Family therapy

• What is meant by family therapy in terms of schiz?

  Name given to a range of interventions aimed at the family of someone with schizophrenia
• what do NICE recommend about family therapy?

  • should be offered to all individuals diagnosed with schizophrenia in contact with family members
  • these interventions should be considered a priority when symptoms are persistent or there’s a high risk of relapse
• What has research shown about high EE families and schizophrenics?

  Schizophrenia in families with highly expressed levels of criticism, hostility or over-involvement have more frequent relapses than people with the same problems that lived in less EE families
• how long does family therapy usually last? how many sessions are involved?

  • 3-12 months
  • ten sessions
• What do family based interventions aim to do?

  • Reduce the levels of EE within the family
  • As EE has shown to increase the likelihood of relapse
• what did Garety et al estimate about the relapse rates for individuals who receive family therapy?

  25%, compared to 50% for those who receive standard care alone
• What does family therapy help with and involve?

  • Providing family members with info about schiz
  • Finding ways to support person with schiz
  • Resolving any practical problems
  • Improves rels within the household because therapist encourages the family members to openly discuss problems, listen to each other and negotiate potential solutions together
• why is it a good idea to involve the schiz patient in family therapy?

  • characteristic of psychoses is that people are often suspicious about their treatment
  • involving individual more actively overcomes this problem
• describe a key study showing the effectiveness of family therapy

  pharaoh et al:

  • reviewed 53 studies to investigate effectiveness of family intervention
  • compared outcomes from family therapy to standard care alone
  • findings- MENTAL STATE- mixed findings, some reported it was better , some didn’t
  • COMPLIANCE WITH MEDS- increased
  • SOCIAL FUNCTIONING- some improvement, but no effect in more concrete outcomes like living independently or being employed
  • REDUCTION IN RELAPSE- and hospital admission during treatment and 24 mths after treatment
• How does family therapy work?

  Aims to reduce relapse incidence, EE, and increasing relatives abilities to solve related problems. Number of techniques used-

  • Psychoeducation- helping person and carers to understand and deal with illness better
  • Forming alliance with relatives- who care for the patients
  • Reducing emotional climate- and burden of care for family members
  • Enhancing anticipation of problems- maintaining reasonable explanations among family members for patient performance. Encourage relatives to set appropriate limits while maintaining degree of separation when needed

  PREA
• Evaluation of family therapy?

  • 😊 economic benefits- NICE review of FT alongside standard care- reduction in hospitalisation due to reduction of relapse
  • 😊increase in compliance with medication- pharaoh et al, 2010, successfully reducing relapse rates
  • ☹️methodological limitations - pharaoh et al meta analysis- some studies were China ones, no random allocation, lack of blinding to standard care/family interventions- lack of validity
  • ☹️FT isnt worth it- Garety et al- no difference in relapse rates for FT and those who had carers, carers showed little EE, good standard care is as effective