Contemporary Family Therapy

, Volume 35, Issue 3, pp 437–451 | Cite as

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

  • Andrew Newman
  • Frank Burbach
  • Janet Reibstein
Original Paper


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.


Psychosis Family therapy Family management Integration Causality Blame 



The Authors would like to thank Dr Janet Smithson, Exeter University for her advice regarding the qualitative analysis of the data.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Andrew Newman
    • 1
    • 4
  • Frank Burbach
    • 2
  • Janet Reibstein
    • 3
  1. 1.Avon and Wiltshire Partnership NHS TrustChippenhamUK
  2. 2.Somerset Partnership NHS Foundation TrustSomersetUK
  3. 3.Exeter UniversityExeterUK
  4. 4.Avon and Wiltshire Partnership NHS Trust, Fromeside ClinicBristolUK

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