Purpose The literature on family-provider relationships in care for individuals with severe mental illness has repeatedly documented family members' dissatisfaction with their interactions with mental health providers and their needs of more involvement in treatment process. However, little is known about the providers' perspectives on these issues. To bridge the gap, this study explores social work case managers' interactions with families of individuals with severe mental illness in community support programs and generates the theoretical framework of their clinical practice with families.

Methods Grounded theory is applied because it facilitates the exploration of a perspective without imposing assumptions, and constructs the theoretical framework of social interactions. Theoretical sampling – a purposeful sampling approach to recruit participants who can best help with theory development – was adopted and in-depth interviews were conducted. Dimensional analysis – a process to reveal the conceptual framework in the text – was applied on verbatim transcripts.

Results While the literature advocates family members' involvement in treatment, case managers focus on family members' involvement in clients' lives. They observe that few clients retain family involvement after years of illness. For those involved families, case managers aim at helping them just “be families” and enjoy quality family events with clients. The key in the theoretical framework of practice with families is the clients' will; i.e. clients decide whether or to what extent case managers can contact families. Case managers also tend to work on the family domain after they have established a trusting relationship with their clients. To establish such relationship, case manages may have to delay family issues. They find that over time clients may change their thoughts about the family-case manager contact. With client permission, case managers can exchange client information with, or provide services to, the family. When client permission is not granted yet the family is eager to contact the case manager, the common solution is to assure the family possibilities of providing information to, but not receiving information from, the case manager about the client. There are significant differences between the literature and the findings. In the literature, family members' caregiving role is reinforced through advocacy on family involvement in treatment and emphases on care functions. Contrarily, case managers work on freeing family members of caregiving responsibilities by providing clients services and enhancing their self care abilities. Families then can develop social functions with clients. Also unlike the literature where the client's will is rarely discussed in family-provider interactions, client decision is centralized in case managers' conceptualization of practice with families.

Implications Professional education/trainings need to recognize variations among families, and include skills of communicating differences in family role expectations with clients and family members and facilitating the transformation of family dynamics. Moreover, practical and ethical dilemmas in working between the client and the family need to be addressed and further discussed. Finally, other than involving families in treatment, case managers adopt various approaches to family issues depending on family situations. Further investigation is necessary to understand how those approaches affect clients' and families' overall well-being.