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Why the family is a unit of interest in clinical work different from focusing on the individual?

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How would you look at the family as the unit of interest for clinical work is different from focusing on the individual? What are the implications resulting from this shift in perspective? What would you need to learn in order to work effectively with families in an addictions setting?
Posted Fri, 22 Feb 2013 in Mental Health
Answered by Dr. Jonas Sundarakumar 15 hours later

Family has an very important role in the well-being of any individual. Similarly the family also plays an essential role in the treatment process of a person with a psychiatric illness. Especially, in many cultures, family is the key resource in the care of patients with mental illness.

The reasons why the family is a unit of interest in clinical work is because of two reasons:

1) The positive involvement of the family in treatment has been found to significantly increase the chances of recovery and improve the overall prognosis of the patient being treated.

2) A non-supportive and stressful family situation is a major factor in the causation of many psychiatric disorders and also results in poor treatment response and a worse prognosis.

There are numerous ways in which the family can be involved in treatment. Of late, there have been strong views and evidence in support of focussing on the family as a unit in the treatment process.

Family-based interventions aim at making use of the following abilities and positive aspects of the family unit:
- fulfilling the physical, spiritual and emotional needs of the individual
- providing support, security and encouragement
- initiating and maintaining growth, producing relationships and experiences within and outside the family
- being supportive and resourceful in times of crisis.

A shift to a family-based approach can have a lot of positive implications. The ways and means by which this can happen are:

1) Psycho-education:
A psycho-educative approach aimed at helping the family understand the nature, course, plan of management and prognosis of the person's illness can have a positive impact on treatment. The patient feels less stigmatized and more supported.

2) Ensuring treatment compliance:
Poor treatment compliance is one of the major reasons for poor treatment response. It has been found that patients with poor social and family support are more likely to have poor compliance and tend to drop out of therapy. So, the family can play a useful role in ensuring treatment adherence and compliance.

3) Expressed emotions:
It has been well established that "expressed emotions" have a significant impact on the prognosis of the patient. Positive expressed emotions nurture emotional well being and improve prognosis, wheras negative expressed emotions can be detrimental to improvement. So, family members need to be taught how to handle the individual and how to positively express their emotions.

4) Role in Rehabilitation:
Pharmacotherapy and psychotherapy can only remove symptoms and control the illness. However, to restore normal functioning of the individual, rehabilitation is absolutely essential. The family has a major role to play in the rehabilitation of the recovering patient. The family unit can play a positive role in resocialization, vocational and social skills training of the patient.

4) Shift to Community-based care:
Over the last few decades, psychiatric care is undergoing a paradigm shift from institutional-based care to community-based care. The proportion of institutionalized treatments has come down drastically and the current focus is on community-based approaches and intergrating the individuals with mental illness with the community, as much as possible. In such a scenario, the family becomes a vital unit in promoting community-based interventions and the involvement and support of the family become essential.

5) Economic benefits:
Improvements in family functioning can reduce the need for intensive medical and social care and thereby produce economic benefits for service providers. Many studies showed that the addition of family approaches produces substantial cost savings to mental health services.

6) Preventive aspect:
The family is the nucleus of all social relationships, has a formative influence over its individuals, teaches individuals about social responsibility and the necessity for co-operation. So, focussing on family as the unit can help prevent a variety of emotional and behavioural disorders. One good example will be that good parenting ad family values can prevent behavioural problems in children and prevent further serious problems like conduct disorders, substance abuse problems and anti-social personality disorders.

However there can be some negative implications also:

1) Family-oriented approach raises a lot of questions about privacy and confidentiality issues.

2) Over-involvement of the family carries a XXXXXXX of undermining individual responsibility and motivation, which can sometimes have a negative impact on treatment response.

In an addictions setting, the role of the family is quite significant. It is important to learn how to use the family unit in a balanced, yet effective way. The role which family plays in the management of addiction disorders is slightly different when compared to other psychiatric disorders. The reasons are:
1)     Often it is the spouse or a family member who brings the patient to medical attention
2)     Addiction problems almost always have an adverse impact on the family members.
3)     Marital disharmony and other relationship problems may themselves be triggering or perpetuating factors for substance abuse.

So, we have to learn to involve the family in a positive way to facilitate treatment of addiction disorders. The family unit can be a tool to
-     To enhance motivation
-     To monitor treatment
-     To provide a stress-free and conducive environment for reformation
-     To provide adequate social support and lifestyle modifications
-      To facilitate rehabilitation and integration into the community.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
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