Association for Family Therapy and Systemic Practice

NICE Clinical Guidelines

recommending Family and
Couple Therapy
August 2016

Compiled by: Dr Lucy Davis (Chartered and Clinical Psychologist/Trainee Systemic Psychotherapist)
 NICE Clinical Guidelines recommending Family and Couple Therapy

Introduction

This document is an up to date summary of the recommendations made by NICE (the National Institute for Health and Care Excellence)
in clinical guidelines and updated clinical guidelines, between March 2012 and July 2016, about using family, couple and systemic
therapies, and / or the involvement of families and carers when working with people with various mental and physical health problems.
This document can be read in conjunction with the Summary of Family and Couple Interventions, Jeni Webster, March 2012, which
summarises NICE guideline recommendations up to March 2012. NICE clinical guidelines give recommendations for Health and Care
Professionals, and for people and their carers, about the most effective care and interventions, based on the best available evidence (as
defined by NICE).

A full list of guidelines that were reviewed is included in the Appendix (see page 11). Guidelines which do not include recommendations
for family, couple and systemic therapies, or the involvement of family members and carers, have not been included in this document.
However, this does not mean that families and carers should be excluded when working with any mental or physical health problem.

Section 1 outlines Clinical Guidelines with an evidence base that meets NICE standards. Section 2 encompasses evidence that
recommends the involvement of families and carers. Further information and full guidance is available from the NICE website ([Link].
[Link]).

Both Sections 1 and 2 have a Quick Reference Table to refer to when seeking guidance about the recommended form of interventions
for each clinical presentation. Further explanation about the method of delivery of treatment can be found in the main body of the text.

Quick Reference

TABLE 1: RECOMMENDATIONS FOR FAMILY AND COUPLE THERAPIES

CG NO. TITLE YEAR OF RECOMMENDATION

PUBLICATION
OR UPDATE
CG115 Alcohol Dependence and Harmful February 2011 Mild Alcohol Dependence/Withdrawal after Moderate/
Alcohol Use Severe Alcohol Use: Behavioural Couples Therapy.

Children and Young People: multi-dimensional family

therapy, brief strategic family therapy, functional family
therapy or multi-systemic therapy.
CG192 Antenatal and Postnatal Mental Health June 2015 With Bi-polar Disorder:
Behavioural Couples Therapy/Family Intervention.
CG158 Antisocial Behaviour and Conduct March 2013 Multi-systemic Therapy.
Disorders in Children and Young
People
CG185 Bipolar Disorder September 2014 Within Primary and Secondary Care:
With Depression: Behavioural Couples Therapy.

Within Long-term Secondary Care:

With Depression:
Structured Psychological Intervention in groups/families.
Introduction / Quick Reference

CG90 Depression in Adults April 2016 Behavioural Couples Therapy

CG28 Depression in Children and Young March 2015 Steps 4 and 5: Moderate to Severe Depression: Family
People Therapy.
NG18 Diabetes August 2015 Behavioural Family Systems Therapy/Multi-systemic
Therapy.
CG178 Psychosis and Schizophrenia in Adults March 2014 Single Family and/or Multi Family Group Interventions.
CG155 Psychosis and Schizophrenia in January 2013 Family Interventions.
Children and Young People

2
 NICE Clinical Guidelines recommending Family and Couple Therapy

SECTION 1: CLINICAL GUIDELINES RECOMMENDING FAMILY AND COUPLE THERAPIES

CG115 – ALCOHOL USE DISORDERS: DIAGNOSIS, meetings over 3 months. It should focus on:
ASSESSMENT AND MANAGEMENT OF HARMFUL • engaging and supporting the family
DRINKING AND ALCOHOL DEPENDENCE • using the support of the wider social and educational systems
• identifying maladaptive family interactions
1.3.3 • promoting new and more adaptive family interactions.
Interventions for harmful drinking and mild alcohol [Link]
dependence Functional family therapy should be conducted over 3 months by
[Link] health or social care staff. It should focus on improving interactions
For people who drink to harmful levels and people with mild within the family, including:
alcohol dependence who have a regular partner who is willing to • engaging and motivating the family in treatment (enhancing
participate in treatment, offer behavioural couples therapy. perception that change is possible, positive reframing and
[Link] establishing a positive alliance)
Behavioural couples therapy should be focused on alcohol-related • problem solving and behavior change through parent training
problems and their impact on relationships. It should aim for and communication training
abstinence, or a level of drinking predetermined and agreed by the • promoting generalisation of change in specific behaviors to broader
therapist and the service user to be reasonable and safe. It should contexts, both within the family and the community (such as schools).
usually consist of one 60-minute session per week for 12 weeks. [Link]
Multisystemic therapy should be provided over 3–6 months by a
1.3.6 dedicated member of staff with a low caseload (typically between
Interventions for moderate and severe alcohol dependence three and six cases). It should:
after successful withdrawal • focus specifically on problem-solving approaches with the family
[Link] • use the resources of peer groups, schools and the wider community.
After a successful withdrawal for people with moderate and
severe alcohol dependence, consider offering acamprosate or CG192 – ANTENATAL AND POSTNATAL MENTAL
oral naltrexone in combination with behavioural couples therapy HEALTH

