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systemagazin Zeitschriftenarchiv: Journal of Family Therapy Heft 1/2006
1/2006 - 2/2006  - 3/2006 - 4/2006 - Übersicht

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Leff, Julian (2006): Editorial: Family Interventions in schizophrenia. In: Journal of Family Therapy 28(1), S. 1-3

Bertrando, Paolo (2006): The evolution of family interventions for schizophrenia. A tribute to Gianfranco Cecchin. In: Journal of Family Therapy 28(1), S. 4-22.

abstract: Family intervention for schizophrenia has informed the whole history of family therapy, although in different fashions. This presentation will deal with the main phases of such intervention, outlining the characteristic features of each one. We can roughly divide the history of family intervention for schizophrenia into four phases: Phase 1 – Conjoint family therapy (1955–1965). Family interventions were aimed at modifying family communication patterns, implying the possibility of a definitive resolution of psychopathology. Phase 2 – Antipsychiatry (1965–1975). This, rather than a treatment model, was a philosophy of psychiatry, which considered schizophrenia as an epiphenomenon of the distortions of Western society. Family treatment was aimed at promoting the awareness of such a dynamic. Phase 3 – Milan systemic therapy (1975–1985). The systemic model was aimed at helping people with schizophrenia to recognize their position within their families (and other significant systems), giving all family members a new sense of their relationships to each other. Phase 4 – Psychoeducation (1985–2005). In most psychoeducational models, schizophrenia was conceived of as a biologically determined disorder. Psychoeducation was a way of helping the not diagnosed family members to cope with problems brought about by the illness, eliciting consensus towards psychiatric treatments such as medication and rehabilitation. A fifth phase of family intervention for schizophrenia is probably developing right now. If this is happening it should probably be an integrative phase, in which different approaches to family dynamics might be bridged and blended, in order to give more effective help to all members of families with schizophrenia.

Fadden, Gráinne (2006): Training and disseminating family interventions for schizophrenia: developing family intervention skills with multi-disciplinary groups. In: Journal of Family Therapy 28(1), S. 23-38.

abstract: Family interventions for psychosis are not routinely available, in spite of a robust evidence base, clear policies and guidelines, and requests from service recipients. The reasons for this are complex involving three key groups: service recipients, clinicians and organizations. This paper first of all identifies barriers to implementation in relation to each of these groups. It then outlines a range of strategies that may be employed at a number of levels to bring about change in each of these systems. The strategies are drawn from current research in the area, and from experiences over a seven-year period in the Meriden West Midlands Family Programme.

Burbach, Frank & Roger Stanbridge (2006): Somerset's family interventions in psychosis service: an update. In: Journal of Family Therapy 28(1), S. 39-57.

abstract: This paper describes a project in which family interventions in psychosis services were successfully established in a routine clinical setting. This has involved the development of a whole-team training approach, an accredited one-year training course, and a clinical approach which integrates the systemic and cognitive-behavioural psychoeducational approaches. Since the original description of this project (Burbach and Stanbridge, 1998) the training course and service have been evaluated and the clinical approach has been further developed. These developments, particularly the 'cognitive interactional' approach and collaborative therapeutic stance, are detailed. The paper explores the factors which have contributed to the successful establishment and maintenance of the service, and describes more recent initiatives to bring about more family/carer-friendly mental health services.

Asen, Eia & Heiner Schuff (2006): Psychosis and multiple family group therapy. In: Journal of Family Therapy 28(1), S. 58-72.

abstract: Despite the growing evidence base for the effectiveness of family intervention in the treatment of individuals suffering from a psychotic disorder, in practice only relatively few mental health teams use family approaches when treating and managing those with schizophrenia or other psychoses. This paper describes a pragmatic model, which may be used in addition to other ongoing treatments, such as medication, CBT or single family therapy. It was developed jointly by clinicians and service users over the past few years. It consists of regular multiple family group work, with six to eight families attending simultaneously, and aims to involve families directly in the treatment, rehabilitation and recovery of their members suffering from psychotic disorder.

Kuipers, Elizabeth (2006): Family interventions in schizophrenia: evidence for efficacy and proposed mechanisms of change. In: Journal of Family Therapy 28(1), S. 73-80.

abstract: Family intervention for psychosis developed from empirical work on the role of emotion in families of those caring for someone with schizophrenia. The level of expressed emotion (EE) has been shown to be a robust predictor of subsequent outcome for service users returning to live in family settings. There is also evidence that staff have similar attitudes. This has led to the development of specific family interventions for schizophrenia. NICE Guidelines for Schizophrenia (2003) confirm that family intervention is effective at reducing service user relapse rates and recommends it for those in contact with carers. Exactly how family intervention improves outcome is less clear. A recent model of psychosis proposes a primarily emotional rather than cognitive route for family factors, and some evidence is presented which supports this. Implications for family interventions are discussed.

Bertrando, Paolo, Gianfranco Cecchin, Massimo Clerici, Jutta Beltz, Alessandra Milesi & Carlo L. Cazzullo (2006): Expressed emotion and Milan systemic intervention: a pilot study on families of people with a diagnosis of schizophrenia. In: Journal of Family Therapy 28(1), S. 81-102.

abstract: This article presents the results of a pilot study carried out on families of people with a diagnosis of schizophrenia (high-frequency users of psychiatric services) using a standardized version of systemic family intervention based on the Milan Approach ('Circular Interview'). We used expressed emotion (EE) to compare and assess two homogeneous samples of families, a treatment group (n = 10) and a control group (n = 8). We found that families participating in circular interviews showed a reduction in criticism, while 30% of their members with a diagnosis of schizophrenia relapsed. Families not receiving treatment showed no changes in EE levels, while 62.5% of their members with a diagnosis of schizophrenia relapsed. Although the difference in relapse rates is not statistically significant, these results justify further studies on the use of nondirective systemic intervention with families of people with a diagnosis of schizophrenia.

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