Family therapy | AQA A-Level Psychology Revision

For 7182 specification, first teach in September 2025

AQA A-Level Psychology | Free Revision Notes

Estimated study time: 60 minutes

Family therapy involves a person with schizophrenia and members of their family working with a therapist to improve communication, understanding and problem-solving. These Family therapy A-Level Psychology revision notes explain how psychoeducation and practical skills can reduce anger, guilt, frustration and expressed emotion within the home.

The treatment aims to lower the stress that may maintain symptoms or contribute to relapse. It does not assume that relatives deliberately caused schizophrenia. Family therapy is one of the psychological treatments explicitly required by the current AQA specification.

Learning Objectives 🎯

By the end of this revision page, you should be able to:

• Explain how family therapy is used to treat schizophrenia.

• Explain the role of the therapist and therapeutic alliance.

• Explain how psychoeducation can improve family understanding.

• Explain how communication and problem-solving skills are developed.

• Explain how family therapy aims to reduce expressed emotion and stress.

• Apply family-therapy techniques to unfamiliar scenarios.

• Evaluate the effectiveness and appropriateness of family therapy.

Revision Notes 📚

Family therapy A-Level Psychology revision overview

Family therapy is a psychological treatment involving the person with schizophrenia and people who play a significant role in their family or home life.

The therapist works with family members to:

• Improve understanding of schizophrenia.

• Reduce anger, guilt and frustration.

• Reduce criticism and hostility.

• Manage emotional over-involvement.

• Improve communication.

• Develop problem-solving skills.

• Create realistic expectations.

• Recognise warning signs of relapse.

• Support treatment and recovery.

AQA’s 2025 mark scheme identifies the central aims as reducing anger, guilt, frustration and expressed emotion while increasing tolerance, understanding and support.

The basic treatment pathway

A simplified family-therapy pathway is:

greater knowledge + clearer communication + reduced criticism and conflict → lower family stress → improved support and coping → reduced risk of symptom worsening or relapse

Family therapy mainly changes the person’s social and emotional environment.

It does not directly:

• Block dopamine receptors.

• Change inherited genes.

• Remove every hallucination.

• Challenge every delusional belief individually.

These other levels of treatment are explored in:

• first-generation dopamine-blocking medication 

• broader-acting antipsychotic medication 

• challenging beliefs and developing coping strategies 

Who takes part in family therapy?

Family therapy may involve:

• The person diagnosed with schizophrenia.

• Parents.

• A partner.

• Siblings.

• Adult children.

• Other relatives or carers involved in everyday support.

• A trained therapist.

The term family does not have to mean a traditional two-parent household.

The important participants are people who:

• Live with the person.

• Provide regular care.

• Have frequent contact.

• Influence the person’s emotional environment.

• Are willing and able to participate.

Sessions together and separately

Family members and the person with schizophrenia usually meet the therapist together for open and productive discussion. Individual meetings may also be useful where someone needs to discuss a sensitive matter privately.

The 2025 AQA mark scheme describes the patient and family members usually meeting together to establish a therapeutic alliance and take part in productive discussion.

What family therapy does not assume

Family therapy does not need to assume that:

• The family caused schizophrenia.

• The parents are at fault.

• Every family is dysfunctional.

• The patient is the only source of difficulty.

• Family members must agree about everything.

• Medication is unnecessary.

• Relatives should become responsible for all treatment.

The treatment can be useful even if schizophrenia has a strong biological basis.

For example:

A person may inherit vulnerability and experience altered dopamine activity, while criticism and conflict in the home increase stress and relapse risk.

Family therapy attempts to change the manageable environmental part of this pathway.

The relationship with family dysfunction

Family therapy follows logically from stressful family communication and expressed emotion.

Family-dysfunction explanations identify patterns such as:

• Double-bind communication.

• Criticism.

• Hostility.

• Emotional over-involvement.

• Rejection.

• Conflict.

Family therapy aims to replace these patterns with:

• Clearer communication.

• Realistic expectations.

• Calm problem-solving.

• Appropriate emotional support.

• Respect for independence.

• Shared understanding.

Explanation versus treatment

Family dysfunction	Family therapy
Psychological explanation	Psychological treatment
Describes problematic family interactions	Attempts to improve interactions
Includes double binds and expressed emotion	Includes communication training and psychoeducation
May contribute to stress or relapse	Aims to reduce stress and relapse
Focuses on risk or maintenance factors	Focuses on practical change
Can appear to blame families	Should work collaboratively without blame

Do not describe the schizophrenogenic mother or double-bind theory at length when a question asks specifically how family therapy is used.

Main aims of family therapy

Reducing family stress

Living with schizophrenia can be stressful for everyone involved.

The person with schizophrenia may experience:

• Distressing voices.

• Suspicious beliefs.

• Avolition.

• Communication difficulties.

• Fear of relapse.

• Medication side effects.

Relatives may experience:

• Worry.

• Confusion.

• Frustration.

• Guilt.

• Exhaustion.

• Uncertainty about how to respond.

• Fear of saying or doing the wrong thing.

Family therapy aims to reduce stress on both sides.

Reducing expressed emotion

Expressed emotion, abbreviated to EE, refers to the emotional climate communicated towards the person with schizophrenia.

High EE includes:

1. Criticism.

2. Hostility.

3. Emotional over-involvement.

High levels of expressed emotion may increase stress and the likelihood of relapse.

Family therapy therefore teaches relatives how to communicate concern without:

• Repeated criticism.

• Personal rejection.

• Constant control.

• Intrusive monitoring.

• Escalating arguments.

Increasing tolerance

Tolerance means responding with greater patience and acceptance when symptoms or difficulties occur.

It does not mean:

• Ignoring dangerous behaviour.

• Accepting abuse.

• Pretending that no problem exists.

• Abandoning reasonable boundaries.

It means understanding that behaviours such as withdrawal or inactivity may be symptoms rather than deliberate attempts to upset the family.

Increasing understanding

Family members learn:

• What schizophrenia is.

• How symptoms may affect behaviour.

• Why symptoms vary.

• How treatment works.

• What side effects may occur.

• What may trigger symptom worsening.

• How to respond constructively.

This understanding can replace inaccurate assumptions such as:

“They are simply lazy.”

with:

“Avolition can make initiating ordinary tasks extremely difficult.”

Supporting recovery

Recovery may involve more than the disappearance of symptoms.

Family therapy may support:

• Stable routines.

• Treatment attendance.

• Increasing independence.

• Social contact.

• Education or employment.

• Confidence.

• Relapse prevention.

• Better quality of life.

Establishing a therapeutic alliance

What is a therapeutic alliance?

A therapeutic alliance is a cooperative and trusting relationship between:

• The therapist.

• The person with schizophrenia.

• Participating family members.

The family needs to believe that the therapist:

• Listens fairly.

• Does not automatically assign blame.

• Understands their concerns.

• Respects confidentiality.

• Has useful psychological knowledge.

• Will help them develop agreed goals.

A strong therapeutic alliance is central to the detailed description rewarded in AQA’s 2025 mark scheme.

Shared goals

The therapist may help the family agree goals such as:

• Fewer arguments.

• More respectful conversations.

• Greater independence for the patient.

• Better management of medication concerns.

• Earlier recognition of relapse signs.

• A fairer distribution of caring responsibilities.

Goals should be:

• Specific.

• Realistic.

• Agreed.

• Relevant to the family’s circumstances.

• Reviewed over time.

Avoiding blame

A therapist should not begin by deciding:

• Which relative caused the problem.

• Who is the “bad” family member.

• Who is always right.

• Whether one person must change while everyone else remains the same.

Blame may make family members:

• Defensive.

• Guilty.

• Angry.

• Unwilling to attend.

