Integrating individual and family treatment for outpatients vulnerable to psychosis.
Most clinicians favor family involvement in the treatment of adult outpatients who are at risk for major mental illness. New models for the family-oriented treatment of mental illness, particularly schizophreania, are, however, not readily adaptable to the situations encountered by practitioners working in clinics or private offices where one-to-one psychotherapy is the norm. This article describes a clinical model that is compatible with such an individualized outpatient practice (particularly for outpatients who are living with their family of origin or a spouse). The innovative feature of this model is the integration of the patient's family into the ongoing treatment on a regular basis, while continuing to maintain the primary focus on the patient and the therapist-patient relationship. To maintain a balanced response to the needs of both patient and family, prevent patient paranoia and family intrusiveness, and facilitate prompt and effective containment for patient losses of control, this model puts into place several mechanisms: (1) the scheduling of family meetings at predetermined times; (2) the establishment of protocol for handling unanticipated phone calls from family members; and (3) the creation of a three-way therapist-patient-family contract for dealing with incipient emergencies.
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Smith College School for Social Work, Brookline, MA.
D000341:Affective Disorders, Psychotic / Q000628:therapy; D003131:Combined Modality Therapy; D005196:Family Therapy / Q000379:methods*; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D012559:Schizophrenia / Q000628:therapy