Exploring the delivery of family interventions to people facing recent-onset psychotic symptoms: The experience of navigating the family system

A first-episode of psychosis (FEP) is characterized by distress and confusion for families. Family interventions (FIs) consider the family as an important resource to help modulate environmental stress and reduce relapse. FIs... [ view full abstract ]

A first-episode of psychosis (FEP) is characterized by distress and confusion for families. Family interventions (FIs) consider the family as an important resource to help modulate environmental stress and reduce relapse. FIs have been difficult to implement in the routine clinical environment. This research explored the lived experience of family workers delivering FIs to people with a FEP and their families. Interpretative Phenomenological Analysis (IPA) was used to analyse the accounts of five participants. These participants were care coordinators in early intervention for psychosis (EIP) services. Themes were developed from individual accounts which were later consolidated across the group. Five superordinate themes were elicited. A) External supports to delivering family work, B) Balancing the care coordinator and family worker roles, C) Barriers to engaging families, D) The internal world of the family worker and E) Family communication and relationships. Participants reported that delivering FIs was daunting and exhausting, but also rewarding. Family work was difficult to integrate into routine clinical work and could be superseded by other work pressures. Many conflicts and dilemmas presented in the course of the work. A number of dilemmas may be overcome by adequate service development and organisation. However, the complexity of working with families resulted in personal dilemmas. These dilemmas related to the concepts of ‘neutrality’, ‘the expert position’, ‘self-reflexivity’, ‘safe uncertainty’ and working with emotion. Dilemmas related to the complexity of working with families may be addressed by high quality supervision and further training, this is key to the development of the family worker.