• Less open during sessions.

The therapist instead treats family interaction as a pattern that can be understood and improved.

Assessment of family strengths and difficulties

At the beginning of therapy, the therapist may assess:

• Current symptoms.

• Sources of family stress.

• Communication patterns.

• Conflict.

• Levels of criticism.

• Emotional over-involvement.

• Existing strengths.

• Treatment knowledge.

• Practical responsibilities.

• Warning signs from previous episodes.

Identifying strengths

Therapy should not focus only on what the family does badly.

Possible strengths include:

• Strong emotional commitment.

• Reliable attendance at appointments.

• Calm communication from one relative.

• Effective practical support.

• Good awareness of early warning signs.

• Willingness to learn.

• Previous successful problem-solving.

Building on existing strengths may feel more respectful and achievable than presenting the family as entirely dysfunctional.

Identifying stressors

Possible stressors include:

• Financial pressure.

• Housing difficulties.

• Caring responsibilities.

• Medication side effects.

• Sleep disruption.

• Repeated hospital admissions.

• Social isolation.

• Misunderstanding of symptoms.

• Conflict about how much independence is safe.

Some difficulties require practical or social support as well as family discussion.

Psychoeducation

What is psychoeducation?

Psychoeducation involves providing accurate and understandable information about schizophrenia and its treatment.

AQA’s 2025 mark scheme explicitly identifies psychoeducation and learning realistic expectations as components of family therapy.

Family members may learn about:

• Positive symptoms.

• Negative symptoms.

• Biological and psychological explanations.

• Drug therapy.

• Psychological treatments.

• Side effects.

• Relapse.

• Stress and vulnerability.

• Warning signs.

• Recovery.

Understanding positive symptoms

Relatives may learn that hallucinations and delusions can feel completely real to the person.

For example:

A person who refuses to open the door because they believe they are being monitored may be responding to a genuine sense of threat.

This does not mean the family must agree that the belief is factually correct.

It means responding calmly rather than:

• Ridiculing the belief.

• Shouting.

• Starting an argument.

• Treating the person as deliberately difficult.

Understanding negative symptoms

Negative symptoms are often misinterpreted.

Avolition may be mistaken for:

• Laziness.

• Selfishness.

• Lack of gratitude.

• Refusal to cooperate.

Speech poverty may be mistaken for:

• Rudeness.

• Deliberate secrecy.

• Lack of interest.

• Defiance.

Psychoeducation helps relatives recognise that reduced motivation and speech may form part of the condition.

Understanding treatment

Families may learn:

• How medication works.

• Why continuing treatment may be recommended.

• Why side effects affect adherence.

• Why medication may reduce positive symptoms more than negative symptoms.

• How CBT and family therapy complement medication.

This knowledge can make relatives more supportive without turning them into medication enforcers.

Understanding relapse

Relatives may learn that relapse does not necessarily mean:

• The patient has failed.

• The family has failed.

• Treatment was pointless.

• Recovery is impossible.

Instead, symptoms can change over time and treatment plans may need adjustment.

Developing realistic expectations

Why expectations matter

Unrealistic expectations can increase criticism and pressure.

For example:

“You have been discharged, so you should immediately return to full-time work and manage everything independently.”

This expectation may overlook:

• Continuing symptoms.

• Medication effects.

• Reduced confidence.

• Cognitive difficulties.

• The gradual nature of recovery.

Expectations that are too low

Expectations can also become too limited.

For example:

“You have schizophrenia, so you should never make decisions or live independently.”

This may encourage:

• Dependence.

• Emotional over-involvement.

• Loss of confidence.

• Reduced autonomy.

Balanced expectations

Family therapy aims for realistic, flexible goals.

For example:

1. Prepare one simple meal with support.

2. Attend one appointment independently.

3. Increase social contact gradually.

4. Take responsibility for one household task.

5. Review progress without criticism.

Realistic expectations reduce the likelihood that ordinary setbacks become family crises.

Improving communication

Why communication is important

Family members need to communicate about:

• Symptoms.

• Treatment.

• Responsibilities.

• Independence.

• Safety.

• Boundaries.

• Support.

Poor communication can create:

• Misunderstanding.

• Anger.

• Contradictory expectations.

• Repeated arguments.

• Increased stress.

Family therapy teaches communication skills that are clear, calm and specific.

Clear communication

A vague complaint might be:

“You never make any effort.”

A clearer statement is:

“I am worried because the dishes have not been washed for three days. Could we agree who will do them and when?”

The clearer statement:

• Identifies the specific problem.

• Avoids attacking the person’s character.

• Allows a practical response.

• Makes problem-solving possible.

Using specific descriptions

The family may be encouraged to describe observable behaviour.

Less helpful:

“You are impossible.”

More helpful:

“When voices become intense, you often miss appointments. How could we plan for that?”

Specific descriptions reduce hostility and global criticism.

Expressing emotions appropriately

Family therapy does not require people to hide every negative emotion.

Relatives may feel:

• Frustrated.

• Sad.

• Afraid.

• Exhausted.

The aim is to communicate these emotions without:

• Personal attacks.

• Threats.

• Blame.

• Humiliation.

• Escalation.

For example:

“I feel worried when I do not know where you are.”

is more constructive than:

“You are selfish and never think about anyone.”

Active listening

Active listening involves:

• Giving attention.

• Allowing the speaker to finish.

• Checking understanding.

• Summarising what has been said.

• Asking relevant questions.

• Avoiding immediate judgement.

A family member might respond:

“You are saying the voices are louder in the evening and that this makes it difficult to sleep. Have I understood that correctly?”

This response communicates interest and reduces misunderstanding.

Turn-taking

Where family conversations become chaotic, the therapist may encourage:

• One person speaking at a time.

• No interruptions.

• Short, clear statements.

• Checking meaning before responding.

• Equal opportunities to contribute.

This is particularly helpful where several relatives attempt to solve the problem simultaneously.

Reducing criticism

Criticism and expressed emotion

Repeated critical comments may increase stress.

Examples include:

• “You are lazy.”

• “You never try.”

• “You ruin everything.”

• “You should be over this by now.”

Family therapy helps relatives distinguish between:

• Criticising the whole person.

• Discussing one specific behaviour.

Reframing criticism

Critical statement:

“You are lazy because you never leave the sofa.”

Reframed statement:

“I have noticed that starting activities has become difficult. Would it help to plan one manageable task?”

The second statement:

• Recognises possible avolition.

• Avoids personal rejection.

• Offers practical support.

• Maintains realistic expectations.

Reducing hostility

Hostility

Hostility is broader than criticism of one behaviour.

It involves anger or rejection directed towards the person as a whole.

Examples include:

• “You are the cause of all our problems.”

• “I cannot stand living with you.”

• “Everything would be better without you.”

Family therapy may help relatives understand how:

• Stress has built up.

• Symptoms affect family life.

• Their emotional response is understandable but damaging.

• Alternative ways of setting boundaries are possible.

Boundaries without hostility

A family can establish a boundary without rejecting the person.

For example:

“We want to support you, but shouting during an argument is not acceptable. Let us agree to pause the conversation when anyone becomes overwhelmed.”

This protects family members while avoiding global condemnation.

Reducing emotional over-involvement

Emotional over-involvement

Emotional over-involvement includes:

• Excessive monitoring.

• Overprotection.

• Constant intervention.

• Speaking for the person.

• Preventing reasonable independence.

• Sacrificing every other part of family life.

It may develop from genuine care and fear.

Why it can be unhelpful

Excessive involvement may:

• Increase pressure.

• Reduce autonomy.

• Reinforce dependence.

• Create conflict.

• Make the person feel constantly observed.

• Exhaust the relative providing care.

