Exploring the process of family interventions in relation to attachment, attributions and the maintenance of difficulties. An IPA study

Family Interventions (FI) are recommended in the treatment of psychosis. This is based on the robust finding that a high rating of Expressed Emotion (EE) is predictive of poor outcome. Research has looked to attachment and attribution theories to further develop our understanding of EE. This study sought to understand how the experience of FI helped family members to develop their thinking about their attachment experiences and the appraisals made about a relative, and how these discussions helped to inform their understanding about the interactional way in which difficulties could be maintained. Six master themes were identified: ‘the significance of the therapeutic relationship’, ‘understanding relationships with significant others’, ‘developing a sense of agency’, ‘making sense of psychosis/difficulties’, ‘exploring and understanding unhelpful patterns of interaction in the family’, and the ‘mechanisms of therapy that were helpful’. The FI was experienced as helpful in bringing about changes in the way family members construed each other and psychosis. This influenced patterns of relating which allowed for an emotional climate within the family that promoted a sense of agency and was experienced as healing.