Sc - Family therapy

Question 1

Family therapy

Answer 1

The name given to a range of interventions aimed at the family (e.g. parents, siblings, partners) of someone with a mental disorder.

Question 2

What is the main aim of family therapy?

Answer 2

To provide support for carers in an attempt to make family life less stressful and so reduce re-hospitalisation.

Question 3

How does family therapy work?

Answer 3

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 SZ.

Question 4

What are the strategies used in family therapy?

Answer 4

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

Forming an alliance with relatives who care for the person with SZ.

Reducing the emotional climate within the family and the burden of care for family members.

Enhancing relatives’ abilities to anticipate and solve problems.

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.

Question 5

What is family therapy often used in conjunction with?

Answer 5

Routine drug treatment and outpatient clinical care.

Question 6

What is the patient encouraged to do during family therapy sessions?

Answer 6

Encouraged to talk to their family and explain what sort of support they find helpful - and what makes things worse for them.

Question 7

What do NICE recommend that family therapy should be offered to?

Answer 7

‘All individuals diagnosed with SZ who are in contact with or live with family members’.

Question 8

When do NICE stress that family therapy interventions should be considered a priority?

Answer 8

Where there are persistent symptoms or a high risk of relapse.

Question 9

For what period of time is family therapy offered?

Answer 9

Between 3 and 12 months and at least 10 sessions.

Question 10

What are family-based interventions aimed at?

Answer 10

Reducing the level of expressed emotion within the family, as EE has been demonstrated to increase the likelihood of relapse.

Question 11

What is the relapse rate estimated at for individuals who receive family therapy as compared to those who receive standard care alone?

Answer 11

Garety et al. (2008) estimate the relapse rate for those that receive it to be 25% compared to 50% for those who don’t.

Question 12

What does family therapy typically involve?

Answer 12

Providing family members with information about SZ, finding ways of supporting an individual with SZ and resolving any practical problems. It should also involve the person with psychosis or SZ if practical.

Question 13

What is a characteristic of psychoses such as SZ to do with treatment?

Answer 13

These individuals are often suspicious about their treatment.

Question 14

How could the issue surrounding individuals experiences psychosis often being suspicious about their treatment be overcome?

Answer 14

By involving the individual more actively in their treatment.

Question 15

What does family therapy improve?

Answer 15

Relationships within the household.

Question 16

How does family therapy improve the relationships within the household?

Answer 16

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

Question 17

What is the key study for family therapy?

Answer 17

Pharoah et al. (2010)

Question 18

Procedure of Pharoah et al. (2010) study on family therapy

Answer 18

• Reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family interventions.
• Studies chosen were conducted in Europe, Asia and North America.
• The studies compared outcomes from family therapy to ‘standard’ care (i.e. antipsychotic medication) alone.
• The researchers concentrated on studies that were randomised controlled trials (RCTs).

Question 19

Findings of Pharoah et al. (2010) study on family therapy

Answer 19

The main results (individuals receiving family therapy compared to those receiving standard care) were:

Mental state - The overall impression was mixed. Some studies reported an improvement in the overall mental state of patients compared to those receiving standard care, whereas 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 a reduction in hospital admission during treatment and in the 24 months after.

Question 20

What is a randomised controlled trial (RCT)?

Answer 20

A study in which people are randomly allocated to 2 (or more) groups to test a specific drug or treatment.

One group receives the treatment being tested; the other receives an alternative treatment, a dummy treatment (placebo) or no treatment at all.