Family therapy

• Family therapy attempts to improve home situation of person with SZ and attempts to improve whole family, not just SZ patient. It takes place with families rather than individual patients. Therapist encourages family to ask questions and learn more about SZ.

  It aims to improve the quality of communication and interaction between family members. Most family therapists aim to reduce stress within the family that may contribute to a patient’s risk of relapse. It aims to reduce levels of expressed emotion.
• psychoeducation is when the family is educated on SZ symptoms to make them more understanding.
• How family therapy helps:

  Fiona Pharoah et al.(2010) identified strategies to improve functioning of a family with a member suffering from SZ:

  forming a therapeutic alliance with all family members, reducing anger and guilt in family members and stress of caring for someone with SZ, helping families maintain a balance between caring for the individual with schizophrenia and maintaining their own lives.
• Pharoah suggested strategies work by reducing stress levels and expressed emotion whilst increasing chances of patients’ complying with medication, leading to reduced likelihood of relapse and readmission to hospital.
• Leff 1985 looked into aftercare of SZ patients. Only 8% who had family therapy relapsed after 9 months compared to 50% who did not. However this had risen to 50 after 2 years and 75% without. Suggests family therapy is helpful in the short term, but families may not maintain positive patterns in long term.
• Family therapy improves symptoms but it is not a cure. .
• Family therapy can take up to a year, patients may drop out if they have severe symptoms or family incident.
• Pharoah et al reviewed evidence for family therapy and concluded that there is moderate evidence to show that family therapy reduces hospital readmission and improves the quality of life for the patient and their families. They noted that different studies had inconsistent findings so the evidence overall for family therapy is weak
• Pharoah et al 2012 reviewed 53 studies published between 2002 and 2010 to investigate family therapy effectiveness. Studies were conducted in Europe, Asia and North America. Compared outcomes of family intervention to standard care. Some studies had improved metnal states compared to standard care whilst others did not. Family intervention increased use of medication. Family therapy seemed to have little effect on social functioning like living independently. It's effectiveness may have more to do with medication compliance. Problem of randomisation: large number of studies came from China.
• The NICE review of family therapy found it is associated with significant cost savings. The extra cost of family therapy led to a reduced cost in hospital administration because of lower relapse rates. There is also evidence that family therapy reduces relapse rates for a significant period after family therapy. This means cost savings would be even higher.
• Most evidence comes from China, hospital administration may differ across countries, meaning data from one country may not be applicable to another.
• Family therapy may be socially sensitive and problematic, as labels such as a schizophrenogenic mother may cause conflict.