Journal of Adolescence 1991, 14, l-l 6
Running groups for parents with schizophrenic adolescents: initial experiences and plans for the future ANNE SHERIDAN AND LUCY M. MOORE Six-session educational and support groups were held for two sets of parents (32 in all) who had an adolescent schizophrenic child. Results indicate no significant increases in knowledge about the disorder following the group (probably due to the relatively high scores obtained at the outset) but gains seem to have been made in ability to handle the teenage patient at home. All parents commented on how they had benefited from the supportive aspect of the group. Future developments of these groups are discussed.
DESCRIPTION
OF THE
SERVICE
The Cluain Mhuire Family Centre, which opened in 1974, is a community psychiatric service comprising separate child, adolescent and adult departments. The adolescent service caters for youngsters aged 12 to 19 years. There are in-patient beds in the Young Person’s Unit in a local private psychiatric hospital, and there is also an adolescent programme in a separate day hospital to which youngsters can progress when they no longer require in-patient care. Finally there is a regular out-patient clinic for teenagers and their families. The department is staffed by a clinical team comprising of a Consultant Psychiatrist and Registrar, a Senior and Trainee Psychologist and two Psychiatric Social Workers. The in-patient programme is run by an Occupational Therapist and Psychiatric Nursing Staff and the day programme is run by a Psychiatric Nurse. Both of these programmes have the back-up of the clinical team. A family approach is taken to the treatment of adolescent difficulties and a youngster will be seen, where possible, with both of his/her parents. *Reprint requests should be addressed to Cluain Mhuire Blackrock, Co. Dublin, Republic of Ireland. 0140-1971/91/010001
+ 16 $03.00/O
81991
Family
The Association
Centre,
Newtownpark
Avenue,
for the Psychiatric Study of Adolescents
A. SHERIDAN AND L. M. MOORE
2 Individual
psychotherapy,
group and family work are considered
gral parts of the treatment provided. Referrals come from many sources by local family the youngsters the ICD-8
classification
(Brennan
disturbance”
1976),
with
especially
those
per cent
category
from
in the 2:l
diate explanation
et al., 1983). This
to be made
breaks down as 19.7 per
and 9.6 per cent of all females
(51.3
is the next largest diagnostic at variance
predominantly
doctors (60.9 per cent total). Approximately 16 per cent of referred to the service are diagnosed as schizophrenic on
cent of the total males referred “situational
but tend
to be inte-
other
of total
referrals),
that we see. These studies
male:female
(e.g.
for this but it is possible
After
figures are somewhat
Weiner
ratio observed.
referred.
schizophrenia
and
Del
Gaudio,
We have no imme-
that it may reflect
local intake
policies or treatment bias, rather than reflecting true morbidity patterns. One way or another, we are dealing with a significant number of families who have a schizophrenic
FAMILY Because crucial
of family
to prognosis.
both around port
We
these parents, effects
their
were
perhaps
child. factors
at home
with their
on the schizophrenic also aware
We
in a group
of family
AND SCHIZOPHRENIA
were living
members
the time of diagnosis
and manage
The
FACTORS
all of our patients
that the effect
youngster.
that
and during felt that setting,
parents
need
their ongoing
some could
on prognosis
families,
youngster
extra
time
we felt could
be
a lot of help efforts
to sup-
spent
helping
be beneficial
in schizophrenia
all round. are well doc-
umented (e.g. Brown et al., 1962; Vaughn and Leff, 1976; 1985). Research suggests that relapse in schizophrenic patients
Leff et al., is linked to
(i) not taking maintenance neuroleptics and (ii) having high face to face contact (>35 hours per week) with “high expressed emotion” relatives. These
relatives
are described
as being
overly
critical
and over
with the patient. The Camberwell Family Interview (Vaughn 1976) has been developed to measure the above factors. A number
of authors
have
attempted
various
types
involved and
Leff,
of intervention,
including group work and family education regarding schizophrenia (Goldstein and Kopeikin, 1981; Leff et al., 1982; 1985; Smith and Birchwood, 1987). Results indicate a favourable outcome in reducing high expressed emotion (Falloon et al., 1982; Leff et al., 1985). Research by Leff et al., (1985) using a combination of support and education for relatives managed to successfully lower high expressed emotion in families and thus positively influence patient relapse rates (0 per cent relapse in experimental group US. 50 per cent relapse in controls). These figures would
appear to be similar to those achieved through intervention by other authors (e.g. Falloon et al., 1982). Results of studies also indicate a favourable outcome in increasing knowledge about the disorder (e.g. Smith and Birchwood, 1987), in increasing parental coping skills and in lowering the perceived burden on families (Goldstein and Kopeikin, 1981). Thus there appears to be some evidence that group work and family education can effect changes both in the behaviour of families towards schizophrenic patients and in their levels of knowledge about the disorder. It should also be noted that the above studies cite data that have been obtained on a predominantly adult, as opposed to adolescent population.
SCHIZOPHRENIA
IN ADOLESCENCE
Most forms of schizophrenic disturbance begin during or soon after the teenage years (Weiner, 1982). Bleuler, who termed the word schizophrenia, commented that “The adolescent age period seems to offer a particular predisposition to this disease”. (Bleuler, 1911, p. 340). However, although schizophrenia in adolescence is continuous with the adult form, certain aspects of its presenting picture, predictive features, prognosis and treatment relate specifically to this developmental stage. For example, in the early stages of the disorder, signs of impairment are often mixed with other kinds of symptoms and the underlying schizophrenic difficulties can be less apparent than during presentation in adulthood. In addition, there is a much greater likelihood (as in our sample) that the adolescent schizophrenic will be living at home with the family and is thus more vulnerable to the negative family factors outlined above.
RATIONALE
FOR THIS
GROUP
INTERVENTION
We have found that following a diagnosis of schizophrenia in a teenager, parents demanded and received a lot of information about the illness and a lot of support in coping with it. We had felt for some time that a lot of this work could usefully take place in a group setting where parents could also make the most of well documented additional benefits of the group process (for example, Bion, 1961; Knopka, 1972). Our aims for the group were twofold: (i) To increase the level of knowledge that parents had about schizophrenia and thus to help them feel more confident in their handling of their youngster; and (ii) to provide group support thus helping parents to feel less isolated and alone in dealing with the disorder.
A. SHERIDAN
4
AND L. hl. MOORE
METHOD
The
first group
14 parents. father) The parents.
Six
couples
October
to December,
and two individual
second
group
Of these,
ran from
March
12 were couples, The
the groups.
not to attend
parents
(one
for a variety
to June,
seven
couples
of reasons.
