Family therapy has been developed due to the possibility that schizophrenia is caused by family problems such as double-blind situations and expressed emotion (EE). This also aims to reduce relapse rates in patients with schizophrenia through contact with high EE family. Therapy aims to change aspects of he patient-relative relationship. It involves educating family about schizophrenia and teaching methods of coping, problem solving and family communication.
Social Skill Training helps with aspects of daily life. Symptoms may be controlled by medication but an individual may still struggle to form friendships, find or keep a job or live independently. This training helps the patient acquire the skills they need to function better on a day to day basis e.g. employment, relationships, self-care and managing medication.
CBT works by modifying delusional beliefs and hallucinations within sufferers. These may occur due to incorrect interpretations of the world around them, themselves, maladaptive thinking or disorder perceptions. The aim of CBT is to help the patient identify these 'faulty' and disorder belied and address them. Patients are taught to recognise signs of potential relapse before they build up into schizophrenic symptoms again.
Left et al researched the effectiveness of treating high EE families. 10 patients were given a 2 year programme of family therapy and 9 were used as controls. 17% of the experimental groups that also took medication relapsed, 78% with medication alone and 83% relapses with no treatment. Therefore this suggests that family is effective in preventing relapse with no treatment. Therefore this suggests that family therapy is effective in preventing relapse. Reliability issues occur due to the problem of the lack of a consistent diagnosis for schizophrenia. Also family therapies may have only been used with those with mild schizophrenic symptoms. Different schizophrenics may have different results. Therefore results may be determines by how sever the initial symptoms were.
Family therapy has only once been seen to be more effective in preventing relapse and not in preventing the onset of the illness. Therefore this is a major weakness for its treatment. Another issue is there is little research into family therapies long term effectiveness of the treatment. Improvement has only been seen short term therefore this may not be appropriate as a long term solution.
McGorry et al found CBT was effective with patients at risk of having a schizophrenic episode receiving different treatments. After 6 months 36% of patients receiving psychotherapy developed schizophrenia, with only 10% of those receiving CBT and drug therapy developed the disorder. This supports the use of CBT as an effective form of treatment. However, it is questionable whether CBT is appropriate as the lower risk of relapse could be due to the drugs rather than the CBT itself. Therefore the drug therapy may have been a confounding variable with CBT having potentially little to no effect. The CBT would be argued to help mask the disorder, through teaching functional behaviour. Therefore the underlying cause may remain.
CBT suffers reductionism as it ignore individual differences and suggests all develop schizophrenia in the same way. It oversimplifies schizophrenia to cognitive thought processes when evidence strongly suggests a biological origin, which is ignored. CBT may only be effective with those who have milder forms of the disorder as an insight and awareness is needed to address problems. Those with severe schizophrenic symptoms may lack this. Appropriateness of CBT must be considered; if it only masks symptoms this raises ethical issues as patients may be encouraged to hide symptoms causing patients to be denied potentially more beneficial treatment. For example if schizophrenia has a biological cause drug therapies would be more appropriate. Therefore suggests CBT as an inappropriate treatment for some individuals.
Overall issues regarding psychological treatments are compared to anti-psychotic treatment, they appear to be less effective. Such therapies are also reductionist in ignoring biological influences which clearly play a role in schizophrenia. Due to this purely psychological therapies may be unlikely to provide long term benefits.
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