Family-Focused Psychoeducational Programs for Minorities with Serious Mental Illness

  • Amy Weisman de Mamani
  • Radha Dunham
  • Stephanie Aldebot
  • Naomi Tuchman
  • Stephanie Wasserman


This chapter will provide an overview of family-focused psychoeducational programs for minorities with serious mental illness. Psychoeducation refers to treatments that impart information about mental and physical health by way of didactic and structured methods (Rummel-Kluge & Kissling, 2008). Psychoeducation for serious mental disorders typically involves providing specific information on the symptoms of the illness, the biological and psychosocial processes contributing to the development of an illness, factors impacting the course of the illness, coping, and problem-solving strategies, as well as information on available treatments and resources for ongoing care for patients and family members coping with the disorder (Goldstein & Miklowitz, 1995). Family-focused psychoeducational approaches are useful in a variety of settings and with a variety of clients, but they appear to be particularly well-suited for minorities, as researchers consistently recommend including the...


Mental Illness Severe Mental Illness Express Emotion Family Cohesion Communication Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Aponte, J. F., & Johnson, L. R. (2000). The impact of culture on the intervention and treatment of ethnic populations. In J. F. Aponte & J. Wohl (Eds.), Psychological intervention and cultural diversity (pp. 18–39). Boston, MA: Allyn and Bacon.Google Scholar
  2. Barrio, C., Yamada, A. M., Hough, R. L., Hawthorne, W., Garcia, P., & Jeste, D. V. (2003). Ethnic disparities in use of public mental health case management services among patients with schizophrenia. Psychiatric Services, 54, 1264–1270.PubMedCrossRefGoogle Scholar
  3. Barrowclough, C., Haddock, G., Tarrier, N., Lewis, S. W., Moring, J., O'Brien, R., et al. (2001). Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. American Journal of Psychiatry, 158, 1706–1713.PubMedCrossRefGoogle Scholar
  4. Brewer, M. B. & Chen, Y. (2007) Where (who) are collectives in collectivism? Toward conceptual clarification of individualism and collectivism. Psychological Review, 114, 133–151.PubMedCrossRefGoogle Scholar
  5. Brewin, C. R., Maccarthy, B., Duda, K., & Vaughn, C. E. (1991). Attribution and expressed emotion in the relatives of patients with schizophrenia. Journal of Abnormal Psychology, 100, 546–554PubMedCrossRefGoogle Scholar
  6. Chen, F., & Greenberg, J. S. (2004). A positive aspect of caregiving: The influence of social support on caregiving gains for family members of relatives with schizophrenia. Community Mental Health Journal, 40, 423–435.PubMedCrossRefGoogle Scholar
  7. Dixon, L., Lyles, A., Scott, J., Lehman, A., Postrado, L., Goldman, H., & McGlynn, E. (1999). Services to families of adults with schizophrenia: From treatment recommendations to dissemination. Psychiatric Services, 50, 233–238.PubMedGoogle Scholar
  8. Dixon, L., McFarlane, W., Lefley, H., Luckstead, A., Cohen, C., & Falloon, I. (2001). Evidence-based practices for services to family members of people with psychiatric difficulties. Psychiatric Services, 52, 903–910.PubMedCrossRefGoogle Scholar
  9. Dunham, R., & Weisman de Mamani, A. (2007). Therapist competence and adherence as a predictor of treatment efficacy in families enrolled in Culturally Informed Therapy for Schizophrenia. Poster presented at the annual meeting of the Society for Research in Psychopathology, Iowa City, IA.Google Scholar
  10. Falloon, I. R. H., Boyd, J. L., & McGill, C. W. (1984). Family care of schizophrenia: A problem-solving approach to the treatment of mental illness. New York: Guilford Press.Google Scholar
