Table Of ContentWorking with Families
of Psychiatric Inpatients
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Working with Families
of Psychiatric Inpatients
A Guide for Clinicians
alison m. heru, m.d.
Associate Professor (Clinical)
and
laura m. drury, m.s.w., l.i.c.s.w.
Senior Clinical Teaching Associate
Department of Psychiatry and Human Behavior
Brown University Medical School
Providence, Rhode Island
The Johns Hopkins University Press
Baltimore
©2007The Johns Hopkins University Press
All rights reserved. Published 2007
Printed in the United States of America on acid-free paper
2 4 6 8 9 7 5 3 1
The Johns Hopkins University Press
2715North Charles Street
Baltimore, Maryland 21218-4363
www.press.jhu.edu
Library of Congress Cataloging-in-Publication Data
Heru, Alison M., 1953–
Working with families of psychiatric inpatients : a guide for
clinicians / Alison M. Heru and Laura M. Drury.
p. ; cm.
Includes bibliographical references and index.
ISBN-13:978-0-8018-8576-1(hardcover : alk. paper)
ISBN-10:0-8018-8576-0(hardcover : alk. paper)
ISBN-13:978-0-8018-8577-8(pbk. : alk. paper)
ISBN-10:0-8018-8577-9(pbk. : alk. paper)
1. Psychiatric hospital care. 2. Family—Mental health. I. Drury,
Laura M., 1948– . II. Title.
[DNLM: 1. Mental Disorders—therapy. 2. Family Relations.
3. Hospitalization. 4. Internship and Residency. 5. Professional-
Family Relations. WM 140H576w2007]
RC439.W6744 2007
362.2'1—dc22
2006026088
A catalog record for this book is available from the British Library.
Contents
Preface vii
Abbreviations xi
part i key concepts
1 What It Takes to Work with Patients’ Families 3
2 The Biopsychosocial Case Formulation and Treatment Plan 15
part ii research on families
and family treatments
3 Research on Families 27
4 Family Treatments 43
part iii mastering skills
5 Abbreviated Assessment of the Family 63
6 Managing a Family Meeting 89
7 Other Inpatient Interventions:
Multifamily Psychoeducational Groups and Genograms 106
part iv challenges in working
with families
8 The Resident’s Perspective: Attitudes and Fears 117
9 The Family’s Perspective: Sources of Anxiety 127
vi CONTENTS
part v the larger system
10 Risk Management and the Family 139
patricia r. recupero, j.d., m.d.
11 Family-Based Services after Hospitalization 149
Appendix: GAP Checklist for Evaluating Competency
in Family-Interview Skills 155
References 157
Index 173
Preface
The primary goal of this book is to provide guidance to clinicians who are
working with psychiatric inpatients and their families. The book offers step-by-
step instruction for successfully working with families. It can be useful to psy-
chiatric residents and trainees in other disciplines who want to learn how to
provide good family-oriented care to mentally ill patients and their families.
Another reason for writing this book is the expectation that residents in
all specialties will be competent in working with families. This expectation
is clearly laid out in the core competencies of the Accreditation Council
for General Medical Education. Residents will be assessed on their knowl-
edge, attitudes, and skills in working with families. The Psychiatric Resi-
dency Review Committee has amplified these criteria for psychiatry, and the
Committee on the Family of the Group for the Advancement of Psychiatry
has fleshed out these criteria to make implementation easier. The criteria
are presented in Chapter 1.
Beyond meeting competency expectations, however, the stronger ratio-
nale for working with families comes from the broad and deep research on
families that exists throughout the medical literature. The research data
clearly demonstrate why family interventions are important for patient care.
Research on families and evidence-based family treatments that are relevant
to inpatient care is described in Chapters 3 and 4. The biopsychosocial
model is discussed in Chapter 2, as it is considered an exemplary model for
integrating family factors into the assessment and treatment of patients.
Chapters5,6, and 7outline the attitudes and skills necessary for the clin-
ician to be able to assess and treat families successfully. Case material,
including teaching points, is used to illustrate these skills. The cases are
loosely based on families that we have worked with in an inpatient setting.
viii PREFACE
While the names and details have been changed, of course, the lessons
learned remain authentic.
The chapters in Part 4, “Challenges in Working with Families,” outline
the barriers that clinicians may encounter with families. Chapter 8con-
tains case examples that illustrate concerns residents have brought to us dur-
ing their training. Families also bring fears and anxieties to a family meeting,
and Chapter 9and its case example help attune the reader to the concerns
of the family. Understanding the family’s perspective enhances the clini-
cian’s capacity for empathy with the family, allowing him or her to intervene
more effectively.
Part 5provides a wider view of the importance of families in psychiatric
care. In Chapter 10, Dr. Patricia Recupero, the vice president of the American
Academy of Psychiatry and the Law and the president and CEO of Butler
Hospital, in Providence, Rhode Island, offers a legal perspective on the impor-
tance of involving families in patient care. Using legal case material, she dis-
cusses risk-management strategies as part of a model of patient care that is fam-
ily oriented. The final chapter places the concerns of the family within a
community perspective and reviews how mental health services, if adequately
funded, can continue family-oriented care beyond hospitalization.
Family skills should be part of the repertoire of every clinician. We do not
suggest that every resident become a family therapist, but all residents
should develop skills that will allow them to easily integrate the family into
patient care. This book offers guidance on how to manage family situations
that are commonly encountered on the inpatient unit and demonstrates why
clinicians should welcome family involvement in patient care. When the
skills of working with families are incorporated into a clinician’s repertoire,
they will counterbalance the recent trend of psychiatrists to become psy-
chopharmacologists. As one former chief resident stated in a letter to the
Psychiatric Times, “Why would a fully trained psychiatrist want to diminish
4years of biopsychosocial training by emphasizing only the training in med-
ications? Psychopharmacologists are inherently consultants, focusing on
one small piece of the biopsychosocial puzzle—and interestingly, perhaps
the smallest piece. For as any psychiatric resident can attest, learning the
meds is the easiest piece. The richness, complexity, artistry and joy of our
specialty come from understanding and optimizing the interaction between
our patients and ourselves” (Heacock 2004, p. 13). To this, we would add that
PREFACE ix
interactions with the patients’ families are another arena in which psychia-
trists can experience the richness and artistry of our profession and opti-
mize patient care.
We gratefully acknowledge the contributions to Chapter 1of the GAP
Committee on the Family members (Ellen Berman, Alison Heru, John Rol-
land, Fred Gottleib, Henry Grunebaum, Beatrice Wood, and Heidi Bruty).
The chapter is adapted from an article published in Academic Psychiatryin
2005. We thank our supervisors, Drs. Nathan Epstein and Duane Bishop, for
guidance throughout our training years. We thank Jody Eyre, a marital and
family therapy intern from the University of Rhode Island, who piloted
genogram groups at Butler Hospital. Finally, we thank the families of our
patients for making our work easier and for the trust they place in us.
This book is dedicated to our own families, in recognition of their support
and encouragement.
Description:Working with the families of inpatients is one of the most important -- and most challenging -- aspects of practicing clinical psychiatry. Clinicians are responsible not only for the well-being of their patients but also for the education and guidance of the patient's family. In this book, Alison M.