Letters
Parents
Child age at time of group
GROUP
2
Both Both Father Mother Both Both Both Both Mother
patients were
for
and one
and catered
for
were
considered
circulated
but
Child currentI> chronic vs. acute
hf.4 1’. 19X8
18 18
23 21 19 18 16 22
1
in
chose
Child diagnosis, previous six months (6) or earlier (E)
24
GROUP
15
and one was a father
were not sent to the parents
7X6 2XE
X = 19.9 years
Mother Both Both Both Both Both Both Father
mother
Background data
who attended
Sex of child
1988
two were widows
of all eligible
A further
Table 1.
group
1987 and catered
parents
attended.
of a youngster. planning
was run from
OCTOBER. 16 20 26 17 16 15 17 20
1987 C C C C A C C C
E E E 6 6 E 6 E
3x6 X = 18.4 years.
5xE
RUNNING
GROUPS
FOR PARENTS
WITH
SCHIZOPHRENIC
ADOLESCENTS
5
of three other patients due to the presence of chronic mental illness in one or both parents. Thus, our groups catered for the parents of 17 young people attending our services. Of these 17, ten were male and seven female. Ages ranged from 16-26 years (x = 19.2 years). Some of these youngsters had been newly diagnosed but other families had been coping with an ill teenager or young adult for a number of years (see Table 1). Therefore, the parents in our groups were at varying levels in both their knowledge of the illness and their adjustment to it. Group leaders consisted of a Social Worker, Psychologist and Psychiatric Registrar from the Adolescent Team. The groups were held from 4.30 p.m. to 6.00 p.m. once a week for six weeks. Two questionnaires were administered to group members prior to the start of the first session (see Appendices 1 and 2 for details) with the expectation that each parent would complete his/her own set of questionnaires. Questionnaire
1
This questionnaire attempted to examine the impact that the illness was having on group members. Questions were asked to assess the effects that managing the illness had had on themselves as parents, couples and individuals in the community. Questionnaire
2
This was designed by the authors to attempt to assess parental levels of knowledge about schizophrenia. It comprised of 17 questions to be answered on a true/false .basis. In designing the questionnaire we used a combination of myths commonly held about the illness and other assumptions which people, particularly parents, make about the causes of schizophrenia. This questionnaire was readministered after the completion of the six sessions in order to assess the information-giving aspect of the group. Questionnaire
3
This questionnaire was designed to provide us with feedback on the running of the group and was administered at the end of the six sessions. We were guided by the results of the initial two questionnaires administered in planning the content and structure of the sessions. A similar outline was used for both groups but the content of each session differed slightly, depending on the needs of each group. Feedback from Group 1 was used in planning the second group.
A. SHERIDAN AND L. &‘I.MOORE
6
Session content The
first session
was an introductory
bers to get to know each other plans for the group. issues: diagnosis Groups’ choice, R.E.H.A.B.
The
subsequent
etc);
from
prognosis
allowed
us to outline
four sessions family issues;
and medication; e.g. representatives
Officer,
one which
and allowed
group
the
and
dealt with the following guest speakers (of the
the Schizophrenia
and
mem-
the purpose
future.
Each
Association, session
com-
prised of some didactic input from ourselves followed by small group discussions. The final session dealt with the parents’ own support network and their lives outside Leaders. taking
The
group
a well-earned
requested months
that time
reviewed
we arrange to
review
each
break,
by
setting
resuming
goals. their
little input
parent
a follow-up
these
made
then moved
and required
with
weekend
progress
Discussion
the family ended
In
a hobby,
etc).
goals The
meeting in approximately this follow-up session
teenager
in the
to their own personal
sion and how they could continue
from the Group
personal
to manage
intervening
(e.g. group
three parents months.
goals from the previous
ses-
in the future.
RESCLTS
Group
2 consisted
ated or widowed, Attendance during
of six couples while Group
rates were in excess
either
parents
who were either
and two individual
separparents.
of 90 per cent and there were no drop outs
group.
Questionnaires the groups.
and three
1 had six couples
1 and 2 were completed
Four
individuals
failed
by everyone
to return
prior to the start of
Questionnaires
2 and 3 after
the end of their group. Results
from each Questionnaire
Questionnaire Both
groups
agreed
were as follows
:
1 (see Table 2)
that the areas of their own lives most affected
were:
(i) having time to relax on their own; and (ii) being able to concentrate on their work, be that at home or in a job. There was general agreement, particularly by the mothers in both groups, that they worried too much. The focus of this worry was primarily their schizophrenic
youngster.
Both groups acknowledged that their attitudes in relation to discipline had definitely changed with regard to their schizophrenic youngster. That this was particularly significant for Group 2 parents may be explained by
RUNNING GROUPS FOR PARENTS WITH SCHIZOPHRENIC ADOLESCENTS Table 2.
Results of Questionnaire 1
Number of parents reporting limitations to various areas of their lives. 1. a) b) :;
Group I 5 11 42
e) f)
8 7
Group 2 3 5 1 3 3 9
Total 8 16 3 7 11 16
N=lS
N=14
N=29
Amount of worry 2. a) b) c)
Group 1 8 1 4
Group 2 7 1 7
N=13
Total 15 2 11
N=lS
N=28
M 5 2 6
F 10 0 5 -
13
15
-
Focus of worry 3.
;
cl 4 e)
Group 1 M+F 6+5 0+1 1+1 o+o o+o N=7
+ 7
Group 2 M +F 7+7 o+o o+o o+o 0+1 N=7
+ 8
Total M+ F 13 + 12 o+ 1 1+ 1 o+ 0 0-t 1 N=14
+ 15
Attitude to discipline 4. :; c) d)
Group 1 6 3 7 6 N=14
Group 2 4 1 13 0 N=15
Total 10 4 20 6 N=29
Family able to discuss/show feelings 5a.
