How Therapists Discuss Causality with Families in an Integrated Family Management and Therapy Service, a Qualitative Study with Focus Groups

Abstract

Family therapy (FT) and family management (FM) approaches to psychosis have been distinguished by their understanding of causality. FM holds a biological understanding which could have negative consequences for the person with psychosis. FT, with its focus on interactions, has been criticised for its potential for implying that families are to blame for their relative’s psychosis. Although these two approaches have been integrated, the manner in which causality is discussed in family sessions within an integrated approach has not been researched. Qualitative research was conducted with clinicians working in an established integrated family intervention service to explore how they discuss causality. Four focus groups were conducted and a framework approach to thematic analysis used. Four themes developed from the analysis: how a shared understanding of causality is constructed; the use of an ‘explorative conversational’ therapeutic style to discuss causality; factors that limited the exploration of causality; and the challenges of working with issues of blame. The stress-vulnerability model, genograms, interactional-cycles and formulation were identified as useful tools to develop 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 key to the integrated model and clinicians felt these two aspects addressed the criticisms that have been levelled at each approach. Complex family problems, abuse and illicit drug use were factors that challenged causality discussions. Families feeling blamed/blaming themselves and attempts to transform blame made up a dominant theme of the research.