Discussing causality with families in a family management and therapy integrated service, a qualitative study with focus groups.

Abstract

Objective. Family Therapy (FT) and Family Management (FM) approaches to psychosis have been divided by their understanding of causality. FM holds a biological understanding which has been identified as having negative consequences for the person with psychosis. FT, by exploring family interactions has been criticised for blaming families for causing their relations psychosis. These two approaches have now been integrated, but how causality is discussed in an integrated approach has only now been explored. Design and methods. This qualitative research asked clinicians working in the most established integrated service how they discuss causality. Four focus groups were conducted and a framework approach using thematic analysis was used. Results. Five themes were explored; uncomfortable discussion; constructing a shared understanding; therapeutic style; limiting exploration; and blame. Conclusion. Discussing causality with families was identified as uncomfortable. However, through the development of a therapeutic-relationship three identified tools can be used to construct a shared understanding of causality. The therapeutic style of explorative conversation--based in FT, integrated with the stress-vulnerability model--based in FM, was identified as an important aspect of an integrated model that resolved criticisms levied at each individual approach. Factors that limited exploration were identified as major challenges to causality discussions, but techniques to remedy these problems were also identified. The risk of families feeling blamed/blaming themselves and attempts to avoid/reduce blame made up a dominant theme of the research. The research concludes by challenging the need to avoid/reduce blame, arguing that blame should be openly explored within family interventions.