family therapy

what is family therapy?

a range of interventions aimed at the family of someone with a mental disorder

what has family therapy developed as a result of?

studies showing a connection between the family environment and the development of SZ

what is the main aim of family therapy?

to provide support for carers in an attempt to make family life less stressful to reduce rehospitalisation

how does family therapy work?

reduces levels of expressed emotion and stress and increases the capacity of relatives to solve related problems

what kind of strategies does family therapy include?

• psychoeducation

• forming an alliance with relatives who care for the schizophrenic

• reducing emotional climate of family

  • enhancing ability to anticipate and solve problems

what is psychoeducation?

helping the person and their carers to understand and be better able to deal with the illness

what is family therapy usually used in conjunction with?

routine drug treatment and outpatient clinical care

what does NICE recommend about family therapy?

it should be recommended to all people with SZ who are still in contact with their family members

when should family therapy be a priority?

where there are persistent symptoms or a high risk of relapse

how long is family therapy typically offered for?

between 3-12 months and at least 10 sessions

what did Garety find about relapse and family therapy?

the relapse rate for individuals who receive family therapy is 25% vs 50% for those who don’t

how can family therapy help overcome suspicion about treatment?

it actively involves the individual

how does family therapy improve household relationships?

therapist encourages family members to listen to each other and openly discuss problems and negotiate potential solutions together

what is the key study for family therapy?

Pharoah et al

what was Pharoah’s procedure?

• reviewed 53 studies between 2002-10

• investigate effectiveness of family therapy

• studies from NA, Europe & Asia

• compared outcomes of FT to ‘standard care’ alone

• concentrated on RCTs

what are RCTs?

randomised controlled trials

what did Pharoah et al find?

• mental state → mixed with some improvement and some lack of

• compliance with medication → FT increased patients compliance

• social functioning → showed some improvement on general functioning, but did not have much effect on more concrete outcomes e.g., living independently or employment

• reduction in relapse and readmission → reduction in risk of relapse and hospital admission during treatment + 24 months after

what are the strengths of family therapy?

• economic benefits - NICE review found it was associated with significant cost savings when offered in addition to standard care - cost of FT offset by reduction in costs of hospitalisation - lower relapse - evidence that lower relapse rates continue for a significant period post intervention

• improve outcomes for family members as well as SZ patients - Lobban: analysed 50 studies and found 60% reported a significant positive impact for at least one outcome category for relatives e.g., coping, problem skills, family functioning - however, methodology was generally poor so it was difficult to distinguish effective from ineffective interventions

what are the weaknesses of family therapy?

• improvements seen in Pharoah study may not be a direct result of FT - authors suggest main reason for effectiveness may have more to do with the fact it increased medication compliance - main benefit would then be that - indirect benefits

• methodological limitation - lack of blinding - methodological quality compromised in Pharoah study because in some studies, raters were not blinded to the condition of the pps - 10/53 studies did not use blinding - 16 did not mention whether or not blinding had been used - esp. problematic in studies with follow ups and pps tend to unintentionally reveal which type of therapy they had received

• may not be worthwhile - Garety: failed to show better outcomes for patients given sessions of family therapy compared to those who had carers but no family therapy - both groups had unexpectedly low rates of relapse compared to ‘no carer’ group - most carers displayed low levels of EE - reflects cultural changes to SZ - for many, FT may not improve outcomes further than a good standard of overall treatment