Family Therapy

Family Therapy in Schizophrenia: Psychology

Family therapy has roots in cognitive behavioural therapy (CBT), which approaches issues within the family similarly.

Family therapy involves family members and the patient and aims to improve their relationships and communication styles through psychoeducation. Therapy also seeks to address stress and criticism in the home, reducing the level of expressed emotion (EE) and, subsequently, improving the relapse rates in schizophrenia.

Ultimately, it addresses mental health by involving the patient with their caregivers and family members. Family therapy typically lasts from nine months to a year, providing therapy for a limited time (much like CBT).

Psychological Treatment for Schizophrenia

Psychological treatments for schizophrenia tackle the disorder from a psychological perspective, and as we mentioned above, family therapy is similar to CBT in its approach. It provides therapy by following certain procedures to identify the problems at home, the true nature of a patient's symptoms, and potential factors exasperating the condition.

Instead of focusing on the individual, it incorporates caregivers and family members.

So, how do we train families to cope with schizophrenia using family therapy in psychology?

Family Therapy in Psychology: Family Therapy Training

During the first stage of family therapy, a therapist interviews and observes families and households to determine the family’s problem areas and strengths.

• Patients and caregivers agree to an open-natured approach to therapy, and focus is placed heavily on informed consent, as issues can crop up when boundaries on information sharing are crossed. Therapists can then share information about the patient to family members and vice versa.
• Families and patients are encouraged to talk freely about their feelings and knowledge about the situation without fear of judgement.

It is often said that families hold the key to what symptoms are truly like for patients in their daily lives.

• As symptoms of schizophrenia affect a person's perceptions of reality (positive symptoms like hallucinations and delusions), caregivers and family members can piece together what is occurring from another perspective.

The therapist encourages patients and their families to learn about the facts and causes of the disease, including the impact of medications and how issues such as added stress and unwarranted guilt can affect the patient AND the caregiver/family.This process is referred to as psychoeducation.

Many problems related to schizophrenia in the family arise from a lack of education/information about the illness. The average family may not know what the symptoms of schizophrenia are and how to treat them effectively. This creates a climate of hostility fueled by ignorance and misinformation.

Family therapy aims to solve this problem by educating the family about the disorder.

Since problems related to schizophrenia in the family are often the result of misunderstanding and the inability of patients and family members to express themselves appropriately, training patients and family members on how to communicate effectively aims to rectify this.

• To do this, patients and their families are encouraged to listen to each other, express their emotions safely and appropriately, and discuss things civilly.

Family Therapy for Schizophrenia: Support for Family Members

Communication helps reduce expressed emotions (EE) and lower levels of anger and guilt. The lowered levels of EE and other factors help to reduce the symptoms of schizophrenia.

Family therapy aims to change the entire family’s behaviour, not just the patient, taking a lot of pressure off the patient and legitimately addressing issues that are out of their control. It also helps family members develop coping strategies of their own, as they are also dealing with the disorder in some form.

Fig. 1 - Family therapy focuses on communication systems within the family.

As a result, communication improves between family members, and they find a healthy balance between caregiving and self-care.

Communication to an improvement in problem-solving skills within the family. Patients and their caregivers or family members can anticipate problems because they know about the condition and have communicated effectively by establishing boundaries and triggering situations.

Evaluation of Family Therapy for Schizophrenia

As with all therapies, there are pros and cons to consider when treating schizophrenia with family therapy. We must evaluate the effectiveness of family therapy as a treatment form.

Family Therapy: Strengths

First, let's examine the strengths of family therapy in schizophrenia.

• Pilling et al. (2002) identified in their meta-analysis that family interventions reduced psychotic relapse rates and readmissions by significant margins. They concluded that family therapy should be offered to patients if they coexist with caregivers.

• Leff et al. (1990) investigated family therapy in schizophrenic patients with high expressed-emotions relatives and higher levels of face-to-face contact. They found that patients with families who had various forms of social interventions had relapse rates of around 40% after two years, whereas those who did not have family interventions/assistance had relapse rates of 75%.

• Pharoah et al. (2010) supported the idea that family therapy improves expressed emotions (EE) in a family, reducing relapse rates and readmission rates to hospitals.

• Lobban (2013) found that 60% of the studies they reviewed highlighted family therapy's positive impact on relatives' outcome categories.

Family Therapy: Weaknesses

Now, let's consider the weaknesses of family therapy in schizophrenia.

• Family therapy relies heavily on informed consent, and ethical boundaries may be crossed, patients may be uncomfortable sharing such details, and confidentiality issues may arise.

• Although studies generally show that family therapy reduces relapse rates in the short term, many studies emphasise that this effect diminishes dramatically after about six months and that improvement does not last longer than six months (Claxton et al., 2017; Leavey et al., 2004; Rossberg et al., 2010).

• Due to the lengthy process, as family therapy can last up to a year, symptoms or incidents (such as disputes or conflicts in the family) may cause patients and family members to drop out of therapy.

• Family therapy focuses on treating symptoms and improving the patient’s home life. It supports family relationships and helps family members cope with symptoms, but it is not a cure.

• It is difficult to say directly that family therapy is the cause of lower relapse rates. As Claxton et al. (2017) illustrated, studies tend to ignore the high variability within families studied and the highly specialised nature of specific treatments, such as family care and standard outpatient treatment.

• Family therapy requires the active involvement of all members, which is not always possible.