  11. Fallot, R. D. (1998). The place of spirituality and religion in mental health services. New Directions for Mental Health Services, 80, 3–12.PubMedCrossRefGoogle Scholar
  12. Flaskerud, J. H. (1986). The effects of culture-compatible intervention on the utilization of mental health services by minority clients. Community Mental Health Journal, 22, 127–141.PubMedCrossRefGoogle Scholar
  13. Getz, G. E., Fleck, D. E., & Strakowski, S. M. (2001). Frequency and severity of religious delusions in Christian patients with psychosis. Psychiatry Research, 103, 87–91.PubMedCrossRefGoogle Scholar
  14. Goldstein, M. J., & Miklowitz, D. J. (1995). The effectiveness of psychoeducational family therapy in the treatment of schizophrenic disorders. Journal of Marital and Family Therapy, 21, 361–376.CrossRefGoogle Scholar
  15. Guarnaccia, P. J., & Parra, P. (1996). Ethnicity, social status, and families’ experiences of caring for a mentally ill family member. Community Mental Health Journal, 32, 243–260.PubMedCrossRefGoogle Scholar
  16. Guarnaccia P. J., Parra, P., Deschamps, A., Milstein, G., & Arqiles, N. (1992). Si Dios quiere: Hispanic families’ experiences of caring for a seriously mentally ill family member. Culture, Medicine and Psychiatry, 16, 187–215.PubMedCrossRefGoogle Scholar
  17. Hashemi, A., & Cochrane, R. (1999). Expressed emotion and schizophrenia: A review of studies across cultures. International Review of Psychiatry, 11, 219–224.CrossRefGoogle Scholar
  18. Hooley, J. M., & Campbell, C. (2002). Control and controllability: beliefs and behaviour in high and low expressed emotion relatives. Psychological Medicine, 32, 1091–1099PubMedCrossRefGoogle Scholar
  19. Hooley, J. M., & Hiller, J. B. (2000). Personality and expressed emotion. Journal of Abnormal Psychology, 109, 40–44.PubMedCrossRefGoogle Scholar
  20. Jenkins, J., Karno, M., De La Selva, A., & Santana, F. (1986). Expressed emotion in cross-cultural context: Familial responses to schizophrenic illness among Mexican-Americans. In M. Goldstein, I. Hand, & K. Hahlweg (Eds.), Treatment of schizophrenia: Family assessment and intervention (pp. 35–49). New York, NY: Springer-Verlag.Google Scholar
  21. Karno, M., Jenkins, J., De La Selva, A., Santana, F., Telles, C., Lopez, S., et al. (1987). Expressed emotion and schizophrenic outcome among Mexican-American families. Journal of Nervous and Mental Disease, 175, 143–151.PubMedCrossRefGoogle Scholar
  22. Koening, H. G., Larson, D. B., & Weaver, A. J. (1998). Research on religion and serious mental illness. New Directions for Mental Health Services, 80, 81–95.CrossRefGoogle Scholar
  23. Kopelowicz, A., Zarate, R., Gonzalez, V., Lopez, S., Ortega, P., Obregón, N., et al. (2002). Evaluation of expressed emotion in schizophrenia: A comparison of Caucasians and Mexican-Americans. Schizophrenia Research, 55, 179–186.PubMedCrossRefGoogle Scholar
  24. Kravetz, S., Faust, M., & David, M. (2000). Accepting the mental illness label, perceived control over the illness, and quality of life. Psychiatric Rehabilitation, 23, 323–332.Google Scholar
  25. Kymalainen, J. Weisman, A., Rosales, G., & Armesto, J. (2006). Ethnicity, expressed emotion, and communication deviance in family members of patients with schizophrenia. The Journal of Nervous and Mental Disease, 194, 1–6.CrossRefGoogle Scholar
  26. Leff, J., Wig, N., Ghosh, A., Bedi, H., Menon, D., Kuipers, L., et al. (1987). Influence of relatives’ EE on the course of schizophrenia in Chandigarh. British Journal of Psychiatry, 151, 166–173.PubMedCrossRefGoogle Scholar
  27. Lueng, P. K., & Boehnlein, J. K. (2005). Vietnamese families. In M. McGoldrick, J. Giordano, & N. Garcia-Preto (Eds.), Ethnicity and family therapy (pp. 363–373). New York: Guilford Press.Google Scholar
  28. Lincoln, C. E., & Mamiya, L. H. (1990). The Black church in the African American experience. New York: Duke University Press.Google Scholar
