Family therapy

Family therapy

Who does family therapy involve?

Families of schizophrenic patient

Family therapy

What does family therapy aim to do?

• improve quality of communication and interaction b/w family members

• reduces EE (hostility, verbal criticism, emotional over-involvement)

• reduce stress within family and S patient → less risk of relapse bcs more likely to be cooperative w/ medical advice/be diligent w/ APs

Family therapy

How does family therapy achieve it’s aims?

• Increases feelings of self-efficacy

• Train families to look for signs of S episodes

• Reduces expression of anger and guilt by family members

• Maintaining reasonable expectations among family members for patient performance

Family therapy

What did Gill (2007) find about family therapy?

• reduced the chances of relapse/rehospitalisation within a year (despite no effect on EE levels)

• improved compliance with taking medication

Family therapy

What was Pharoah et al (2010)’s procedure?

• reviewed 53 studies published b/w 2002-10 on effectiveness of family intervention

• studies conducted in Europe, Asia and North America

• vs outcomes of standard care

Family therapy

What are the results of Pharoah et al (2010)

• Cognitive: mixed results on improvement to mental state

• Behavioural: improved compliance w/ meds

• Behavioural: improved social functioning BUT to an extent (eg: employment not effected)

• Reduced relapse/rehospitalisation during + 2 yrs after treatment

Family therapy (FT)

What do the findings of Pharoah et al (2010) suggest?

• FT effective in improving clinical outcomes (eg: mental state)

• BUT may be bcs of increase of AP compliance not FT itself (like Gill (2007)

Family therapy

Evaluation: Support

Pharoah et al (2010) suggests FT is effective - found less likely to relapse than those w/o FT → suggests FT = important to reduce relapse rates BUT - evidence (eg: Pharoah et al (2010), Gill (2007)) suggests improvement is bcs of compliance to medication, NOT FT alone → suggests that if patients complied w/o FT results would be similar → Qs effectiveness of FT

Family therapy

Evaluation: methodological issue w/ Pharoah et al (2010)

Pharoah’s M-A identified problem of random allocation → Large no. of studies were from China → Wu (2006) found many Chinese studies stated use of random allocation, BUT didn’t → in some studies the observers weren’t blind to condition (FT vs standard care) → SO may increased observer bias → SO issues w/ evidence makes hard to conclude effectiveness

Family therapy

Evaluation: alternative

CBTp = alt → seeks to help patient understand symptoms/normalise experience → can reduce anxiety + develop healthy coping strategies to help day-to-day life→ improves quality of life where they’re challenging/understanding thoughts/experiences which previously scared them + activating healthy behaviours they otherwise may not have used → SO may be better alt, esp for SP’s whose fams = unwilling to do FT

Family therapy

Evaluation: practical application

Econ benefits → NICE's review found FT's associated w/ sig. cost savings when offered w/ standard care → extra costs of FT = offset by lower relapse rates → cost savings = higher

Family therapy

Evaluation: Culture bias, nomothetic approach

Nomothetic approach (suggests everyone will have similar benefits) BUT may not be culturally universal + more research needed to find effectiveness in other cultures eg: African cultures→ suggests idiographic approach = better when considering treatment