Family Inclusive Therapeutic Interventions

  • Akram Wilson
  • Samir Ibrahim
  • Massimo Clerici
  • Ester di Giacomo
  • Gabor Keitner


Given the improtance of the family in the etio-pathogenesis of psychopathology, family interventions have become a focus in therapeutic approaches in treating such mental disorders. This chapter covers the latest research in The Field of Family Interventions for Bipolar Disorders, Schizophrenia, and Depressive Illness. This area of research is advancing leading to new paragidm in “family-inclusive” therapeutic intterventions.


  1. 1.
    Weinstock LM, Wenze SJ, Miller IW, Munroe MK. Concordance between patient and family reports of family functioning in bipolar disorder and major depressive disorder. J Nerv Ment Dis. 2013;201(5):377–83.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Keitner GI, Heru A, Glick I. Clinical manual of couples and family therapy. Arlington: American Psychiatric Publishing Inc.; 2010. p. 48.Google Scholar
  3. 3.
    Mansfield AK, Dealy JA, Keitner GI. Family interventions for bipolar disorder: a review of the literature. Neuropsychiatry. 2012;2(3):231–8.CrossRefGoogle Scholar
  4. 4.
    Salcedo S, Gold AK, Sheikh S, Marcus PH, Nierenberg AA, Deckersbach T, Sylvia LG. Empirically supported psychosocial interventions for bipolar disorder: current state of the research. J Affect Disord. 2016;201:203–14.CrossRefPubMedGoogle Scholar
  5. 5.
    Fiorillo A, Sampogna G, del Gaudio L, Luciano M, Del Vecchio V. Psychoeducational family intervention for people with bipolar I disorder and their relatives. J Psychopathol. 2013;19(2):134–42.Google Scholar
  6. 6.
    Reinares M, Bonnin CM, Hidalgo-Mazzei D, Sanchez-Moreno J, Colom F, Vieta E. The role of family interventions in bipolar disorders: a systematic review. Clin Psychol Rev. 2016;43:47–57.CrossRefPubMedGoogle Scholar
  7. 7.
    Sullivan AE, Judd CM, Axelson DA, Miklowitz DJ. Family functioning and the course of adolescent bipolar disorder. Behav Ther. 2012;43(4):837–47.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Miklowitz DJ. Evidence-based family intervention for adolescents and young adult with bipolar disorder. J Clin Psychiatry. 2016;77:1–10.Google Scholar
  9. 9.
    Miklowitz DJ, O’Brien MP, Schlosser DA, Addington J, Candan KA, Marshall C, et al. Family-focused treatment for adolescents and young adults at high risk for psychosis: results of a randomized trial. J Am Acad Child Adolesc Psychiatry. 2014;53(8):848–58.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Goldstein BI, Goldstein TR, Axelson DA, Birmaher B, Collinger KA, Bukstein OG, Koutra K, Basta M, Simos P, Vgontzas AN, Roumeliotaki T, Lioni C, Triliva S. Impaired family functioning in psychosis and its relevance to relapse: a two year follow up study. Compr Psychiatry. 2015;62:1–12.CrossRefGoogle Scholar
  11. 11.
    Fredman SJ, Baucom DH, Boeding SE, Miklowitz DJ. Relatives’ emotional involvement moderates the effects of family therapy for bipolar disorder. J Consul Clin Pychol. 2015;83(1):81–91.CrossRefGoogle Scholar
  12. 12.
    Koutra K, Basta M, Stefanakis Z, Vgontzas AN, Roumeliotaki T, Lionis C, Triliva S. Family functioning, expressed emotion and family burden in relatives of first episode and chronic patients with schizophrenia and bipolar disorder: preliminary findings. Eur Psychiatry. 2013;28:34–9.CrossRefGoogle Scholar
  13. 13.
    Berutti M, Dias RS, Pereira VA, Lafer B, Nery FG. Association between history of suicide attempts and family functioning in bipolar disorder. J Affect Disord. 2016;192:28–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Peters S, Pontin E, Lobban F, Morris R. Involving relatives in relapse prevention for bipolar disorder: a multi-perspective qualitative study of value and barriers. BMC Psychiatry. 2011;11:40–8.CrossRefGoogle Scholar
  15. 15.
    Fiorillo A, Del Vecchio V, Luciano M, Sampogna GD, Catapano F, DeRosa C, Malangone C, Tortorella A, Maj M, Graziani A, Veltro F, Nicolo G, Piselli M, Bardicchia F, Clampini G, Lampis D, Moroni A, Bassi M, Lapichino S, Biondi S, Orlandi E, Starace F, Baronessa C, Carra G. Feasibility of a psychoeducational family intervention for people with bipolar I disorder and their relatives: results from an Italian real-world multicentre study. J Affect Disord. 2016;190:657–62.CrossRefPubMedGoogle Scholar
  16. 16.