  29. Ling, S., Zhao, C., Yang, W., Wang, R., Jin, Z., Ma, T., et al. (1999). Efficacy of family intervention on schizophrenics in remission in community: Result of one year follow-up study. Chinese Mental Health Journal, 13, 325–327.Google Scholar
  30. López, S., Hipke, K., Polo, A., Jenkins, J., Karno, M., Vaughn, C., et al. (2004). Ethnicity, expressed emotion, attributions, and course of schizophrenia: Family warmth matters. Journal of Abnormal Psychology, 113, 428–439.PubMedCrossRefGoogle Scholar
  31. Mak, W. W., & Wu, C. F. (2006). Cognitive insight and causal attribution in the development of self-stigma among individuals with schizophrenia. Psychiatric Services, 57, 1800–1802.PubMedCrossRefGoogle Scholar
  32. Magliano, L., Fiorillo, A., Fadden, F., Gair, F., Economou, M., Kallert, T., et al. (2005). Effectiveness of a psychoeducational intervention for families of patients with schizophrenia: Preliminary results of a study funded by the European Commission. World Psychiatry, 4, 45–49.PubMedGoogle Scholar
  33. Magliano, L., Fiorillo, A., Malangome, C., De Rosa, C., & Maj, M. (2006). Patient functioning and family burden in a controlled, real-world trial of family psychoeducation for schizophrenia. Psychiatric Services, 57, 1784–1791.PubMedCrossRefGoogle Scholar
  34. Marín, G., & Marín, B. V. (1991). Research with Hispanic populations. Applied social research method series, 23. Newbery Park, CA: Sage Publications.Google Scholar
  35. Marsh, D. T., & Lefley, H. P. (1996). The family experience of mental illness: Evidence for resilience. Psychiatric Rehabilitation Journal, 20, 3–12.Google Scholar
  36. McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., & Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19, 211–222.PubMedCrossRefGoogle Scholar
  37. McFarlane, W. R., Dixon, L., Lukens, E., & Lucksted, A. (2003). Family psychoeducation and schizophrenia: a review of the literature. Journal of Marital and Family Therapy, 69, 3–12.Google Scholar
  38. McGoldrick, M., Giordano, J., & Garcia-Preto, N (Eds.). (2005). Ethnicity and family therapy. New York: Guilford Press.Google Scholar
  39. Miklowitz, D. J., & Goldstein, M. J. (1997). Bipolar disorder. A family focused treatment approach. New York: Guilford Press.Google Scholar
  40. Miklowitz, D. J., Simoneua, T. L., George, E. L., Richards, J. A., Kalbarg, A., Sachs-Ericcson, et al. (2000). Family focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy, Biological Psychiatry, 48, 582–592.PubMedCrossRefGoogle Scholar
  41. Millhouse, V. H., Asante, M. K. & Nwosu, P. O. (2001). Transcultural realities: Interdisciplinary perspectives on cross-cultural relations. Thousand Oaks, CA: Sage.Google Scholar
  42. Mino, Y., Tanaka, S., Inoue, S., Tsuda, T., Babazono, A., & Aoyama, H. (1995). Expressed emotion components in families of schizophrenic patients in Japan. International Journal of Mental Health, 24, 38–49.Google Scholar
  43. Moline, R., Singh, S., Morris, A., & Meltzer, H. (1985). Family EE and relapse in schizophrenia in 24 urban American patients. American Journal of Psychiatry, 142, 1169–1177.Google Scholar
  44. Monroe, A. D., & Shiranzian, T. (2004). Challenging linguistic barriers to health care: Students as medical interpreters. Academic Medicine, 79, 118–122.PubMedCrossRefGoogle Scholar
  45. Muela Martinez, J. A., & Godoy Garcia, J. F. (2001). Family intervention program for schizophrenia: Two-year follow-up of the Andalusia Study. Apuntes de Psicología, 19, 421–430.Google Scholar
  46. Mueser, K. T., & Glynn, S. M. (1999). Behavioral family therapy for psychiatric disorders (2nd ed.). Oakland, CA: New Harbinger.Google Scholar
  47. Mueser, K. T., Torrey, W. C., Lynde, D., Singer, P., & Drae, R. (2003). Implementing evidence based practices for people with severe mental illness. Behavior Modification, 27, 387–411.PubMedCrossRefGoogle Scholar
