Psychoeducation and family psychoeducation — structured clinical viva

Viva map (candidate answers)

1. Define PE and FPE

PE: structured collaborative education on illness, treatment, early signs, coping — basic psychotherapeutic intervention, not a lecture monologue.[17] FPE: multi-session package for patient + relatives: education, support, communication, problem-solving, relapse planning (Hogarty/Anderson, Falloon, McFarlane lineages).[16][17]

2. EE components and link to this case

Criticism, hostility, EOI. Meta-analysis: high EE associates with higher relapse risk.[1] Mother's "laziness" comments and housing threats = criticism ± hostility; assess EOI separately. Mechanism: interpersonal stress on vulnerability, plus adherence/help-seeking pathways. Not "Mum caused schizophrenia."

3. Session structure and dose

Joining (no blame) → assessment → education modules → communication skills → problem-solving + early warning signs → boosters. NICE-style family intervention: multi-session over months (commonly ≥10 sessions, 3–12 months), service user included when possible.[3][17]

4. Landmark evidence to name

• Hogarty/Anderson FPE; Falloon BFT; McFarlane MFG.[9][16]
• Pharoah Cochrane family intervention; Xia PE Cochrane/summary.[3][5]
• Bipolar: Colom group PE; Miklowitz FFT (if asked cross-diagnosis).[13][15]

5. Confidentiality and non-blame stance

Agree a sharing contract with the patient before joint sessions. Join mother as partner under stress, not as villain. Validate housing fears while redirecting from criticism to skills and shared goals. Include brother with age-appropriate boundaries. FPE implementation literature emphasises structured engagement without blame or privacy breaches.[11]

6. When to defer joint PE

Active IPV/coercive control, child protection risk, severe intoxication, absolute refusal by a capacious patient, acute medical emergency. Screen for coercion behind the housing threat; if coercive control, protect and restructure rather than force joint work. Joint PE is deferred when safety duties override family meetings.[11]

Examiner probes

• Difference PE vs MI vs CBTp (education vs ambivalence work vs residual-symptom CBT).[17]
• MFG vs single-family FPE (peer multi-family problem-solving vs single-household skills package).[9]
• Implementation gap despite evidence.[11]
• Cultural EOI vs closeness — do not pathologise collectivist care as EOI.[1]
• Carer depression assessment and burden pathways.[18]