    Epstein NB, Baldwin LM, Bishop DS. The McMaster family assessment device. J Marital Family Therapy. 1983;9:203–8.CrossRefGoogle Scholar
  17. 17.
    Mansfield AK, Dealy JA, Keitner GI. The family assessment device: an update. Fam Process. 2014;87:1–12.Google Scholar
  18. 18.
    Staccini L, Tomba E, Grandi S, Keitner GI. The evaluation of family functioning by the family assessment device: a systematic review of studies in adult clinical populations. Fam Process. 2015;54:94–115.CrossRefPubMedGoogle Scholar
  19. 19.
    Perlick DA, Lopez N, Chou J, Kalvin C, Adzhiashvili V, Miklowitz DJ. Family focused treatment for caregivers of patients with bipolar disorder. Bipolar Disord. 2010;12(6):627–37.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Perlick DA, et al. Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disorder. 2010;12(6):629–37.CrossRefGoogle Scholar
  21. 21.
    Archambault R, Mansfield AK, Evans D, Keitner GI. Using the tenets of Problem-Centered Systems Therapy of the Family (PCSTF) to teach the McMaster approach to family therapists. Fam Process. 2014;X:1–16.Google Scholar
  22. 22.
    McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev. 2008;30:67–76.CrossRefPubMedGoogle Scholar
  23. 23.
    McGue M, Gottesman I. The genetic epidemiology of schizophrenia and the design of linkage studies. Eur Arch Psychiatry Clin Neurosci. 1991;240(3):174–81.CrossRefPubMedGoogle Scholar
  24. 24.
    Maziade M, Raymond V, Cliche D, Fournier JP, Caron C, Garneau Y, et al. Linkage results on 11Q21-22 in Eastern Quebec pedigrees densely affected by schizophrenia. Am J Med Genet. 1995;60(6):522–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Maziade M, Bissonnette L, Rouillard E, Martinez M, Turgeon M, Charron L, et al. 6p24-22 region and major psychoses in the Eastern Quebec population. Le Groupe IREP. Am J Med Genet. 1997;74(3):311–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Murru A, Carpiniello B. Duration of untreated illness as a key to early intervention in schizophrenia: a review. Neurosci Lett. 2016. pii: S0304-3940(16)30745-5. doi:  10.1016/j.neulet.2016.10.003 CrossRefPubMedGoogle Scholar
  27. 27.
    McFarlane WR, Cook WL. Family expressed emotion prior to onset of psychosis. Fam Process. 2007;46(2):185–97.CrossRefPubMedGoogle Scholar
  28. 28.
    Zubin J, Steinhauer SR, Condray R. Vulnerability to relapse in schizophrenia. Br J Psychiatry Suppl. 1992;18:13–8.Google Scholar
  29. 29.
    Brown GW, Birley RM. The measurement of family activities and relationships: methodological study. Hum Relat. 1966;19:241–63.CrossRefGoogle Scholar
  30. 30.
    Cheng A. Expressed emotion: a cross-culturally valid concept? Br J Psychiatry. 2002;181(6):466–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Miklowitz DJ, Velligan DI, Goldstein MJ, Nuechterlein KH, Gitlin MJ, Ranlett G, et al. Communication deviance in families of schizophrenic and manic patients. J Abnorm Psychol. 1991;100(2):163–73.CrossRefPubMedGoogle Scholar
  32. 32.
    Goldstein MJ. Family factors that antedate the onset of schizophrenia and related disorders: the results of a fifteen year prospective longitudinal study. Acta Psychiatr Scand Suppl. 1985;319:7–18.CrossRefPubMedGoogle Scholar
  33. 33.
    Tienari P, Wynne LC, Sorri A, Lahti I, Laksy K, Moring J, et al. Genotype-environment interaction in schizophrenia-spectrum disorder. Long-term follow-up study of Finnish adoptees. Br J Psychiatry. 2004;184:216–22.CrossRefPubMedGoogle Scholar
  34. 34.
    Koenigsberg HW, Handley R. Expressed emotion: from predictive index to clinical construct. Am J Psychiatry. 1986;143(11):1361–73.CrossRefPubMedGoogle Scholar
  35. 35.
    Leff HS, Cook JA, Gold PB, Toprac M, Blyler C, Goldberg RW, et al. Effects of job development and job support on competitive employment of persons with severe mental illness. Psychiatr Serv. 2005;56(10):1237–44.CrossRefPubMedGoogle Scholar
  36. 36.
