Exploring therapists ideas about engaging families in Behavioural Family Therapy

1
Exploring therapists ideas about engaging
families in Behavioural Family Therapy

• Carolyn James,
• Birmingham and Solihull Mental Health Trust
• Delia Cushway,
• Coventry University and University of Warwick
• Grainne Fadden,
• Birmingham and Solihull Mental Health Trust

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Engagement in Behavioural Family Therapy

• Literature review
• Rationale for qualitative process research
• Method
• Results
• Discussion
• Conclusion and Recommendations

3
Literature Review

• Quantitative studies
• Strong outcome data (Pilling et al, 2002)
• Implementation difficulties (Fadden Birchwood,
  2002)
• Engagement problematic (Smith, 1992 Barrowclough
  Tarrier, 1992 Montero eg al, 1999)
• Therapist and family factors (Fadden,1997,1998
  Gray, 2001 Horvath, 1994 Horvath Greenberg,
  1994 Montero et al, 1999)

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Rationale for qualitative study on engagement

• Importance of engagement
• Clinical experience in engagement and process
  research
• Absence of literature on
• process research
• therapist factors
• difficulties in engagement
• Qualitative research useful
• in areas where little is known
• understanding process issues

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Method

• Grounded theory
• Interviews with
• Staff trained in BFT
• Families who had participated in BFT
• Semi-structured interviews
• Transcribed verbatim
• (Chamberlain, 1999 Charmaz, 1995 Giles, 2002
  Strauss Corbin,1998)

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Participants

• Seven workers trained in BFT
• Three male, four female
• Aged 25 65
• White European
• Mix of disciplines
• Trained in BFT 3-7 years
• Range of teams
• Worked with 3-10 families

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Participants cont.

• Three families
• Seven participants
• Three male, four female
• White European
• Parents, step-parents and one service user
• Aged 25 85 years
• Contact with services 5-20 years

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Data collection and analysis
Relational sampling collects data to develop
lower order categories
Axial coding organises lower order categories
into small number of higher order categories
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Quality and Reliability

• Paper Trail
• Reflexive journal
• Memos
• Precisely written definitions of categories
• Analytic auditing
• Respondent validation

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A model of engagement in Behavioural Family
Therapy The therapists perspective
Context
Humanity
Reflective practitioner
Learning and integration
Ideas about engagement
Ideas about family work
Integrated practice of BFT
Tasks
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Results Therapist qualities and their practice

• Core category Humanity
• thats how I hope somebody would treat me and so
  thats something that you try to bear in mind,
  if it was me that was coming in with my loved
  one, how would I be treated? (Eileen, 281-285)
• even when youre psychoticyou get a sense about
  people and whether they are genuine or not, and
  whether you can trust them or not (Beth,
  961-966)

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Results Therapist qualities and their practice
cont

• Reflective practice
• I think Ive shifted a lot actuallyI identify
  much more now, particularly with carers, than I
  did then (Ron, 405-408)
• Learning and integration
• You also need structure otherwise you dont
  actually achieve what youre setting out to do
  (Caroline, 69-70)

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Results continued Therapists ideas and beliefs

• Ideas about families and family work
• it is kind of this big teamyou know the family
  members and us as a team kind of have this kind
  of direction that were all kind of tootling
  onit is like a sort of bigger team (Anne,
  836-839)
• If you have a common goal and you all know where
  youre headedits easy to all go together. We do
  have a common goal and weve always recognised
  that (Cath, 929-935)

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Results continued Therapists ideas and beliefs

• Ideas about engagement
• its when it feels appropriateas I say sow the
  seed and then just nurture it a little (Sam,
  845-852)
• Id say gentle preparationtheyre making a
  judgement about you as much as youre beginning
  to make judgementsI see it very much as a two
  way process (Ellen, 150-154)

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Results continued External factors

• Context
• if theres only one or two of you that perhaps
  have a similar philosophy, um its difficult
  building that into a ward culture (Eileen,
  363-365)
• Tasks
• you need to kind of deal with a relationship for
  them to see you as being okaybefore going in and
  offering the whole approachThey need to trust
  you first (Ron, 101-105)

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Discussion

• Therapist factors
• Being oneself
• Confidence
• Competence
• Attitudes about BFT
• Engagement as a process
• Implementation issues
• Training
• Supervision
• Organisational culture

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Limitations

• Of the model
• No family perspective/model
• Of the study
• Demographic and minority ethnic status
• Workers not working with families
• Retrospective

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Suggestions

• Using the model in practice
• Personal reflection
• Use of self
• Discussion in supervision
• Listening to families
• Further research
• Qualitative studies
• User-led research on families perspective
• Non-engaged families (and therapists!)

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References

• Barrowclough, C., Tarrier, N., (1992). Families
  of schizophrenic patients Cognitive behavioural
  intervention. London Chapman Hall.
• Chamberlain, K, (1999) Using grounded theory in
  health psychology. In M. Murray K. Chamberlain
  (Eds.), Qualitative health psychology Theories
  and methods (pp 183-201). London Sage
  Publications
• Charmaz, K. (1995). Grounded theory. In J.A.
  Smith, K. Harre, L. Van Langenhove (Eds.),
  Rethinking methods in psychology (pp 27-49).
  London Sage Publications
• Fadden, G., (1997), Implementation of family
  interventions in routine clinical practice
  following staff training programs A major cause
  for concern. Journal of Mental Health, 6, 599-612
• Fadden, G., (1998). Research up date
  Psychoeducational family interventions. Journal
  of Family Therapy, 20, 293-309
• Fadden, G., Birchwood, M. (2002). British
  models for expanding family psychoeducation in
  routine practice. In H.P. Lefley D.L. Johnson
  (Eds.) Family interventions in mental illness
  international perspectives. Connecticut
  Greenwood Publishing Group Inc.
• Giles, D.C. (2002) Advanced research methods in
  psychology, London Routledge
• Montero, I., Asencio, A.P., Ruiz, I.,
  Hernandez, I. (1999) Family interventions in
  schizophrenia An analysis of non-adherence. Acta
  Psychiatrica Scandinavica, 100, 136-141
• Pilling., S., Bebbington, P., Kuipers, E.,
  Garety, P., Geddes, J., Orbach, G., Morgan, C.
  (2002) Psychological treatments in schizophrenia
  I. Meta-analysis of family intervention and
  cognitive behavioural therapy. Psychological
  Medicine, 32, 763-782
• Smith, J. (1992). Family interventions Service
  implications in innovations. In M. Birchwood N.
  Tarrier (Eds.), The psychological management of
  schizophrenia Assessment, treatment and
  services, Chichester John Wiley Sons Ltd.
• Strauss, A., Corbin, J. (1998). Basics of
  qualitative research, 2nd edition, Thousand Oaks
  Sage Publications