Psychoeducation – Recovery Phase Copy

More formal education should commence once the person’s positive symptoms begin to respond to medication, usually within a few weeks. At each visit, the client and family should receive more detailed explanations regarding the course of the illness, etiology, treatments, and lifestyle management. Clients and families should be walked through materials, so that they understand what information the materials provide and how they are useful. More in-depth materials can be given to the client or family at this point, with appropriate discussion and questions answered at subsequent visits.

Education should continue to be paced. One-hour sessions are often too long for a client who is in the early recovery phase. Consideration should be given to attention span, cognitive abilities and feelings of restlessness and agitation. As materials will need to be adapted to be both phase and age-appropriate, shorter sessions could be held with the client and longer sessions with the family. Alternatively if the client and family prefer, education could be provided to both at the same time. Involving the family simultaneously in education provides more opportunity for the family and client to learn about the illness together, appreciate each other’s perspective, and work out family issues. Clinicians can be flexible in how education is provided – the main thing is to ensure that it is provided to both client and family on an ongoing basis.

It is essential to use materials that are tailored specifically to early psychosis, as much of the self-help and client-based literature designed for people with established chronic illnesses is inappropriate. Peer education and learning about others who have recovered through personal contact or media can be a powerful source of hope for both client and family members.

Videos can also be a useful tools for education. Video resources may be particularly useful in more rural communities where peer education is not easy to provide.

Through BCSS site – there are resources and videos on early psychosis intervention (i.e., Reaching Out).

Goals of Education

The three key goals for psychoeducation in early psychosis have been articulated as:

1. Negotiate “meaning” through a constructive assimilation of the illness experience into one’s worldview
2. Develop “mastery” by acquiring or enhancing the subjective and objective skills needed to exert control over the disorder and its effects
3. Protect “self-esteem” threatened by assaults on self-identity, social roles, relationships, and future plans.

In order to achieve these goals, psychoeducation must cover a broad range of topics, impart both knowledge and skills, deal with the emotional consequences of the psychosis, and attempt to normalize and destigmatize the experience.

Topics

Below is an overview of the topics to cover with the client and family. Many of these topics will be covered in more detail in other modules.

Psychosis

• Symptoms and features of psychosis
• Diagnoses and reasons for diagnostic ambiguity
• Causes of psychosis
• Phases of psychosis

Normalize the Experience

• Issues of stigma and demoralization should be addressed
• Expectation of full recovery should be communicated

Treatments

• Information on medications and psychosocial treatments (including possible side effects of treatment)
• Use of groups as a treatment modality
• Rationale for early intervention and for treatment.
• Self-management of illness should be encouraged.

Lifestyle Management

• Factors that enhance recovery
• Grief and loss
• Boundary setting
• Anxiety management
• Including lifestyle (exercise, nutrition, sexuality, etc.), physical health, socialization, and drug use.

Relapse

• Early warning signs
• Relapse Prevention Plan
• Community resources
• Safety planning

Stress management

• Stress management strategies (relaxation, breathing)
• Use of social supports
• Practical suggestions for family coping. (communication strategies, advocacy)
• Problem solving
• Goal setting

In addition, family members need to learn:

1. What to reasonably expect from the person with psychosis and how to handle challenging behaviour (lack of motivation, excessive sleeping).
2. How to handle their own fears and concerns.
3. How to help all family members talk about the illness.
4. How to reduce stress and cope with the illness.
5. How to handle emergency situations.
6. How to make reasonable plans for the family.
7. How to take care of themselves.

Studies of more than 80,000 youth confirm the importance of at least one trusted adult relationship in the success and well being of young people. For both the recovering individual and their closest supports, the acute phase can be quite intensive, with the introduction of and reliance upon helping professionals. As the active psychosis symptoms subside, the family’s attention often turns to understanding more fully what recovery entails and steps toward prevention of future episodes. One often overlooked element of recovery is the restoration of feeling – recovery from the flattened affect of psychosis. This aspect of recovery requires the safety of a trusted relationship, whether personal, professional, or both. If you are interested in further insights about losing and then recovering the ability to feel, you may access this webinar for helping professionals, educators and parents. This link, “Making Sense of Troubled Kids” provides complimentary access exclusively for EPI trainees, courtesy of Dr. Gordon Neufeld. (Passcode 0906TRKIDS). Please note: the Neufeld Institute will make this and other webinars available for purchase through the public website in the near future, in the event you would like to share it with others, such as parents/supports of those in the At Risk Mental State.

In a survey of first-episode families, respondents indicated low satisfaction with the care provided around: advice on how to handle specific problems – especially how to handle psychotic experiences, help with preserving or regaining social functioning, help with regaining structure and routine, information and prompt assistance preferably in the clients own environment. So these topics are particularly important to address in detail.

Some suggestions for family coping can be found in the family coping handout – click here to read this. This booklet is also available on the care pathway page.

The following video is approximately 7 and a half minutes long. Click on the picture to download the video. Please be patient – the download may take several minutes. You will likely find it helpful to take notes during the video

Later in Recovery

Later in recovery, groups for continuing psychoeducation (client, siblings and family) are a good option as they allow members to share experiences and foster social supports. Groups should be considered as an adjunct (not a substitute) for individualized education. Where it is not possible to have groups of solely early psychosis clients and families, existing groups (such as BCSS) may be utilized. However, caution must be exercised when exposing families and clients with early psychosis to families and individuals with more chronic psychotic disorders as there are significantly differ issues each group is grappling with. Opportunities for individualized education should still be available at this phase of recovery as questions may arise for clients and families through attending groups.

Click HERE for a transcript of this interview about how David is coping.