    Cook WL, Kenny DA, Goldstein MJ. Parental affective style risk and the family system: a social relations model analysis. J Abnorm Psychol. 1991;100(4):492–501.CrossRefPubMedGoogle Scholar
  37. 37.
    McFarlane WR. Prevention of the first episode of psychosis. Psychiatr Clin North Am. 2011;34(1):95–107.CrossRefPubMedGoogle Scholar
  38. 38.
    McGlashan TH, Carpenter WT. Identifying unmet therapeutic domains in schizophrenia patients: the early contributions of Wayne Fenton from Chestnut Lodge. Schizophr Bull. 2007;33(5):1086–92.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    McFarlane WR, Melton S, Ryan P. Family psychoeducation in clinical high risk and first- episode psychosis. Washington, DC: Regional Research Institute for Human Services Publications; 2012.Google Scholar
  40. 40.
    Beltz J, Clerici M, Cazzullo CL. The aggressive behaviours in the families of psychotic patients. Ital J Psychiat Behav Sci. 1999;9(1):16–8.Google Scholar
  41. 41.
    Bertrando P, Bressi C, Clerici M, Cunteri L, Cazzullo CL. Family assessment and linguistic interaction: analysis of the Camberwell family interview. Psychother Psychosom. 1989;51(3):120–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Bertrando P, Cecchin G, Clerici M, Beltz J, Milesi A, Cazzullo CL. Expressed emotion and Milan systemic intervention: a pilot study on families of people with a diagnosis of schizophrenia. J Fam Ther. 2006;28(1):81–102.CrossRefGoogle Scholar
  43. 43.
    Bertrando P, Beltz J, Bressi C, Clerici M, Farma T, Invernizzi G, Cazzullo CL. Expressed emotion and schizophrenia in Italy. A study of an urban population. Br J Psychiatry. 1992;161:223–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Bertrando P, Beltz J, Garavaglia R, Ferrarini F, Clerici M. Emotional family patterns in different psychiatric and neurological populations. Ital J Psychiat Behav Sci. 1991;1(1):57–66.Google Scholar
  45. 45.
    Carrà G, Cazzullo CL, Clerici M. The association between expressed emotion, illness severity and subjective burden of care in relatives of patients with schizophrenia. Findings from an Italian population. BMC Psychiatry. 2012;12(1):140.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Carrà G, Montomoli C, Clerici M, Cazzullo CL. Family interventions for schizophrenia in Italy: randomized controlled trial. Eur Arch Psychiatry Clin Neurosci. 2007;257(1):23–30.CrossRefPubMedGoogle Scholar
  47. 47.
    Carrà G, Clerici M, Cazzullo CL. Schizophrenia and psychosocial family intervention. A study on users’ characteristics and one-year follow-up. Epidemiol Psichiatr Soc. 1995;4(3):212–26.CrossRefGoogle Scholar
  48. 48.
    Cazzullo CL, Bressi C, Bertrando P, Clerici M, Maffei C. Schizophrenia and family expressed emotion: study of an Italian population. Encéphale. 1989;15(1):1–6.PubMedGoogle Scholar
  49. 49.
    Cazzullo CL, Clerici M, Bertrando P. Future strategies in family research and intervention. Integr Psychiatry. 1994;10(1):20–3.Google Scholar
  50. 50.
    Cazzullo CL, Bertrando P, Clerici M, Bressi C, da Ponte C, Albertini E. The efficacy of an information group intervention on relatives of schizophrenics. Int J Soc Psychiatry. 1989;35(4):313–23.CrossRefPubMedGoogle Scholar
  51. 51.
    Clerici M, Beltz J, Bertrando P, Cazzullo CL. Family diagnostic patterns and compliance with medication in schizophrenia. Ital J Psychiat Behav Sci. 1994;4(1):49–53.Google Scholar
  52. 52.
    Clerici M, Beltz J, Cazzullo CL. Family coping and psychoeducation in the treatment of mood disorders. Preliminary findings. Ital J Psychiat Behav Sci. 2000;10(3):90–6.Google Scholar
  53. 53.
    Clerici M, Bertrando P, Carrà G, Doria S, Cazzullo CL. Psychosocial profiles of a sample of schizophrenic patients and their families: the ARS experience. Psychiatr Hung. 1993;VIII(5):361–9.Google Scholar
  54. 54.
    Clerici M, Beltz J, Bressi C, Bertrando P, Invernizzi G, Cazzullo CL. Expressed emotion: from research to psychosocial treatments. Acta Psychiatr Belg. 1989;89(1–2):31–9.PubMedGoogle Scholar
  55. 55.