Encouraging appropriate independence

Family therapy may help relatives ask:

• Which tasks can the person complete alone?

• What support is genuinely needed?

• When should help be offered?

• How can independence be increased safely?

• How can relatives maintain their own lives?

For example:

Rather than checking medication repeatedly throughout the day, the family and patient might agree on one reminder system.

The goal is support without unnecessary control.

Reducing double-bind communication

Double binds

A double bind involves contradictory messages that place a person in a no-win situation.

For example:

“We want you to be independent, but we become angry whenever you make a decision without us.”

Family therapy may help family members:

• Identify the contradiction.

• State expectations clearly.

• Agree which message should guide behaviour.

• Allow questions about unclear communication.

• Avoid punishing every possible response.

AQA’s 2025 mark scheme identifies reduction in double-bind communication as a possible positive outcome of family therapy.

Worked example

Original pattern:

• Parent says, “Tell me when you need help.”

• Parent complains, “You are too dependent,” when help is requested.

• Parent complains, “You shut us out,” when help is not requested.

Therapeutic improvement:

“You can ask for help with appointments. For everyday household tasks, we will encourage you to try independently before we step in.”

The expectation is now clearer and more consistent.

Problem-solving skills

Why problem-solving is taught

Families may face recurring practical problems involving:

• Missed appointments.

• Household responsibilities.

• Medication side effects.

• Money.

• Social withdrawal.

• Sleep.

• Early warning signs.

• Conflict about independence.

Without an agreed process, each problem may become an emotional argument.

AQA identifies the development of problem-solving skills as a key component of family therapy.

A structured problem-solving sequence

A typical sequence may involve:

1. Identify one specific problem.

2. Allow everyone to explain their perspective.

3. Generate several possible solutions.

4. Consider the advantages and disadvantages.

5. Select a realistic solution.

6. Agree who will do what.

7. Try the plan.

8. Review the outcome.

9. Revise the plan where necessary.

Step 1: define the problem

Too broad:

“Nothing works in this family.”

Specific:

“Appointments are often missed because transport is not organised.”

A specific problem is easier to solve.

Step 2: gather perspectives

The person with schizophrenia might say:

“I miss appointments because crowded buses make the voices worse.”

A relative might say:

“I cannot always leave work to provide transport.”

Both perspectives contain useful information.

Step 3: generate alternatives

Possible options include:

• Arrange appointments at quieter times.

• Use a different transport route.

• Ask whether remote appointments are available.

• Arrange help from another person.

• Use a planned coping strategy during travel.

Step 4: agree a plan

The plan should specify:

• What will happen.

• Who is responsible.

• When it will happen.

• How success will be assessed.

Behavioural family therapy

What is behavioural family therapy?

Behavioural family therapy uses practical and structured techniques to change patterns of behaviour and communication within the family.

AQA’s 2025 mark scheme identifies Falloon in connection with behavioural family therapy.

It may include:

• Psychoeducation.

• Communication training.

• Problem-solving practice.

• Rehearsal of skills.

• Goal-setting.

• Review of progress.

• Positive reinforcement of constructive behaviour.

Rehearsal

The family may practise difficult conversations during a session.

For example:

A relative rehearses how to express concern about missed medication without accusing or threatening the patient.

The therapist can provide immediate feedback on:

• Tone.

• Clarity.

• Specific wording.

• Listening.

• Emotional escalation.

Positive reinforcement

Constructive changes may be acknowledged and encouraged.

For example:

• Thanking someone for expressing a concern calmly.

• Recognising the patient’s attempt to complete a task.

• Praising relatives for listening without interruption.

This is not a token economy.

The aim is to strengthen useful communication and support within ordinary family life.

Increasing positive interactions

Family therapy is not only about reducing negative behaviour.

It may also encourage:

• Shared enjoyable activities.

• Recognition of progress.

• Respectful conversation.

• Appropriate praise.

• Time in which schizophrenia is not the only topic.

• Balanced family relationships.

A home consisting entirely of monitoring, treatment discussion and crisis management can become stressful even when relatives intend to help.

Positive interaction may protect:

• Relationships.

• Hope.

• Identity.

• Motivation.

• Family wellbeing.

Reducing anger, guilt and frustration

Anger

Relatives may feel angry about:

• Repeated crises.

• Disrupted plans.

• Damaged relationships.

• Responsibilities they did not expect.

Therapy provides a safer setting for discussing anger without directing hostility towards the patient.

Guilt

Family members may believe:

• They caused schizophrenia.

• They failed to recognise symptoms.

• They handled an episode incorrectly.

• They are selfish for needing time away.

Psychoeducation can reduce unrealistic guilt by explaining that schizophrenia has complex biological, psychological and environmental influences.

Frustration

Relatives may become frustrated when improvement is:

• Slow.

• Uneven.

• Followed by relapse.

• Limited to particular symptoms.

Realistic expectations can reduce the belief that recovery should follow a simple, rapid path.

The patient’s emotions

The person with schizophrenia may also feel:

• Angry about being monitored.

• Guilty about the effect on relatives.

• Frustrated by loss of independence.

• Ashamed of symptoms.

• Afraid of rejection.

Family therapy should address everyone’s experience rather than treating relatives as the only people with emotional needs.

Developing a relapse-prevention plan

What is relapse?

Relapse is the return or worsening of symptoms following improvement.

Family therapy may help the family identify early warning signs such as:

• Sleep changes.

• Increased withdrawal.

• Growing suspiciousness.

• Reduced self-care.

• Missed medication.

• Increased voices.

• Disorganised speech.

• Rising family conflict.

The exact warning signs differ between individuals.

A relapse plan

A plan may identify:

• Which signs appeared before previous episodes.

• Who should be contacted.

• How the family should communicate concerns.

• What coping strategies help.

• What changes to routine may reduce stress.

• When professional help is needed.

Responding without panic

Without preparation, a mild warning sign may lead relatives to:

• Become highly anxious.

• Monitor the person constantly.

• Start repeated arguments.

• Demand immediate hospitalisation.

This reaction may increase stress.

A planned response is more likely to be:

• Calm.

• Proportionate.

• Agreed.

• Supportive.

• Connected with professional care.

Medication and family therapy

Family therapy may support the use of typical antipsychotics or atypical antipsychotics.

Supporting informed adherence

Family members can help by:

• Understanding why medication is prescribed.

• Recognising side effects.

• Encouraging discussion with the care team.

• Helping organise appointments.

• Supporting an agreed routine.

They should not necessarily:

• Threaten the person.

• Hide medication in food.

• Assume every refusal is irrational.

• Ignore serious side effects.

• Turn the home into a constant medication check.

Discussing side effects

A person may stop medication because of:

• Tremors.

• Weight gain.

• Sedation.

• Muscle stiffness.

• Blood-monitoring demands.

• Limited improvement.

Family therapy can help relatives understand that non-adherence is not always carelessness.

The family and patient may work together to:

• Report side effects.

• Discuss alternatives.

• Arrange clinical review.

• Plan reminders agreed by the patient.

Adjunctive treatment

Family therapy is often an adjunct, meaning it is used alongside another treatment rather than as a complete replacement.

AQA’s 2025 mark scheme explicitly recognises family therapy as an adjunct to drug therapy.

A possible combination is:

medication reduces symptom intensity + family therapy reduces environmental stress and relapse risk

Family therapy and CBT

Family therapy and Cognitive behaviour therapy are both psychological treatments, but they operate differently.

Family therapy	CBT
Involves relatives or carers	Usually focuses mainly on the individual
Targets communication and emotional climate	Targets beliefs and interpretations
Reduces expressed emotion	Uses cognitive restructuring and reality testing
Develops family problem-solving	Develops personal coping strategies
May reduce relapse-related stress	May reduce distress linked with voices and delusions
Requires family cooperation	Requires individual cognitive engagement

The two treatments may be combined.

