Purpose

Define Expressed Emotion and direct to resources to help reduce this in families

Information:

There has been a lot of research on "Expressed Emotion" (or EE) - which refers to the prevailing emotional climate in a family (or care-giving) setting.

Certain features which can be found in some families are quite clearly related to an increased risk of relapse of mental health problems, so working with EE is a key part of Relapse prevention.

In particular, high levels of HOSTILITY, CRITICISM, BLAMING or "ENMESHED" relationships (typically parents who take their child's behaviour very personally, or who struggle to disentangle what is happening to their child from what is happening to them, have been associated with increased relapses (particularly in conditions like Psychosis, but this is probably relevant for a much wider range of conditions.)

Risk

There is a risk that work on EE can be experienced by families as highly BLAMING - as though we are saying:

"the only reason your child is getting ill is YOUR bad parenting."

As we know, the causes of most mental health problems are multifactorial, and we also know that many young people with mental health problems can be very stressful for other family members, or even provocative.

A Mentalization based approach to FamilyWork is helpful in reducing the negative effects of EE, but re-framing the FamilyWork in this context, so as to emphasise its postive intent, rather than any implied criticism of past parenting, is important:

"There are many things that we may NOT be able to change, in trying to keep your child well, but as you are the people nearest to X, and who know X as well as anyone, YOU are probably in the best position of anyone to make a real impact... some of the work we will be doing will be stuff that you may have already tried to do before, and just because X got ill before, doesn't mean you maybe weren't on the right track! We base what we suggest on a lot of research evidence that suggests that giving families skills to keep the emotional temperature as cool or calm as possible is really worth doing..."