Psychological Therapies: CBT & Family Therapy (AQA A Level Psychology): Revision Note

Cognitive behavioural therapy

• Cognitive Behavioural Therapy (CBT) is a well-established psychological therapy which is used to treat a range of disorders, from depression to OCD to schizophrenia

• The cognitive aspect of CBT refers to the ways in which the therapy enables the client to challenge negative/dysfunctional thoughts; the behavioural aspect of CBT helps the client to modify their actions and responses to their dysfunctional thoughts

• CBT is generally a short-term solution to treating schizophrenia (12 to 16 weeks duration for an hour per week) 

• CBT as applied to schizophrenia typically involves the therapist aiming to help the client understand what is real/what is fantasy, e.g., by helping them to understand that voices in their head are not real (a positive symptom) and by putting routines and strategies in place to live life productively (to avoid avolition, a negative symptom)

• CBT may also help clients with schizophrenia in terms of developing a range of social skills and problem-solving skills which should equip them with the tools and mechanisms to manage their condition and to avoid relapse

Family therapy

• Family therapy is – as it sounds – a therapy which involves the family members of the person with schizophrenia

• The psychological explanations of schizophrenia (schizophrenogenic mother, double-bind and expressed emotion) focus squarely on the possible toxic home environment as key contributing factors to the development of schizophrenia so it makes sense to address the family dynamic in therapy sessions

• Family therapy sessions aim to reduce the stress of schizophrenia for all those involved: the patient themselves and their immediate family who have to cope with the illness indirectly on a daily basis

• Family therapy sessions will aim to reduce stress, help family members process their thoughts and feelings about the illness and come together to find practical, feasible problem-solving solutions to the situation

• Pharaoh et al. (2010) identified the most important goals of family therapy for schizophrenia patients:

  • Eliminate or at least reduce destructive emotions such as shame, guilt, anger, which can affect all family members

  • Enable the family to work as a team and to understand that ‘we’re all in this together’

  • Educate family members as to the nature of schizophrenia as an illness and dispel any myths or misinformation they may have about the condition

• The outcome of family therapy should be that the person with schizophrenia is supported in their illness to the extent that the aversive symptoms of schizophrenia reduce significantly

Research which investigates psychological therapies

• Kart et al. (2021) – A review article which concluded that CBT is an effective therapy, particularly in treating the positive symptoms of schizophrenia

• Turkington et al. (2006) found that CBT can be combined with family therapy to treat both positive and negative symptoms of schizophrenia and to generally improve outcomes for the person with schizophrenia

• Caqueo-Urizar et al. (2015) – A review article which emphasises the vital role of family therapy in the face of cut-backs in mental health care facilities and which stresses the need for health professionals to assist and guide family members in the care of the person with schizophrenia

Evaluation of psychological therapies

Strengths

• Strengths

  • CBT has been tried and tested as a suitable therapy for schizophrenia (and for some of the comorbid disorders which patients might suffer from, e.g., depression), which means that as a treatment, it has good validity

  • Family therapy should result in a schizophrenia patient feeling less alone and isolated, which should ultimately benefit the economy, as it means less reliance on external mental health providers, plus the patient may be able to work, which means fewer days absence lost to sickness

  Weaknesses

  • Not everybody is suited to CBT and as schizophrenia exists on a spectrum, it may only be appropriate for those whose symptoms are mild or easily managed

  • Family therapy may actually worsen someone’s symptoms if they feel that they are being forced to interact with or depend on people who are emotionally destructive, i.e., the family dynamic is too toxic but the patient may not be able to express or admit this to a health professional

Issues & Debates

• Psychological therapies take a more holistic approach, considering social, emotional, and cognitive aspects of schizophrenia rather than just biology

  • Family therapy, in particular, recognises the importance of social context and relationships, helping to reduce symptoms and relapse risk by improving communication

  • This makes psychological therapies more well-rounded than purely drug-based interventions

• CBT encourages patients to take control of their thoughts and behaviours, promoting free will and personal agency

  • This contrasts with biological determinism, which suggests schizophrenia is caused by uncontrollable brain chemistry or genes

  • Psychological therapies like CBT support the idea that individuals can actively manage their symptoms