CLINICAL HANDBOOK OF SCHIZOPHRENIA

222 IV. PSYCHOSOCIAL TREATMENTtients with schizophrenia by using the Illness Perception Questionnaire. As with previousstudies, there was little association between the measures of caregiver functioning (usingmeasures of distress and burden) and patient functioning. However, when relatives perceivedgreater negative consequences for the patient because of the illness, they showedgreater distress and subjective burden.FUTURE DIRECTIONSIn summary, a number of important conclusions can be drawn from recent analyses offamily intervention studies. First, although there is robust evidence for the efficacy offamily interventions in schizophrenia, it is also clear that short family education orcounseling programs do not affect relapse rates: “[receiving] a few lessons on schizophrenia. . . was simply not sufficient to substantially influence the relapse rate”(Pitschel-Walz et al., 2001, p. 84). The quality of interventions needs to be enhancedand monitored to ensure that families are offered the intensity of help likely to providesubstantial benefits. Successful family interventions require considerable investment intime, skills, and commitment; and because for many patients the effect is to delayrather than to prevent relapse, many patients and families need long-term, continuingintervention. Work with relatives of recently diagnosed patients with schizophrenia indicatesthat this help needs to begin from the first onset of the psychosis. Second, weneed to concentrate more research effort on developing interventions that are beneficialto the relatives’ own well-being. Third, we need to continue to address disseminationand engagement issues. Although many patients and families benefit greatly from theintervention programs, a substantial number of families are difficult to engage, and theimplementation of family programs within services presents many challenges. Finally,further work needs to identify optimum techniques for changing family attitudes whenproblems are particularly complex, for example, in schizophrenia and comorbid substancemisuse.TREATMENT RECOMMENDATIONS1. Family interventions should be offered as part of a cohesive treatment package,tailored to meet the individual needs of each family. A systematic nonblaming rationaleshould be made clear to emphasize that although family members are not seen as responsiblefor causing the mental health problems, they may be able to play an important rolein recovery.2. Repeated attempts may be necessary to engage the family. Offering support andinformation at key times of distress, such as the first schizophrenia episode, relapse, orcrisis, may be a useful way to begin to involve the family in a more structured intervention.3. A long-term commitment to offer a minimum of 10 sessions over a period ofabout 6 months may be necessary to achieve an effective outcome. Short-term, limited interventionsappear to be less effective.4. The exact mechanism of change in successful family interventions remains unclear.Therefore, it is impossible to identify precisely what the key components of any interventionshould be, and it is likely that these components may vary depending on the specificneeds of the family. However, interventions should include the following components:• Providing practical and emotional support to family members