For example:

• CBT helps the person question the power of a voice.

• Family therapy helps relatives respond calmly when the voice becomes distressing.

Applying family therapy: criticism and avolition

Sana’s family repeatedly tell her that she is lazy because she rarely begins household tasks.

A family therapist might:

• Provide psychoeducation about avolition.

• Explain that initiating goal-directed behaviour may be difficult.

• Help relatives replace global criticism with one specific request.

• Agree a manageable household task.

• Encourage constructive feedback rather than hostility.

• Review whether the goal is realistic.

A developed application would state:

“Psychoeducation may help Sana’s relatives understand that her inactivity can be a negative symptom rather than deliberate laziness. This may reduce critical comments and therefore lower expressed emotion and stress.”

Applying family therapy: emotional over-involvement

Since Tariq returned from hospital, his parents monitor him constantly, make every decision for him and prevent him leaving home alone.

The therapist might:

• Acknowledge that the parents are frightened about relapse.

• Explain emotional over-involvement.

• Identify tasks Tariq can complete independently.

• Develop agreed boundaries.

• Reduce unnecessary monitoring.

• Create a proportionate relapse plan.

• Help Tariq regain autonomy gradually.

The aim is not to remove all family support.

It is to replace intrusive control with appropriate support.

Applying family therapy: hostility

Aisha’s brother says that she has ruined the family and becomes angry whenever she discusses her voices.

The therapist might:

• Explore the brother’s fear and frustration.

• Explain how hostility may increase stress.

• Teach him to describe specific concerns rather than reject Aisha as a person.

• Help Aisha explain how the voices affect her.

• Establish rules for calm discussion.

• Agree that conversations will pause if shouting begins.

Applying family therapy: contradictory communication

Kai’s family tell him to become independent but criticise him whenever he makes a decision without consulting them.

The therapist might:

• Identify the contradictory expectations.

• Explain how the pattern creates a double bind.

• Ask the family to define what independence means.

• Agree which decisions Kai can make alone.

• Clarify when advice should be requested.

• Ensure that agreed independent behaviour is not punished.

Applying family therapy: treatment conflict

One parent insists that Leah must take medication, while another tells her that medication is unnecessary and harmful.

The therapist might:

• Allow each person to express their concern.

• Provide accurate information about benefits and side effects.

• Reinforce that medication decisions require Leah and appropriate clinicians.

• Reduce conflict around each dose.

• Agree how concerns will be communicated.

• Encourage Leah to report side effects rather than stopping abruptly without support.

Applying family therapy: relapse prevention

Before his previous relapse, Aaron slept very little, stopped speaking to relatives and became increasingly suspicious.

The therapist might help the family:

• Record these as possible early warning signs.

• Agree who will raise concerns.

• Use calm and specific language.

• Contact the care team at an agreed point.

• Reduce unnecessary conflict and stimulation.

• Support Aaron’s existing coping strategies.

A complete application structure

Use:

scenario detail → family-therapy technique → change in interaction → intended outcome

For example:

“Mina’s relatives repeatedly accuse her of being lazy when she does not begin daily tasks. The therapist could use psychoeducation to explain avolition and help the family replace criticism with a specific, manageable request. This should reduce expressed emotion and the stress that may increase Mina’s relapse risk.”

Worked comparison: support versus therapy

Ordinary support

A relative may:

• Offer transport.

• Remind the person of an appointment.

• Listen to concerns.

• Help prepare food.

These actions may be helpful.

Family therapy

Family therapy involves a planned psychological intervention in which a trained practitioner:

• Establishes a therapeutic alliance.

• Educates family members.

• Identifies unhelpful interaction patterns.

• Teaches communication and problem-solving.

• Reviews progress.

• Develops relapse-prevention plans.

The June 2025 examiner report noted that weaker answers often relied on commonsense statements about relatives being supportive or helping with medication. More sophisticated responses discussed therapeutic alliance, psychoeducation and reduction of dysfunctional communication.

Evaluating family therapy

Strength: evidence relating to hospital readmission

AQA’s 2025 mark scheme identifies Pharoah’s research concerning the effect of family therapy on hospital readmissions as relevant evidence when evaluating effectiveness.

A reduction in readmission would be valuable because it may indicate:

• Fewer severe relapses.

• Greater stability in the community.

• Better management of symptoms.

• Reduced disruption to the person and family.

• Lower use of intensive hospital care.

Limitation of readmission as an outcome

Hospital readmission is not a complete measure of recovery.

A person may avoid admission but continue to experience:

• Distressing voices.

• Avolition.

• Social isolation.

• Poor quality of life.

• Family conflict.

Admission decisions may also depend on:

• Availability of hospital beds.

• Local service policy.

• Family willingness to provide care.

• Access to community support.

Family therapy should therefore be evaluated using several outcomes.

Strength: evidence relating to relapse

AQA also identifies Pilling’s meta-analysis of relapse rates as relevant evaluation evidence.

A meta-analysis is useful because it:

• Combines findings from several studies.

• Produces a larger overall sample.

• Reduces dependence on one unusual investigation.

• Allows a broader estimate of effectiveness.

Evidence of reduced relapse is consistent with the proposed mechanism:

improved family interaction → reduced expressed emotion and stress → lower relapse risk

Limitation of meta-analysis

A meta-analysis depends on the quality of the original studies.

Possible problems include:

• Different definitions of relapse.

• Different forms of family therapy.

• Different session lengths.

• Different medication arrangements.

• Variation in family involvement.

• Publication bias.

• Differences between patient groups.

Combining studies can create a precise average without guaranteeing that the studies measured exactly the same treatment.

Limitation: high dropout

AQA’s 2025 mark scheme identifies Montero’s finding of a high dropout rate as evidence relevant to evaluation.

Dropout may occur because:

• A relative feels blamed.

• The patient does not want family involvement.

• Conflict becomes uncomfortable.

• Sessions are difficult to arrange.

• Family members have work or caring responsibilities.

• Relationships are already severely damaged.

• The family does not accept the treatment rationale.

Why dropout matters

A therapy cannot provide its full benefit if participants leave early.

High dropout can reduce:

• Practical effectiveness.

• Generalisability of research findings.

• Confidence in long-term outcomes.

• Cost-effectiveness.

Studies reporting only people who complete therapy may make the treatment appear more successful than it is in ordinary clinical practice.

Strength: family therapy has a clear psychological mechanism

Family therapy is not simply based on the idea that “talking helps”.

It targets identified processes such as:

• Criticism.

• Hostility.

• Emotional over-involvement.

• Double-bind communication.

• Poor problem-solving.

• Unrealistic expectations.

The proposed causal pathway is clear and testable:

therapy reduces high EE → stress decreases → relapse becomes less likely

This gives the treatment theoretical coherence.

Limitation: improvement does not prove family dysfunction caused schizophrenia

If family therapy reduces relapse, this shows that family interaction affects the course of the condition.

It does not prove that relatives caused the original development of schizophrenia.

A treatment can alter a maintaining factor without identifying the original cause.

For example:

• Genetic vulnerability may contribute to the condition.

• Dopamine dysfunction may contribute to symptoms.

• Family stress may affect whether symptoms worsen or return.

The most accurate conclusion is:

Family interaction can influence outcome even where it was not the original cause.

Strength: practical application of expressed-emotion research

Family therapy translates research about expressed emotion into practical intervention.

Rather than simply observing that criticism predicts relapse, therapists can:

• Teach calmer communication.

• Reframe critical comments.

• Reduce hostility.

• Encourage appropriate independence.

• Develop coping and relapse plans.

This gives family-dysfunction research practical value.