Group 1 Yes = 10 No = 4 N=14
Group 2 Yes = 10 No = 5 N=lS
Total Yes = 20 No = 9 N=29
7
A. SHERIDAN
8
AND L. M. MOORE
Table 2. Family’s
difficulty
in showing
5b.
continued
feelings
Angry HappI Sad Worried
9 ii) iii) iv)
1 4 4 5
2 0 1 4
terms
many
that
of this group
with the diagnosis
stances. Most
people
in both
groups
feelings
readily.
and sadness
sonably
were
competent
changes
described For
more
difficult
at expressing
The
average
Given
or mean
in scores
score
before
that the highest
cated little room ferences between
of anger
Parents
for both groups
that the two groups
Table 3. Illean
scores:
Group
Before 124 (Range
and 1 “not
allocated
Results of Questionnaire 1 (IV= 14)
= 6-16)
Maximum
indicated
154 (Range
score possible
= 17
dif-
(see Table
3).
scores
indi-
no significant
dif-
on a scale from (see Table
rankings
2: Knowledge scores:
13.5 (Range
1 to 5, where sessions,
espe-
of schizophrenia Group
2 (9=
15)
After = 1 l-15)
5
4). It can be seen
to certain
Before = 13-17)
no significant
in the group
Mean
Ajter
of
felt rea-
.?
helpful”
different
and
and happiness.
for improvement anyway. We found scores obtained by males and females.
useful”
majority
was 17, their good initial
were asked to rate each session “very
open feelings
I
and after participation score possible
The
to
circum-
as being
and fathers,
to express.
feelings
stage of coming
adolescent’s
families
mothers
Questionnaire
indicated
in their
their
both
Questionnaire
ference
LV=26
were still at an early
and recent
able to discuss worry
3 4 8 0
5=13
9=13
the fact
Total
Group 2
Group I
1-k-C (Range
= 13-16)
cially to numbers 3 and 5. Session five looked at the whole area of prognosis and the future and was very highly ranked by Group 1 but not by Group 2. This may be explained by the fact Group 1 contained a greater number of parents of chronic schizophrenics where the whole area of prognosis was foremost in their minds. Group 2 parents were at a much earlier stage and seemed to need more input on the features of the illness and its day to day management. Session three looked at family issues and the discrepancy in rankings was due to the fact that we used the feedback information from Group 1 to substantially change the presentation of this session for the second group, which appears to have increased its perceived usefulness. Different ratings may also reflect the differing needs and stages of adjustment of both groups. Aspects of the group that parents unanimously found most useful were meeting and listening to others in a similar situation. Most people liked the small group format. The Registrar’s talk on medical aspects of the illness was also highly rated and the parents commented on how useful it had been to have had such open access to a psychiatrist. In terms of suggestions for future groups, the majority of people wanted more information on coping with specific aspects of the young person’s behaviour, e.g. moodiness, wanting to be alone, suicidal threats, etc.
DISCUSSION
It would appear from the data collected that the single most valuable aspect of the group was the support it offered to these parents. That it was a useful experience for group members is borne out by their almost unTable 4.
Results of Questionnaire 3: Feedback on the group sessions
Session 1. 2. 3. 4. 5. 6.
Introduction Diagnosis and medication Family issues Guest speaker The future Focus on parents
Group 1 X rating Rank 4.5 4.2 4.1 4.3 4.6 4.4
2 5 6 4 1 3
Group X rating
2 Rank
3.6 3.7 3.8 4.3 3.2 4.1
5 4 3 1 6 2
Ratings were made on a scale of 1-5, where 1 indicated “not helpful” and 5 indicated “very helpful”. Rankings were allocated to each session on the basis of these mean ratings. A ranking of 1 indicating the most popular session for that group. Statistical differences between the two groups were not calculated.
10
A. SHERIDAN
AND L. M. MOORE
failing attendance and the arrangements they had to make either at work or at home, to enable them attend. Although they enjoyed discussions in small groups, all acknowledged the usefulness of some structured or didactic input. The impression of the team from individual involvement with each family was that their participation and confidence in the group setting was matched by their increased ability to manage their youngster at home. This is similar to the results gained by Smith and Birchwood (1987). Although we have no objective evidence, the Adolescent Team feel that there were fewer distressed telephone calls from these parents both during and after the group. There are, of course, very obvious limitations to this study, for example no control group was used so we do not have objective evidence that the changes which we perceived as occurring would not have happened anyway. Therefore our results could not be generalized to other groups of similar parents. No standardized questionnaires were used during these groups but we are considering incorporating the Knowledge of Schizophrenia Questionnaire used by Smith and Birchwood (1987) and would also like to use the Camberwell Family Interview (Vaughn and Leff, 1976) which would enable us to look more closely at the area of high vs. low levels of expressed emotion. The use of such tools would enable us to compare our results to those obtained in other studies and thus broaden the scope of our work. The negative role of high expressed emotion in families of schizophrenics has already been mentioned. Our clinical impression is that young schizophrenic sufferers living at home in families where there is a high level of criticism and negative expressed emotions do least well. However, we have never used formal instruments to measure these attributes. Thus we feel the Camberwell Family Interview would be particularly helpful in a future study. We now intend to incorporate group work of a similar nature as an integral part of the service we offer to the families of adolescents suffering from schizophrenia. It may also be possible to provide more follow-up meetings for these parents, and thus provide a cost-effective, parent-centered and more long term support system for the future. As experienced by Thornton et al., (1981) we feel that this group’s need for professional input may dwindle and that the parents will gradually take over the running of the follow-up meetings themselves. This may be done in conjunction with the local branch of the Schizophrenia Association. In addition, future developments may include the preparation of an informational booklet specifically designed for the parents of adolescent sufferers-the information available at present is predominantly aimed at
RUNNING
GROUPS
FOR PARENTS
WITH
SCHIZOPHRENIC
ADOLESCENTS
11
the families of adult sufferers. We are also considering producing some information for sufferers themselves. We would like to build up a resource library of films, videos, literature, etc., which is specific to the adolescent schizophrenic and which might be of use both to ourselves in our work and to the families whom we see. It is possible that a group for the siblings of sufferers may also be developed. This could run along the lines of our Parents’ Group, or could be modelled on the Alateen support group for the children of alcoholics.
ACKNOWLEDGEMENTS
The Authors wish to acknowledge the help of Dr Louis O’Carroll and Dr Brian Houlihan in the running of these Groups along with the support of the staff in Cluain Mhuire Family Centre.
REFERENCES Bion, W.R. (1961). Experiences in Groups. London: Tavistock. Bleuler, E. (1911). Dementia Precox or the Group of Schizophenias. New York: International Universities Press, 1950. Brennan, T.G., O’Loideain, D.S., Menton, M. and Sheehy-Skeffington, A.R. (1983). A Preliminary Report. Irish Medical Psychopathology in Irish Adolescents:
Journal, 76 (3), 142-145. Brown, of
G.W., Monck, E.M., Family Life on the
Preventive
Carstairs, G.M. and Wing, J.K. (1962). The Influence Course of Schizophrenic Illness. British Journal of
and Social Medicine, 16, 55-65.