SECTION 1: CLINICAL GUIDELINES RECOMMENDING FAMILY AND COUPLE THERAPIES

to service users who have a regular partner and whose partner is
willing to participate in treatment (see section 1.3.3). Interventions for severe mental illness
1.8.16
1.3.7 Consider psychological interventions for women with bipolar
Special Considerations for Children and Young People who disorder. This includes:
Misuse Alcohol • CBT, IPT and behavioural couples therapy for bipolar depression
[Link] • structured individual, group and family interventions designed
For children and young people aged 10–17 years who misuse for bipolar disorder to reduce the risk of relapse, particularly when
alcohol offer: individual cognitive behavioural therapy for medication is changed or stopped [new 2014].
those with limited co-morbidities and good social support. 1.8.18
-Multi-component programmes (such as multidimensional Consider psychological interventions (CBT or family intervention)
family therapy, brief strategic family therapy, functional family delivered as described in section 1.3.7 of the guideline on
therapy or multi-systemic therapy) for those with significant co- psychosis and schizophrenia in adults (NICE guideline CG178) for
morbidities and/or limited social support. a woman with psychosis or schizophrenia who becomes pregnant
and is at risk of relapse arising from:
Delivering psychological and psychosocial interventions for • stress associated with pregnancy or the postnatal period
children and young people • a change in medication, including stopping antipsychotic
[Link] medication [new 2014].
Multidimensional family therapy should usually consist of 12-15
family focused structured treatment sessions over 12 weeks. CG158 – ANTI SOCIAL BEHAVIOUR AND CONDUCT
There should be a strong emphasis on care coordination and, DISORDERS IN CHILDREN AND YOUNG PEOPLE:
if necessary, crisis management. As well as family sessions, RECOGNITION AND MANAGEMENT
individual interventions may be provided for both the child or
young person and the parents. The intervention should aim to Several interventions have been developed for children with
improve: conduct disorder and related problems, such as parenting
• alcohol and drug misuse programmes typically focused on younger children and multi-
• the child or young person’s educational and social behavior systemic approaches usually focused on older children.
• parental well-being and parenting skills
• relationships with the wider social system. Multimodal interventions
[Link] 1.5.13
Brief strategic family therapy should usually consist of fortnightly Offer multimodal interventions, for example, multi-systemic

3
 NICE Clinical Guidelines recommending Family and Couple Therapy

therapy, to children and young people aged between 11 and 17 1.7.2

years for the treatment of conduct disorder. Offer a family intervention to people with bipolar disorder
1.5.14 who are living, or in close contact, with their family in line with
Multimodal interventions should involve the child or young person recommendation [Link] in the NICE clinical guideline on psychosis
and their parents and carers and should: and schizophrenia in adults.
• have an explicit and supportive family focus
• be based on a social learning model with interventions provided 4. Recognising, diagnosing and managing bipolar disorder in
at individual, family, school, criminal justice and community children and young people
levels 1.11.11
• be provided by specially trained case managers Bipolar Depression: Offer a structured psychological intervention
• typically consist of 3 to 4 meetings per week over a 3- to 5-month (individual cognitive behavioural therapy or interpersonal therapy)
period. to young people with bipolar depression. The intervention
should be of at least 3 months’ duration and have a published
CG185 – BIPOLAR DISORDER: ASSESSMENT AND evidence-based manual describing how it should be delivered.
MANAGEMENT 1.11.12
If after 4 to 6 weeks there is no or a limited response to cognitive
1. Managing bipolar disorder in primary care behavioural therapy or interpersonal therapy, carry out a
Offer people with bipolar depression: multidisciplinary review and consider an alternative individual or
• a psychological intervention that has been developed specifically family psychological intervention.
for bipolar disorder and has a published evidence-based manual 1.11.13
describing how it should be delivered or If there is a risk of suicide or self-harm or any other risk outlined in
• a high-intensity psychological intervention (cognitive behavioural recommendation 1.3.5, carry out an urgent review and develop a
therapy, interpersonal therapy or behavioural couples therapy) risk management plan as outlined in recommendation 1.4.1.
in line with recommendations [Link]–[Link] in the NICE clinical 1.11.14
guideline on depression. After the multidisciplinary review, if there are coexisting factors
• Discuss with the person the possible benefits and risks of such as comorbid conditions, persisting psychosocial risk factors
psychological interventions and their preference. Monitor mood such as family discord, or parental mental ill-health, consider an
and if there are signs of hypomania or deterioration of the alternative psychological intervention for bipolar depression for the
SECTION 1: CLINICAL GUIDELINES RECOMMENDING FAMILY AND COUPLE THERAPIES