Limitation: families may feel blamed

Family therapy can unintentionally suggest:

“You are being included because you caused the disorder.”

Possible consequences include:

• Guilt.

• Shame.

• Defensiveness.

• Family conflict.

• Treatment refusal.

• Reduced trust in professionals.

AQA’s 2025 mark scheme identifies the possibility that relatives may question whether they are responsible as an ethical issue.

Reducing blame

Therapists should explain that:

• Schizophrenia has multiple influences.

• Family stress is one possible factor.

• Symptoms also affect relatives’ behaviour.

• High EE often develops from worry and exhaustion.

• The purpose of therapy is improvement, not fault-finding.

Ethical issue: confidentiality

Family therapy involves several people sharing sensitive information.

Potential difficulties include:

• The patient revealing information about relatives.

• Relatives discussing the patient’s behaviour.

• One family member wanting information kept from another.

• Disagreement about what may be shared with clinicians.

• Information disclosed privately affecting joint sessions.

AQA’s 2025 mark scheme highlights privacy and confidentiality as important ethical issues.

Managing confidentiality

The therapist should clarify:

• What information is confidential.

• What may be shared.

• What happens if serious risk is disclosed.

• Whether private individual sessions are available.

• How notes will be stored.

Family participation does not remove each person’s right to privacy.

Ethical issue: consent

The person with schizophrenia should be involved in decisions about:

• Which relatives attend.

• What goals are set.

• Which information is discussed.

• Whether therapy continues.

Relatives should also consent rather than being pressured to take part.

Consent may be complicated where:

• The patient is experiencing severe psychosis.

• A relative controls access to care.

• Participation is treated as a condition of discharge.

• Family members feel professionally blamed.

Limitation: therapy requires cooperation

Family therapy requires a reasonably positive attitude and cooperation from several people.

AQA’s 2025 mark scheme explicitly identifies cooperation as a suitability issue.

The treatment may be difficult where:

• The patient does not want relatives involved.

• Family members refuse to attend.

• Relationships have completely broken down.

• Relatives live far away.

• There is active abuse.

• Communication is unsafe.

• Severe symptoms prevent participation.

This means family therapy is not equally appropriate for every patient.

Limitation: family circumstances vary

Some people with schizophrenia:

• Live alone.

• Have little family contact.

• Have no safe family relationship.

• Live in supported accommodation.

• Rely mainly on friends or professional carers.

A treatment requiring family participation may therefore be unavailable or inappropriate.

The principles may sometimes be adapted to include other important members of the person’s support network, but this depends on circumstances and consent.

Limitation: severe symptoms can affect participation

Positive symptoms may lead the person to:

• Distrust the therapist.

• Believe relatives are involved in a conspiracy.

• Find joint discussion threatening.

Negative symptoms may lead to:

• Reduced speech.

• Limited motivation.

• Difficulty attending sessions.

• Reduced participation in problem-solving.

Medication or individual support may be needed before family therapy becomes practical.

Limitation: time and availability

Family therapy may require:

• Repeated sessions.

• Coordination of several schedules.

• Travel.

• Time away from work.

• Childcare.

• Access to trained therapists.

• Follow-up.

AQA’s mark scheme identifies time, availability and access to skilled practitioners as relevant practical considerations.

Why scheduling is difficult

A session may require:

• The patient.

• Several relatives.

• A therapist.

• Possibly an interpreter or another professional.

Finding a suitable time for everyone can delay treatment or increase dropout.

Cost-effectiveness

Possible economic benefits

Family therapy may reduce costs if it leads to:

• Fewer relapses.

• Fewer hospital admissions.

• Shorter admissions.

• Less use of emergency services.

• Improved medication adherence.

• Greater stability in community care.

AQA identifies a possible reduction in the revolving-door effect as a reasoned cost-effectiveness argument.

Revolving-door effect

The revolving-door effect describes repeated movement between:

• Hospital treatment.

• Discharge into the community.

• Relapse.

• Readmission.

If family therapy reduces stress and improves relapse planning, this cycle may become less frequent.

Possible economic costs

Family therapy requires:

• Trained professionals.

• Multiple sessions.

• Suitable facilities.

• Administrative coordination.

• Time from several family members.

It may be more expensive initially than prescribing medication alone.

The relevant question is whether the initial cost produces larger long-term savings and better outcomes.

Developing an economic point

Weak:

“Family therapy is expensive.”

Stronger:

“Family therapy requires repeated sessions involving a trained practitioner and several relatives, which creates initial costs. However, if improved communication reduces relapse and hospital readmission, it may save the health service money in the longer term.”

Strength: it may improve outcomes beyond symptoms

Family therapy may improve:

• Communication.

• Family relationships.

• Confidence.

• Problem-solving.

• Knowledge.

• Treatment cooperation.

• Independence.

• Emotional wellbeing.

These outcomes matter even if hallucinations do not disappear entirely.

A family may benefit because:

• Arguments become less frequent.

• The patient feels less criticised.

• Relatives understand symptoms.

• Everyone responds more calmly to warning signs.

Limitation: measuring family interaction is difficult

Researchers may measure:

• Number of critical comments.

• Relapse rates.

• Readmission.

• Family satisfaction.

• Communication ratings.

• Treatment adherence.

Each measure captures only part of the outcome.

For example:

• Fewer critical comments may reflect genuine improvement.

• Alternatively, relatives may suppress criticism during observation.

• Reduced readmission may reflect community-service availability.

• Self-reported satisfaction may be affected by social desirability.

Several measures and follow-up periods are needed.

Limitation: therapist effects

Family therapy outcomes may depend on:

• Therapist skill.

• Experience.

• Ability to manage conflict.

• Cultural understanding.

• Warmth.

• Neutrality.

• Ability to build an alliance.

Two therapists using the same broad treatment may produce different results.

This makes standardisation more difficult than in a tightly controlled drug trial.

Limitation: blind procedures are difficult

Participants know that they are receiving family therapy.

The therapist also knows which treatment is being delivered.

A fully double-blind procedure is therefore impossible.

Improvement may be influenced partly by:

• Expectations.

• Extra professional attention.

• Motivation.

• The supportive relationship.

Independent researchers can assess outcomes without knowing the treatment condition, reducing some investigator bias.

Limitation: family therapy programmes vary

The label “family therapy” may include programmes differing in:

• Length.

• Number of sessions.

• Psychoeducation.

• Communication training.

• Behavioural techniques.

• Relapse planning.

• Inclusion of medication support.

This variation makes studies difficult to compare.

A treatment showing strong results may not be identical to the programme available in another service.

Strength: family therapy is relatively holistic

Family therapy considers:

• Symptoms.

• Relationships.

• Communication.

• Emotion.

• Medication.

• Practical stress.

• Relapse.

• The needs of carers.

This may be more holistic than a treatment focusing only on:

• Dopamine receptors.

• One person’s beliefs.

• One isolated symptom.

AQA’s 2025 mark scheme identifies holism versus reductionism as a relevant broader issue.

Limits to its holism

Family therapy can still be incomplete if it overlooks:

• Genes.

• Neural correlates.

• Social disadvantage outside the family.

• Trauma.

• Housing.

• Employment.

• Cultural discrimination.

It is broader than some treatments but does not include every possible influence.

Comparison with antipsychotic medication

Family therapy	Antipsychotic medication
Psychological and social treatment	Biological treatment
Targets communication and stress	Targets neurotransmitter activity
Involves relatives	Administered to the patient
Requires cooperation and discussion	Requires medication adherence
No movement or metabolic drug effects	May cause physical side effects
May reduce relapse	May reduce positive symptoms and relapse
Time-intensive	Can act more quickly during acute symptoms
Teaches transferable skills	Biological effect depends on continued treatment
Does not directly alter dopamine	Does not directly improve family communication

Complementary use

The treatments can work together:

antipsychotic reduces severe symptoms → patient can participate more effectively → family therapy reduces environmental stress → relapse risk may fall

Family therapy should not automatically replace effective medication during an acute psychotic episode.