Falloon, I.R.H., Boyd, J.L., Magill, C.W., Razani, J., Moss, H.B. and Gilderman, A.M. (1982). Family Management in the Prevention of Exacerbation of Schizophrenia. New EnglandJournal of Medicine, 306,221-223. Goldstein, M. and Kopeikin, H. (1981). Short and Long Term Effects of Combining Drug and Family Therapy. In New Developments in Interventions with Families of Schizophrenics, Goldstein, M. (Ed). San Francisco: Jossey-Bass. Knopka, G. (1972). Social Group Work: A Helping Process. Englewood Cliffs, N.J.: Prentice Hall. Leff, J.P., Kuipers, L., Berkowitz, R., Eberlein-Fries, R. and Sturgeon, D. (1982). A Controlled Trial of Intervention in the Families of Schizophrenic Patients. British Journal of Psychiatry, 141, 121-134. Leff, J.P., Kuipers, L., Berkovitz, R. and Sturgeon, D., (1985). A Controlled Trial of Social Intervention in the Families of Schizophrenic Patients: A Two Year Follow-up. British Journal of Psychiatry, 146, 594-600. McCreadie, R.G. (1982). The Nithsdale Schizophrenia Survey 1. Psychiatric and Social Handicaps. British Journal of Psychiatry, 140, 582-586. McCreadie, R.G., and Robinson, A.D.T. (1987). The Nithsdale Schizophrenia Prevalence, Patterns and Clinical Survey: VI. Relatives Expressed Emotion: Assessment. British Journal of Psychiatry, 150,640-644.
A, SHERIDAN
12
AND L. M. MOORE
Smith, J.V. and Birchwood, M.J. (1987). Specific and Non-specific Effects of Educational Intervention with Families Living with a Schizophrenic Relative. British Journal of Psychiatry, 150, 645-652. Thornton, J.F., Plummer, E.. Seeman, M.V., and Littmann, S.K. (1981). Schizophrenia: Group Support for Relatives. Canadian Journal of Psychiatr?, 26 (S), 341-344. Vaughn, C.E., and Leff, J.P. (1976). The Measurement of Expressed Emotion in the Families of Psychiatric Patients. British Journal of Social and Clinical Psychology, 15,157-165. Weiner, I.B. (1982). Child and Adolescent Psychopathology. New York: \Vilev and Sons. Weiner, I.B. and Del Gaudio, A.C. (1976). Psychopathology in Adolescence: An Epidemiological Study. Archices of General Psychiatry, 33, 187-l 93.
APPENDIX
1
Questionnaire
1
1. As a parent, do you find that having a schizophrenic youngster living at home with you limits your own personal life in any of the following ways?
Yes (a) Going (b) Having
No
out with friends time to relax on your own
(c) Having people in (d) Going out with spouse
ii
or partner
(e) Going away on holidays (f) Concentrating on your work (at home or in your job) 2. All parents
have worries
and concerns
about
their
families.
EE 0
cl
At the pre-
sent time do you feel that: (a) You worry too much (b) You do not worry enough (c) You worry just the right amount 3. Who
do you worry
about
? Please
rank from
person you worry most about : (a) Your schizophrenic youngster (b) Another child (or children) in the family (c) Your spouse or partner (d) Someone outside of the immediate e.g. a friend or grandparent. (e) Yourself
family,
1 to 5, where
1 denotes
ES cl
the
cl
RUNNING
4. Has (a) (b) (c) (d)
GROUPS
FOR PARENTS
WITH
SCHIZOPHRENIC
ADOLESCENTS
13
Yes No your attitude to discipline changed since your youngster became ill? In relation to all your children cl0 In relation to some of them In relation to your schizophrenic youngster None of the above
5. Do you see yourselves as a family who : (a) Discuss your feelings readily (b) Show your feelings when you are: (i) (ii) (iii) (iv)
Angry Happy Sad Worried
6. What percentage of your schizophrenic do you think is due to: (i) His/her illness (ii) Him/her just “playing up”
teenager’s
difficult
behaviour
l-J/& 0%
7. Some schizophrenic youngsters do not appear to have as much motivation or drive to “get things done” as other teenagers. In your case, do you think that this is because of : Yes / No (a) His/her illness Yes 1 No (b) A temporary lapse in his/her motivation
A. SHERIDAN AND L. M. MOORE
14
APPENDIX
2
Questionnaire
1.
Schizophrenia
2.
Sometimes
3.
there
Hearing
5.
Schizophrenia Parents
voices
Parents
means
8.
there
may develop
is not a common
can prevent
having
sign of schizophrenia
a split personality
a youngster
from having
themselves
always makes
people
Many
schizophrenics
their own. They 10. Family
violent
cl
cl
cl
0
cl
Cl
cl
0
cl
cl
0
cl
cl
0
0
cl
cl
0
0
cl
q
0
0
cl
0
and
always be allowed
to do this
do not bother
teenager
11. (a) Often schizophrenic show their feelings (b) This means strong feelings
cl
like to spend a lot of time on
should
rows and disagreements
the schizophrenic
cl
for a youngster
unpredictable 9.
False
0
a
the disorder
Schizophrenia
True
is a
the disorder
breakdown
are right to blame
developing
component
has schizophrenia
that a second
schizophrenic 7.
is a genetic
member
chance
4.
6.
is infectious
If one family strong
2
teenagers
find it hard to
that they do not have deep or
12. Schizophrenic teenagers seem to need more than the average teenager 13. If a patient is on medication takes his/her drugs regularly
it is essential
criticism
that he/she
RUNNING
GROUPS
FOR PARENTS
WITH
SCHIZOPHRENIC
ADOLESCENTS
True
False
14. Parents should expect their schizophrenic teenager to do as well as ever in school once they have got over their initial breakdown
cl
cl
15. It is possible to grow out of schizophrenia
cl
cl
16.A schizophrenic teenager, as he/she grows older can never lead an independent life
cl
0
17. Indicate your contact with the Schizophrenia Association by placing a tick in the appropriate (a) We have attended group meetings
cl
(b) We have read their literature
cl
(c) We have had no contact at all
cl
APPENDIX
Questionnaire Name
15
box :
3
3
: Parent Group Evaluation
We would like to know how useful you found the various sessions that we held. Please could you rate each session on a scale from 1 to 5, where 1 = not useful at all and 5 = extremely useful. 1. Introduction, getting to know each other, discussing expectations about the group, etc.
0
2. Diagnosis
cl
and medication.
3. How it has affected the family.
Looking at “normal adolescence”. Telling the family about the illness.
cl
A. SHERIDAN
16
4. Guest
L. 51. MOORE
speaker.
5. Prognosis
6. Your
cl
and the future.
own supports
Finishing
We
AND
would
0
as parents.
q
off.
like
help us plan further
some
suggestions
and
critical
comments
groups.
1. What
aspects
of the Group
did you find most helpful
What
aspects
of the Group
could
differently to make them more (Please write something !!!)
Have you any further help us in planning
have been done
helpful
suggestions
another
?
that could
Group
?
4. Would you like any more Group meetings If so, what format could this take ?
5. Is there any other help/support you need right now ? Yes If Yes,
Thank
please
from
?
that you feel No
specify.
you for filling in these forms
for us.