depressive symptoms, liaise with or refer the person to secondary young person, their parents or other family member or
care. If the person develops mania or severe depression, refer • an additional psychological intervention for any coexisting mental
them urgently to secondary care. health problems in line with relevant NICE guidance for the young
person, their parents or other family member.
1.2.6
Psychological therapists working with people with bipolar 5. Long-term management
depression in primary care should have training in and experience 1.11.16
of working with people with bipolar disorder After the multidisciplinary review, consider a structured
individual or family psychological intervention for managing
2. Managing bipolar depression in adults in secondary care bipolar disorder in young people in the longer term. Offer a
Offer adults with bipolar depression: structured psychological intervention (individual, group or
• a psychological intervention that has been developed specifically family), which has been designed for bipolar disorder and has
for bipolar disorder and has a published evidence-based manual a published evidence-based manual describing how it should
describing how it should be delivered or be delivered, to prevent relapse or for people who have some
• a high-intensity psychological intervention (cognitive behavioural persisting symptoms between episodes of mania or bipolar
therapy, interpersonal therapy or behavioural couples therapy) depression.
in line with recommendations [Link]–[Link] in the NICE clinical
guideline on depression. CG90 – DEPRESSION IN ADULTS: RECOGNITION AND
• Discuss with the person the possible benefits and risks of MANAGEMENT
psychological interventions and their preference. Monitor
mood for signs of mania or hypomania or deterioration of the 1.5
depressive symptoms. Step 3: Persistent sub-threshold depressive symptoms or mild
to moderate depression with inadequate response to initial
3. Managing bipolar disorder in adults in the longer term in interventions, and moderate and severe depression
secondary care
Offer a structured psychological intervention (individual, group 1.5.1
or family), which has been designed for bipolar disorder and has Treatment options
a published evidence-based manual describing how it should [Link]
be delivered, to prevent relapse or for people who have some High-intensity psychological intervention
persisting symptoms between episodes of mania or bipolar • behavioural couples therapy for people who have a regular
depression. partner and where the relationship may contribute to the

4
 NICE Clinical Guidelines recommending Family and Couple Therapy

development or maintenance of depression, or where involving cognitive behavioural therapy (CBT), including CBT focused on
the partner is considered to be of potential therapeutic benefit. quality of life
[Link] • adherence to diabetes treatment – for example, motivational
Behavioural couples therapy for depression should normally interviewing or multi-systemic therapy
be based on behavioural principles, and an adequate course of
therapy should be 15 to 20 sessions over 5 to 6 months. CG178 – PSYCHOSIS AND SCHIZOPHRENIA IN
ADULTS: PREVENTION AND MANAGEMENT
CG28 – DEPRESSION IN CHILDREN AND YOUNG
PEOPLE; ASSESSMENT AND MANAGEMENT 1
Preventing psychosis
Treatment Considerations in all Settings • If a person is considered to be at increased risk of developing
Steps 4 and 5: Moderate to severe depression psychosis (as described in recommendation [Link])
• Offer children and young people with moderate to severe • offer individual cognitive behavioural therapy (CBT) with or
depression a specific psychological therapy (individual CBT, without family intervention (delivered as described in section
interpersonal therapy, family therapy, or psychodynamic 1.3.7) and
psychotherapy) that runs for at least 3 months [new 2015]. • offer family intervention to all families of people with psychosis or
schizophrenia who live with or are in close contact with the
1.6.1 service user (delivered as described in recommendation [Link]).
Treatments for moderate to severe depression This can be started either during the acute phase or later,
[Link].1 including in inpatient settings [2009].
Offer children and young people with moderate to severe
depression a specific psychological therapy (individual CBT, 1.2.3
interpersonal therapy, family therapy, or psychodynamic Treatment options to prevent psychosis
psychotherapy) that runs for at least 3 months. [Link]
[Link] If a person is considered to be at increased risk of developing
Following multidisciplinary review, if the child or young person’s psychosis (as described in recommendation [Link]):
depression is not responding to psychological therapy as a result • offer individual cognitive behavioural therapy (CBT) with or
of other coexisting factors such as the presence of co-morbid without family intervention (delivered as described in section