Comparison with CBT

Family therapy	Cognitive behaviour therapy
Changes family interaction	Changes individual interpretations and coping
Reduces expressed emotion	Uses cognitive restructuring
Teaches shared problem-solving	Uses reality testing and behavioural experiments
Helps relatives understand symptoms	Helps the patient understand thoughts and voices
May reduce relapse stress	May reduce symptom-related distress
Requires family participation	Requires individual engagement

Both avoid many physical drug side effects, but both require:

• Skilled therapists.

• Time.

• Cooperation.

• Active participation.

Family therapy as an interactionist treatment

Family therapy fits an interactionist approach because it can be combined with biological treatment.

A possible model is:

1. The person has genetic or neural vulnerability.

2. Stressful family interaction raises arousal.

3. Symptoms emerge or become more severe.

4. Medication reduces biological symptom processes.

5. Family therapy reduces environmental stress.

6. The combination reduces relapse risk.

This approach is developed fully in biological and psychological treatments working together.

Cultural considerations

Family structures and communication styles vary between cultures.

Differences may involve:

• The role of extended family.

• Expectations of independence.

• Expressions of concern.

• Decision-making.

• Respect for elders.

• Privacy.

• Responsibility for care.

A therapist should avoid assuming that one communication style is universally correct.

Emotional involvement and culture

Close family involvement may be:

• Considered intrusive in one context.

• Expected and valued in another.

The therapist should consider:

• Whether the person experiences the involvement as supportive.

• Whether it increases stress.

• Whether autonomy is being restricted.

• Whether cultural values are being respected.

Language

Where family members use different first languages, therapy may require:

• A trained interpreter.

• Clear explanations.

• Attention to culturally specific meanings.

• Extra time for discussion.

A relative should not automatically act as interpreter where this compromises privacy or accuracy.

Social sensitivity

Family therapy must be discussed sensitively because careless descriptions may reinforce the claim that families cause schizophrenia.

Responsible language includes:

• “Family interaction may influence stress or relapse.”

• “High expressed emotion is associated with poorer outcomes.”

• “Therapy aims to improve communication.”

• “Relatives are not assumed to have deliberately caused the condition.”

Avoid:

• “Bad parenting creates schizophrenia.”

• “The family is to blame.”

• “Mothers cause psychosis.”

• “Every family of a person with schizophrenia is dysfunctional.”

Effectiveness versus appropriateness

Effectiveness

Effectiveness concerns whether the treatment achieves useful outcomes.

These may include:

• Reduced relapse.

• Fewer hospital admissions.

• Lower expressed emotion.

• Better communication.

• Improved treatment adherence.

• Better quality of life.

Appropriateness

Appropriateness concerns whether the treatment is suitable for a particular person and family.

Consider:

• Willingness to participate.

• Safety of the relationships.

• Privacy.

• Cultural context.

• Practical availability.

• Symptom severity.

• Family contact.

• Personal preference.

A treatment may be effective in research but inappropriate for someone who does not wish their family to participate.

When family therapy may be particularly appropriate

Family therapy may be useful where:

• The person lives with relatives.

• Family members provide regular care.

• Conflict or criticism is high.

• Relatives do not understand symptoms.

• Emotional over-involvement is present.

• Relapse has followed family stress.

• Medication adherence creates conflict.

• Everyone is willing to work together.

When family therapy may be less appropriate

It may be difficult or unsuitable where:

• The patient has no regular family contact.

• Relationships are abusive or unsafe.

• Family members refuse to attend.

• The patient does not consent.

• Severe symptoms prevent joint discussion.

• Confidentiality cannot be managed safely.

• Practical barriers make regular attendance impossible.

Family therapy should not be used to force reconciliation with unsafe relatives.

Structuring an eight-mark answer

AQA’s June 2025 question asked students to:

Describe and evaluate family therapy as a treatment for schizophrenia.

The marks were:

• AO1: 3 marks

• AO3: 5 marks

This means evaluation should take up more of the answer than description.

AO1 paragraph

Include:

• Family members and patient meet the therapist.

• Psychoeducation.

• Reduced expressed emotion and stress.

• Communication or problem-solving training.

AO3 paragraph 1

Use evidence:

• Pharoah and hospital readmission.

• Pilling and relapse.

• Explain the implication.

AO3 paragraph 2

Discuss a limitation:

• Montero and dropout.

• Cooperation and suitability.

• Explain why this limits effectiveness.

AO3 paragraph 3

Reach a balanced judgement:

• Practical or ethical concerns.

• Comparison with medication.

• Family therapy as an adjunct.

Example eight-mark plan

Description

Family therapy involves the patient and relatives meeting a therapist to reduce expressed emotion, anger and frustration. Psychoeducation helps the family understand schizophrenia and form realistic expectations. The therapist also teaches clearer communication and structured problem-solving so that family stress is reduced.

Evidence

Research evidence concerning relapse and readmission supports the treatment because improved family interaction appears to affect clinically meaningful outcomes.

Limitation

Family therapy requires several people to cooperate. High dropout means research based mainly on completers may exaggerate its effectiveness and the treatment may be unsuitable where relationships are severely damaged.

Judgement

Family therapy is most appropriate as part of combined treatment because it reduces environmental stress but does not directly alter the biological processes targeted by antipsychotics.

Structuring a 16-mark application essay

Paragraph 1: Overview

• Define family therapy.

• Explain its aims.

• Identify stress and expressed emotion.

Paragraph 2: Psychoeducation and application

• Identify misunderstanding of symptoms.

• Explain what relatives would learn.

• Show how this reduces criticism or guilt.

Paragraph 3: Communication and application

• Identify criticism, hostility or contradictory messages.

• Explain clear communication and active listening.

• Apply to exact scenario details.

Paragraph 4: Emotional over-involvement and independence

• Identify intrusive monitoring or control.

• Explain appropriate boundaries and realistic autonomy.

Paragraph 5: Problem-solving and relapse planning

• Select one practical difficulty.

• Explain the structured process.

• Identify early warning signs.

Paragraph 6: Evidence

• Use Pharoah or Pilling.

• State what outcome is relevant.

• Explain why it supports the treatment.

Paragraph 7: Limitations and ethics

• Cooperation and dropout.

• Time and cost.

• Confidentiality.

• Family blame.

Paragraph 8: Balanced conclusion

• Compare with CBT or medication.

• Explain why combined treatment may be more complete.

Overall conclusion

Family therapy involves the person with schizophrenia and important family members working with a therapist.

Its main components include:

• Therapeutic alliance.

• Psychoeducation.

• Realistic expectations.

• Reduction of expressed emotion.

• Communication training.

• Problem-solving.

• Relapse prevention.

• Support for recovery and agreed treatment.

The treatment is valuable because schizophrenia affects the family environment, while the family environment can affect stress and relapse.

Evidence relating to readmission and relapse supports family therapy, and improved communication may have benefits beyond symptom reduction. However, the treatment requires cooperation, can have a high dropout rate and raises issues involving privacy, blame, time and access.

The most defensible conclusion is:

Family therapy can reduce stress and improve the course of schizophrenia, but it is generally most effective and appropriate when used collaboratively alongside suitable biological and individual psychological treatment.

Hints from the Examiner Reports 💡

Examiner hint: Do not rely on commonsense statements such as:

“The family supports the patient.”

The June 2025 examiner report found that weaker responses often focused only on general support and medication help. Stronger responses explained therapeutic alliance, psychoeducation and the reduction of dysfunctional communication.