?
you
to
Running groups for parents with schizophrenic adolescents: initial experiences and plans for the future ANNE SHERIDAN AND LUCY M. MOORE Six-session educational and support groups were held for two sets of parents (32 in all) who had an adolescent schizophrenic child. Results indicate no significant increases in knowledge about the disorder following the group (probably due to the relatively high scores obtained at the outset) but gains seem to have been made in ability to handle the teenage patient at home. All parents commented on how they had benefited from the supportive aspect of the group. Future developments of these groups are discussed.
DESCRIPTION
OF THE
SERVICE
The Cluain Mhuire Family Centre, which opened in 1974, is a community psychiatric service comprising separate child, adolescent and adult departments. The adolescent service caters for youngsters aged 12 to 19 years. There are in-patient beds in the Young Person’s Unit in a local private psychiatric hospital, and there is also an adolescent programme in a separate day hospital to which youngsters can progress when they no longer require in-patient care. Finally there is a regular out-patient clinic for teenagers and their families. The department is staffed by a clinical team comprising of a Consultant Psychiatrist and Registrar, a Senior and Trainee Psychologist and two Psychiatric Social Workers. The in-patient programme is run by an Occupational Therapist and Psychiatric Nursing Staff and the day programme is run by a Psychiatric Nurse. Both of these programmes have the back-up of the clinical team. A family approach is taken to the treatment of adolescent difficulties and a youngster will be seen, where possible, with both of his/her parents. *Reprint requests should be addressed to Cluain Mhuire Blackrock, Co. Dublin, Republic of Ireland. 0140-1971/91/010001
+ 16 $03.00/O
81991
Family
The Association
Centre,
Newtownpark
Avenue,
for the Psychiatric Study of Adolescents
A. SHERIDAN AND L. M. MOORE
2 Individual
psychotherapy,
group and family work are considered
gral parts of the treatment provided. Referrals come from many sources by local family the youngsters the ICD-8
classification
(Brennan
disturbance”
1976),
with
especially
those
per cent
category
from
in the 2:l
diate explanation
et al., 1983). This
to be made
breaks down as 19.7 per
and 9.6 per cent of all females
(51.3
is the next largest diagnostic at variance
predominantly
doctors (60.9 per cent total). Approximately 16 per cent of referred to the service are diagnosed as schizophrenic on
cent of the total males referred “situational
but tend
to be inte-
other
of total
referrals),
that we see. These studies
male:female
(e.g.
for this but it is possible
After
figures are somewhat
Weiner
ratio observed.
referred.
schizophrenia
and
Del
Gaudio,
We have no imme-
that it may reflect
local intake
policies or treatment bias, rather than reflecting true morbidity patterns. One way or another, we are dealing with a significant number of families who have a schizophrenic
FAMILY Because crucial
of family
to prognosis.
both around port
We
these parents, effects
their
were
perhaps
child. factors
at home
with their
on the schizophrenic also aware
We
in a group
of family
AND SCHIZOPHRENIA
were living
members
the time of diagnosis
and manage
The
FACTORS
all of our patients
that the effect
youngster.
that
and during felt that setting,
parents
need
their ongoing
some could
on prognosis
families,
youngster
extra
time
we felt could
be
a lot of help efforts
to sup-
spent
helping
be beneficial
in schizophrenia
all round. are well doc-
umented (e.g. Brown et al., 1962; Vaughn and Leff, 1976; 1985). Research suggests that relapse in schizophrenic patients
Leff et al., is linked to
(i) not taking maintenance neuroleptics and (ii) having high face to face contact (>35 hours per week) with “high expressed emotion” relatives. These
relatives
are described
as being
overly
critical
and over
with the patient. The Camberwell Family Interview (Vaughn 1976) has been developed to measure the above factors. A number
of authors
have
attempted
various
types
involved and
Leff,
of intervention,
including group work and family education regarding schizophrenia (Goldstein and Kopeikin, 1981; Leff et al., 1982; 1985; Smith and Birchwood, 1987). Results indicate a favourable outcome in reducing high expressed emotion (Falloon et al., 1982; Leff et al., 1985). Research by Leff et al., (1985) using a combination of support and education for relatives managed to successfully lower high expressed emotion in families and thus positively influence patient relapse rates (0 per cent relapse in experimental group US. 50 per cent relapse in controls). These figures would
appear to be similar to those achieved through intervention by other authors (e.g. Falloon et al., 1982). Results of studies also indicate a favourable outcome in increasing knowledge about the disorder (e.g. Smith and Birchwood, 1987), in increasing parental coping skills and in lowering the perceived burden on families (Goldstein and Kopeikin, 1981). Thus there appears to be some evidence that group work and family education can effect changes both in the behaviour of families towards schizophrenic patients and in their levels of knowledge about the disorder. It should also be noted that the above studies cite data that have been obtained on a predominantly adult, as opposed to adolescent population.
SCHIZOPHRENIA
IN ADOLESCENCE
Most forms of schizophrenic disturbance begin during or soon after the teenage years (Weiner, 1982). Bleuler, who termed the word schizophrenia, commented that “The adolescent age period seems to offer a particular predisposition to this disease”. (Bleuler, 1911, p. 340). However, although schizophrenia in adolescence is continuous with the adult form, certain aspects of its presenting picture, predictive features, prognosis and treatment relate specifically to this developmental stage. For example, in the early stages of the disorder, signs of impairment are often mixed with other kinds of symptoms and the underlying schizophrenic difficulties can be less apparent than during presentation in adulthood. In addition, there is a much greater likelihood (as in our sample) that the adolescent schizophrenic will be living at home with the family and is thus more vulnerable to the negative family factors outlined above.
RATIONALE
FOR THIS
GROUP
INTERVENTION
We have found that following a diagnosis of schizophrenia in a teenager, parents demanded and received a lot of information about the illness and a lot of support in coping with it. We had felt for some time that a lot of this work could usefully take place in a group setting where parents could also make the most of well documented additional benefits of the group process (for example, Bion, 1961; Knopka, 1972). Our aims for the group were twofold: (i) To increase the level of knowledge that parents had about schizophrenia and thus to help them feel more confident in their handling of their youngster; and (ii) to provide group support thus helping parents to feel less isolated and alone in dealing with the disorder.
A. SHERIDAN
4
AND L. hl. MOORE
METHOD
The
first group
14 parents. father) The parents.
Six
couples
October
to December,
and two individual
second
group
Of these,
ran from
March
12 were couples, The
the groups.
not to attend
parents
(one
for a variety
to June,
seven
couples
of reasons.
