Importance of the trialogue

The family help system

Author: A. Urbane, mother of a daughter suffering from a psychosis

The relationship between relatives and those active in psychiatry, particularly in clinical psychiatry, is frequently burdened through tension and a mutual lack of understanding. Relatives report - and we have experienced it personally - that they are treated gruffly, that conversations are refused for varying reasons, that they have the feeling of not being taken seriously, that one does not believe what they say. Relatives frequently have the impression that the clinics concentrate predominantly on fighting against the psychopathological symptoms and do not place enough attention on the everyday life of the patients after they have been discharged from the clinic, that the clinics are not fully aware of the significance of the family help system. The stationary therapy, as a rule, only involves an extremely short period in the very long history of an illness. The decreased time spent in the clinic ever increasingly leads this stationary treatment to assume more the character of a crisis intervention. Essential decisions and developments now occur in the ambulatory region, in the domestic environment, in the family or under participation of the family.

A good medical and psychotherapeutic treatment in the clinic is surely an important factor which will decisively determine the further course of the illness.

For the long-term course of convalescence, however, further factors are also significant, e.g.

  • the basic social and material conditions,
  • the ability to activate one's own available resources,
  • the possibility for meaningful activity,
  • secured financial relationships,
  • appropriate living quarters which fulfil personal needs,
  • especially important, the maintenance or re-establishment of the family help system

From the experiences which we were able to make with our daughter over the course of 16 years, we know how endlessly significant the family can be for people like her. This became particularly clear always then when measures were applied for or a new method was attempted or a crisis eliminated those advances which one had already achieved. "Without my family, I wouldn't have been able to get as far as I have!", is a sentence from her.

Relatives are the supporters of the largest help system, namely the family help system. It is a task of the therapy to maintain this family help system as far as possible for those who have fallen ill. It cannot and must not be the major goal of therapeutic efforts, to alienate those who have fallen ill from their families, and to ground this action with the reason that they must become independent. Unfortunately, we repeatedly experience such a conduct especially for young adults who have fallen ill. As a result, we often have dependence on the legal caregiver and on the staff members of the ambulatory services.

Relatives as experts

  • They have knowledge of the past history and course of the illness.
  • Many psychologically ill persons live with their families.
  • Spouses live with their ill spouse.
  • Psychologically ill children who have grown up live with their parents
  • Siblings grow up along with psychologically ill brothers or sisters.
  • Children grow up together with psychologically ill parents

During the course of an illness of one of their family members, relatives gradually become experts. Relatives are frequently familiar with the course of the illness over a number of years and decades, and that made from a close proximity. Relatives are not only aware of the course of the illness, they frequently know very precisely about personal problems, behaviour and reactions of the persons affected, they often have knowledge of earlier therapies, their effects and side effects, and can frequently provide very much more precise information about these things than the persons affected are able to themselves. It is irresponsible if therapists believe that they can dispense with this information, or if they regard this information as being implausible or irrelevant.

Knowledge of the entire situation

Patients are frequently not in a position to provide sufficient information concerning their past history and their entire situation, or they have an unrealistic assessment of their situation. Information about the threatening loss of a home, debts, problems at the workplace, etc., for example, are frequently only recognised by the family, friends, neighbours or acquaintances. Consequently, therapists only acquire this information if they speak with the relatives.

Relatives as a resource

It is uncontested that, in the course of a psychological illness, considerable tensions can arise within the family. The reasons are diverse and known sufficiently. Nevertheless, for many of those who have fallen ill, their own family still offers support when the professional systems have failed or were not taken advantage of.

Contacts to the external world

In recent times, the public discussion concerning psychologically ill patients has frequently made use of a term involving their "ghettoisation". Psychologically ill persons are frequently not integrated into the community, but at best into the psychiatric community. Relatives are frequently their last remaining bridges to everyday life. This contact is a highly valued commodity which must be protected and intensified. Hardly any individual is voluntarily and happy to be without a family. How can it be assumed that this could be any different for people who are psychologically ill?

Why are relatives excluded?

In scientific discussions, it is to be heard nearly everywhere that an early integration in the family is essential in the therapeutic process. Occasionally, it is even considered to be close to malpractice if one does not carry this out.

It is well known that the demanded inclusion of relatives is by no means realised everywhere. Daily experience teaches us that the exclusion of relatives is more frequently the rule - not always but, nevertheless, still too often.

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