SECTION 1: CLINICAL GUIDELINES RECOMMENDING FAMILY AND COUPLE THERAPIES

conditions, persisting psychosocial risk factors such as family 1.3.7)
discord, or the presence of parental mental ill-health, alternative
or perhaps additional psychological therapy for the parent or 1.3.4
other family members, or alternative psychological therapy for the Treatment options
patient, should be considered [2005]. [Link]
For people with first episode psychosis offer:
1.6.3 • oral antipsychotic medication (see sections 1.3.5 and 1.3.6) in
Depression unresponsive to combined treatment conjunction with
[Link] • psychological interventions (family intervention and individual
Following multidisciplinary review, the following should be CBT, delivered as described in section 1.3.7) [new 2014].
considered: an alternative psychological therapy which has not [Link]
been tried previously (individual CBT, interpersonal therapy or Advise people who want to try psychological interventions alone
shorter-term family therapy, of at least 3 months’ duration), or that these are more effective when delivered in conjunction
systemic family therapy (at least 15 fortnightly sessions), or with antipsychotic medication. If the person still wants to try
individual child psychotherapy (approximately 30 weekly sessions) psychological interventions alone:
[2005]. • offer family intervention and CBT
• agree a time (1 month or less) to review treatment options,
NG18 – DIABETES including introducing antipsychotic medication
• continue to monitor symptoms, distress, impairment and level
Psychological and social issues in children and young people of functioning (including education, training and employment)
with Type 1 Diabetes regularly [new 2014].
1.2.102 [Link]
Offer specific family-based behavioural interventions, such as If the person’s symptoms and behaviour suggest an affective
behavioural family systems therapy, if there are difficulties with psychosis or disorder, including bipolar disorder and unipolar
diabetes-related family conflict. [new 2015] psychotic depression, follow the recommendations in Bipolar
1.2.103 disorder (NICE clinical guideline 38) or Depression (NICE clinical
Consider a programme of behavioural intervention therapy or guideline 90). [new 2014]
behavioural techniques for children and young people with type
1 diabetes in whom there are concerns about psychological [Link]
wellbeing in order to improve: Family intervention should:
• health-related quality of life – for example, counselling or • include the person with psychosis or schizophrenia if practical

5
 NICE Clinical Guidelines recommending Family and Couple Therapy

• be carried out for between 3 months and 1 year Treatment options for symptoms not sufficient for a diagnosis of
• include at least 10 planned sessions psychosis or schizophrenia
• take account of the whole family’s preference for either single- • When transient or attenuated psychotic symptoms or other
family intervention or multi-family group intervention mental state changes associated with distress, impairment or
• take account of the relationship between the main carer and the help-seeking behaviour are not sufficient for a diagnosis of
person with psychosis or schizophrenia psychosis or schizophrenia:
• have a specific supportive, educational or treatment function and • consider individual cognitive behavioural therapy (CBT) (delivered
include negotiated problem solving or crisis management work as set out in recommendation 1.3.28) with or without family
[2009]. intervention (delivered as set out in recommendation 1.3.27), and
• offer treatments recommended in NICE guidance for children
1.4.4 and young people with any of the anxiety disorders,
Psychological and psychosocial interventions depression, emerging personality disorder or substance
[Link] misuse.
Offer family intervention to all families of people with psychosis or
schizophrenia who live with or are in close contact with the service Treatment of subsequent acute episodes of psychosis or
user (delivered as described in recommendation [Link]). This can be schizophrenia
started either during the acute phase or later, including in inpatient Offer family intervention (delivered as set out in recommendation
settings [2009]. 1.3.27) to all families of children and young people with psychosis
[Link] or schizophrenia, particularly for preventing and reducing relapse.
Do not routinely offer counselling and supportive psychotherapy This can be started either during the acute phase or later, including
(as specific interventions) to people with psychosis or in inpatient settings [3].
schizophrenia. However, take service user preferences into
account, especially if other more efficacious psychological Treatment options for symptoms not sufficient for a diagnosis
treatments, such as CBT, family intervention and arts therapies, of psychosis or schizophrenia
are not available locally [2009]. 1.2.5
When transient or attenuated psychotic symptoms or other mental
1.5.4 state changes associated with distress, impairment or help-
Psychological interventions seeking behaviour are not sufficient for a diagnosis of psychosis or
SECTION 1: CLINICAL GUIDELINES RECOMMENDING FAMILY AND COUPLE THERAPIES

