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Article Excerpt
Relationship Enhancement" (RE) therapy can be a useful intervention for adolescents with serious mental illness and their family members. The authors review the basic concepts and effectiveness of RE therapy and illustrate how it is implemented. Following 18 hours of RE therapy, a family--consisting of a mother, a father, and a son with serious mental illness and substance dependence--exhibited the ability to communicate and solve problems effectively. A discussion of the implications of this case example for research and mental health counseling are also included.
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Relationship Enhancement (RE) therapy is a family-based intervention that can be effective in treating families and their children with serious mental illness (SMI; Accordino & Guerney, 2001; Accordino & Herbert, 1997; Guerney, 1977). The authors describe the fundamental tenets of RE therapy and its effectiveness with various populations. They also offer an illustration of RE therapy with an adolescent diagnosed with SMI along with drug and alcohol problems. Although RE therapy has been conducted effectively with parents and adolescents (Guerney, Coufal, & Vogelsong, 1981; Guerney, Vogelsong, & Coufal, 1983; Haynes & Avery, 1979), the number of studies implementing RE therapy as a family intervention for adolescents with SMI has been limited. The authors hope that this case study will help contribute to the mental health counseling literature related to this population.
Having an adolescent with an SMI combined with a drug and alcohol problem is associated with severe dysfunctional behavior in the family (Clark, Neighbors, Lesnick, Lynch, & Donovan, 1998). According to clinical outcome studies, family-based interventions can be effective in improving the cohesion, communication, and coping skills of families and their children with SMI (Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998). Specifically, these interventions were found to improve (a) interpersonal effectiveness, (b) problem, solving, and (c) communication effectiveness (Falloon, Krekorian, Shanahan, Laporta, &McLees, 1993; Left et al., 1988,1990). Three major findings regarding the positive effects of family-based interventions were revealed in the literature: (a) the significant reduction and prevention of relapse of SMI in diagnosed family members with mental illness, (b) the greater cost effectiveness of treatment when compared to inpatient hospitalization, and (c) the overall greater efficacy when compared to educational-based assessments alone (Falloon et al.; Lam, 1991; Left et al.; Tarrier, Lowson, & Barrowclough, 1991).
RELATIONSHIP ENHANCEMENT THERAPY
RE therapy uses a psychoeducational approach that emphasizes strengths and skill building to achieve symptom reduction and to prevent interpersonal problems (Accordino & Guerney, 2001; Guerney, 1977; Guerney & Hardley, 1989). In addition, RE therapy synthesizes aspects of different theories including behavioral, client-centered, and social learning/reinforcement. One of the primary objectives of RE therapy is to help people create and strengthen intimate relationships and then maintain the quality of those relationships over time. RE therapy is a method that promotes positive change in self-differentiation and self-esteem and patterns of communication (Greene, 1986, Griffin & Apostal, 1993; Guerney).
RE therapy consists of teaching a structured set of nine skills that are effective in the treatment and prevention of interpersonal problems. In addition to the skills that improve relationship effectiveness, several skills enable regular practice of the skills to prevent deterioration of skill usage (see Guerney, 1991 for further description of the skills). Clients usually read of the RE program manual (Guerney), which describes the skills with examples. In addition, each skill is summarized in a set of brief guidelines that, like rules of a game, when followed lead to a skilled performance. Each guideline is spelled out usually in behavioral terms. For example, the guidelines recommend specific actions that participants should take in order to learn and use each skill effectively. Keep in mind the first four skills are considered the core of RE therapy and are taught first. When the core skills have been grasped, which is evident by the participants' ability to solve minor and major conflicts and exchange positive feelings in their relationships, the final five skills are then presented. Below, we provide a very brief statement of the purpose of each skill along with an example.
1. Empathic skill--helping others feel understood, safe, and involved enough to communicate openly, candidly, and less defensively, while simultaneously increasing understanding of other people, particularly their thoughts, feelings, and wishes. Mother demonstrates compassionate understanding by empathically responding to her daughter and better understands her daughter's fear of having a psychotic relapse.
2. Expressive skill--becoming aware of own thoughts, feelings, and wishes and expressing them in ways that are least likely to create defensiveness in others. Mother compassionately expresses to her daughter feelings of frustration and anxiety as the result of her daughter's unpredictable behaviors.
3. Discussion/Negotiation skill--discussing topics that are laden with strong emotions in a manner that is positive, and structuring the discussion in a way that reduces digression to other topics. Mother and father discuss appropriate ways to react when daughter experiences a psychotic relapse.
4. Problem/Conflict Resolution skill--promoting finding solutions to interpersonal problems by means of structured steps resulting in concrete, behaviorally oriented, constructive plans that are most likely to endure over time and best meet the needs of all family members. Mother and father develop with daughter specific responsibilities and goals (determining who will do what and when) with respect to the daughter finding volunteer or paid employment.
5. Facilitation skill--instructing others informally in the RE therapy skills...
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