Table 2 Important challenges emphasised by mental health professionals conducting psychoeducational family interventions in early psychosis

Motivating patients to participate

“The recruitment period starts very early and it is necessary to take small steps to avoid frightening the patients away.”

“I had to put my heart into the work; I had to say that I really believe this intervention is something worth trying…I know it has been useful for others in the same situation.”

“Patients get a lot of offers and you have to promote the intervention.”

“For some patients it took a year before they were ready to accept the invitation.”

“It was much more difficult to recruit patients into a group than I would have thought.”

Selecting participants

“In the future I would have been much more responsive to patients who do not want to participate.”

“This type of family work is an important part of treatment for psychosis, and it feels like a loss when someone drops out. But it isn’t right for everyone.”

“Looking back, I think we exposed some patients to too much pressure during the recruitment phase, the family members were motivated, but the situation caused substantial anxiety for the patient.”

“I think he [the patient] became traumatized and it hurts to think about it…In the future I will listen to my clinical experience.”

“I don’t think it is right to bring people from different life situations and with different types of illness, symptoms and needs into the same group.”

Choosing group format

“Those who are able to identify themselves as having an illness, and at the same time are able to distance themselves from feelings of loss and sorrow, gained more from participating in a group …the ones caught up in their emotions became anxious.”

“In a single-family group, family secrets could have been revealed. This would give the family members opportunities to talk about issues they never have discussed before.”

“It was difficult to handle the group, especially when some family members talked too much or ignored the structure.”

Preserving patient independence

“Patients often feel embarrassed participating in an intervention together with their family members; they hardly want their family to participate in an ordinary treatment session.”

“Patients prefer to keep up with their usual activities and to maintain their normal life.”

“If the patients’ capacity is to be social twice a week, they prefer to be with friends rather than in a group.”

Adherence to protocol

“…if you are unfamiliar with the method, the manual could be something to hold on to.”

“You have to be flexible and make use of your clinical experience, not strictly follow the manual.”

“You have to be yourself and communicate in a language and in words you feel comfortable with.”

“The ability to look above and beyond the manual makes you a good group leader.”

Fostering good problem-solving

“Being able to explore together in the group and realising that they [the patients] were able to handle the problem”

“I think a more optimistic view … and talking about hope, achievements and resources, would have suited the participant better than talking about problems“

“The opportunity to ask about what is going well is the brilliant part of this intervention, which improved conversations. Otherwise it could have been difficult to handle”