Key Elements of a Family Intervention for Schizophrenia: A Qualitative Analysis of an RCT

• Date: 01 March 2018
• Published date: 01 March 2018
• Author: Manuel Gonçalves‐Pereira,Jaime Grácio,Julian Leff
• DOI: http://doi.org/10.1111/famp.12271

Key Elements of a Family Intervention for

Schizophrenia: A Qualitative Analysis of an RCT

JAIME GR



ACIO*

,†

MANUEL GONC

ßALVES-PEREIRA*

JULIAN LEFF

‡,§

Schizophrenia is a complex biopsychosocial condition in which expressed emotion in

family members is a robust predictor of relapse. Not surprisingly, family interventions are

remarkably effective and thus recommended in current treatment guidelines. Their key ele-

ments seem to be common therapeutic factors, followed by education and coping skills

training. However, few studies have explored these key elements and the process of the

intervention itself. We conducted a qualitative and quantitative analysis of the recor ds

from a pioneering family intervention trial addressing expressed emotion, published by

Leff and colleagues four decades ago. Records were analyzed into categories and data

explored using descriptive statistics. This was complemented by a narrative evaluation

using an inductive approach based on emotional markers and markers of change. Th e most

used strategies in the intervention were addressing needs, followed by coping skills

enhancement, advice, and emotional support. Dealing with overinvolvement and refram -

ing were the next most frequent. Single-family home sessions seemed to augment the thera-

peutic work conducted in family groups. Overall the intervention seemed to promote

cognitive and emotional change in the participants, and therapists were sensitive to the

emotional trajectory of each subject. On the basis of our findings, we developed a longitudi-

nal framework for better understanding the process of this treatment approach.

Keywords: Family Interven tions; Psychoeducation; Psychosis; Schizophrenia; Process;

Qualitative Research

Fam Proc 57:100–112, 2018

BACKGROUND

The debate over the definition of what constitute key elements of family interventions

for psychosis (FIP) is not over. Although there have been contributions outlining their

main components (Kuipers, 2006; Liberman & Liberman, 2003; McFarlane, 1991; World

*Chronic Diseases Research Center (CEDOC), Nova Medical School/Faculdade de Ci^

encias M

edicas, Universi-

dade Nova de Lisboa, Lisbon, Portugal.

†

Cl

ınica Psiqui

atrica de S. Jos

e, Sisters Hospitallers, Lisbon, Portugal.

‡

King’s College London, London, UK.

§

University College London, London, UK.

Correspondence concerning this article should be addressed to Jaime Gr

acio, Cl

ınica Psiqui

atrica de S.

Jos

e, Sisters Hospitallers, Azinhaga da Torre do Fato, 8, 1600-774 Lisboa, Portugal. E-mail: jaime.

gracio@nms.unl.pt.

We thank Elizabeth Kuipers and Ruth Berkowitz for describing their approaches to working with the

relatives and helping to identify the EE levels of the relatives. We also thank Carla Nunes, Catarina Mor-

ais, Daniel Mira, Daniela Marques, Maria Jo~

ao Marques, Pedro Aguiar, and S

onia Dias for their valuable

help in data coding and analysis. Finally, we thank Daniel Sampaio and Telmo Baptista for their thought-

ful comments on the methods of this research project.

100

Family Process, Vol. 57, No. 1, 2018 ©2016 Family Process Institute

doi: 10.1111/famp.12271