    D’Urso N, Scarone S, Clerici M. Factors affecting the choice of a family psychosocial intervention. A retrospective study from an experience of 8 years. Riv Psichiatr. 2015;50(2):80–8.PubMedGoogle Scholar
  56. 56.
    Invernizzi G, Clerici M, Bertrando P, Bressi C, Cazzullo CL. Family expressed emotion. From research to therapeutic intervention. Minerva Psichiatr. 1990;31(2):89–96.PubMedGoogle Scholar
  57. 57.
    Tényi T, Trixler M, Hwerold R, Clerici M, Bertrando P, Cazzullo CL. Comparative Italian-Hungarian Study of the psychosocial profiles of schizophrenic patients and their families. Ital J Psychiat Behav Sci. 1995;5(2):95–104.Google Scholar
  58. 58.
    Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev. 2010;12:Cd000088.Google Scholar
  59. 59.
    Hode Y. Psychoeducation of patients and their family members during episode psychosis. L’Encephale. 2013;39(Suppl 2):S110–4.CrossRefPubMedGoogle Scholar
  60. 60.
    Sin J, Norman I. Psychoeducational interventions for family members of people with schizophrenia: a mixed-method systematic review. J Clin Psychiatry. 2013;74(12):e1145–62.CrossRefPubMedGoogle Scholar
  61. 61.
    Miklowitz DJ. Treatment development and feasibility study of family-focused treatment for adolescents with bipolar disorder and comorbid substance use disorders. J Psychiatr Pract. 2014;20(3):237–48.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Lyse HG, Haahr UH, Fjell A, Dichmann B, Flensborg E, Simonsen E. Psychoeducation and multifamily groups for patients with first-episode psychosis. Ugeskr Laeger. 2007;169(43):3668–72.PubMedGoogle Scholar
  63. 63.
    McFarlane WR, Lukens E, Link B, Dushay R, Deakins SA, Newmark M, et al. Multiple-family groups and psychoeducation in the treatment of schizophrenia. Arch Gen Psychiatry. 1995;52(8):679–87.CrossRefPubMedGoogle Scholar
  64. 64.
    McFarlane WR, Dushay RA, Stastny P, Deakins SM, Link B. A comparison of two levels of family-aided assertive community treatment. Psychiatr Serv. 1996;47(7):744–50.CrossRefPubMedGoogle Scholar
  65. 65.
    McFarlane WR, Lynch S, Melton R. Family psychoeducation in clinical high risk and first-episode psychosis. Adolesc Psychiatry. 2012;2(2):182–94.CrossRefGoogle Scholar
  66. 66.
    Smith JV, Birchwood MJ. Specific and non-specific effects of educational intervention with families living with a schizophrenic relative. Br J Psychiatry. 1987;150:645–52.CrossRefPubMedGoogle Scholar
  67. 67.
    Okpokoro U, Adams CE, Sampson S. Family intervention (brief) for schizophrenia. Cochrane Database Syst Rev. 2014;3:Cd009802.Google Scholar
  68. 68.
    Youssef FA. Discharge planning for psychiatric patients: the effects of a family-patient teaching programme. J Adv Nurs. 1987;12(5):611–6.PubMedGoogle Scholar
  69. 69.
    Okpokoro U, Sampson S. Brief family intervention for schizophrenia. Schizophr Bull. 2014;40(3):497–8.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Donohue JM, Pincus HA. Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. PharmacoEconomics. 2007;25:7.CrossRefPubMedGoogle Scholar
  71. 71.
    Sobocki P, Jönsson B, Angst J, Rehnberg C. Cost of depression in Europe. J Ment Health Policy Econ. 2006;9:87.PubMedGoogle Scholar
  72. 72.
    Andrade L, Caraveo-Anduaga JJ, Berglund P, et al. The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) surveys. Int J Methods Psychiatr Res. 2003;12:3.CrossRefPubMedGoogle Scholar
  73. 73.
    Kessler RC, Ormel J, Petukhova M, et al. Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry. 2011;68:90.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Ramana R, et al. Remission and relapse in major depression: a two-year prospective follow up study. Psychol Med. 2003;33:839–45.CrossRefGoogle Scholar
  75. 75.
    Okasha A, et al. Expressed emotions, perceived criticism, and relapse in depression: a replication in an Egyptian community. Am J Psychiatry. 1994;151:1001–5.CrossRefPubMedGoogle Scholar
  76. 76.
