Behavioural Family Therapy

The model of family work used by the Meriden Programme is an evidence-based, psychoeducational approach known as Behavioural Family Therapy (BFT). The model was originally developed by Professor Ian Falloon and colleagues in the early 1980’s. It is a practical, skills based intervention that usually takes 10 to 14 sessions to deliver. It typically involves sharing information with the service user and their family about the service user’s mental health issues, experience and treatment. The family also complete work on recognising early signs of relapse and develop a clear staying well plan. BFT promotes positive communication, problem solving skills and stress management within the family. The needs of all family members are addressed, and each family member is encouraged to identify and work towards clear personal goals.

 

Who can BFT help?

Research has shown that BFT is effective in reducing stress for service users and their families and that it can significantly reduce relapse rates and promote recovery; especially for those living with severe and enduring mental health problems. Because of this, the main focus of delivery has been around working with families where a member experiences psychosis or bipolar disorder. However, family interventions may be helpful for families experiencing a range of mental health problems, including anxiety, depression, eating disorders, the dementias and learning disabilities.

In the United Kingdom, the National Institute for Clinical Excellence (NICE) Schizophrenia guidelines, originally published in 2002, recommended family interventions should be offered to 100% of individuals with schizophrenia who have experienced a recent relapse. The revised and updated review of the guidelines (published in 2014 and not due for review until 2022) confirms this and further recommends that families are offered intervention and are engaged during the acute phase of illness, or as a method of promoting recovery for those with persisting symptoms.

The NICE guidelines for Bipolar Disorder (2014 – updated February 2020) similarly recommend that family intervention is offered to people with bipolar disorder who are living, or in close contact, with their family.

Family and carer involvement is also referenced in the NICE clinical guidelines for depression , depression in long term conditions and eating disorders.  For example the May 2017 NICE guideline  ‘Eating Disorders: recognition and treatment’ includes the following guidance:

“Consider anorexia-nervosa-focused family therapy for children and young people (FT-AN), delivered as single-family therapy or a combination of single- and multi-family therapy.

Some key points from the document:

• need to emphasise the role of the family in helping the person to recover
• should not blame the person or their family members or carers
• include psychoeducation about nutrition and the effects of malnutrition
• early in treatment, support the parents or carers to take a central role in helping the person manage their eating, and emphasise that this is a temporary role
• in the first phase, aim to establish a good therapeutic alliance with the person, their parents or carers and other family members “

 

The overall aims of BFT are increased understanding, stress reduction, and improved communication and problem-solving skills within the family. Although the research evidence base is strongest for those families experiencing psychosis or bipolar disorder, the approach can be used effectively to help meet the needs of other families in contact with mental health services. In addition, there is growing support for using the approach with families experiencing stress in relation to long-term physical conditions.

 

Overview of the BFT Process

The approach is not a ‘package’ where components are delivered to all families. It is an individualised approach based on the assessment of each family and tailored to their specific needs. Equally the pace and timescale of the support offered varies from family to family. In this collaborative approach, the therapist and family determine together what the agenda will be. Family work is generally offered in the family home unless the family have a preference for meeting elsewhere.

 

Family work using the Behavioural Family Therapy model will typically include:

 

• Meeting with the family to discuss the benefits of the approach
• An agreement with the family that they are willing to try the approach
• Assessment of individual family members
• Assessment of the family’s communication and problem solving skills
• Review of the assessment information on the family’s resources, problems and goals
• Meeting with the family to discuss/plan how to proceed and the establishment of family meetings
• Information-sharing about the mental health issue and reaching a shared understanding
• Early warning signs and relapse prevention work – development of ‘staying well’ plans
• Helping the family to develop effective communication skills
• Supporting the development of the family’s problem solving skills
• Booster sessions
• Review and on-going support or closure

Additional Resources:

For reading material regarding the evidence base for Behavioural Family Therapy please see our Resources section, which includes a number of Reference lists.

Information on the training offered by the Meriden Programme can be viewed in our Training & Consultancy and Events sections