Family therapy

AO1

• Based on psychological explanation of sz

• Involves the patient and their family in structured sessions with a trained therapist.

• aims to reduce dysfunction & and improve communication and problem-solving within the family.

• Sessions typically involve all key family members and last 1–2 hours, usually weekly over several months.

• Techniques created by Pharoah include:

• Communication training – teaching families to express emotions and concerns without hostility or shame, reduce EE which can reduce relapse rates.

• Problem-solving strategies – helping families to work together to manage daily challenges.

• Psychoeducation – educate family about sz to dispel any myths or misundertstandings, increase sympathy & support

• Pharoah suggested these strategies work by reducing stress for patient & increasing chances of complying with medication, therefore decreasing chances of relapse

Strengths AO3

• P - research support

• E - Pharoah et al. conducted a meta-analysis of 53 controlled trials involving patients with schizophrenia and found that FT delivered alongside standard care significantly reduced relapse rates by 20-25% & improved social functioning.

• T- demonstrates that FT is a an effectivee treatment, making it a practical intervention for schizophrenia in real-world clinical settings. Economic implications

• HOWEVER was used alongside drug treatments so difficult to establish whether improvements were actually due to family therapy or solely due to drug treatment. May be more appropriate as an adjunctive treatment rather than a standalone

Limitations AO3

• P - not suitable for all patients or families

• E - FT requires both the patient and family members to be motivated, engaged, and able to communicate effectively, as therapy relies on techniques such as problem-solving, communication training, and reality testing. Patients with severe positive symptoms (eg intense hallucinations & delusions) may lack the insight or stability required to participate meaningfully, limiting their ability to benefit from therapy. Likewise, families experiencing high levels of dysfunction, conflict, or abuse may struggle to attend sessions consistently, engage cooperatively, or implement the coping strategies taught in therapy. In some cases, attempts to involve such families may even increase stress, as unresolved conflicts or feelings of blame are brought to the surface.

• T - while family therapy can be highly beneficial for families who are stable, supportive, and motivated, it is not universally applicable, meaning that a substantial proportion of patients with schizophrenia may not have access to, or benefit from, this intervention. This limitation highlights the need for individual assessment before offering FT and suggests that alternative or supplementary treatments may be necessary for less suitable cases.

• P - time consuming & costly

• E - typically involves multiple sessions over several months, often delivered weekly or fortnightly by highly trained therapists. This intensive format requires substantial financial and staffing resources, making it difficult for healthcare systems such as the NHS to provide the therapy to all patients who could benefit. The time commitment can also be challenging for patients and family members, particularly those who are working, caring for others, or experiencing high stress, which may lead to irregular attendance or early dropout. High attrition rates limit the continuity of therapy, reducing the opportunity for families to fully develop the communication and coping skills necessary to prevent relapse.

• T - practical application is constrained, and many patients may not receive the full therapeutic benefit. This limitation highlights the challenge of implementing FT widely and suggests that, despite its proven efficacy, it may be less feasible as a standard treatment for all families affected by schizophrenia.

• P - does not directly address the biological symptoms of schizophrenia, such as hallucinations, delusions, or cognitive deficits.

• E - sz has a strong biological component, including dopamine dysregulation and genetic vulnerability, which FT cannot modify. While therapy can help patients cope with symptoms and reduce environmental stressors that trigger relapse, it does not reduce the underlying neurochemical or structural causes of the disorder. This means that family therapy is usually used alongside antipsychotic medication, which targets these biological factors.

• T - Consequently, FT is primarily an adjunctive or supportive treatment rather than a standalone intervention, limiting its overall effectiveness in fully treating the disorder. Patients who rely solely on FT would likely continue to experience significant symptoms, highlighting that it cannot replace pharmacological treatment and must be combined with medication to achieve meaningful symptom reduction. This limitation underscores the need for a holistic treatment approach for schizophrenia that addresses both biological and psychosocial factors.

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