[Link] schizophrenia:
Offer family intervention to families of people with psychosis • consider individual cognitive behavioural therapy (CBT) (delivered
or schizophrenia who live with or are in close contact with as set out in recommendation 1.3.28) with or without family
the service user. Deliver family intervention as described in intervention (delivered as set out in recommendation 1.3.27).
recommendation [Link] [2009].
[Link] Treatment options for first episode psychosis
Family intervention may be particularly useful for families of people 1.3.11
with psychosis or schizophrenia who have: For children and young people with first episode psychosis offer:
• recently relapsed or are at risk of relapse • oral antipsychotic medication [7] (see recommendations 1.3.14–
• persisting symptoms [2009]. 1.3.25) in conjunction with
• psychological interventions (family intervention with individual
[Link] CBT, delivered as set out in recommendations 1.3.26–1.3.32).
For people with schizophrenia whose illness has not 1.3.12
responded adequately to pharmacological or psychological If the child or young person and their parents or carers wish to try
treatment: psychological interventions (family intervention with individual CBT)
• Review engagement with and use of psychological treatments alone without antipsychotic medication, advise that psychological
and ensure that these have been offered according to this interventions are more effective when delivered in conjunction
guideline. If family intervention has been undertaken suggest with antipsychotic medication. If the child or young person and
CBT; if CBT has been undertaken suggest family intervention for their parents or carers still wish to try psychological interventions
people in close contact with their families. alone, then offer family intervention with individual CBT. Agree
a time limit (1 month or less) for reviewing treatment options,
CG155 – PSYCHOSIS AND SCHIZOPHRENIA IN including introducing antipsychotic medication. Continue to monitor
CHILDREN AND YOUNG PEOPLE: RECOGNITION AND symptoms, level of distress, impairment and level of functioning,
MANAGEMENT including educational engagement and achievement, regularly.
1.3.13
A number of psychological interventions, including family If the child or young person shows symptoms and behaviour
intervention, cognitive behavioural therapy (CBT) and arts sufficient for a diagnosis of an affective psychosis or disorder,
therapies, have been used but evidence of efficacy is currently including bipolar disorder and unipolar psychotic depression,
unavailable in children and young people and provision of follow the recommendations in Bipolar disorder (NICE clinical
these therapies for children and young people and for adults is guideline 38) or Depression in children and young people (NICE
variable. clinical guideline 28).

6
 NICE Clinical Guidelines recommending Family and Couple Therapy

How to deliver psychological interventions

1.3.27
Family intervention should:
• include the child or young person with psychosis or schizophrenia
if practical
• be carried out for between 3 months and 1 year
• include at least 10 planned sessions
• take account of the whole family’s preference for either single-
family intervention or multi-family group intervention
• take account of the relationship between the parent or carer and
the child or young person with psychosis or schizophrenia
• have a specific supportive, educational or treatment function and
include negotiated problem solving or crisis management work
[6].

1.4
Subsequent acute episodes of psychosis or schizophrenia
1.4.1
For children and young people with an acute exacerbation or
recurrence of psychosis or schizophrenia offer:
• oral antipsychotic medication[7] in conjunction with
• psychological interventions (family intervention with individual
CBT).

Psychological and psychosocial interventions

1.4.4
Offer family intervention (delivered as set out in recommendation

SECTION 1: CLINICAL GUIDELINES RECOMMENDING FAMILY AND COUPLE THERAPIES

1.3.27) to all families of children and young people with psychosis
or schizophrenia, particularly for preventing and reducing relapse.
This can be started either during the acute phase or later, including
in inpatient settings [6].

Interventions for children and young people whose illness has

not responded adequately to treatment
• review engagement with and use of psychological interventions
and ensure that these have been offered according to this
guideline; if family intervention has been undertaken suggest
CBT; if CBT has been undertaken suggest family intervention
for children and young people in close contact with their
families.

7
 NICE Clinical Guidelines recommending Family and Couple Therapy

Quick Reference

TABLE 2: RECOMMENDATIONS FOR INCLUDING FAMILIES AND CARERS

CG NO/ TITLE YEAR OF PUBLICATION OR UPDATE

REFERENCE
CG72 ADHD: Diagnosis and Management February 2016
CG170 Autism in Under 19s August 2013
NG11 Challenging Behaviour and Learning Disabilities May 2015
NG26 Children’s Attachment November 2015
CG42 Dementia May 2016
CG137 Epilepsies February 2016
CG156 Fertility Problems February 2013
NG42 Motor Neurone Disease February 2016
NG43 Obesity Prevention March 2015
CG189 Obesity: Identification, assessment and management November 2014
CG175 Prostate Cancer January 2014
CG159 Social Anxiety Disorder May 2013
CG162 Stroke Rehabilitation in Adults June 2013

