief. Anger, fear and exhaustion often present once the information seeking has not given them the answers they had hoped for. Gaining a diagnosis can be frightening to family members as well as the young person and needs to be considered carefully. A diagnosis of psychosis is shocking to families and needs to be framed with accurate information about treatment, recovery phases and relapse prevention. Acknowledging the grief and loss associated with diagnosis is compulsory. Education out of the context of personal response is likely to lead to non-compliance and refusal of services.

Working with Families in EPI:

To view the recorded webinar presentation about working with families, click here.

* 3-Nov-18 This webinar is currently on my Google Drive where you may have to download the video to show it. Our web developer is working on converting the format to our private YouTube collection-    Michele

Parents may be in shock and likely experiencing a range of fluctuating emotions.

Some affected parents have described their feelings as follows:

Sorrow“We feel like we lost a child.”
Anxiety“We’re afraid to leave him alone or hurt his feelings.”
Fear“Will we be safe from physical harm? Will our son or daughter harm himself or herself?”
Shame and Guilt“Are we to blame? What will people think?”
Feelings of isolation“No one can understand.”
Bitterness“Why did this happen to us?”
Ambivalence toward the afflicted person“We love him a great deal but when his disability causes him to be cruel, we also wish he’d go away.”
Depression“We can’t talk without crying.”
Complete denial of the illness“This can’t happen in our family.”
Denial of the severity of the illness“This is only a phase that will pass.”
Blaming each other“If you had been a better parent”
Inability to think or talk about anything but the illness“All our lives were bent around the problem.”
Marital discord“My relationship with my husband became cold. I seemed dead inside.”
Divorce“It tears a family apart.”
Preoccupation with moving away“Maybe if we lived somewhere else, things would be better.”
Sleeplessness“I aged double time in the last year.”
Weight loss“We have been through the mill, and it shows in our health.”
Withdrawal from social activities“We don’t attend family get-togethers.”
Excessive search of the past for possible explanations“Was it something we did to him?”
Increased drinking/use of tranquilizers“Our evening drink turned into three or four.”
Concern for the future“What’s going to happen after we’re gone? Who will take care of him or her?”

(From Rays of Hope, SSC, 2003)

Involving Siblings

Family education should not be limited to the parents. The needs of siblings should not be forgotten. Other supportive persons should also be engagged.

Clinicians can expect that the siblings of the client are experiencing mixed emotions at this time and the following reactions are common:

Guiltknowing their own lives are better than their sibling
Fear and anxietythat they themselves will develop psychosis
Sadness and grieffor the loss of the person their brother or sister was before psychosis developed
Embarrassmentin front of their friends or in public as a result of stigma or of their sibling’s strange behaviour
Anger and resentmentat the disruption of family life and the resulting decrease in attention they get from their parents;
Empathy and lovefor their ill brother or sister.

(From Rays of Hope, SSC, 2003) (Adapted from Rays of Hope, SSC, 2003)

  • The Canadian Mental Health Association has developed a Sibling’s Guide to Psychosis – it can be found on the CMHA website in their Support Centre under Resources

Activity One
Review the psychoeducation materials available in the Care Pathway for clients and their families.

  • Do you know of any additional sources for educational materials specific to early psychosis – post any suggestions in the group forum discussion for this module.
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