Family therapy

• Family therapy aims to improve communication and interaction between families if the therapist sees the family as the root cause of the condition
• Family therapy reduces stress within families that might contribute to relapse
• Family therapy aims to reduce levels of expressed emotion
• Pharaoh et al ( 2010 ) identified strategies used in family therapy:

  Forming therapeutic alliance with family members

  Reduce the stress of caring for a relative with SZ

  Improve ability of the family to anticipate and solve problems

  Reduce anger and guilt in families

  Help family balance their life

  Educate about SZ
• Family therapy key study - Pharoah et al ( 2010 )
• Pharoah et al ( 2010 ) reviewed 53 studies to investigate the effectiveness of family intervention
• Pharoah et al ( 2010 ) used studies from Europe, Asia and North America
• Pharoah et al ( 2010 ) compared the effectiveness of family therapy to " standard " care such as antipsychotics alone
• Pharoah et al ( 2010 ) found that family therapy lead to:

  Mental state - mixed, some improved and some didn't

  Compliance with medication - increased

  Social functioning - some improvement on general functioning, but didn't have an impact on living independently

  Reduction in relapse and readmission - there was a reduction in the risk of a relapse and a reduction in hospital admission during treatment and 24 months after
• We are unsure if family therapy is effective. Pharoah et al ( 2010 ) conducted meta analysis and found that family therapy can be effective in improving clinical outcomes such as mental state and social functioning. However, the authors suggest that this is less to do with the therapy and more to do with the fact it increases medication compliance. Patients are more likely to reap the benefits of medication because they are more likely to comply with their medication, helping them recover. 
• There are methodological limitations of family therapy studies. Pharoah ( 2010 ) meta analysis has a problem of random allocation. Although all 53 studies claim to have randomly allocated participants to treatment conditions, the researchers note that a large number of studies used in this analysis were from China. Evidence has emerged that in many Chinese studies, random allocation has been stated, but was not used. 
• There are economic benefits of family therapy.  The NICE review of family therapy studies demonstrated that family therapy is associated with significant cost savings when offered to patients. The extra cost of family therapy is offset by a reduction in hospital costs because of lower relapse rates. There is also evidence that family therapy reduces relapse rates for a significant period after completion of the intervention. This means that the cost savings associated with family therapy would be even higher. 
• Family therapy has been shown to have an advantage on not only the sz patient but the other family members involved. Lobban et al ( 2013 ) analysed the results of 50 family therapy studies that had included an intervention to support relatives. 60 % of these studies reported a significant positive impact of the intervention on at least one outcome category for relatives. However, the researchers also concluded the methodological quality of the studies was generally poor, making it difficult to distinguish effective from ineffective interventions.