psychological therapy for schizophrenia

• The aims of CBT are to help clients identify irrational thoughts and try to change them. Clients usually have 15-20 sessions in groups or individually. Clients are helped to make sense of how their delusions and hallucinations impact their feelings and behaviour. For example, a client may hear voices and believe they are demons so they become afraid
• a case example of CBT is Tarkington et al. who treated a paranoid client who believed the mafia were plotting to kill him. The therapist acknowledged the client's anxiety, and explained that there were other, less frightening possibilities and gently challenged the client's evidence for his belief in the mafia explanation
• Family therapy aim to reduce levels of expressed emotion and negative symptoms such as anger and guilt which create stress. The therapist encourages family members to form a therapeutic alliance where they all agree on the aims of therapy. The therapist also tries to ensure that family members achieve a balance between caring for the individual with SZ and maintaining their own lives
• Burbach's model of family therapy includes:

  • phases 1 and 2- share information and identify resources family can offer
  • phases 3 and 4- learn mental understanding and look at unhelpful patterns of interaction
  • phases 5,6 and 7- skills training such as stress management techniques, relapse prevention and maintenance
• One strength if CBT is evidence for its effectiveness. Jauhar et al. reviewed 34 studies of CBT for SZ, and concluded that there is evidence for significant effects on symptoms. Portillo et al. found reductions in audiotory hallucinations. Clinical advice from NICE recommends CBT for people with SZ. This means both research and clinical experience support CBT for SZ
• One limitation of CBT is the quality of evidence. Thomas points out that different studies have focused on different CBT techniques and people with different symptoms. Overall, modest benefits of CBT for SZ may conceal a range of effects of different techniques on different symptoms. This means that it is hard to say how effective CBT will be for treating a particular person with SZ
• One strength of family therapy is that there is evidence for its effectiveness. McFarlane concluded family therapy is effective for SZ. Relapse rates were reduced by 50-60%. Particularly promising during time when mental health initially starts ti decline. NICE reccomends family therapy. This means that family therapy is good for people with both early and 'full-blown' SZ
• One strength of family therapy is that it benefits the whole family. Therapy is not just for benefit of identified patient but also for the families that provide bulk of care for people with SZ. Family therapy lessens the negative impact of SZ on the family and strengthens ability of the family to give support. This means family therapy has wider benefits beyond the obvious positive impact on the identified patient.