SECTION 2: CLINICAL GUIDELINES RECOMMENDING INVOLVEMENT WITH FAMILIES AND CARERS

SECTION 2: CLINICAL GUIDELINES RECOMMENDING INVOLVEMENT WITH FAMILIES AND CARERS

CG72 – ADHD: DIAGNOSIS AND MANAGEMENT [Link]

When individual-based parent-training/education programmes for
1.5 pre-school children with ADHD are undertaken, the skills training
Treatment for children and young people stages should involve both the parents or carers and the child. [2008].

1.5.1 CG170 – AUTISM IN UNDER 19S: SUPPORT AND

Treatment for pre-school children MANAGEMENT
Parent-training/education programmes are the first-line
treatment for parents or carers of pre-school children. These 1.2
programmes are the same as those recommended for the Families and Carers
parents or carers of other children with conduct disorder. If
more help is needed the child can be referred to a tertiary 1.2.1
service. Offer all families (including siblings) and carers verbal and written
[Link] information about their right to:
Group-based parent-training/education programmes, developed • short breaks and other respite care
for the treatment and management of children with conduct • a formal carer’s assessment of their own physical and mental
disorders [3], should be fully accessible to parents or carers of health needs, and how to access these.
children with ADHD whether or not the child also has a formal 1.2.2
diagnosis of conduct disorder [2008]. Offer families (including siblings) and carers an assessment of their
[Link] own needs, including whether they have:
Individual-based parent-training/education programmes [3] • personal, social and emotional support
are recommended in the management of children with ADHD • practical support in their caring role, including short breaks and
when: emergency plans
• a group programme is not possible because of low participant • a plan for future care for the child or young person, including
numbers transition to adult services.
• there are particular difficulties for families in attending group 1.2.3
sessions (for example, because of disability, needs related When the needs of families and carers have been identified, discuss
to diversity such as language differences, parental ill-health, help available locally and, taking into account their preferences,
problems with transport, or where other factors suggest poor offer information, advice, training and support, especially if they:
prospects for therapeutic engagement) • need help with the personal, social or emotional care of the child
• a family’s needs are too complex to be met by group-based or young person, including age-related needs such as self-care,
parent-training/education programmes [2008]. relationships or sexuality

8
 NICE Clinical Guidelines recommending Family and Couple Therapy

• are involved in the delivery of an intervention for the child CG137 – EPILEPSIES; DIAGNOSIS AND
or young person in collaboration with health and social care MANAGEMENT
professionals.
Management
NG11 – CHALLENGING BEHAVIOUR AND LEARNING Healthcare professionals should adopt a consulting style that
DISABILITIES: PREVENTION AND INTERVENTIONS enables the child, young person or adult with epilepsy, and their
FOR PEOPLE WITH A LEARNING DISABILITY WHOSE family and/or carers as appropriate, to participate as partners in all
BEHAVIOUR CHALLENGES decisions about their healthcare, and take fully into account their
race, culture and any specific needs [2004].
Support and interventions for family members or carers 1.3.8
When providing support to family members or carers (including The child, young person or adult with epilepsy and their family
siblings): and/or carers as appropriate should know how to contact a named
• recognise the impact of living with or caring for a person with a individual when information is needed. This named individual
learning disability and behaviour that challenges should be a member of the healthcare team and be responsible for
• explain how to access family advocacy ensuring that the information needs of the child, young person or
• consider family support and information group if there is a risk of adult and/or their family and/or carers are met [2004].
behaviour that challenges, or it is emerging 1.3.9
• consider formal support through disability-specific support The possibility of having seizures should be discussed, and
groups for family members or carers and regular assessment of information on epilepsy should be provided before seizures occur,
the extent and severity of the behaviour that challenges for children, young people and adults at high risk of developing
• provide skills training and emotional support, or information seizures (such as after severe brain injury), with a learning disability,
about these, to help them take part in and support interventions or who have a strong family history of epilepsy [2004].
for the person with a learning disability and behaviour that 1.3.13
challenges Tailored information and discussion between the child, young person
• the person and their family members and carers are fully involved or adult with epilepsy, their family and/or carers (as appropriate) and