Letters
Parents
Child age at time of group
GROUP
2
Both Both Father Mother Both Both Both Both Mother
patients were
for
and one
and catered
for
were
considered
circulated
but
Child currentI> chronic vs. acute
hf.4 1’. 19X8
18 18
23 21 19 18 16 22
1
in
chose
Child diagnosis, previous six months (6) or earlier (E)
24
GROUP
15
and one was a father
were not sent to the parents
7X6 2XE
X = 19.9 years
Mother Both Both Both Both Both Both Father
mother
Background data
who attended
Sex of child
1988
two were widows
of all eligible
A further
Table 1.
group
1987 and catered
parents
attended.
of a youngster. planning
was run from
OCTOBER. 16 20 26 17 16 15 17 20
1987 C C C C A C C C
E E E 6 6 E 6 E
3x6 X = 18.4 years.
5xE
RUNNING
GROUPS
FOR PARENTS
WITH
SCHIZOPHRENIC
ADOLESCENTS
5
of three other patients due to the presence of chronic mental illness in one or both parents. Thus, our groups catered for the parents of 17 young people attending our services. Of these 17, ten were male and seven female. Ages ranged from 16-26 years (x = 19.2 years). Some of these youngsters had been newly diagnosed but other families had been coping with an ill teenager or young adult for a number of years (see Table 1). Therefore, the parents in our groups were at varying levels in both their knowledge of the illness and their adjustment to it. Group leaders consisted of a Social Worker, Psychologist and Psychiatric Registrar from the Adolescent Team. The groups were held from 4.30 p.m. to 6.00 p.m. once a week for six weeks. Two questionnaires were administered to group members prior to the start of the first session (see Appendices 1 and 2 for details) with the expectation that each parent would complete his/her own set of questionnaires. Questionnaire
1
This questionnaire attempted to examine the impact that the illness was having on group members. Questions were asked to assess the effects that managing the illness had had on themselves as parents, couples and individuals in the community. Questionnaire
2
This was designed by the authors to attempt to assess parental levels of knowledge about schizophrenia. It comprised of 17 questions to be answered on a true/false .basis. In designing the questionnaire we used a combination of myths commonly held about the illness and other assumptions which people, particularly parents, make about the causes of schizophrenia. This questionnaire was readministered after the completion of the six sessions in order to assess the information-giving aspect of the group. Questionnaire
3
This questionnaire was designed to provide us with feedback on the running of the group and was administered at the end of the six sessions. We were guided by the results of the initial two questionnaires administered in planning the content and structure of the sessions. A similar outline was used for both groups but the content of each session differed slightly, depending on the needs of each group. Feedback from Group 1 was used in planning the second group.
A. SHERIDAN AND L. &‘I.MOORE
6
Session content The
first session
was an introductory
bers to get to know each other plans for the group. issues: diagnosis Groups’ choice, R.E.H.A.B.
The
subsequent
etc);
from
prognosis
allowed
us to outline
four sessions family issues;
and medication; e.g. representatives
Officer,
one which
and allowed
group
the
and
dealt with the following guest speakers (of the
the Schizophrenia
and
mem-
the purpose
future.
Each
Association, session
com-
prised of some didactic input from ourselves followed by small group discussions. The final session dealt with the parents’ own support network and their lives outside Leaders. taking
The
group
a well-earned
requested months
that time
reviewed
we arrange to
review
each
break,
by
setting
resuming
goals. their
little input
parent
a follow-up
these
made
then moved
and required
with
weekend
progress
Discussion
the family ended
In
a hobby,
etc).
goals The
meeting in approximately this follow-up session
teenager
in the
to their own personal
sion and how they could continue
from the Group
personal
to manage
intervening
(e.g. group
three parents months.
goals from the previous
ses-
in the future.
RESCLTS
Group
2 consisted
ated or widowed, Attendance during
of six couples while Group
rates were in excess
either
parents
who were either
and two individual
separparents.
of 90 per cent and there were no drop outs
group.
Questionnaires the groups.
and three
1 had six couples
1 and 2 were completed
Four
individuals
failed
by everyone
to return
prior to the start of
Questionnaires
2 and 3 after
the end of their group. Results
from each Questionnaire
Questionnaire Both
groups
agreed
were as follows
:
1 (see Table 2)
that the areas of their own lives most affected
were:
(i) having time to relax on their own; and (ii) being able to concentrate on their work, be that at home or in a job. There was general agreement, particularly by the mothers in both groups, that they worried too much. The focus of this worry was primarily their schizophrenic
youngster.
Both groups acknowledged that their attitudes in relation to discipline had definitely changed with regard to their schizophrenic youngster. That this was particularly significant for Group 2 parents may be explained by
RUNNING GROUPS FOR PARENTS WITH SCHIZOPHRENIC ADOLESCENTS Table 2.
Results of Questionnaire 1
Number of parents reporting limitations to various areas of their lives. 1. a) b) :;
Group I 5 11 42
e) f)
8 7
Group 2 3 5 1 3 3 9
Total 8 16 3 7 11 16
N=lS
N=14
N=29
Amount of worry 2. a) b) c)
Group 1 8 1 4
Group 2 7 1 7
N=13
Total 15 2 11
N=lS
N=28
M 5 2 6
F 10 0 5 -
13
15
-
Focus of worry 3.
;
cl 4 e)
Group 1 M+F 6+5 0+1 1+1 o+o o+o N=7
+ 7
Group 2 M +F 7+7 o+o o+o o+o 0+1 N=7
+ 8
Total M+ F 13 + 12 o+ 1 1+ 1 o+ 0 0-t 1 N=14
+ 15
Attitude to discipline 4. :; c) d)
Group 1 6 3 7 6 N=14
Group 2 4 1 13 0 N=15
Total 10 4 20 6 N=29
Family able to discuss/show feelings 5a.
Group 1 Yes = 10 No = 4 N=14
Group 2 Yes = 10 No = 5 N=lS
Total Yes = 20 No = 9 N=29
7
A. SHERIDAN
8
AND L. M. MOORE
Table 2. Family’s
difficulty
in showing
5b.
continued
feelings
Angry HappI Sad Worried
9 ii) iii) iv)
1 4 4 5
2 0 1 4
terms
many
that
of this group
with the diagnosis
stances. Most
people
in both
groups
feelings
readily.
and sadness
sonably
were
competent
changes
described For
more
difficult
at expressing
The
average
Given
or mean
in scores
score
before
that the highest
cated little room ferences between
of anger
Parents
for both groups
that the two groups
Table 3. Illean
scores:
Group
Before 124 (Range
and 1 “not
allocated
Results of Questionnaire 1 (IV= 14)
= 6-16)
Maximum
indicated
154 (Range
score possible
= 17
dif-
(see Table
3).
