Family therapy

  • Families can play an important role in helping a person with schizophrenia recover and stay well

  • Family intervention in the treatment of schizophrenia has developed as a result of studies of the family environment and its possible role in affecting the course of schizophrenia

  • Research has consistently shown that the long-term outcome for an individual with schizophrenia has much to do with the relationship between the individual and those who care for them

  • Based upon the assumption that stressful family life causes relapse

  • Brown et al. (1972): Families in which there were high levels of criticism, hostility or over involvement in the person’s problems had a higher rate of relapse than any other group

Fiona Pharaoh et al. (2010) outlined the main aim for family intervention therapy saying that it is to make the family environment less stressful to reduce rates of readmission

Works to:

  • Reduce the level of emotional expression in the family

  • Reduce the level of stress in the family

  • Increase capacity to solve problems within the family

It does this by:

  1. Forming a therapeutic alliance with all family members

  2. Reducing the stress of caring for a relative

  3. Improving the ability of the family to anticipate and solve problems

  4. Reducing guilt and anger in family members

  5. Helping family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives

  6. Improving families’ beliefs about behaviour towards schizophrenia

This is used as part of a treatment plan and is not able to be applied on its own.

  • Family therapy is typically offered for a period of between 3 and 12 months and at least 10 sessions. Family-based interventions are aimed at reducing the level of expressed emotion within the family, as expressed emotion has been demonstrated to increase the likelihood of relapse. Garety et al (2008) estimate the relapse rate for individuals who receive family therapy are 25% compared to 50% for those who receive standard care alone

Support for family therapy

  • Reduced rates of readmission

  • NICE (2009): Meta analysis of 32 studies - found benefit of family intervention therapy - showing improved longer-term outcomes for those receiving it as an extra compared to those having other forms of treatment alone. After 24 months having a 26% relapse rate compared to 50% relapse rate

  • Pharoah et al. (2012): Meta analysis of 53 studies - increased compliance with medical treatments. Even if this is the only benefit it is significant as failing to take medication is one of the biggest flaws of the otherwise most effective treatments

  • NICE (2009) - caused a significant cost saving from not having to readmit

Criticisms for family therapy

  • Pharaoh et al. (2010) noted moderate benefit from family therapies, although they did point out data quality and results are inconsistent

  • Sample size in such studies is always small due to the nature of the area, yet also means that all studies run significant risks in terms of reliability

  • There are other ways that work which don;t require people to accept what another person is telling them is true. Art therapy is one. Therefore, there are more effective treatments.