Family therapy for persons with schizophrenia: neglected yet important

Since the 1950s, the observed disturbances in family relationships in which a member has been diagnosed as having schizophrenia has led many systemic family therapists to the hypothesis that these family interactions may have preceded the onset of illness and contributed to it. However, attempts at using traditional family therapy with families of patients with schizophrenia were not successful or widely adopted. With the introduction of neuroleptic medication, the treatment of schizophrenia changed dramatically, and patients often returned to their family in varying stages of partial remission, increasing the burden on relatives. Furthermore, research based on the expressed emotion concept demonstrated that the chance of relapse increases by a factor of 2.5 when a patient returns to a high-EE-family in contrast to a low-EE-family environment; consequently, the vulnerability–stress model started to guide treatment development. Based on these developments, since 1980, several psychoeducational family management programs have been evaluated showing a significant reduction in relapse when compared to standard psychiatric care from 49 to 13%. To date, at least 50 RCT studies have been published showing the effectiveness of family interventions in various culturally diverse countries. Therefore, according to the NICE and other guidelines, family intervention should be offered to all families of people with psychosis who live with or are in close contact with the patient, in conjunction with neuroleptic treatment. Despite this strong recommendation, family involvement is under-implemented in mental health care, despite its strong scientific, economic, legal and moral basis. To improve the psychosocial health of patients with psychotic disorders and their relatives, more research is necessary, as well as more training for professionals in effective family interventions.