scores
indi-
no significant
dif-
on a scale from (see Table
rankings
2: Knowledge scores:
13.5 (Range
1 to 5, where sessions,
espe-
of schizophrenia Group
2 (9=
15)
After = 1 l-15)
5
4). It can be seen
to certain
Before = 13-17)
no significant
in the group
Mean
Ajter
of
felt rea-
.?
helpful”
different
and
and happiness.
for improvement anyway. We found scores obtained by males and females.
useful”
majority
was 17, their good initial
were asked to rate each session “very
open feelings
I
and after participation score possible
The
to
circum-
as being
and fathers,
to express.
feelings
stage of coming
adolescent’s
families
mothers
Questionnaire
indicated
in their
their
both
Questionnaire
ference
LV=26
were still at an early
and recent
able to discuss worry
3 4 8 0
5=13
9=13
the fact
Total
Group 2
Group I
1-k-C (Range
= 13-16)
cially to numbers 3 and 5. Session five looked at the whole area of prognosis and the future and was very highly ranked by Group 1 but not by Group 2. This may be explained by the fact Group 1 contained a greater number of parents of chronic schizophrenics where the whole area of prognosis was foremost in their minds. Group 2 parents were at a much earlier stage and seemed to need more input on the features of the illness and its day to day management. Session three looked at family issues and the discrepancy in rankings was due to the fact that we used the feedback information from Group 1 to substantially change the presentation of this session for the second group, which appears to have increased its perceived usefulness. Different ratings may also reflect the differing needs and stages of adjustment of both groups. Aspects of the group that parents unanimously found most useful were meeting and listening to others in a similar situation. Most people liked the small group format. The Registrar’s talk on medical aspects of the illness was also highly rated and the parents commented on how useful it had been to have had such open access to a psychiatrist. In terms of suggestions for future groups, the majority of people wanted more information on coping with specific aspects of the young person’s behaviour, e.g. moodiness, wanting to be alone, suicidal threats, etc.
DISCUSSION
It would appear from the data collected that the single most valuable aspect of the group was the support it offered to these parents. That it was a useful experience for group members is borne out by their almost unTable 4.
Results of Questionnaire 3: Feedback on the group sessions
Session 1. 2. 3. 4. 5. 6.
Introduction Diagnosis and medication Family issues Guest speaker The future Focus on parents
Group 1 X rating Rank 4.5 4.2 4.1 4.3 4.6 4.4
2 5 6 4 1 3
Group X rating
2 Rank
3.6 3.7 3.8 4.3 3.2 4.1
5 4 3 1 6 2
Ratings were made on a scale of 1-5, where 1 indicated “not helpful” and 5 indicated “very helpful”. Rankings were allocated to each session on the basis of these mean ratings. A ranking of 1 indicating the most popular session for that group. Statistical differences between the two groups were not calculated.
10
A. SHERIDAN
AND L. M. MOORE
failing attendance and the arrangements they had to make either at work or at home, to enable them attend. Although they enjoyed discussions in small groups, all acknowledged the usefulness of some structured or didactic input. The impression of the team from individual involvement with each family was that their participation and confidence in the group setting was matched by their increased ability to manage their youngster at home. This is similar to the results gained by Smith and Birchwood (1987). Although we have no objective evidence, the Adolescent Team feel that there were fewer distressed telephone calls from these parents both during and after the group. There are, of course, very obvious limitations to this study, for example no control group was used so we do not have objective evidence that the changes which we perceived as occurring would not have happened anyway. Therefore our results could not be generalized to other groups of similar parents. No standardized questionnaires were used during these groups but we are considering incorporating the Knowledge of Schizophrenia Questionnaire used by Smith and Birchwood (1987) and would also like to use the Camberwell Family Interview (Vaughn and Leff, 1976) which would enable us to look more closely at the area of high vs. low levels of expressed emotion. The use of such tools would enable us to compare our results to those obtained in other studies and thus broaden the scope of our work. The negative role of high expressed emotion in families of schizophrenics has already been mentioned. Our clinical impression is that young schizophrenic sufferers living at home in families where there is a high level of criticism and negative expressed emotions do least well. However, we have never used formal instruments to measure these attributes. Thus we feel the Camberwell Family Interview would be particularly helpful in a future study. We now intend to incorporate group work of a similar nature as an integral part of the service we offer to the families of adolescents suffering from schizophrenia. It may also be possible to provide more follow-up meetings for these parents, and thus provide a cost-effective, parent-centered and more long term support system for the future. As experienced by Thornton et al., (1981) we feel that this group’s need for professional input may dwindle and that the parents will gradually take over the running of the follow-up meetings themselves. This may be done in conjunction with the local branch of the Schizophrenia Association. In addition, future developments may include the preparation of an informational booklet specifically designed for the parents of adolescent sufferers-the information available at present is predominantly aimed at
RUNNING
GROUPS
FOR PARENTS
WITH
SCHIZOPHRENIC
ADOLESCENTS
11
the families of adult sufferers. We are also considering producing some information for sufferers themselves. We would like to build up a resource library of films, videos, literature, etc., which is specific to the adolescent schizophrenic and which might be of use both to ourselves in our work and to the families whom we see. It is possible that a group for the siblings of sufferers may also be developed. This could run along the lines of our Parents’ Group, or could be modelled on the Alateen support group for the children of alcoholics.
ACKNOWLEDGEMENTS
The Authors wish to acknowledge the help of Dr Louis O’Carroll and Dr Brian Houlihan in the running of these Groups along with the support of the staff in Cluain Mhuire Family Centre.
REFERENCES Bion, W.R. (1961). Experiences in Groups. London: Tavistock. Bleuler, E. (1911). Dementia Precox or the Group of Schizophenias. New York: International Universities Press, 1950. Brennan, T.G., O’Loideain, D.S., Menton, M. and Sheehy-Skeffington, A.R. (1983). A Preliminary Report. Irish Medical Psychopathology in Irish Adolescents:
Journal, 76 (3), 142-145. Brown, of
G.W., Monck, E.M., Family Life on the
Preventive
Carstairs, G.M. and Wing, J.K. (1962). The Influence Course of Schizophrenic Illness. British Journal of
and Social Medicine, 16, 55-65.
