Family Therapy Treatment of Mental Illness There has been a growing movement towards the use of family therapy methods for the treatment of mental illness in recent years. To determine the facts about this trend, this paper provides a review of the relevant literature concerning family therapy treatment of mental illness in three sections. In Section 1, a discussion concerning the views of O'Hanlon and Rowan's (2003) and Zeig and Munion (1999) for working with clients with chronic or severe mental illness is followed by an analysis of the extent to which they succeed in making a strong case for "brief therapy" with intensive clients. An assessment concerning the contribution of Milton Erickson to the assessment and treatment of different mental health diagnoses is followed by an analysis of their respective approaches and the corresponding benefits and limitations of each of these models. Section II provides a discussion concerning the usefulness of psychoeducational approaches to chronic and severe mental illness and the degree to which the principles identified in selected juried articles can be applied in the psychoeducational treatment of other types of disorders or presenting problems as well as the respective effectiveness of these psychoeducational treatments. Finally, a discussion concerning two treatment principles from the field of family therapy that can be applied to working with a broad range of disorders and presenting problems is followed by a summary of the research and important findings concerning the foregoing issues in the conclusion.

Section 1: Discussing Solution-Oriented Treatments

According to O'Hanlon and Rowan (2003), so-called "brief therapy" represents a valuable and significant change in the traditional approach to treating mental illness because it recognizes that clients are important partners in the treatment process and treatment sessions that are demarcated by pragmatic time considerations. In this regard, Gurman and Messer (2009) report that, "The recent enormous acceleration in various forms of managed mental health care has given further impetus to the development and expansion of various forms of brief therapy" (p. 359).

There are other important reasons to apply brief therapy in certain circumstances as well. For instance, Gurman and Messer add that, "With nothing to restrain the length of therapy, there would not be a theory of dosage. ... The prediction that therapy would get longer and longer was undone by adventurous therapists willing to use common sense" (2009, p. 359). The application of common sense approaches also means that clinicians must draw on what resources are available to develop an understanding of the issues that are adversely affecting clients.

An important point made by O'Hanlon and Rowan (2003) to optimize the effectiveness of the brief therapy approach was the need for clinicians to develop a therapeutic rapport with the clients in order to gain as many insights into the mental health illness state as possible. In this regard, O'Hanlon and Rowan "challenge the notion that clients are not accountable for any aspects of their behavior, or that any concerns or insights they may have are only another manifestation of the illness and have no basis in reality" (cited in Daroff, 2005, p. 308).

Likewise, O'Hanlon and Rowan (2003) stress the need to actively listen to clients and their family members because they are in the best position to fully understand the day-to-day aspects of the disease state. For example, according to O'Hanlon and Rowan, "Clients, and families, do have their own areas of expertise, which therapists tend to ignore and stifle. They are experts on their experience with the problem. ... The expertise of clients and family members is the keystone of the solution-oriented approach to working with 'tough' clients" (cited in Daroff, 2005, p. 309).

Similarly, Zeig and Munion (1999) describe the contribution of Milton Erickson to the assessment and treatment of different mental health diagnoses. According to Zeig and Munion (1999), Erickson's expertise with hypnosis was highly effective for use in brief therapeutic sessions with mental illness clients. As Zeig and Munion point out, though, "These interventions emanated not from a theory of personality or therapy, but from an orientation toward the patient and the therapy situation" (1999, p. 25). In general, Erickson's approaches to mental health treatment include the following:

1. An atheoretical approach in which a novel treatment modality was specifically designed to address the client's unique situation (Zeig & Munion, 1999, p. 27);

2. A symptom-focused non-pathologic model in which conventional "massive personality reconstruction" was replaced with a "positive approach that presupposes a healthy outcome since only symptoms or problems need to be resolved" (Zeig & Munion, 1999, p. 31);

3. Active-directive therapeutic role in which the prevailing psychodynamic and client-centered approaches were replaced with...

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While it is reasonable to suggest that many clinicians could readily apply these treatment alternatives in their own practice, Erickson's preeminence as one of the leading hypnotists in the world undoubtedly enhanced the effectiveness of these treatment modalities. Therefore, clinicians should fully understand how, why and when these alternatives should be applied in order to ensure optimal outcomes.

Section 2: Examine Psychoeducation

The usefulness of psychoeducational approaches to chronic and severe mental illness was the focus of an article by McFarlane, Dixon, Lukens and Lucksted (2003) who provide a systematic review of the literature concerning its use in the treatment of bipolar disorder major depression, schizophrenia, as well as other mental health disorders. According to McFarlane and his colleagues (2003), family psychoeducation first emerged during the late 1970s in response to the growing recognition that conventional approaches were failing to achieve the desired results. As McFarlane et al. (2003) emphasize, "It became increasingly clear that, under these circumstances, a well-functioning family has to possess the available knowledge about the illness itself and coping skills specific to a particular disorder, skills that are counterintuitive and only nascent in most families" (p. 223).

By the late 20th century, family psychoeducation had become more fully developed and sought to more fully engage family members of mental health patients in a collaborative fashion that could provide them with the information they needed to understand the mental health problem, identify ways that could facilitate recovery, and provide them with coping strategies to minimize the burden the mental health problem caused the family unit (McFarlane et al., 2003). These are important issues because the world in which the mentally ill in general and those suffering from bipolar disorder major depression and schizophrenia live can be difficult for others to fully understanding (Simoneau & Miklowitz, 2001): Although the group of family psychoeducation interventions that emerged from this process was largely focused on bipolar disorder major depression and schizophrenia, it is clear that family members represent a valuable resource for clinicians and clients alike since they are on the front-lines of providing the day-to-day support mental health patients need to effect rehabilitation.

Section 3: Discuss Family Therapy Treatments

As noted in Sections I and II above, family psychoeducation has been increasingly recognized as an effective approach for various mental health issues and family therapy treatments share some common attributes that make them appropriate to use in working with clients who are diagnosed with severe and chronic mental disorders. Two treatment principles drawn from the field of family therapy that can be applied to working with a broad range of disorders and presenting problems include the American Association for Marriage and Family Therapy's (AAMFT) clinical updates on depression and obsessive compulsive disorder which are discussed below.

For instance, in his AAMFT clinical update on depression, Yapko (1999) emphasizes that, "Family members are not immune to the depressive's negativity -- the never-ending complaints, the steady stream of criticisms, the lack of emotional closeness, and the loss of the ability to have fun together" (p. 5). As a result, family relationships can deteriorate even further, thereby exacerbating the disease process and adversely affecting the effectiveness of any intervention used to treat the problem. In this regard, Yapko adds that, "Spouses can feel hurt and alienated, and children may feel guilty, resentful, and as if they are to blame. In turn, family relationships can also exacerbate depressive symptoms" (1999, p. 5).

The importance of including family members in the treatment process for clients with obsessive compulsive disorder (OCD) was also the focus on an AAMFT clinical update by Steketee (2003). In this regard, Steketee (2003) reports that, "Many family members have difficulty understanding the exaggerated behaviors people with OCD engage in, and they may misinterpret these actions as willful or crazy and react with frustration and anger or excessive efforts to help" (p. 1). Frustration, anger and excessive efforts to help (termed "expression emotion") can also interfere and derail the treatment process is they are allowed to persist (Steketee, 2003).

Therefore, including family members in the treatment process can help provide all stakeholders with the information they need to better understand the disease state and what steps they can take to facilitate recovery (Steketee, 2003). For instance, Steketee adds that, "Family members and patients both tend to benefit when family members participate in psychoeducational groups, especially when patients are concurrently in behavioral treatment" (2003, p. 4). Taken together, it…