Examiner hint: Learn the four central AO1 elements:

1. Reduce anger, guilt, frustration and expressed emotion.

2. Establish a therapeutic alliance.

3. Educate the family and develop realistic expectations.

4. Improve problem-solving and communication.

These formed the indicative content of the 2025 mark scheme.

Examiner hint: Keep the mark weighting in mind.

The 2025 eight-mark question awarded:

• 3 marks for knowledge.

• 5 marks for evaluation.

An answer containing a page of description and one brief criticism would not match the assessment balance.

Examiner hint: Explain the mechanism.

Weak:

“Family therapy reduces relapse.”

Stronger:

“Psychoeducation and communication training reduce criticism and hostility, lowering expressed emotion and stress. This may reduce the likelihood of relapse.”

Examiner hint: Use evidence analytically.

Do not write only:

“Pilling supports family therapy.”

Explain that evidence concerning relapse supports the proposed link between improved family interaction and the continuing course of schizophrenia.

Examiner hint: Distinguish family therapy from family dysfunction.

• Family dysfunction is an explanation.

• Family therapy is a treatment.

Examiner hint: Do not say family therapy proves that relatives caused schizophrenia.

Evidence of reduced relapse supports an influence on maintenance or recurrence, not necessarily the original cause.

Examiner hint: Develop dropout as an evaluation point:

unwillingness or scheduling difficulty → incomplete treatment → reduced practical effectiveness → possible bias in research using completers

Examiner hint: Explain confidentiality rather than merely naming it.

Several people attend therapy, so private information may be disclosed or requested. The therapist must establish what can be shared and protect each participant’s rights.

Examiner hint: Apply each scenario detail separately.

• Criticism → communication training and reduced EE.

• Overprotection → boundaries and independence.

• Misunderstood avolition → psychoeducation.

• Repeated practical conflict → problem-solving.

• Previous relapse → warning-sign plan.

Examiner hint: Compare treatment approaches directly.

For example:

“Family therapy reduces environmental stress, whereas antipsychotic medication reduces neurotransmitter activity. The approaches may therefore be combined rather than treated as alternatives.”

Common Mistakes ⚠️

Mistake: Describing family dysfunction instead of family therapy

Why this is incorrect:

One is an explanation and the other is a treatment.

How to improve:

Focus on what the therapist and family do to change interaction.

Mistake: Saying family therapy proves that parents caused schizophrenia

Why this is incorrect:

Treatment effectiveness does not establish the original cause.

How to improve:

State that family interaction may affect stress, maintenance or relapse.

Mistake: Saying family therapy means relatives give medication

Why this is incomplete:

Medication support may be discussed, but the central treatment includes psychoeducation, communication and problem-solving.

How to improve:

Describe a trained therapist and structured psychological techniques.

Mistake: Saying the therapist identifies who is to blame

Why this is inappropriate:

Blame can increase guilt, conflict and dropout.

How to improve:

Explain the collaborative therapeutic alliance.

Mistake: Saying expressed emotion means showing any emotion

Why this is incorrect:

High EE has specific components.

How to improve:

Name criticism, hostility and emotional over-involvement.

Mistake: Treating all family involvement as harmful

Why this is incorrect:

Supportive involvement can improve recovery.

How to improve:

Distinguish appropriate support from intrusive over-involvement.

Mistake: Saying emotional over-involvement means caring too much

Why this is imprecise:

The problem is excessive control, intrusion or prevention of independence.

How to improve:

Describe the observable family behaviour.

Mistake: Saying tolerance means accepting all behaviour

Why this is incorrect:

Families can maintain safety and boundaries while avoiding personal hostility.

How to improve:

Explain patience, realistic expectations and calm problem-solving.

Mistake: Describing psychoeducation as teaching only the patient

Why this is incomplete:

In family therapy, relatives also learn about schizophrenia, symptoms and treatment.

How to improve:

Show how new knowledge changes family responses.

Mistake: Giving a vague communication point

Why this is incomplete:

“Communicate better” does not explain the technique.

How to improve:

Refer to clear statements, active listening, turn-taking or reducing criticism.

Mistake: Saying family therapy removes hallucinations directly

Why this is too strong:

The treatment mainly changes stress and interaction.

How to improve:

Explain that symptoms or relapse risk may reduce indirectly.

Mistake: Saying it replaces antipsychotic medication

Why this is inaccurate:

Family therapy is often used as an adjunct.

How to improve:

Explain how biological and psychological treatments complement one another.

Mistake: Naming research without explaining the finding

Why this is incomplete:

A researcher’s name alone is not evaluation.

How to improve:

Identify the relevant outcome and its implication.

Mistake: Saying low readmission proves complete recovery

Why this is incorrect:

A person may remain symptomatic without returning to hospital.

How to improve:

Discuss several measures of effectiveness.

Mistake: Ignoring dropout

Why this weakens evaluation:

The treatment requires several people to cooperate over time.

How to improve:

Explain how dropout affects practical effectiveness and research conclusions.

Mistake: Calling family therapy free

Why this is inaccurate:

It requires trained professionals and repeated sessions.

How to improve:

Balance initial costs against possible savings from reduced readmission.

Mistake: Saying family therapy has no ethical issues

Why this is incorrect:

Privacy, consent, blame and control can all be relevant.

How to improve:

Develop at least one ethical issue fully.

Mistake: Assuming every patient has an available family

Why this is incorrect:

Some people live alone or have unsafe or limited family contact.

How to improve:

Evaluate suitability for individual circumstances.

Mistake: Treating a culturally close family as automatically over-involved

Why this may be biased:

Expectations of family involvement differ.

How to improve:

Assess whether the involvement increases stress or restricts the person’s wishes.

Exam-Style Questions ✍️

Questions

1. What is meant by family therapy as a treatment for schizophrenia?[2 marks]

2. Explain one aim of family therapy.[3 marks]

3. Explain how psychoeducation may be used in family therapy for schizophrenia.[4 marks]

4. Explain how family therapy may reduce expressed emotion.[4 marks]

5. Explain one communication skill and one problem-solving skill that may be developed during family therapy.[4 marks]

6. Keira’s family repeatedly describe her as lazy because she rarely begins daily activities.

Explain how family therapy might help Keira and her family.[4 marks]

7. Since Joel returned from hospital, his parents monitor everything he does and make all his decisions for him.

Explain how a family therapist might address this situation.[4 marks]

8. Explain one difference between family therapy and cognitive behaviour therapy as treatments for schizophrenia.[4 marks]

9. Researchers compare relapse in two groups over one year:

Treatment condition	Number who relapsed	Number who began treatment
Medication plus family therapy	12	50
Medication only	21	50

a) Calculate the percentage who relapsed in the medication-plus-family-therapy group.[2 marks]

b) Calculate the percentage who relapsed in the medication-only group.[2 marks]

c) Explain one conclusion and one limitation of these findings.[4 marks]

10. Explain one strength and one limitation of family therapy as a treatment for schizophrenia.[6 marks]

11. Describe and evaluate family therapy as a treatment for schizophrenia.[8 marks]

12. Compare family therapy and antipsychotic medication as treatments for schizophrenia.[8 marks]

13. Discuss family therapy as a treatment for schizophrenia. Refer to the following scenario in your answer.

Luca has returned home following treatment for schizophrenia. His parents criticise him for not working and continually check where he is. They frequently argue with Luca and with each other about his medication. Before his previous relapse, Luca stopped sleeping and became increasingly suspicious.

[16 marks]

Answers and Mark Scheme

Question 1

Award up to two marks:

• Family therapy is a psychological treatment involving the person with schizophrenia and important family members.

• It aims to improve understanding, communication and problem-solving or reduce expressed emotion and stress.

