Family Therapy Schizophrenia

• The importance of family, particularly in schizophrenic relapse has led to the development of numerous family interventions.
• Family interventions use a variety of therapeutic techniques to educate and inform the patient and their family and develop strategies for managing the illness.
• Family therapy helps to overcome the issues associated with dysfunctional families and shows them more positive ways of dealing with the stress of a life with a family member with schizophrenia.
• Family therapy takes place with families as well as the identified patient. The therapy aims to improve the quality of communication and interaction between family members.
• Pharoah et al (2010) identified a range of strategies that family therapists use to try and improve the functioning of the family that has a member with schizophrenia.
• Family therapy aims to reduce levels of expressed emotion (EE), which is often felt through negative emotions such as anger and guilt.
• Returning home to high expressed emotion (EE) environments causes higher relapse rates in patients with schizophrenia.
• Family therapy can help reduce stress which in turn lowers the likelihood of patients having a relapse.
• The goals of family therapy are to give the family all the information they need to understand the illness.
• Family therapy encourages discussion about what it is like to live with a family member with schizophrenia. This discussion is carried out to allow family members an opportunity to share their support.
• Family therapy can help the family understand that they are not to blame for the illness and give them ways to help the individual with the disorder move forward.
• Family therapy allows all members to voice their opinions and provides a safe space to discuss their feelings about living with a family member with schizophrenia.
• Family therapy takes place over many sessions and is usually carried out in the patient's home. Group sessions can also take place where several families share their experiences.
• In family therapy the therapist encourages the family members to form a therapeutic alliance whereby they all agree on the aims of the therapy.
• In family therapy the therapist tries to improve the family's beliefs, attitudes and behaviours towards schizophrenia.
• Another aim of family therapy is to ensure that family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.
• Burbach (2018) proposed a model for working with families dealing with schizophrenia. This model of practise enables the family to move through a series of phases to offer emotional and practical support to their family member.
• Pilling et al (2002) compared family therapy to other types of treatment in a meta-analysis of 18 different studies. They found patients who experienced family therapy had fewer relapses and less hospital admissions.
• A meta-analysis by Bird et al (2010) showed that family interventions in early psychosis significantly reduced relapse and re-admission rates.
• A review article by Caqueo-Urizar et al (2015) highlighted the burden placed on the family when caring for a patient with schizophrenia. Without support they frequently experience stress and isolation but will have more positive outcomes with family intervention.
• One form of family therapy, known as the Optimal Treatment Project, combines training for patients and their families in coping with stress, social skills and crisis management.
• The Optimal Treatment Project (family therapy) has been successfully used in more than 20 countries worldwide.
• Family therapy has been found to have a positive influence on many outcomes including drug compliance.
• The National Institute for Health and Care Excellence (NICE) suggest that family intervention should be used for patients who have persistent and relapsing conditions and who are supported by a caregiver.
• Falloon et al (1985) looked at relapse rates for patients receiving family therapy where 11% were re-hospitalised within one year compared with those receiving only individual therapy where 50% were re-hospitalised within a year.
• Pharoah et al (2003) found that relapse rates and hospitalisations were significantly reduced following family interventions.
• During family therapy individual family members can provide valuable information about how the patient is dealing with the disorder on a day-to-day basis.
• Younger patients with schizophrenia will still be living at home with their parents as caregivers, and will benefit from the support of family therapy.
• McFarlane (2016) conducted a review of studies and concluded that family therapy was one of the most consistently effective treatments available for schizophrenia.
• McFarlane (2016) found that relapse rates were reduced by 50-60% in patients with schizophrenia following family therapy.
• Lobban & Barrowclough (2016) concluded family therapy was just as important for the identified patient as it is for the families themselves.
• If family therapy is conducted in the homes of patients, it is likely to have less of an economic impact on the institutionalised healthcare system.
• Family therapy does not work in all cases as each family member has to be prepared to engage with the therapy.
• As with CBT, family therapy is usually used in conjunction with medication.
• Patients with schizophrenia come from a wide variety of family backgrounds, so family intervention may not always be appropriate.
• Family therapy is time consuming and can be a costly process which may explain why it is not as successful as drug therapy.