ABSTRACT
However training is only the beginning of the process; the training programmes seek to ensure that the philosophy of inclusion and interventions taught are implemented in clinical practice. Therefore, unlike many other training or academic courses, strong links are established prior to, during and post training with clinical supervisors, service leaders and managers. In addition, the courses are designed to promote user involvement by incorporating the expertise of users and carers into curriculum development, teaching and supervision teams, with the aim of reducing exclusivity and endorsing the philosophy that knowledge and expertise is shared, both during and beyond training. The Theoretical Underpinnings of PSI: Expressed Emotion and the Stressvulnerability Model The development of psychosocial interventions emerged from the seminal work of Brown, Birley and Wing (1972) which identified Expressed Emotion (EE) within
family settings as a factor that influences the frequency of relapse in people suffering from schizophrenia. Expressed Emotion (EE) refers to response characteristics of family members living with individuals with schizophrenia. Research has indicated that high EE responses, such as critical, hostile or emotional over-involvement with the relative with schizophrenia, has a negative impact on the occurrence of relapse (Leff and Vaughn, 1985). During the same time period, influential stress-vulnerability models were emerging (Zubin and Spring, 1977; Neuchterlein and Dawson, 1984), drawing attention to the importance of social and environmental factors, in particular ‘ambient stress’, on the course and prognosis of schizophrenia. According to these models, symptoms are viewed as the product of life stressors and the person’s predisposition to cope with that stress in combination with their illness. Understanding this relationship, within the context of the developing work on family intervention (discussed later in this chapter), has assisted with the development of broad models of psychosocial educational programmes (Barrowclough and Tarrier, 1992; Kuipers, et al., 1992; Falloon and Graham-Hole, 1994). Definition of Psychosocial Interventions Unfortunately there is no commonly agreed single definition of psychosocial interventions. A useful definition, that we will use as the ‘working definition’ of PSI for this chapter, comes from the ‘Avoiding the Washout’ document (Repper and Brooker, 2002), which states that:
Psychosocial interventions has become a term that can best be understood as an ideological and political force within contemporary mental health practice that seeks to challenge a dominant non-recovery approach to working with psychosis. It supports the vision that an integrated approach to aid the process of self discovery is a basic human right of people who experience psychosis and their carers. This leads to the premise that the mental health workforce possesses positive attitudes, up to date knowledge and a wide range of skills to help individuals and carers improve the quality of their lives (p. 42).
