Behavioural family therapy and family psychoeducation

Domain V · Systemic, relational, group & community · Falloon, Anderson, McFarlane · 1982

What it is

These are two closely related family interventions for serious mental illness, chiefly schizophrenia and other psychoses. Both are also used for bipolar disorder and clinical-high-risk states, and the Falloon model has been used more widely. BFT is a home-based, skills-training model. The family,…

Format

• Format. Sessions are held at home where possible, because skills learned in hospital transfer poorly. Every household member who wants to take part is included, not only the identified patient. Sessions last about an hour, at a fixed weekly time. Each one runs: review of treatment progress → review…
• Dose. Falloon's original research schedule was 13 weekly home sessions, then 13 fortnightly sessions, then monthly sessions for up to about six further months. The simplified WFSAD version runs about 10–12 weekly sessions, with later meetings as needed. NICE's minimum recommended dose is.

Who practises it, and how they are trained or regulated

• Training and fidelity. No licence is needed to use the name. Meriden runs a skills-based BFT course followed by supervision, ongoing supervision by telephone, and a training-of-trainers course. The original programme had quality control of its home visits. Practise under supervision from a Meriden-trained (or equivalent) supervisor, and rate your own recorded sessions against the module steps.
• Training and fidelity. A fidelity scale exists, and programmes scoring higher on it are reported to get better outcomes. Core fidelity elements are: the full joining sequence, the session structure and its time allocations, the problem-solving steps, use of the family guidelines, routine meetings, a shared team role as educators, and deliberate self-disclosure. Supports include session checklists and consultation…
• These are two closely related family interventions for serious mental illness, chiefly schizophrenia and other psychoses. Both are also used for bipolar disorder and clinical-high-risk states, and the Falloon model has been used more widely. BFT is a home-based, skills-training model. The family, including the person with the illness, learns about the disorder, agrees an early-warning-signs plan, and is coached in…

Evidence status, as the guide reports it

• Engagement. Present the approach as evidence-based, collaborative and focused on practical here-and-now problems. Agree that the family need not disclose everything.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• see 'non-adherence' in section 5.
• the family hearing contradictory messages from different staff.
• choosing a big chronic conflict too early. Start with something small and solvable.
• disclosures that shift the focus onto you, or that are emotionally loaded. Keep them brief.
• summaries that slip into rebuttal. It is working when the speaker confirms the summary was accurate.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.