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Autumn 2009 | Vol 13 No 1

Review

Kate Tschakovsky

Working with families of psychiatric inpatients

Working with Families of Psychiatric Inpatients: A Guide for Clinicians focuses on situations commonly encountered by psychiatric residents in their work with inpatients and their families. The authors suggest that skilled intervention with families improves outcome and reduces the risk of relapse and re-hospitalization. They cite research about the role and influence of families in illness and treatment and explore several models of illness and recovery, primarily the biopsychosocial model.

Strength and resilience in families and protective and risk factors are illustrated, and the authors briefly discuss specific illnesses and the unique pressures and historical perspectives on family function or dysfunction in the face of such challenges.

The strength of this book is in its detailed case scenarios of meetings with patients, families and residents. Particularly enlightening are the specific interventions for “difficult” situations, which feature hostile, domineering, challenging or silent family members. The authors provide simple and direct interventions and strategies for managing these situations and discuss how to set limits and re-direct and re-focus the family meeting so it does not become stuck in a non-productive conflictual mode.

The authors also address mistakes that residents new to family work often make, as well as the fears and anxieties residents may have about working with challenging families. The relationship of the resident’s supervisor and the importance of supportive mentoring are discussed, as are the anxieties, concerns and perspectives of families themselves and how they may incorporate these dynamics into their encounters with residents.

The authors discuss risk management and ethical issues and touch on issues of confidentiality, suicidality, medication, family member alienation and legal concerns. Follow-up care and the value of psycho-educational support groups for families and patients after discharge are also discussed, as is research about what families identify as important and helpful in their engagement with residents. A checklist of core competencies for work with families is a helpful self-evaluation tool.

In an effort to keep the book manageable, some topics are covered only briefly but may serve as stepping stones for further education. Cross-cultural and diversity issues are one example. The families presented follow the traditional heterosexual model and little mention is made of alternative families or LBGT family structures. Caregiver burden is discussed, but the issues of women as primary caregivers and stigma and mental illness and their impact on the family are only slightly acknowledged.

The focus of learning, mentoring, support and working together is almost exclusively illustrated by the relationship between resident and supervisor, with little mention of other members of the multi-disciplinary team, such as social workers or patient advocate workers, who have much to contribute to the education and skill development of the resident, as well as providing support and therapy to the family.

The writing is mostly warm and engaging, particularly as it seeks to reassure residents that their anxieties about working with challenging families are common but not insurmountable. The examples and strategies are clear and straightforward; more of this kind of practical and encouraging dialogue would be helpful.

The research pertaining to the importance of family work is extensive and well documented and encourages residents to enrich their scope of practice beyond medication management and pathology. This book would be of primary interest to psychiatric residents and their supervisors, but other practitioners may find it helpful in better understanding the challenges faced by residents new to inpatient family work.

Working with Families of Psychiatric Inpatients: A Guide for Clinicians. Alison M. Heru and Laura M. Drury. Johns Hopkins University Press, 2007, 192 pp. $20US.

Kate Tschakovsky is a social worker at the Centre for Addiction and Mental Health in Toronto.