Family Therapy in Trouble: Psychoeducation as Solution and as Problem

The authors cite clinical literature attesting to the importance of recognizing the family, rather than the individual, as the proper locus of conceptualizing, diagnosing, and treating mental illnesses. Specifically with regard to severe psychiatric illnesses, in particular schizophrenia, family dysfunction contributes to the emergence of the illness, significantly affects its course, and strongly influences the achievement and maintenance of treatment gains. Currently, a movement is afoot to limit sharply the amount and kind of treatment offered to schizophrenic patients and their families. Rooted in a “medical model” or “biogenic” view of the etiology of schizophrenia, this school of thought prescribes psychoeducation as the family treatment of choice. The present article looks at some misconceptions regarding treatment that prompted a widespread turning away from psychoanalytically oriented family psychotherapy for schizophrenic patients and their families, examines the reductionism (biological and behavioral) inhering in the exclusive use of psychoeducation, and looks at the clinical dangers of such reductionism. Finally, it proposes that family psycho-therapists should not abandon a concern with the inner lives of severely ill patients and their families in the face of spuriously generalized claims made by reductionist researchers.     

A reanalysis of the influence of a "friendly visitor" program

A paper in the American Journal of Community Psychology (AJCP), by Reinke, Holmes, and myself, reported the results of a study of the influence of a friendly visitor program on the cognitive functioning and morale of elderly individuals. The program was reported to have had a significant multivariate effect on a combination of cognitive and morale measures and significant univariate effects on memory, self-perceived health, and activity director's ratings. Being intrigued by the memory finding, I conducted a follow-up study to further investigate the effect of a visitation program on cognitive functioning. In this second study the dependent measures included all of the cognitive variables included in the original study as well as some additional memory variables. The visitation program in the follow-up study had no effect on any of these measures. As a result of my failure to obtain a significant memory effect such as that reported in Reinke et al. (1981), I reanalyzed the data from the original study. In my reanalysis, the only significant effect was a borderline univariate effect for self-perceived health; the multivariate effect did not approach significance. On the basis of my inability to produce the results reported in Reinke et al. when I reanalyzed the original data, I must conclude that the friendly visitor program did not have the effects attributed to it in the original report.     

Frontal amnesia and the dysexecutive syndrome

This study analyzes the memory deficits shown by an amnesic patient with bilateral frontal damage and a dysexecutive syndrome. He resembles a classic amnesic patient in showing grossly impaired episodic memory for both verbal and nonverbal material, together with normal digit span, and on occasion normal recency in free recall. He differs from the classic amnesic pattern however in showing an impairment in both the speed and accuracy of performance on tests of semantic memory, and in clear evidence for impaired performance on some though not all procedural learning tasks. Finally, his autobiographical memory was poor and subject to substantial confabulation. It is suggested that the pattern of deficits is consistent with a combination of a classic amnesic syndrome with the additional problems associated with the frontal dysexecutive syndrome, rather than exhibiting a qualitatively different form of amnesia.