  48. Murphy, H. B.M. & Raman, A. C. (1971). The chronicity of schizophrenia in indigenous tropical peoples: Results of a 12-year follow-up on Muritius. British Journal of Psychiatry, 118, 489–497.PubMedCrossRefGoogle Scholar
  49. Musgrave, C. F., Allen, C. E., & Allen, G. J. (2002). Spirituality and health for women of color. American Journal of Public Health, 92, 557–560.PubMedCrossRefGoogle Scholar
  50. National Institute of Mental Health. (1999). Strategic plan on reducing health disparities. Rockville, MD: Author.Google Scholar
  51. Ng, R., Mui, J., Cheung, H., & Leung, S. (2001). Expressed emotion and relapse of schizophrenia in Hong Kong. Hong Kong Journal of Psychiatry, 11, 4–11.Google Scholar
  52. Organista, K. C., & Munoz, R. F. (1996). Cognitive behavioral therapy with Latinos. Cognitive and Behavioral Practice, 3, 255–270.CrossRefGoogle Scholar
  53. Oyserman, D., Coon, H. M., & Kemmelmeier, M. (2002). Rethinking individualism and collectivism: Evaluation of theoretical assumptions and meta-analyses. Psychological Bulletin, 128, 3–72.PubMedCrossRefGoogle Scholar
  54. Pargament, K. I. (1997). The psychology of religion and coping: Theory, research, and practice. New York: Guilford Press.Google Scholar
  55. Pitschel-Walz, G., Leucht, S., Bauml, J., Kissling, W., & Engel, R. (2001). The effect of family interventions on relapse and rehospitalization in schizophrenia: A meta-analysis. Schizophrenia Bulletin, 27, 73–92.PubMedGoogle Scholar
  56. Ran, M., Leff, J., Hou, Z., Xiang, M., & Chan, C. (2003). The characteristics of expressed emotion among relatives of patients with schizophrenia in Chengdu, China. Culture, Medicine and Psychiatry, 27, 95–106.PubMedCrossRefGoogle Scholar
  57. Rosenfarb, I., Bellack, A., & Aziz, N. (2004). Race, family interventions and patient stabilization in schizophrenia. Journal of Abnormal Psychology, 113, 109–115.PubMedCrossRefGoogle Scholar
  58. Rummel-Kluge, C., & Kissling, W. (2008). Psychoeducation in schizophrenia: new developments and approaches in the field. Current Opinions in Psychiatry, 21, 168–172.CrossRefGoogle Scholar
  59. Rund, B. R., Moe, L., Sollien, T., Fjell, A., Borchgrevink, T., Hallert, M., et al. (1994). The Psychosis Project: Outcome and cost-effectiveness of a psychoeducational treatment programme for schizophrenic adolescents. Acta Psychiatrica Scandinavica, 89, 211–218.PubMedCrossRefGoogle Scholar
  60. Santisteban, D. A., & Szapocznik, J. (1994). Bridging theory, research and practice to more successfully engage substance abusing youth and their families into therapy. Journal of Child and Adolescent Substance Abuse, 3, 9–24.CrossRefGoogle Scholar
  61. Saravanan, B., Jacob, K. S, Johnson, S., Prince, M., Bhugra, D., & David, A. S. (2007). Assessing insight in schizophrenia: East meets West. British Journal of Psychiatry, 190, 243–247.PubMedCrossRefGoogle Scholar
  62. Singelis, T. M. (1994). The measurement of independent and interdependent self-construals. Personality and Social Psychology Bulletin, 20, 580–591.CrossRefGoogle Scholar
  63. Snowden, L. R. (2007). Explaining mental health treatment disparities: Ethnic and cultural differences in family involvement. Culture, Medicine and Psychiatry, 31, 389–402.PubMedCrossRefGoogle Scholar
  64. Sperry, L. (2001). Spirituality in clinical practice: Incorporating the spiritual dimension in psychotherapy and counseling. Ann Arbor, MI: Sheridan Books.Google Scholar
  65. Stander, V., Piercy, F. P., Mackinnon, D., & Helmeke, K. (1994). Spirituality, religion and family therapy: competing or complementary worlds? The American Journal of Family Therapy, 22, 27–41.CrossRefGoogle Scholar
  66. Szapocznik, J. (Ed.). (1994). A Hispanic/Latino family approach to substance abuse prevention. Rockville, MD: Center for Substance Abuse Prevention.Google Scholar
