From The Carlat Psychiatry Blog, ,

Family members can tell you about your patient’s level of functioning, can confirm sleeping and eating schedules, and raise questions about cultural beliefs and values, says Alison Heru, MD, a professor of psychiatry at University of Colorado School of Medicine, and author of the book, “Working With Families in Medical Settings.”

In an article Dr. Heru wrote for the The Carlat Psychiatry Report, she says you should seek to learn the family’s story, observe family interactions, and most importantly, ensure the meeting doesn’t get contentious. Contentious family members should be politely asked to leave the room for a cooling down period. If arguments persist, call a halt to the meeting and let everyone know that it won’t resume until all agree to calmly have their say.

Since many times individual family members will try to dominate the conversation, you should ensure that everyone gets a chance to offer their two cents. Engage quieter family members by specifically directing questions to them.

You can help head off conflict by establishing “ground rules” before meeting—let family members know that the exercise won’t be useful unless people respond calmly and respectfully, and everyone is offered a chance to participate.

During the family meeting, you should work to assess the following:

Global family functioning: To avoid any suggestions of blame, externalize the illness. Ask family members, “How are you all coping with the illness? How is the illness affecting you as a family? How is the illness interfering with your ability to live your lives as you might wish? How is the illness interfering with retirement, schooling, etc? Are there unresolved issues/feelings that you as a family have about the illness?”

How caregivers are coping: Physical, emotional, or financial demands can overwhelm families of patients—which can impact the caregivers’ health and mental well-being. So, ask the family caregivers how they are coping with providing care (Heru AM, J Psychiatr Pract 2015; 21(5):381-388).

Educational needs: Ask family members, “Would you like more education about the illness? Would you like someone to consult with your family about the emotional side of dealing with the disease?” Family psychoeducation means providing illness education and giving family members the opportunity to express their feelings and discuss their difficulties managing the illness.

The greatest family problems: Ask, “How do you generally solve family problems? Who has the final say? Which problems are easy and which ones are difficult to resolve?” Family members typically need to address practical problems, such as helping the patient get medications from the pharmacy, making time to attend appointments, and arranging day care for children.

Other family problems: In addition to common practical and emotion problems, you should try to learn about additional issues by asking, “Are there other family problems that you are all coping with at this time? Do other people in the family have illnesses or problems they are struggling with?” If family problems predate the illness, then recommend family therapy.

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