Falloon, I.R.H., Boyd, J.L., Magill, C.W., Razani, J., Moss, H.B. and Gilderman, A.M. (1982). Family Management in the Prevention of Exacerbation of Schizophrenia. New EnglandJournal of Medicine, 306,221-223. Goldstein, M. and Kopeikin, H. (1981). Short and Long Term Effects of Combining Drug and Family Therapy. In New Developments in Interventions with Families of Schizophrenics, Goldstein, M. (Ed). San Francisco: Jossey-Bass. Knopka, G. (1972). Social Group Work: A Helping Process. Englewood Cliffs, N.J.: Prentice Hall. Leff, J.P., Kuipers, L., Berkowitz, R., Eberlein-Fries, R. and Sturgeon, D. (1982). A Controlled Trial of Intervention in the Families of Schizophrenic Patients. British Journal of Psychiatry, 141, 121-134. Leff, J.P., Kuipers, L., Berkovitz, R. and Sturgeon, D., (1985). A Controlled Trial of Social Intervention in the Families of Schizophrenic Patients: A Two Year Follow-up. British Journal of Psychiatry, 146, 594-600. McCreadie, R.G. (1982). The Nithsdale Schizophrenia Survey 1. Psychiatric and Social Handicaps. British Journal of Psychiatry, 140, 582-586. McCreadie, R.G., and Robinson, A.D.T. (1987). The Nithsdale Schizophrenia Prevalence, Patterns and Clinical Survey: VI. Relatives Expressed Emotion: Assessment. British Journal of Psychiatry, 150,640-644.
A, SHERIDAN
12
AND L. M. MOORE
Smith, J.V. and Birchwood, M.J. (1987). Specific and Non-specific Effects of Educational Intervention with Families Living with a Schizophrenic Relative. British Journal of Psychiatry, 150, 645-652. Thornton, J.F., Plummer, E.. Seeman, M.V., and Littmann, S.K. (1981). Schizophrenia: Group Support for Relatives. Canadian Journal of Psychiatr?, 26 (S), 341-344. Vaughn, C.E., and Leff, J.P. (1976). The Measurement of Expressed Emotion in the Families of Psychiatric Patients. British Journal of Social and Clinical Psychology, 15,157-165. Weiner, I.B. (1982). Child and Adolescent Psychopathology. New York: \Vilev and Sons. Weiner, I.B. and Del Gaudio, A.C. (1976). Psychopathology in Adolescence: An Epidemiological Study. Archices of General Psychiatry, 33, 187-l 93.
APPENDIX
1
Questionnaire
1
1. As a parent, do you find that having a schizophrenic youngster living at home with you limits your own personal life in any of the following ways?
Yes (a) Going (b) Having
No
out with friends time to relax on your own
(c) Having people in (d) Going out with spouse
ii
or partner
(e) Going away on holidays (f) Concentrating on your work (at home or in your job) 2. All parents
have worries
and concerns
about
their
families.
EE 0
cl
At the pre-
sent time do you feel that: (a) You worry too much (b) You do not worry enough (c) You worry just the right amount 3. Who
do you worry
about
? Please
rank from
person you worry most about : (a) Your schizophrenic youngster (b) Another child (or children) in the family (c) Your spouse or partner (d) Someone outside of the immediate e.g. a friend or grandparent. (e) Yourself
family,
1 to 5, where
1 denotes
ES cl
the
cl
RUNNING
4. Has (a) (b) (c) (d)
GROUPS
FOR PARENTS
WITH
SCHIZOPHRENIC
ADOLESCENTS
13
Yes No your attitude to discipline changed since your youngster became ill? In relation to all your children cl0 In relation to some of them In relation to your schizophrenic youngster None of the above
5. Do you see yourselves as a family who : (a) Discuss your feelings readily (b) Show your feelings when you are: (i) (ii) (iii) (iv)
Angry Happy Sad Worried
6. What percentage of your schizophrenic do you think is due to: (i) His/her illness (ii) Him/her just “playing up”
teenager’s
difficult
behaviour
l-J/& 0%
7. Some schizophrenic youngsters do not appear to have as much motivation or drive to “get things done” as other teenagers. In your case, do you think that this is because of : Yes / No (a) His/her illness Yes 1 No (b) A temporary lapse in his/her motivation
A. SHERIDAN AND L. M. MOORE
14
APPENDIX
2
Questionnaire
1.
Schizophrenia
2.
Sometimes
3.
there
Hearing
5.
Schizophrenia Parents
voices
Parents
means
8.
there
may develop
is not a common
can prevent
having
sign of schizophrenia
a split personality
a youngster
from having
themselves
always makes
people
Many
schizophrenics
their own. They 10. Family
violent
cl
cl
cl
0
cl
Cl
cl
0
cl
cl
0
cl
cl
0
0
cl
cl
0
0
cl
q
0
0
cl
0
and
always be allowed
to do this
do not bother
teenager
11. (a) Often schizophrenic show their feelings (b) This means strong feelings
cl
like to spend a lot of time on
should
rows and disagreements
the schizophrenic
cl
for a youngster
unpredictable 9.
False
0
a
the disorder
Schizophrenia
True
is a
the disorder
breakdown
are right to blame
developing
component
has schizophrenia
that a second
schizophrenic 7.
is a genetic
member
chance
4.
6.
is infectious
If one family strong
2
teenagers
find it hard to
that they do not have deep or
12. Schizophrenic teenagers seem to need more than the average teenager 13. If a patient is on medication takes his/her drugs regularly
it is essential
criticism
that he/she
RUNNING
GROUPS
FOR PARENTS
WITH
SCHIZOPHRENIC
ADOLESCENTS
True
False
14. Parents should expect their schizophrenic teenager to do as well as ever in school once they have got over their initial breakdown
cl
cl
15. It is possible to grow out of schizophrenia
cl
cl
16.A schizophrenic teenager, as he/she grows older can never lead an independent life
cl
0
17. Indicate your contact with the Schizophrenia Association by placing a tick in the appropriate (a) We have attended group meetings
cl
(b) We have read their literature
cl
(c) We have had no contact at all
cl
APPENDIX
Questionnaire Name
15
box :
3
3
: Parent Group Evaluation
We would like to know how useful you found the various sessions that we held. Please could you rate each session on a scale from 1 to 5, where 1 = not useful at all and 5 = extremely useful. 1. Introduction, getting to know each other, discussing expectations about the group, etc.
0
2. Diagnosis
cl
and medication.
3. How it has affected the family.
Looking at “normal adolescence”. Telling the family about the illness.
cl
A. SHERIDAN
16
4. Guest
L. 51. MOORE
speaker.
5. Prognosis
6. Your
cl
and the future.
own supports
Finishing
We
AND
would
0
as parents.
q
off.
like
help us plan further
some
suggestions
and
critical
comments
groups.
1. What
aspects
of the Group
did you find most helpful
What
aspects
of the Group
could
differently to make them more (Please write something !!!)
Have you any further help us in planning
have been done
helpful
suggestions
another
?
that could
Group
?
4. Would you like any more Group meetings If so, what format could this take ?
5. Is there any other help/support you need right now ? Yes If Yes,
Thank
please
from
?
that you feel No
specify.
you for filling in these forms
for us.
?
you
to