  67. Szapocznik, J., & Kurtines, W. M. (1993). Family psychology and cultural diversity: opportunities for theory, research, and application. American Psychologist, 48, 400–407.CrossRefGoogle Scholar
  68. Szapocznik, J., Rio, A., Perez-Vida, A., & Kurtines, W. (1986). Bicultural effectiveness training: An experimental test of an intervention modality for families experiencing intergeneration/intercultural conflict. Hispanic Journal of Behavioral Sciences, 8, 303–330.CrossRefGoogle Scholar
  69. Tompson, M., Goldstein, M., Lebell, M., Mintz, L., Marder, S., & Mintz, J. (1995). Schizophrenic patients’ perceptions of their relatives’ attitudes. Psychiatry Research, 57, 155–167.PubMedCrossRefGoogle Scholar
  70. Torrey, E. F. (1995). Surviving schizophrenia: A manual for families, consumers, and providers (3rd ed.). New York: Harper Perennial.Google Scholar
  71. Torrey, E. F., Bowler, A. E., Taylor, E. H., & Gottesman, I. I. (1994). Schizophrenia and manic-depressive disorder. New York: BasicBooks.Google Scholar
  72. Triandis, H. C., McCusker, C., & Hui, C. H. (1990). Multimethod probes of individualism and collectivism. Journal of Personality and Social Psychology, 59, 1006–1020.CrossRefGoogle Scholar
  73. Vaughn, C. E., Snyder, K. S., Jones, S., Freeman, W. B., & Falloon, I. R. (1984). Family factors in schizophrenic relapse: Replication in California of British research on expressed emotion. Archives of General Psychiatry, 41, 1169–1177.PubMedGoogle Scholar
  74. Weisman, A. G., Duarte, E., Koneru, V., & Wasserman, S. (2006). The development of a culturally informed, family focused treatment for schizophrenia. Family Process, 45, 171–186.PubMedCrossRefGoogle Scholar
  75. Weisman, A. G., Gomes, L. G., & Lopez, S. R. (2003). Shifting blame away from ill relatives: Latino families' reactions to schizophrenia. Journal of Nervous and Mental Disorders, 191, 574–581.CrossRefGoogle Scholar
  76. Weisman de Mamani, A. G., Kymalainen, J., Rosales, G., & Armesto, J. (2007). Expressed emotion and interdependence in White and Latino/Hispanic family members of patients with schizophrenia. Psychiatry Research, 151, 107–113PubMedCrossRefGoogle Scholar
  77. Weisman, A. G., & Lopez, S. R. (1997). An attributional analysis of emotional reactions to schizophrenia in Mexican and Anglo American cultures. Journal of Applied Social Psychology, 27, 223–244.CrossRefGoogle Scholar
  78. Weisman, A. G., Lopez, S. R., Karno, M., & Jenkins, J. (1993). An attributional analysis of expressed emotion in Mexican-American families with schizophrenia. Journal of Abnormal Psychology, 102, 601–606.PubMedCrossRefGoogle Scholar
  79. Weisman, A. G., Nuechterlein, K. H., Goldstein, M. J., & Snyder, K. S. (1998). Expressed emotion, attributions, and schizophrenia symptom dimensions. Journal of Abnormal Psychology, 107, 355–359.PubMedCrossRefGoogle Scholar
  80. Weisman, A., Rosales, G., Kymalainen, J., & Armesto, J. (2005). Ethnicity, family cohesion, religiosity and general emotional distress in patients with schizophrenia and their relatives. Journal of Nervous & Mental Disease, 193, 359–368CrossRefGoogle Scholar
  81. Weisman, A. G., Rosales, G. A., Kymalainen, J. A., & Armesto, J. C. (2006), Ethnicity, expressed emotion, and schizophrenia patients’ perceptions of their family members’ criticism. The Journal of Nervous and Mental Disease, 194, 644–649.PubMedCrossRefGoogle Scholar
  82. Wing, J. K. (1978). Social influences on the course of schizophrenia. In L. C. Winny, R. L. Cromwell, & S. Matthysse (Eds.), The nature of schizophrenia (pp. 599–616). New York: Wiley.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Amy Weisman de Mamani
    • 1
  • Radha Dunham
  • Stephanie Aldebot
  • Naomi Tuchman
  • Stephanie Wasserman
  1. 1.Department of PsychologyUniversity of MiamiCoral Gables

Personalised recommendations