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.     

Perceived family environment as a moderator of young adolescents' life stress adjustment

A longitudinal design was employed to test the main and stress-moderating effects of young adolescents' perceived family environment (Family Environment Scales; FES; Moos & Moos, 1981) on their depression, anxiety, and self-esteem. This study was part of a larger longitudinal project (L. Cohen, Burt, & Bjorck, 1987) that demonstrated the significant cross-sectional effects of the young adolescents' controllable and uncontrollable negative events, and the significant longitudinal effects of the former. The present cross-sectional analyses demonstrated the hypothesized main effects of the FES scores; families perceived as cohesive, organized, and expressive were related to positive psychological functioning, whereas families perceived as conflict-ridden and controlling were related to negative functioning. However, in general these effects were nonsignificant in the longitudinal analyses. Although there were a number of significant Negative Events x FES interactions, in no instance did the pattern support the hypothesized stress-buffering role of positive family climate.     

The social supports of suicide attempters: The different roles of family and friends

The social support patterns of a sample of 101 suicide attempters were compared with the patterns of a control sample on the basis of structured interview data. Network characteristics and the extent of support in different functional categories were examined as to their absolute and relative power to discriminate between the suicide attempters and the controls. A clear separation of the functions of kin and of friends/acquaintances emerged. The crucial difference between the attempters and the controls lay in the number of friends with whom the subjects had agreeable everyday interactions and in the number of kin that provided crisis support, both psychological and instrumental. Other support differences between the two groups were of secondary importance. While there was no overall difference in the frequency of social interactions between the two groups, the size of the social network differed greatly. Consequences for the conceptualization and measurement of social support as well as for the prevention of suicidal behavior are discussed.