Family therapy

• Families can play an important role in helping a person with schizophrenia recover and stay well
• The main aim of family therapy is to improve the quality of communication and interaction between family members and provide support for carers in an attempt to make family life less stressful and reduce rehospitalisation
• Nature of family therapy:

  Offered for a period of between 3 and 12 months and at least 10 sessions. Family-based interventions are aimed at reducing levels of expressed emotions
• Family therapy typically involves providing family members with information about schizophrenia, finding ways of supporting an individual with SZ and resolving any practical problems
• Family therapy improves relationships within the household because the therapist encourages family members to listen to each other and openly discuss problems and negotiate potential solutions together
• Family therapies include a number of strategies:

  • Psychoeducation
  • Alliance
  • Reducing emotional climate
  • Enhancing relatives abilities
  • Reducing expressions
• Psychoeducation - helping the person and their carers to understand and be better able to deal with the illness
• Alliance - forming an alliance with relatives who care for the person with SZ
• Reducing emotional climate - within the family and the burden of care for family members
• Enhancing relatives abilities - to anticipate and solve problems
• Reducing expressions - such as anger and guilt by family members
• Appropriate limits - encouraging relatives to set appropriate limits whilst maintaining some degree of separation when needed
• AO3 - research evidence

  Pharoah reviewed 53 studies to investigate effectiveness of family intervention, comparing family therapy to standard care
• AO3 - Pharoah main findings

  Mental state - overall impression was mixed. Some reported improvement in mental state due to family therapy

  Compliance with medication - family intervention increased patients compliance

  Social functioning - family intervention didn't appear to have much of an affect

  Reduction in relapse and readmission - reduction in the risk of relapse due to family therapy
• AO3 - methodological limitations

  Problem of random allocation - in Pharaohs 53 studies a large number of studies use people from China. Evidence emerged that in many Chinese studies, random allocation was not used
• AO3 - methodological limitations

  Lack of binding - possibility of observer bias where raters were not 'binded' to the condition to which people were allocated. 10 studies reported no form of binding was used