A Psychoanalytic Contribution to Understanding the Lack of Professional Involvement in Psychotherapeutic Work with Families where there is Psychosis

I offer some psychoanalytic perspectives and hypotheses to contribute to understanding why family interventions are rarely offered in psychosis. This is despite decades of evidence that family difficulties often predate onset of psychosis and that skilled family interventions are at least as effective as medication in reducing relapse rates. I contend that it is often unbearably disturbing for some families to even consider the possibility of having contributed to the vulnerability of a member to psychosis and that professionals fear accusations of ‘blaming’. Multisystem defences, involving both families and professionals, shift explanations for psychosis, reducing them as a disorder of brain chemistry and somewhat exclusively allowing the logical consequence that only pharmacological interventions ‘make sense’. I summarize the unfortunate consequences of these defences and suggest that there is denial of the important difference between describing possible family environmental contributing factors in psychosis and attributing ‘blame’. Whole team training that involves families and social networks in a highly respectful and humane manner overcomes some of these obstacles. Several decades of increasingly successful research in the Finnish psychodynamically orientated ‘need‐adapted approach to psychosis’ resulting in recent more global interest in open dialogue indicate an effective way of engaging families and of achieving superior outcomes in returning individuals to social engagement as students or to employment.