SECTION 2: CLINICAL GUIDELINES RECOMMENDING INVOLVEMENT WITH FAMILIES AND CARERS

in the assessment process healthcare professionals should take account of the small but definite
• the resilience, resources and skills of family members and carers risk of SUDEP (sudden unexpected death in epilepsy) [2004].
are taken into account.
CG156 – FERTILITY PROBLEMS: ASSESSMENT AND
Consider in-depth assessment involving interviews with family TREATMENT
members, carers and others, direct observations, structured record
keeping, questionnaires and reviews of case records. 1.1.2
Psychological effects of fertility problems
NG26 – CHILDREN’S ATTACHMENT: ATTACHMENT IN [Link]
CHILDREN AND YOUNG PEOPLE WHO ARE ADOPTED People who experience fertility problems should be offered
FROM CARE, IN CARE, OR AT HIGH RISK OF GOING counselling because fertility problems themselves, and the
INTO CARE investigation and treatment of fertility problems, can cause
psychological stress. [2004]
Interventions for children with attachment difficulties include:
video feedback programmes to foster carers, special guardians 1.14.2
and adoptive parents; intensive training and support and group Information and counselling
therapeutic play sessions. Further details about the method of [Link]
delivery of such interventions can be accessed via the full NICE Couples considering donor insemination should be offered
Guideline. counselling from someone who is independent of the treatment
unit regarding all the physical and psychological implications of
CG42 – DEMENTIA: SUPPORTING PEOPPLE WITH treatment for themselves and potential children. [2004]
DEMENTIA AND THEIR CARERS IN HEALTH AND [Link]
SOCIAL CARE Oocyte recipients and donors should be offered counselling from
someone who is independent of the treatment unit regarding
[Link] – The experience of the diagnosis of dementia is the physical and psychological implications of treatment for
challenging both for people with dementia and family themselves and their genetic children, including any potential
members and for healthcare professionals, so health care children resulting from donated oocytes. [2004]
professionals should make time available to discuss the
diagnosis and its implications with the person with dementia NG42 – MOTOR NEURONE DISEASE: ASSESSMENT
and also with family members (usually only with the consent AND MANAGEMENT
of the person with dementia). Healthcare professionals should
be aware that people with dementia and family members may 1.5.9
need ongoing support to cope with the difficulties presented Inform all healthcare professionals and social care practitioners
by the diagnosis. involved in the person’s care about key decisions reached with the

9
 NICE Clinical Guidelines recommending Family and Couple Therapy

person and their family members and/or carers (as appropriate) 1.1.8
[new 2016]. Encourage parents (or carers) to take main responsibility for lifestyle
1.6.3 changes in children who are overweight or obese, especially if they
During multidisciplinary team assessments and other are younger than 12 years. Take into account the age and maturity
appointments, discuss the psychological and emotional impact of of the child, and the preferences of the child and the parents. [2006]
MND with family members and/or carers (as appropriate), and ask
whether they have any psychological or social care support needs. CG175 – PROSTATE CANCER; DIAGNOSIS AND
1.6.4 MANAGEMENT
Offer family members and/or carers (as appropriate) information
about respite care and sources of emotional and psychological 1.1.13
support, including support groups, online forums and counselling Offer men with prostate cancer and their partners or carers the
or psychology services [new 2016]. opportunity to talk to a healthcare professional experienced in
dealing with psychosexual issues at any stage of the illness and its
CG43 – OBESITY PREVENTION treatment [2008].

[Link] CG159 – SOCIAL ANXIETY DISORDER: RECOGNITION,

Interventions to improve diet (and reduce energy intake) should ASSESSMENT AND TREATMENT
be multicomponent (for example, including dietary modification,
targeted advice, family involvement and goal setting), be tailored Working with parents and carers
to the individual and provide ongoing support. 1.1.15
[Link] If a parent or carer cannot attend meetings for assessment or
Families of children and young people identified as being at high risk treatment, ensure that written information is provided and shared
of obesity – such as children with at least one obese parent – should with them.
be offered ongoing support from an appropriately trained health 1.1.16
professional. Individual as well as family-based interventions should If parents or carers are involved in the assessment or treatment
SECTION 2: CLINICAL GUIDELINES RECOMMENDING INVOLVEMENT WITH FAMILIES AND CARERS

