Family Involvement in Patient Care One Key to Success

A prime source of valuable information about psychiatric patients is their family members, and psychiatrists should make meeting with them a priority. Families exert a powerful influence on the health and mental health of its members, and such influence can be leveraged in a positive way to support treatment and help ensure its success.

There is extensive research highlighting how family and relational factors interact with biological systems to produce and modify disease. Risk factors for adverse outcomes include relational conflicts, rigidity, blame, and high levels of criticism. However, good communication, support, clear roles, adaptability, and problem-solving skills provide protection from the negative effects of illness. Meeting with families to assess their ways of dealing with a family member who has a mental illness and enlist their participation as collaborators in the treatment process should be a routine part of psychiatric care.

While some families of psychiatric patients are dysfunctional, many deal effectively with recurring, chronic, and severe illnesses. All families, however, can benefit from receiving information about the illness, validation of effective ways of coping, and reinforcement of resilience in the face of major stress.

Family meetings can be focused, time efficient, and structured to minimize disruptions. The primary goal of a family meeting is to provide a safe place for all participants to express their concerns without being blamed, invalidated, or criticized. It is a place for them to listen to each other and find ways to work together. The task of the therapist is to create that safe space.

The therapist should orient family members about what to expect during the meeting and lay out the ground rules for working together. They should be told the following: Such meetings are part of routine care; no one is being singled out as problematic or judged to be right or wrong; the purpose is to identify the family’s concerns; people should take turns talking; and everyone will have the opportunity to ask questions and be involved in treatment decisions. If the family members do not follow the agreed-upon process, the meeting may be terminated. They should then be asked for permission to proceed with the meeting. This introductory discussion takes only a few minutes but saves time in the long run.

The duration of the meeting can be kept reasonable by limiting the amount of time each person is given to outline his or her concerns. As each person describes a problem, the therapist can reflect back what was said and, if it is correct, move on to the next problem. This also gives family members a chance to correct any misconceptions. There are usually a finite number of problems, so the process does not take very long. Once all the problems have been identified, it is useful to evaluate how the family is coping with them, including how they communicate with each other, solve problems, connect emotionally, divide responsibilities for managing their household, and set rules and expectations of each other.

The final step is for the therapist to reflect back his or her understanding of family members’ concerns and ways of dealing with them and ask what, if anything, they would like to do about the problems and what help they may want or need.

Most families are grateful for the opportunity to meet with their loved one’s psychiatrist, to be listened to, to hear each other’s concerns, and to be actively involved in the treatment process. In turn, the psychiatrist is in a position to harness the family’s energy to benefit their loved one and provide improved care. ■

Gabor I. Keitner, M.D., is a professor of psychiatry at the Warren Alpert School of Medicine at Brown University.