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Objective: To test an interactive hypothesis that, in schizophrenia, a combination of patients' and relatives' characteristics at 1-month postdischarge from hospital (Time 1 [T1]) better predicts the level of psychotic symptoms at follow-up (Time 2 [T2]), than do the characteristics of patients or relatives alone. Methods: Male patients (n = 38) with a diagnosis of schizophrenia, without substance abuse, and in contact with their families, were recruited at the time of hospital discharge. Patients' psychotic symptom levels were monitored every 2 weeks until follow-up, while family measures were administered at T1 and T2. The 4 predictor variables in the regression analysis were T1 symptom levels of the patient and 3 measures of family interaction (expressed emotion, family burden, and family functioning). Results: The model based on the family variable, family burden at T1, and the patient variable, patients' remitted levels of psychotic symptoms at T1, was found to significantly predict the level of psychotic symptoms at T2. These 2 T1 variables made independent and additive contributions to the level of psychotic symptoms at T2, predicting 19% of the variance. Neither expressed emotion nor family functioning at T1 added to the prediction. Conclusion: This finding suggests a patient-family interactional component to symptomatic relapse in schizophrenia. Can J Psychiatry. 2009;54(7):446-451. Clinical Implications * The findings of this study suggest that addressing the nature of the social interaction within the patient's primary relationships may influence symptom severity for the patient. * More specifically, the findings of this study suggest that the clinician should target family interventions to address the reciprocal influences of the patient's illness behaviours on the relative, and the relative's emotional attitudes on the patient. Limitations * Other characteristics than those measured by the variables in this study may influence symptomatic outcome in schizophrenia. * The exclusion of women in the sample may limit the generalizability of the findings to women and their families. Key Words: family burden and schizophrenia, expressed emotion and schizophrenia, family functioning and schizophrenia, predictors of symptom severity in schizophrenia Abbreviations used in this article BPRS Brief Psychiatric Rating Scale DSM Diagnostic and Statistical Manual of Mental Disorders EE expressed emotion FB family burden FF family functioning PFBS Perceived Family Burden Scale T1 Time 1 T2 Time 2 Expressed emotion research has found a relation between parental EE and early relapse for patients without determining whether this association is a function of the vulnerability of the patient, the emotional attitudes of the relative, or the interaction between them. The relation between EE and relapse was first demonstrated for patients with schizophrenia1-31 and then affective disorders.32-38 The link between EE and relapse has since been replicated across several diagnostic categories39-41 and many cultural groups.42-50 The relapse rate for patients from high EE families has been reported as 3 to 4 times higher than for patients from low EE families.14,15,26,27 Some EE research suggests a causal relation between relatives' characteristics and early relapse for patients.24-27 In commenting on the early EE literature, Vaughn51 stated: "the differences (between high and low EE families) lie not in the patients but in the relatives - low EE and high EE relatives differ markedly in their response to patients' objective condition."p 99 However, King52 and King et al53 as well as others32,54-56 have questioned this direction of effects. Their findings suggest that EE status of relatives may be a response to symptom severity, rather than a cause of it. In another line of investigation, EE research has examined a more interactive8,57-60 model in which EE has been found to index both relatives' and patients' behaviours. …

This article expresses concern about the indiscriminate acceptance of the solution-focused brief therapy (SFBT) model by some social workers and social agencies in spite of the dearth of empirical support for its claims to provide clients with more rapid and more enduring change than other treatment models. The article reviews the core assumptions and techniques of SFBT and outlines the strengths and limitations of the model in the context of the findings of psychotherapy process and outcome research and from the perspective of mainstream social work. The authors argue that social workers should avoid rigid adherence to narrow models of therapy and that social work students need to be exposed to multiple theories and techniques to be adequately prepared for practice. Agencies are encouraged to offer services based on a variety of treatment models in order to more adequately serve their clients and also to better position themselves to contribute to research that would further inform the profession about the combinations of model, client, and worker characteristics that lead to the most efficient and effective outcomes.

During the past 30 years, the prescription of neuroleptic medication has made a major impact on the treatment of symptoms in patients with schizophrenia. Nonetheless, for many patients, symptom remission and social functioning remain less than optimal. Consequently, clinicians have employed a combined approach of drugs, psychosocial therapies, and psychiatric rehabilitation to treat the range of deficits presented by individuals suffering with this illness. In this article, we describe Focal Family Therapy, a model of family therapy developed for working with families and patients who are struggling with schizophrenia. Using the example of a particular case, we illustrate the following: (a) the identification and formulation of the Focal Issue; (b) the targeting of behavior and attitudes that will constitute the Focal Change; and (c) the techniques of Focal Family Therapy.

This pilot study compared the efficacy of two models of family therapy plus medication in the treatment of ten schizophrenic patients previously considered poor responders to neuroleptics alone. Focal Family Therapy (FFT), a limited psychodynamic model, was compared with Supportive Management Counselling (SMC), an educative, problem-solving approach. Family treatment was begun during admission to hospital and continued for up to six months post-discharge. Patient and family measures were administered on assessment, termination, and at three, six and 12 month follow-up interviews. Our data suggest that patients in both groups improved significantly following treatment on measures of social functioning and community tenure. The average increase in amount of time out of hospital was a full year, compared to previous rates. Patients receiving FFT demonstrated significantly greater improvement in symptoms, compared to patients in the SMC group. On average, families scored in the normal range on the family functioning measure at assessment and upon termination of treatment.