Family Therapy Flashcards
role of families in schizophrenia
5
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 into 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 depends on the relationship between the individual and their family
poor relationships tend to result in poor outcomes, including a greater chance of relapse and increased symptoms
therefore, the main aim of family therapy is to provide support for carers in an attempt to make family life less stressful and so reduce re-hospitalisation
what is family therapy?
4
family therapy = a range of interventions aimed at the family (including parents, siblings and partners) of someone with a mental disorder like schizophrenia
in their guidance on the treatment and management of schizophrenia, NICE recommend that family therapy should be offered to “all individuals diagnosed with schizophrenia who are in contact with or live with family members”
they also stress that such interventions should be considered a priority when there are persistent symptoms or a high risk of relapse
research has shown that schizophrenics in families that express high levels of criticism, hostility or overinvolvement have more frequent relapses than schizophrenics whose families are less expressive in their emotions
what does family therapy involve?
6
family therapy is typically offered for a period of between 3 and 12 months and for 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 that the relapse rate for individuals who receive family therapy is 25%, compared to 50% for those who receive standard care alone
it typically involves providing family members with information about schizophrenia, finding ways of supporting the person with schizophrenia and resolving any practical problems
it should also involve the person with schizophrenia if possible because a characteristic of schizophrenia is that individuals are often suspicious about their treatment, but involving the individual more actively in their treatment overcomes this problem
family therapy improves relationships within the household because the therapist encourages family members to listen to each other, openly discuss problems and negotiate potential solutions together
how does family therapy work?
10
by reducing levels of expressed emotion and stress and by increasing the capacity of family members to solve related problems, family therapy attempts to reduce the incidence of relapse for the person with schizophrenia
family therapy makes use of a number of strategies including….
- psychoeducation — helping the person and their carers to understand and be better able to deal with the illness, including enhancing the family’s ability to anticipate and solve problems relating to schizophrenia
- forming an alliance with relatives who care for the person with schizophrenia
- reducing the emotional climate within the family and the burden of care for family members
- reducing expressions of anger and guilt by family members
- maintaining reasonable expectations among family members for patient performance
- encouraging relatives to set appropriate limits whilst maintaining some degree of separation when needed
family therapy forms part of an overall treatment package and is commonly used in conjunction with routine drug treatment and outpatient clinical care
during family therapy sessions, the individual with schizophrenia is encouraged to talk to their family and explain what sort of support they might find helpful and what makes things worse for them
key study: procedure
5
Pharaoh et al (2010) 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
they compared outcomes from family therapy to standard care (antipsychotic medication alone)
the researchers concentrated on studies that were randomised controlled trials — an RCT is a study in which people are randomly allocated to two or more groups to test a specific drug or treatment
one group receives the treatment being tested, while the other group receives an alternative treatment, a placebo or no treatment at all
key study: findings
5
the main results comparing individuals receiving family therapy to those receiving standard care….
- mental state — the overall impression was mixed, some studies reported an improvement in the overall mental state of family therapy patients compared to those receiving standard care, but others did not
- compliance with medication — the use of family intervention increased patients’ compliance with medication
- 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
- reduction in relapse and readmission — there was a reduction in the risk of relapse and hospital readmission during treatment and in the 24 months after family therapy
x4 evaluation points for family therapy
research support for its effectiveness
economic benefits of family therapy
positive impact on family members
challenging research suggesting family therapy may not be worthwhile
EVALUATION
research support for its effectiveness
6
Pharaoh et al (2010) reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family intervention
they found that although the overall effect on mental state was mixed, with some studies reporting an improvement in the overall mental state of family therapy patients compared to those receiving standard care while others did not, family therapy was still shown to have some important benefits
for instance, the use of family intervention increased patients’ compliance with medication, allowing them to actually reap the benefits of their medication
it also appeared to lead to some improvement in terms of the patients’ general functioning
furthermore, there was a reduction in the risk of relapse and hospital readmission during treatment and in the 24 months after family therapy
this suggests that family therapy can be an effective treatment for schizophrenia
EVALUATION
economic benefits of family therapy
4
an additional advantage of family therapy is that it has considerable economic benefits associated with the treatment of schizophrenia
the NICE review of family therapy studies demonstrated that family therapy is associated with significant cost savings when offered to people with schizophrenia in addition to standard care
the extra cost family therapy is offset by a reduction in the costs of hospitalisation because of the lower relapse rates associated with this form of intervention
there is also evidence that family therapy reduces relapse rates for a significant period after completion of the intervention, meaning that the cost savings associated with family therapy are even higher and more prolonged
EVALUATION
positive impact on family members
5
family therapy has been shown to have a positive impact on the person with schizophrenia by improving their outcomes, as well as a positive impact on family members
Lobban et al (2013) analysed the results of 50 family therapy studies that had included an intervention to support relatives
60% of the studies reported a significant positive impact of family therapy and demonstrated that it improved relatives’ abilities to cope and solve problems relating to schizophrenia
it also seemed to improve family functioning and relationship quality in general
therefore, family therapy can be said to be a useful treatment for schizophrenia
EVALUATION
challenging research suggesting family therapy may not be worthwhile
4
a study by Garety et al (2008) failed to show any better outcomes for patients given sessions of family therapy compared to those who simply had carers but no family therapy
individuals in both groups were found to have low rates of relapse, contrasting markedly with the rates found in the no carer group
the researchers found that most of the carers in the study displayed relatively low rates of expressed emotion, which may reflect widespread cultural practices in carers’ knowledge and attitudes towards schizophrenia
this may suggest that for many people, family therapy may not improve their outcomes any further than a good standard of treatment will, thus limiting the effectiveness of family therapy
