4.7 Family Therapy Flashcards
define family therapy
the name given to a range of interventions aimed at the family (e.g. parents, siblings, partners) of someone with a mental health disorder
summarise family therapy
interventions aimed at the family of someone with schizophrenia
aims to reduce rates of expressed emotion (EE) within families as EE increases likelihood of relapse
Garety et al. estimated relapse rates of 25% for family intervention, 50% for standard care alone
Involves providing family members with information about schizophrenia, finding ways to support and resolving practical problems
list the steps in the process of family therapy
psychoeducation
forming an alliance with relatives
reducing emotional climate
enhancing relatives’ problem-solving skills
reducing expression of anger and guilt
maintaining reasonable expectations
encouraging relatives to set appropriate limits
key study: Pharoah et al. (2010)
explain the procedure
reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family intervention
studies chosen were conducted in Europe, Asia and North America
studies compared outcomes from family intervention with standard care (antipsychotic medication alone).
researcher concentrated on studies that were randomised controlled trials (RTC’s)
key study: Pharoah et al. (2010)
explain the findings
mental state - the overall impression was mixed. Some studies reported an improvement in the overall mental state of some patients compared to those receiving standard care, whereas others did not.
compliance with medication - the use of family intervention increased the patients compliance with medication regimens
reduction in relapse and readmission - there was a reduction in the risk of relapse and a reduction in hospital admission during treatment and the 24 months after
social functioning - although appearing to show some improvement on general functioning, family intervention did not appear to have much of an effect on more concrete outcomes such as living independently or employment
What is a RTC
a randomised controlled trial
people are randomly allocated to two (or more) groups to test a specific drug or treatment
one group receives the treatment being tested; the other group receives an alternative treatment, a dummy treatment (placebo) or no treatment at al
evaluate the use of family therapy in the treatment of schizophrenia
why is it effective? may be effective only because it improves compliance with antipsychotic medication
methodological limitations of family therapy studies - not all studies in Pharoah et al. meta-analysis had used randomisation or blinding
economic benefits - extra cost of family intervention is offset by reduction of costs of hospitalisation associated with relapse
impact on family members - Lobban et al. analysed 50 studies and found 60% reported positive impact on relatives
is family intervention worthwhile? Garety et al. found it did not improve outcomes further than that possible with relatives providing a good standard of care
methodological limitations of family therapy studies?
the problem of random allocation
lack of binding
why is the problem of random allocation a methodological limitation of family therapy studies?
although all 53 studies that Pharoah et al. looked at claimed to have randomly allocated participants to treatment conditions, the researchers noted that a large number of the studies used in this review were from the People’s Republic of China
Evidence has emerged that, in many Chinese studies, random allocation had been stated as having been used, yet was not (Wu et al. 2006)
why is lack of binding a methodological limitation of family therapy studies?
there was the possibility of observer bias where raters were not ‘blinded’ to the condition (i.e family intervention or standard care) to which people were allocated.
Ten studies reported that no form of binding was used.
A further 16 did not mention whether binding had been used at all.
how does family therapy work?
by reducing levels of expressed emotion and stress, and by increasing the capacity of relatives to solve related problems, family therapy attempts to reduce the incidence of relapse for the person with schizophrenia
one of the strategies included in family therapy is ‘psychoeducation’ , define
helping the person and their carers to understand and be better able to deal with the illness
one of the strategies included in family therapy is ‘forming an alliance with relatives’ , define
forming an alliance with relatives who care for the person with schizophrenia
one of the strategies included in family therapy is ‘reducing emotional climate’ , define
reducing the emotional climate within the family and the burden of care for family members.
one of the strategies included in family therapy is ‘enhancing relatives’ problem-solving skills’ , define
enhancing relatives’ ability to anticipate and solve problems
