Psychoeducation

A third option is to provide psychoeducation for families; this may occur in tandem with assessment as a part of a "family meeting." The case conceptualization should guide how the psychoeducation is presented and what aspects are emphasized. Psychoeducation may be helpful for a number of different reasons. First, it may be particularly important when family members are very critical of the patient's behavior. Very critical family members often believe that the patient's negative behavior is controllable, and they may blame the patient for his/her symptoms (Barrowclough & Hooley, 2003). Psychoeducation may help family members to make more benign attributions for their relative's behavior (e.g., "It's not that he is lazy, it is that he is depressed"). This in turn may decrease criticism.

Second, psychoeducation may help family members who are unsure about how best to help their depressed relative. Should they leave him alone? Encourage him to do things? Try to get him to talk to them? The therapist, the depressed individual, and his family members may discuss what types of behaviors on the part of the family members are most helpful. For example, as a group, they may decide that the depressed person needs gentle encouragement to get out of the house, attend social events, exercise, and so forth. They may come to see that their previous strategy (of avoiding the patient when he was depressed and irritable) may have served to maintain the depression. This change in point of view may result not only in increased support for the patient engaging in positive behavior change, but also in increased feelings of efficacy and hopefulness on the part of the family members.

Third, psychoeducation about the process of treatment may also be helpful. Family members may have misconceptions about therapy that interfere with providing necessary emotional and instrumental support to help the patient attend therapy sessions. For example, if family members believe that the patient spends therapy sessions just complaining about them, and that the therapist blames the family members for the patient's problems, they may be less willing to care for children so that the patient may attend his/ her session. Another family member may believe that psychotherapy will go on for many years, and be concerned about the potential cost. If family members have an accurate understanding about what treatment involves, they may be more willing to facilitate the patient attending therapy.

In general, "psychoeducation" consists of an explanation of the symptoms of depression, their consequences for family and work functioning, and an explanation of treatment of depression. Therapists may also review potential causes of the patient's depression (always emphasizing the multiple factors that interact, and avoiding any type of approach that may be construed as blaming the family). To target the psychoeducation session to a particular family's needs, the cognitive therapist may begin by inquiring about family members' beliefs and knowledge about depression, about the patient's behavior, about how they should react to the patient, and about therapy and treatment. It is always useful to provide written materials to family members that reinforce the points covered during this session.

One caveat about psychoeducation: Although increased knowledge may help family members to modify negative cognitions about the patient or therapy, it does not guarantee that behavior change will occur. More intensive family therapy may be needed to help family members change established negative behavior patterns.

Letting Go, Moving On

Letting Go, Moving On

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