Family interventions for psychosis are now well established with the US Department of Veterans Affairs and Department of Defence recommendations for first episode psychosis and schizophrenia strongly supporting family interventions to reduce symptoms and improve remission rates. Jolley and Grice (2023) note that ‘family interventions are a cornerstone of international guidelines for the treatment of psychosis, and of workforce development initiatives. Effect sizes for clinical and economic outcomes are large, and the evidence base is robust and reliable, not only for outcomes but also for the underpinning theoretical models, which are coherent and consistent.’
While these assertions are reassuring, they do not directly address the effect of these approaches on the most vulnerable family members: children.
Psychosis in a Parent
It is estimated that in the UK about 50% of those who are diagnosed with psychosis are parents and 63% are mothers, often managing without a partner. About a quarter experience difficulty successfully meeting their caring responsibilities. Social stigma and economic disadvantage and disrupted attachment due to foster placement add to stressors for children. Children of a parent with psychosis are at greater risk of experiencing their own mental health issues with preliminary findings suggesting 1 in 3 may develop a similar condition to their parent and 50% risk developing any mental health condition.
Family Therapy for Psychosis
While there is a strong evidence base for family interventions most were developed in the context of adult carers, most usually an adult son seen with an elderly mother. However, there is a scarcity of literature about the inclusion of children and adaptations to make these interventions appropriate. This contrasts with repeated calls to generally include children more actively in family therapy and the recognition of their contribution.
A Study to Explore Best Practice for Inclusion of Children
Thompson et al (2020) used a three round Delphi methodology which structures group opinions and seeks consensus between experts to discover what they deem best practice in the absence of relevant literature. The question of whether, how and when to include children when a parent experienced psychosis was the focus of enquiry.
Practitioners overwhelmingly endorsed the inclusion of children in family sessions which is in line with the consensus about the importance of their place in all family work. Therapy should be flexible and tailored to the needs of each family and the vulnerability and need for safety of children.
Items that related to ‘collaborative, respectful contracting of information sharing and agreeing boundaries with families’ were also highly endorsed. All participants agreed that the service should be offered in a way that did not result in parents feeling scrutinised which reflected the awareness of the stigmatisation parents feel and the need to protect their parental role.
Most participants agreed that the parenting experience should be directly addressed and most supported talking to children about their experiences in the family. However, some noted that parents may share information that is not appropriate, and support for these conversations may be required.
Items which related to organisational factors were all endorsed, reflecting the recognition that successful family-focused work requires wider systems support and cross agency collaboration.
In Conclusion
There seems little doubt that allowing children a voice in the family context when a parent has been diagnosed with psychosis enhances their resilience and reduces worry. Parents feel more confident, less criticised and more supported following this experience and more willing to remain engaged in services. A good outcome for all, and strong reasons for practitioners to more routinely include children when a parent is suffering.
Jolley, S. and Grice, S. State of the art in psychological therapies for psychosis: Family interventions for psychosis Psychol Psychother Theory Res Pract. 2024;97:19–33.
Thompson, O., Maria Griffiths, M., Allen, J., and Jones, F. A Delphi survey to explore best practice for practitioners offering family intervention for psychosis to families with children Journal of Family Therapy (2020) 42: 560–587
©Copyright Bower Place Pty. Ltd. 2025
