CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 22FAMILY INTERVENTIONCHRISTINE BARROWCLOUGHFIONA LOBBANFamilies play an essential role in supporting people with long-term mental illness in thecommunity and are focal in the social networks of people with a schizophrenia diagnosis.Over 60% of persons with a first episode of a major mental illness return to live withrelatives, and this percentage is reduced only by 10–20% when those with subsequent admissionsare included. Living with a close relative who experiences psychosis can presentmany challenges and may be associated with considerable personal costs. In schizophrenia,estimates from different studies suggest that up to two-thirds of family members experiencesignificant stress and subjective burden as a consequence of their caregiver role.Such stress is not only likely to affect the well-being of the relatives and compromise theirlong-term ability to support the patient, but it may also have an impact on the course ofthe illness itself and on outcomes for the client. Hence, one of the most important advancesin the treatment of schizophrenia in the last two decades has been the developmentof family-based intervention programs. The efficacy of this form of treatment isnow well established, with many randomized controlled trials having demonstrated thesuperiority of family intervention over routine care in terms of patient relapse and hospitalizationoutcomes. This chapter outlines the background to this area of work, describesintervention approaches, summarizes the research findings to date, draws attention to importantareas for future development, and provides treatment guidelines based on currentknowledge.BACKGROUNDThe development of multifactorial models of the processes determining risk and relapsein schizophrenia provided the general rationale for the development of family interventions.These “stress–vulnerability” models emphasized the contribution of psychologicaland socioenvironmental stressors to the illness course, thereby opening up the way topsychological interventions. In particular family interventions found much of their initial214