Psychological: Family dysfunction & Family therapy

Family dysfunction is a for schizophrenia

Risk factor

What is the double find theory (risk factor )?

When you receive two conflicting messages: verbally affectionate but non-verbally hostile. This causes child to feel worried about doing the wrong thing, but as they receive mixed messages they are unsure if something is right or wrong. When they get it 'wrong', they are punished with withdrawal of love. Child thinks the world is dangerous, confusing, and unpredictable.

What 4 symptoms could be magnified by the double bind? How?

Paranoid delusions - child can’t predict the world, paranoid of what negative conflict will happen next.

Avolition - child faced with failure constantly, appears to always be in the wrong, helpless and unmotivated

Disorganised behaviour - could act out as don’t know what’s right or wrong

Emotional flattening - child afraid to show emotion as this has maybe been followed by a negative confrontation

What type of explanation is schizophrenic mother?

Causal explanation

Explain the schizophrenic mother theory, and symptoms it can cause.

Mother is cold, rejecting, and controlling. Environment is tense and full of secrecy.

Leads to child feeling distrust, could develop into paranoid delusions. Child may feel they are being victimised, could magnify into child believing people are out to get them. Also, mother doesn't show much normal emotion, could lead to emotional flattening due to little opportunity to observe normal emotional functioning.

Who came up with schizophrenic mother theory? How?

Fromm-reichman from what she had heard from patients.

What type of explanation is expressed emotion?

Risk to triggering relapse

Explain expressed emotion

This is a family communication style of: criticism, hostility and over-involvement. They tend to talk more and listen less. It is important to recognise that this theory only claims to explain how someone with a genetic vulnerability can be triggered to develop schizophrenia OR it can cause a RELAPSE in someone who already has schizophrenia.

It appears that the negative emotional climate in these families, leads to high levels of stress. This stress mounts on top of their already impaired coping mechanisms, thus triggering a schizophrenic episode.

Research to support the double bind theory

Bateson - outlines examples through clinical observations and interviews of dysfunctional families. One example included observing a mother who was visiting her son in hospital after a schizophrenic episode. He put his arm around her and the mother stiffened and moved away. When he withdrew his arm and the mother asked him "Don't you love me any more?" Following her departure he assaulted a nurse. This evidences the confusing mixed messages that may be experienced and evidences a link between family dysfunction and schizophrenia.

Useful applications of family dysfunction as risk factors/causal explanations

Development of family therapies

Research of family therapy effectiveness

Pharoah et al. developed a type of family therapy and reviewed 53 studies in order to understand the effectiveness of it for families of schizophrenia sufferers. They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of a year and improves quality of life for patients and their families.

Issue with research for family dysfunction

Double bind and schizophrenic mother have no empirical evidence. Bateson is anecdotal, and could be biased as may have looked for examples in love with his theory. The research gathered about childhood experiences was collected after symptoms had developed. The patients may have distorted views of their childhood as they may have experienced auditory or visual hallucinations that they were unable to separate from reality.

How are the theories/research socially sensitive?

Research by Fromm-Reichman and Bateson create a sense of parent blaming. Parents have already suffered enough by living with a child who has schizophrenia. Parents of schizophrenics are typically life long carers. There are serious ethical concerns in blaming the family, particularly as there is little evidence upon which to base this.

Alternate explanations to family dysfunction and research

Risk of developing schizophrenia was 27.3% for children who had 2 parents diagnosed with bipolar or schizophrenia. The family dysfunction explanation and the cognitive explanation ignores the impact of the biological causes. This suggests that the psychological explanations are too simplistic. It is also difficult to assume that cognitive faults or family dysfunction leads to hallucinations, especially when there is a lot more biological support for the positive symptoms.

Main aim of family therapy for schizophrenics

Provide support for carers to make family life less stressful and reduce re-hospitalisation

3 main steps of family therapy

Identify, educate, communicate

Identify - family therapy

Through interviews and observation, therapist identifies strengths and weaknesses of family members and identifies problem behaviours

Educate - family therapy

Teaching patient and family the actual facts about the illness, its causes, influence of drugs, and effect of stress and guilt

Communicate - family therapy

Training family in skills that help them to communicate more effectively with each other

Pharoah et al recommends many strategies for family therapy. What is the memory device?

UNITES

UNITES

Unity in caring for schizophrenic individual
Negative emotion and stress reduction
Irritation and guilt reduction
Teaching boundaries
Educating relatives about schizophrenia
Solve and anticipate problems

Research to support the effectiveness of family therapy

Pharoah et al - developed a type of family therapy and then reviewed 53 studies in order to understand the effectiveness of it for families of schizophrenia sufferers. They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of a year, improves medication compliance and improves quality of life for patients and their families.

Research to question the effectiveness of family therapy

Pharoah et al showed mixed results. They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of a year, improves medication compliance and improves quality of life for patients and their families. Firstly, the evidence is described as 'moderate', which implies that there is mixed findings in terms of how effective it is. Secondly, it could be suggested that the main reason for its effectiveness is more to do with the fact that it increases medication compliance. Patients are more likely to reap the benefits of medication because they're more likely to comply with their medication. This casts doubt on the effectiveness of family therapy alone. Therefore, we must be cautious in drawing the conclusion that family therapy is effective in treating schizophrenia as it is difficult to establish a cause and effect when considering the research by Pharoah.

How does family therapy encourage free will?

works on the basis that the patient has to make a conscious choice to be committed to the treatment causes some issues. So patient is empowered!

Issues with free will in family therapy

requires the commitment of not just one member, but several. This may not be possible, as some members of the family may not be want to participate as they find it too painful. In addition, the negative symptoms such as avolition and emotional flattening can lead to a reluctance to participate and an inability to engage and therefore act as a deterministic factor.

Positive of family therapy vs drugs

doesn't cause any physical side effects in comparison to anti-psychotic drugs

Issue with family therapy practicality

Expensive and time consuming, hard to do o a mass scale

How is family therapy idiographic?

Family therapy targets and improves the unique deficits of each individual. Unlike drug therapies that provide a one fits all approach.