CLINICAL HANDBOOK OF SCHIZOPHRENIA

22. Family Intervention 223• Providing information about the illness, mental health services, and other availablesupport systems• Helping the family to develop a working explanatory model of the illness• Modifying beliefs about the illness that are unhelpful or inaccurate• Increasing perceived coping for all family members• Enhancing problem-solving skills• Enhancing positive communication within the family• Involving family members in an ongoing relapse prevention plan5. Family interventions should aim to improve outcome for both patients and caregivers.The focus should be on recovery in terms of social relationships, employment,housing, dating and marriage, quality of life, and so forth, for both the patient and relatives,rather than exclusively on symptom reduction.6. Despite the many barriers to offering family interventions, an attempt should alwaysbe made to work in collaboration with relatives who support people with mentalhealth problems, and to do the best we can to support their efforts.KEY POINTS• Families play an essential role in supporting people with long-term mental health problems.• Family intervention for schizophrenia reduces patient relapses and hospitalizations.• Special programs have been developed for working with relatives of patients with a first episodeand families of patients with co-occurring substance misuse.• There is a lot of variation in approaches, but longer term, more intensive approaches seemto be more successful.• More research effort is required for developing interventions that benefit relatives’ wellbeing.• Engagement of families can sometimes be problematic.• More effort to disseminate family interventions into services is required.REFERENCES AND RECOMMENDED READINGSAddington, J., & Burnett, P. (2004). Working with families in the early stages of psychosis. In J.Gleeson & P. McGorry (Eds.), Psychological interventions in early psychosis: A treatment handbook.New York: Wiley.Barrowclough, C. (2003). Family intervention for substance use in psychosis. In H. L. Graham, A.Copello, M. Birchwood, & K. T. Mueser (Eds.), Substance misuse in psychosis: Approaches totreatment and service delivery. Chichester, UK: Wiley.Barrowclough, C., & Hooley, J. M. (2003). Attributions and expressed emotion: A review. ClinicalPsychology Review, 23, 849–880.Barrowclough, C., Lobban, F., Hatton, C., & Quinn, J. (2001). An investigation of models of illness incarers of schizophrenic patients using the Illness Perception Questionnaire. British Journal ofClinical Psychology, 40, 371–385.Barrowclough, C., & Tarrier, N. (1992). Families of schizophrenic patients: Cognitive behavioural intervention.London: Chapman & Hall.Barrowclough, C., Tarrier, N., Lewis, S., Sellwood, W., Mainwaring, J., Quinn, J., et al. (1999). Randomisedcontrolled effectiveness trial of a needs-based psychosocial intervention service forcarers of people with schizophrenia. British Journal of Psychiatry, 174, 505–511.Buchremer, G., Klinberg, S., Holle, R., Schulze-Monking, H., & Hornung, P. (1997). Psychoeducationalpsychotherapy for schizophrenic patients and their key relatives: Results of a two year followup. Acta Psychiatrica Scandinavia, 96, 483–491.