be considered, depending on the age and maturity of the child. of a young person with social anxiety disorder, discuss with the
[Link] young person (taking into account their developmental level,
Family programmes to prevent obesity, improve diet (and reduce emotional maturity and cognitive capacity) what form they would
energy intake) and/or increase physical activity levels should like this involvement to take. Such discussions should take place at
provide ongoing, tailored support and incorporate a range of intervals to take account of any changes in circumstances, including
behaviour change techniques (see section 1.2.4). developmental level, and should not happen only once. As the
involvement of parents and carers can be quite complex, staff
CG189 – OBESITY: IDENTIFICATION, ASSESSMENT should receive training in the skills needed to negotiate and work
AND MANAGEMENT with parents and carers, and also in managing issues relating to
information sharing and confidentiality. [This recommendation is
Children adapted from Service user experience in adult mental health (NICE
1.1.4 clinical guidance 136).]
Coordinate the care of children and young people around their 1.1.17
individual and family needs. Comply with the approaches outlined Offer parents and carers an assessment of their own needs including:
in the Department of Health’s A call to action on obesity in • personal, social and emotional support.
England[1] [2006, amended 2014]. • support in their caring role, including emergency plans.
1.1.5 • advice on and help with obtaining practical support.
Aim to create a supportive environment [2] that helps a child who
is overweight or who has obesity, and their family, make lifestyle CG162 – STROKE REHABILITATION IN ADULTS
changes [2006, amended 2014].
1.1.6 If the patient agrees, families and carers should have the
Make decisions about the care of a child who is overweight or has opportunity to be involved in decisions about treatment and
obesity (including assessment and agreeing goals and actions) care. Families and carers should also be given the information and
together with the child and family. Tailor interventions to the needs support they need.
and preferences of the child and the family [2006]. 1.5.2
1.1.7 Support and educate people after stroke and their families and
Ensure that interventions for children who are overweight or have carers, in relation to emotional adjustment to stroke, recognising
obesity address lifestyle within the family and in social settings that psychological needs may change over time and in different
[2006, amended 2014]. settings.

10
 NICE Clinical Guidelines recommending Family and Couple Therapy

APPENDIX

Title Date Published/Updated

Antenatal & postnatal mental health clinical management & service guidance – CG192 December 2014
Antisocial behaviour & conduct disorders in children & young people: recognition & management March 2013
– CG158
Antisocial personality disorder: prevention & management – CG77 March 2013
Attention deficit & hyperactivity disorder: diagnosis & management – CG72 February 2016
Autism in under 19s: support & management – CG170 August 2013
Bipolar disorder: assessment & management – CG185 February 2016
Cardiovascular disease: risk assessment & reduction – CG181 July 2016
Care of dying adults in last days of life – NG31 December 2015
Challenging behaviour & learning disabilities: prevention & interventions for people with learning May 2015
disability whose behaviour challenges – NG11
Children’s attachment: attachment in children & young people who are adopted from care, in care, November 2015
or at high risk of going into care – NG26
Chronic kidney disease in adults: assessment & management – CG182 January 2015
Community engagement: improving health & wellbeing & reducing health inequalities – NG44 January 2015
Cirrhosis in Over 16s: Assessment and Management – NG50 July 2016
Crohn’s Disease: Management – CG152 May 2016
Dementia: supporting people with dementia & their carers in health & social care – CG42 May 2016
Depression in adults: recognition & management – CG90 April 2016
Depression in children & young people: identification & management – CG28 March 2015
Diabetes Type 1 & 2 in children & young people: diagnosis & management – NG18 August 2015
Epilepsies: diagnosis & management – CG137 February 2016
Familial breast cancer: classification, care & management of breast cancer & related risks in people August 2015
with familial history of breast cancer – CG164
Fertility problems: assessment & treatment – CG156 February 2013
Hepatitis B chronic: diagnosis & management – CG165 June 2013
IBS in adults: diagnosis & management – CG61 February 2015
Motor neurone disease: assessment & management – NG42 February 2016
MS in adults: management – CG186 October 2014
Non-alcoholic fatty liver disease: assessment & management – NG49 July 2016
Non-Hodgkin’s Lymphoma: Diagnosis and Management – NG49 July 2016
Obesity: prevention – CG43 March 2015
Obesity: identification, assessment & management – CG177 February 2014
Prostate cancer: diagnosis & management – CG175 January 2014
Psychosis & schizophrenia in adults: prevention & management – CG178 March 2014
Psychosis & schizophrenia in children & young people: recognition & management – CG155 May 2016
Rheumatoid arthritis in adults: management – CG79 December 2015
Social anxiety disorder: recognition, assessment & treatment – CG159 May 2013
Stroke rehabilitation in adults – CG162 June 2013
Suspected cancer: recognition & referral – NG12 June 2015
Transition from children’s to adults’ services for children & young people using health & social care February 2016
services – NG43
Type 1 diabetes in adults: diagnosis & management – NG17 July 2016
APPENDIX

Type 2 diabetes in adults: management – NG28 July 2016

Violence & aggression: short-term management in health, mental health & community settings – May 2015
NG10

11
NICE Clinical Guidelines recommending Family and Couple Therapy

12