Psychotherapy

Question 1

How can family therapy be explained to a patient/relative?

Answer 1

We acknowledge how difficult it can be to have a relative who is unwell

This can cause stress and strain to the family as there may be change in INSERT NAMES behaviour

Family members may also disagree how to help INSERT NAME

Family therapy works by seeing families as systems whereby one members actions/words may impact another family member and so on

Members of the family may not be aware of how what they say/do is interpreted by others and the emotions/beliefs that arise from that

The aim is to avoid blame but to discover why family members may feel/behave the way they do and how this can be changed through understanding the system of interactions and developing strategies

May add for schizophrenia stations:
- Family therapy can reduce rate of relapses and improve medication adherence

Question 2

How can expressed emotions be explained?

Answer 2

In families sometimes when there are times of increased stress individuals may communicate in ways that are more intense, hostile or negative.

While this is understandable as individuals may care a lot about each other it can have a detrimental effect

For the patient they may feel blamed or a burden / be over-protected and lose their independence. For the care giver they may feel like the bad person

High expressed emotion has been shown to increase the risk of relapse

Question 3

What areas may family therapy focus on?

Answer 3

Recognising precipitating stressors

Relapse prevention work - recognising relapse signatures

Structured problem solving

Communication skills

Stress management

Question 4

How may a suitability for family therapy station be structured?

Answer 4

• Explore experience as a caregiver
• Ask about interpersonal behaviours and dynamics related to challenges in care-giving
• Can the person accept different explanations of others behaviour and that their behaviour may be interpreted differently?
• Repeated misunderstanding may lead to continued problematic interactions
• Explore if they can see a benefit in helping their understanding of others experiences

Question 5

How should a CBT-P suitability station be structured?

Answer 5

• Brief history of initial presentation
• Understanding of their recovery
• Current treatment and attitudes

Identify 4Ps:
- Predisposing
- Precipitating
- Perpetuating
- Protective

Give formulation

Question 6

How would CBT-P be explained to a patient?

Answer 6

• CBT looks at how thoughts, emotions, behaviours and bodily sensations are linked
• In CBT-P it aims to get an understanding of why their experiences may have come about
• This formulation will help them link how their early life experience may link to their psychotic symptoms.
• Aim of preventing relapse or tolerating the symptoms if ongoing
• Benefits of improving patients awareness, reducing unhelpful behaviours, improving self-esteem, improving medication compliance