Yes, family work is time-consuming and cumbersome when it comes to scheduling appointments, and getting them together can be tantamount to herding cats.

But let’s face it. Clients’ family members are our de-facto healthcare specialists. They’ve witnessed the anguish and unpredictability associated with the mental health struggles of their ill family member, so in this sense, they’re not merely uninvolved bystanders. Family members can also sway their ill loved one to enter treatment in the first place, and adhere to treatment regimens once the work has started.

In my work with families, I benefit not only from their verbal responses regarding their kin’s situation, but mostly from their non-verbal actions and gestures — head nods, looking at me wide-eyed, eyebrow-raising and motioning with their hands when they disagree with their loved one’s “side of the story.” This is invaluable to me because these types of responses are purely spontaneous, unplanned and truthful.

When you’ve finally gathered up family members willing and able to attend, consider assessing for the following:

  1. Overall family functioning. Do a GAF. Yes, DSM-5 excludes this, but I still routinely do them — particularly when family members enter the treatment picture. Ask family members how they’re coping with the illness overall and whether it is interfering with their ability to live their lives as they choose. Then dig a bit deeper. “Has ‘Mary’s’ situation prompted any of you to take time off from work?” “To what extent have you lives been altered by this?” Do your best to get all involved and encourage the less verbal family member(s) to offer up their input.
  2. Identify the ringleader. Invariably, someone will emerge as the spokesperson, so to speak. You’ll know rather quickly, as this person will take as much airtime as you’re willing to give them. This doesn’t mean this individual is the most aggrieved; most often it indicates that this person is the identified family leader and is expected to serve in that capacity. The key is to keep this person from monopolizing the discussion and dominating the process, as you don’t want things to unevenly tilt in any one direction.
  3. Get them up to speed. Inquire if they are interested in having regularly scheduled family sessions, either with you or via referral. In my experience, many family members come to a session with pent-up feelings and emotions that have been eating away at them, affecting their ability and capacity to cope with the situation more rationally. Issues may be financial, logistical and burdensome for a host of reasons, and some family may not be physically equipped for what’s being asked of them. After all, their lives have changed and are now replete with new demands such as obtaining “Mary’s” prescriptions from the pharmacy, arranging for child care so as to be able to sit with her and accompanying her to other appointments. And then there’s the issue of being uninformed about the scope and severity of “Mary’s” present plight, so offer specific reading material and Web information that you trust will adequately inform them. This can aid in challenging some of their faulty belief systems and engender more cooperation.
  4. By all means, keep the meeting under control. I have found it a wise practice to establish ground rules before any family member utters even the first word. Here’s where you politely, yet assertively, take center stage, making it clear that excessive contentiousness serves no viable purpose and won’t be tolerated, and if this is violated, the offender will be asked to leave the meeting room for a cooling off period. If arguments persist, call a halt to the proceedings — with an invitation to resume when all agree they can respectfully have their say.

Remember too that they’ll have questions — often many questions — as how they operate day-to-day is changing before their very eyes. Answer these as straightforwardly as possible, because achieving a successful outcome for the ill family member means you’ll need all the allies you can get.

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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.

To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.