Question 2

Award up to three marks for one developed aim.

Possible answer:

• One aim is to reduce expressed emotion.

• Relatives learn to reduce criticism, hostility or emotional over-involvement.

• This lowers stress for the person with schizophrenia and may reduce relapse risk.

Alternative aims include:

• Increasing understanding.

• Reducing anger, guilt and frustration.

• Improving communication.

• Developing realistic expectations.

• Supporting relapse prevention.

Question 3

Award up to four marks:

• Psychoeducation provides relatives and the patient with accurate information about schizophrenia.

• This may include symptoms, treatment, side effects and relapse.

• Relatives may learn that avolition or speech poverty are symptoms rather than deliberate behaviour.

• This can create more realistic expectations.

• Reduced misunderstanding may lower criticism, guilt and family stress.

Question 4

Award up to four marks:

• The therapist identifies criticism, hostility or emotional over-involvement.

• Family members learn clearer and calmer communication.

• They replace global personal criticism with specific descriptions or requests.

• Boundaries are developed to reduce intrusive monitoring.

• Lower EE reduces stress and may lower the likelihood of relapse.

Question 5

Award up to two marks for each skill.

Communication skill:

• Active listening, allowing a family member to speak and checking understanding.

• Alternatively, expressing a concern calmly and specifically rather than using hostile personal criticism.

Problem-solving skill:

• Identify one clear problem.

• Generate possible solutions.

• Compare advantages and disadvantages.

• Agree and review a practical plan.

Question 6

Award up to four marks:

• Keira’s reduced initiation may represent avolition rather than laziness.

• Psychoeducation could help her relatives understand the negative symptom.

• The therapist could help them replace criticism with a specific, manageable request.

• The family might agree small realistic goals.

• This should reduce expressed emotion and stress.

Question 7

Award up to four marks:

• Constant monitoring and decision-making may demonstrate emotional over-involvement.

• The therapist could acknowledge that the parents may be worried about relapse.

• The family could identify decisions Joel can make independently.

• Clear boundaries and a proportionate relapse plan could replace constant checking.

• This may increase Joel’s autonomy and reduce family stress.

Question 8

Award up to four marks:

• Family therapy involves relatives and targets family communication or expressed emotion.

• CBT generally works with the individual’s beliefs, interpretations and coping.

• For example, family therapy may reduce criticism, whereas CBT may use reality testing to challenge a persecutory belief.

• Both are psychological treatments and may be combined.

Higher marks require a direct comparison.

Question 9a

5012​×100=24%

Award:

• One mark for appropriate working.

• One mark for 24%.

Question 9b

5021​×100=42%

Award:

• One mark for appropriate working.

• One mark for 42%.

Question 9c

Award up to four marks.

Possible conclusion:

• Relapse was lower among participants receiving medication plus family therapy.

• The difference was 18 percentage points.

• The result is consistent with family therapy providing an additional benefit.

Possible limitation:

• No inferential-test result is provided, so statistical significance cannot be claimed.

• The groups may have differed in initial symptom severity or family support.

• Dropout or adherence information is not provided.

• Relapse is only one measure and does not show quality of life.

• The findings do not show which component of family therapy produced the difference.

Question 10

Award up to three marks for a developed strength and three marks for a developed limitation.

Possible strength:

Family therapy targets expressed emotion, which has been associated with relapse. Psychoeducation and communication training may reduce criticism and family stress, helping the person remain stable outside hospital.

Possible limitation:

The treatment requires cooperation from the patient and several relatives. Where family members refuse, live far away or feel blamed, dropout may occur and the therapy may provide little practical benefit.

Alternative creditworthy points include:

• Evidence concerning relapse or readmission.

• Improved communication.

• No physical drug side effects.

• Cost-effectiveness.

• Confidentiality.

• Time and therapist availability.

• Family blame.

• Difficulty measuring outcomes.

Question 11

A strong response should contain approximately three marks of description and five marks of evaluation.

Description

• Patient and relatives meet a therapist.

• A therapeutic alliance is established.

• Psychoeducation improves understanding.

• Realistic expectations are developed.

• Communication and problem-solving are taught.

• Criticism, hostility and emotional over-involvement are reduced.

• Stress and relapse risk may decrease.

Evaluation

• Pharoah’s evidence concerning hospital readmission.

• Pilling’s meta-analysis relating to relapse.

• Montero’s finding concerning dropout.

• Cooperation and positive engagement are required.

• Family therapy may improve communication beyond symptom reduction.

• It may reduce double-bind communication.

• Time, cost and therapist availability.

• Privacy and confidentiality.

• Risk of family blame.

• Comparison with medication or CBT.

• Value as an adjunct to drug therapy.

• Holistic consideration of social and treatment factors.

The June 2025 mark scheme explicitly allocated more marks to evaluation than description.

Question 12

A strong comparison may include:

• Family therapy is psychological and social, whereas medication is biological.

• Family therapy targets communication and expressed emotion.

• Medication targets neurotransmitter activity.

• Family therapy involves relatives, while medication is administered to the patient.

• Family therapy requires active cooperation from several people.

• Medication can be used more rapidly during severe acute psychosis.

• Family therapy does not produce movement or metabolic drug effects.

• Medication may produce significant physical side effects.

• Family therapy may reduce relapse by lowering stress.

• Medication may reduce relapse through continuing biological action.

• Family therapy teaches transferable communication skills.

• Medication effects may depend on continued adherence.

• Both can experience dropout or non-adherence.

• Both may reduce hospital readmission.

• They are often most effective when combined.

Higher marks require direct comparisons using terms such as “whereas”, “both” and “in contrast”.

Question 13

A strong answer should include:

Knowledge and understanding

• Family therapy as a psychological treatment.

• Patient and family meetings.

• Therapeutic alliance.

• Psychoeducation.

• Realistic expectations.

• Reduction of anger, guilt and frustration.

• Reduction of expressed emotion.

• Criticism, hostility and emotional over-involvement.

• Communication training.

• Active listening.

• Problem-solving.

• Appropriate independence.

• Relapse-prevention planning.

• Family therapy as an adjunct to medication.

Application

• Criticism about not working may show high EE.

• Psychoeducation can explain avolition and gradual recovery.

• The family can replace global criticism with specific, realistic goals.

• Constant checking suggests emotional over-involvement.

• Agreed boundaries can increase Luca’s independence.

• Frequent arguments demonstrate hostility and poor communication.

• Turn-taking, active listening and calm statements may reduce conflict.

• Arguments about medication can be addressed through psychoeducation and structured problem-solving.

• Luca should remain involved in medication decisions.

• Reduced sleep and increasing suspiciousness can be recorded as early warning signs.

• The family can agree when and how to contact the care team.

• These changes may reduce stress and relapse risk.

Evaluation

• Research concerning relapse and hospital readmission supports family therapy.

• Reduced readmission does not prove complete recovery.

• Meta-analytic evidence is broader than one study but depends on original-study quality.

• Dropout may reduce practical effectiveness.

• The treatment requires cooperation from Luca and his parents.

• Severe suspiciousness may make joint sessions difficult.

• Family members may feel blamed.

• Confidentiality and medication discussions raise ethical issues.

• Therapy requires time and a skilled practitioner.

• Initial costs may be offset by fewer readmissions.

• The treatment addresses family stress but not dopamine or genetic vulnerability directly.

• Medication may reduce symptoms sufficiently for Luca to participate.

• Family therapy may improve relationships even if symptoms remain.

• Combined treatment is more complete than relying on family therapy alone.

Higher-level responses will connect each separate scenario detail with an appropriate family-therapy technique and balance evidence of reduced relapse against suitability, dropout, ethical concerns and the value of combined treatment