Therapists' Intervention and Consumers' Receptivity in Family Psychoeducation on Schizophrenia for Chinese American Families - a Qualitative Study

Background and Purpose: Developing culturally competent mental health treatments for Asian Americans has been an important challenge since mental health disparities have continued to exist for this population for decades. Although a variety of mental health treatments for Asian Americans have been applied to enhance the receptivity and quality of mental health services, little research has been conducted to examine specific intervention strategies that were found effective within intervention modalities.

The purpose of the current study is to explore therapists’ intervention strategies and the corresponding change process for Chinese American families who have a member with schizophrenia, in single-family sessions in the context of psychoeducation. Exploring what types of specific intervention strategies were implemented and how families’ level of receptivity varied will provide information for developing culturally competent practices for this population.

Methods: Chinese American consumers (N=12, age 18+) with a schizophrenic form of disorder and their caregivers (N=22, age 18+) were recruited in a study of ethnic-sensitive family psychoeducation protocol from one of the biggest mental health agencies serving the Asian population in a Northeast city in the US.

Nine intake summaries and 104 single-family session notes (available from 9 consumers and 16 caregivers) were analyzed through coding. The study examined specific intervention strategies therapists implemented and participants’ receptivity by looking at the latter’s immediate responses and pertinent changes. The coding process and data interpretation followed the principles of grounded theory using open, axial, and selective coding with qualitative study software ATLAS.ti.

Findings: In order to improve communication skills among family members and reduce negative impacts (stress, overdependency, burden, and high expressed emotions of criticism and overinvolvement) and unhealthy family dynamics (e.g. enmeshment) mediation and cognitive reframing were most frequently used and showed high receptivity. To facilitate proper limit setting for the consumers, therapists applied relatively authoritative instruction to which the families responded mostly positively. When assisting with case management functions to connect consumers to appropriate external service systems, giving concrete information and practical help were more effective than simply assigning tasks for exploration. Psychoeducation about the nature of the illness and medication, and assigning tasks for medication management were both well-received. However, behavioral modification (positive or negative reinforcement) intended to replace consumers’ undesirable behaviors had mixed or low receptivity.

Conclusion and Implications: To attain more effective changes among Chinese American families with a member having schizophrenia, facilitating effective and healthy communication, setting appropriate family boundaries and proper limits for the consumers, and actively addressing consumers’ tangible needs by offering assistance with case management functions were most important. When intervention strategies of mediation, cognitive reframing, authoritative instruction, giving concrete information, and practical help were implemented, they were more effective and better received by the families. It is critical to recognize that many immigrant Chinese families struggle to meet their tangible needs in daily living, and these families have a cultural tendency to become enmeshed and to take over consumers’ autonomy. Such recognitions will help social workers to develop effective culturally-sensitive intervention strategies for this population.