    Frank F, et al. Effectiveness of a brief psychoeducational group intervention for relatives on the course of disease in patients after inpatient depression treatment compared with treatment as usual – study protocol of a multisite randomised controlled trial. BMC Psychiatry. 2015;15(1):259.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Rado S. The problem of melancholia. Int J Psychoanal. 1928;9:420.Google Scholar
  78. 78.
    Bifulco A, et al. Maternal attachment style and depression associated with childbirth: preliminary results from a European and US cross-cultural study. Br J Psychiatry. 2004;184(suppl. 46):s31–7.CrossRefGoogle Scholar
  79. 79.
    Williams V. Psychometric validation of the depression and family function scale. Curr Med Res Opin. 2016;32:639–50.CrossRefPubMedGoogle Scholar
  80. 80.
    Wang J, Zhao X. Family functioning assessed by self-reported and observed reported rating scales of depressed patients and their partners. J Nerv Ment Dis. 2013;201(5):384–8.CrossRefPubMedGoogle Scholar
  81. 81.
    Rush AJ, Nirenberg A. Mood disorders: treatment of depression. In: Kaplan and Sadock’s: comprehensive textbook of psychiatry. Philadelphia: Wolters Kluwer and Lippincott Williams & Wilkins; 2009. p. 1734–43.Google Scholar
  82. 82.
    Mc Farlane W. Multifamily groups in the treatment of severe psychiatric disorders. New York: Guilford Press; 2002. p. 2002.Google Scholar
  83. 83.
    Lewinsohn P, Clarke G. The coping with depression course. Adv Behav Res Ther. 1984;6:99.CrossRefGoogle Scholar
  84. 84.
    Shimazu K, et al. Family psychoeducation for major depression: randomised control trial. Br J Psychiatry. 2011;198(5):385–90.CrossRefPubMedGoogle Scholar
  85. 85.
    Shimodera S, et al. Cost-effectiveness of family psychoeducation to prevent relapse in major depression: results from a randomized controlled trial. BMC Psychiatry. 2012;12:40.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Keitner G, Miller I. Family functioning and major depression: an overview. Am J Psychiatry. 1990;147:1128–37.CrossRefPubMedGoogle Scholar
  87. 87.
    Francois C, Nielsen RZ, Danchenko N, Lancon C. The effect of Vortioxetine on family functioning in adults with major depressive disorder. Value Health. 2015;18(3):A124.CrossRefGoogle Scholar
  88. 88.
    Miller I, Keitner G, Ryan CE, Solomon DA, Cardemil EV, Beevers CG. Treatment matching in the post-hospital care of depressed patients. Am J Psychiatry. 2005;162:2131–8.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Spitz I, Spitz S. Family and couple therapy. In: Kaplan and Sadock’s: comprehensive textbook of psychiatry. Philadelphia: Wolters Kluwer and Lippincott Williams & Wilkins; 2009. p. 2845–57.Google Scholar
  90. 90.
    Anderson C, Reiss D, Hogarty B. Schizophrenia and the family. New York: Guilford Press; 1986.Google Scholar
  91. 91.
    McQuaid J. Mood disorders psychotherapy. In: Kaplan and Sadock’s: comprehensive textbook of psychiatry. Philadelphia: Wolters Kluwer and Lippincott Williams & Wilkins; 2009. p. 1813–22.Google Scholar
  92. 92.
    Jacobson N, Dobson K, Truax P, Addis M, Koerner K. A component analysis of cognitive behavioural treatment for depression. J Consult Clin Psychol. 1996;64:295.CrossRefPubMedGoogle Scholar
  93. 93.
    Milkowitz D, Goldstein M. Bipolar disorder: a family focussed treatment approach. New York: Guilford Press; 1979.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Akram Wilson
    • 1
    • 2
    • 3
  • Samir Ibrahim
    • 3
    • 4
    • 5
  • Massimo Clerici
    • 3
    • 6
    • 7
  • Ester di Giacomo
    • 7
  • Gabor Keitner
    • 8
  1. 1.Suez Canal UniversityIsmailiaEgypt
  2. 2.Sussex Partnership NHS Foundation and Teaching TrustWest SussexUK
  3. 3.“Family Research and Interventions” Section, WPAGenevaSwitzerland
  4. 4.TMS Department at Northpark Private HospitalBundooraAustralia
  5. 5.Family Violence Interest Group R.A.N.Z.C.P.GenevaSwitzerland
  6. 6.University of Milano BicoccaMilanItaly
  7. 7.Psychiatric DepartmentSan Gerardo Health Care TrustMonzaItaly
  8. 8.Department of PsychiatryBrown UniversityProvidenceUSA

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