Psych · Professional — psychosocial interventions
Family and systemic interventions
Also known as Family therapy · Systemic therapy · Family psychoeducation · Expressed emotion · Multifamily groups · Behavioural family therapy · Family-focused therapy · Structural family therapy
Exam-exhaustive fellowship reference on family and systemic interventions — expressed emotion and psychosis relapse, structural and systemic models, behavioural family therapy, multifamily psychoeducation groups, FFT, ABFT, FBT, MST, engagement without blame, and CASC technique. FRANZCP-primary, globally tagged.
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Red flags
- Blaming families as 'causing' schizophrenia (obsolete schizophrenogenic models — harmful and false)
- Joint family sessions when intimate partner violence or child abuse is active — protect and report first
- Breaching individual confidentiality without a clear, consented family-sharing plan
- Pathologising cultural closeness as emotional over-involvement
- Offering unstructured 'family chats' when structured family intervention for psychosis is indicated
- Ignoring carer mental health, burden, and suicide risk in relatives
Meet the family
A 21-year-old man is two weeks post-discharge after a first episode of psychosis. He is on aripiprazole, he is sleeping, and the voices have quietened. He is also home eleven hours a day with a mother who has not slept properly in four months.[1][21]
In the clinic she says, in front of him: "He just sits there. I've told him a hundred times to get up. If he wanted to get better he would." Then, quietly, to you: "Is it something I did?"[2][3][21]
Two exam questions are now live: what does that exchange predict, and what do you actually offer this family — not a supportive chat, a named intervention? Everything below answers those two.[1][5][6]
References22ShowHide
- [1]Butzlaff RL, Hooley JM Expressed emotion and psychiatric relapse: a meta-analysis Arch Gen Psychiatry, 1998.PMID 9633674
- [2]Brown GW, Birley JL, Wing JK Influence of family life on the course of schizophrenic disorders: a replication Br J Psychiatry, 1972.PMID 5073778
- [3]Vaughn CE, Leff JP The influence of family and social factors on the course of psychiatric illness. A comparison of schizophrenic and depressed neurotic patients Br J Psychiatry, 1976.PMID 963348
- [4]Bebbington P, Kuipers L The predictive utility of expressed emotion in schizophrenia: an aggregate analysis Psychol Med, 1994.PMID 7991753
- [5]Pharoah F, Mari J, Rathbone J, et al. Family intervention for schizophrenia Cochrane Database Syst Rev, 2010.PMID 21154340
- [6]Rodolico A, Bighelli I, Avanzato C, et al. Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis Lancet Psychiatry, 2022.PMID 35093198
- [7]Pilling S, Bebbington P, Kuipers E, et al. Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy Psychol Med, 2002.PMID 12171372
- [8]Leff J, Kuipers L, Berkowitz R, et al. A controlled trial of social intervention in the families of schizophrenic patients: two year follow-up Br J Psychiatry, 1985.PMID 3893605
- [9]Falloon IR, Boyd JL, McGill CW, et al. Family management in the prevention of morbidity of schizophrenia. Clinical outcome of a two-year longitudinal study Arch Gen Psychiatry, 1985.PMID 2864032
- [10]Falloon IR, McGill CW, Boyd JL, et al. Family management in the prevention of morbidity of schizophrenia: social outcome of a two-year longitudinal study Psychol Med, 1987.PMID 3575578
- [11]Hogarty GE, Anderson CM, Reiss DJ, et al. Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. II. Two-year effects of a controlled study on relapse and adjustment Arch Gen Psychiatry, 1991.PMID 1672589
- [12]McFarlane WR Family Interventions for Schizophrenia and the Psychoses: A Review Fam Process, 2016.PMID 27411376
- [13]Lucksted A, McFarlane W, Downing D, et al. Recent developments in family psychoeducation as an evidence-based practice Psychiatr Serv, 2012.PMID 22283383
- [14]Breitborde NJ, Moreno FA, Mai-Dixon N, et al. Multifamily group psychoeducation and cognitive remediation for first-episode psychosis: a randomized controlled trial Early Interv Psychiatry, 2011.PMID 21226941
- [15]Miklowitz DJ, George EL, Richards JA, et al. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder Arch Gen Psychiatry, 2003.PMID 12963672
- [16]Rea MM, Tompson MC, Miklowitz DJ, et al. Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial J Consult Clin Psychol, 2003.PMID 12795572
- [17]Diamond GS, Reis BF, Diamond GM, et al. Attachment-based family therapy for depressed adolescents: a treatment development study J Am Acad Child Adolesc Psychiatry, 2002.PMID 12364840
- [18]Lock J, Le Grange D, Agras WS, et al. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa Arch Gen Psychiatry, 2010.PMID 20921118
- [19]von Sydow K, Beher S, Schweitzer J, et al. The efficacy of systemic therapy with adult patients: a meta-content analysis of 38 randomized controlled trials Fam Process, 2010.PMID 21083549
- [20]Retzlaff R, von Sydow K, Beher S, et al. The efficacy of systemic therapy for internalizing and other disorders of childhood and adolescence: a systematic review of 38 randomized trials Fam Process, 2013.PMID 24329407
- [21]Kuipers E, Onwumere J, Bebbington P Cognitive model of caregiving in psychosis Br J Psychiatry, 2010.PMID 20357299
- [22]Bäuml J, Froböse T, Kraemer S, et al. Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families Schizophr Bull, 2006.PMID 16920788