Psychoeducational Multiple Family Groups: Four-Year Relapse Outcome in Schizophrenia

Earlier studies of family psychoeducation and clinical reports on multiple family groups (MFGs) have reported substantial reductions in relapse rates for patients with schizophrenia. These groups offer an expanded social network and thereby may confer a margin of protection against relapse. However, to date, there has not been an empirical trial of this modality. The advent of family psychoeducational and behavioral management strategies provided the basis for an experimental, three-way comparison of psychoeducational MFGs to psychoeducation in a single-family format and to MFGs without psychoeducation, using symptomatic relapse as the outcome criterion. After 4 years, the psychoeducational MFGs were significantly more effective in extending remission than the single-family format, while the MFGs without psychoeducation approximated outcome in the psychoeducational MFGs. The respective relapse rates at 4 years were 50%, 78%, and 57%; MFGs averaged 12.5% and 14% per year. These results point toward an enhanced and independent, long-term therapeutic effect for multiple family groups, when combined with antipsychotic medication and psychoeducation, with especially promising cost-effectiveness.     

Accountability: A Total Commitment

The counseling profession has the knowledge and methodology to provide accountability in delivering its services. What remains is for leaders to use these resources and to develop more effective services. This article describes the program concepts and procedures implemented in one state employment service agency to establish an accountable counseling program. These procedures include the development of a compentency-based training and supervision system. The competency model is described and its goals are specified. Accountability at all levels of the system is defined, including the responsibility of management to guarantee the public quality counseling services.     

Continuum of Counseling Goals: A Framework for Differentiating Counseling Strategies

Counseling process goals are presented in a developmental continuum similar in concept to Maslow's hierarchy of needs with implications for counseling practice.     

Differential Diagnosis and Treatment of Career Indecision

Although progress has been made in developing a more complete understanding of career indecision, there continues to be a need for a better diagnostic approach to career indecision.