Skip to main content

Family therapy and schizophrenia: a brief theoretical overview and a framework for clinical practice

  • Frank R. Burbach (a1)

Family or systemic therapy is often contrasted with psychoeducational approaches, but their historical differences have become blurred with the increasing development of integrated family interventions for psychosis. This article describes the theoretical context for the development of integrated family interventions and provides a framework for practice. It presents a collaborative, resource-oriented integrated family intervention for working with families and wider support networks within seven phases: the sharing of information and provision of emotional and practical support; identification of patient, family and wider network resources; encouraging mutual understanding; identification and alteration of unhelpful patterns of interaction; improving stress management, communication and problem-solving skills; coping with symptoms and relapse prevention planning; ending and ensuring that each session is a mini-intervention. It also includes guidelines for family intervention practice, as well as ideas for service development.


  • Understand the theoretical developments in the field
  • Be able to apply the integrated framework to family intervention in practice
  • Consider different ways of developing family-based services



Corresponding author
Correspondence Dr Frank R. Burbach, Somerset Partnership NHS Foundation Trust, Foundation House, Wellsprings Road, Taunton TA2 7PQ, UK. Email:
Hide All

For a commentary on this article, see pp. 235–236, this issue.

Hide All
Baucom, DH, Whisman, MA, Paprocki, C (2012) Couple-based interventions for psychopathology. Journal of Family Therapy, 34: 250–70.
Bentovim, A (1996) Trauma-organized systems in practice: implications for work with abused and abusing children and young people. Clinical Child Psychology and Psychiatry, 1: 513–24.
Ben-Zeev, D, Drake, RE, Brian, RM (2015) Technologies for people with serious mental illness. In Behavioral Health Care and Technology: Using Science-Based Innovations to Transform Practice (eds Marsch, LA, Lord, SE, Dallery, J, et al. ): 7080. Oxford University Press.
Bertolino, B, O'Hanlon, WH (2002) Collaborative, Competency-Based Counseling and Therapy. Prentice Hall.
Bertolote, J, McGorry, P (2005) Early intervention and recovery for young people with early psychosis: consensus statement. British Journal of Psychiatry, 187 (suppl 48): s1169.
Bertrando, P (2006) The evolution of family interventions for schizophrenia. A tribute to Gianfranco Cecchin. Journal of Family Therapy, 28(1): 422.
Bird, V, Premkumar, P, Kendall, T, et al. (2010) Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. British Journal of Psychiatry, 197: 350–6.
Burbach, FR (1996) Family based interventions in psychosis: an overview of, and comparison between, family therapy and family management approaches. Journal of Mental Health, 5: 111–34.
Burbach, FR, Stanbridge, RI (2006) Somerset's family interventions in psychosis service: an update. Journal of Family Therapy, 20: 311–25.
Burbach, FR, Fadden, G, Smith, J (2010) Family interventions for first-episode psychosis. In Promoting Recovery in Early Psychosis: A Practice Manual (eds French, P, Read, M, Smith, J, et al. ): 210–25. Wiley-Blackwell.
Burbach, FR (2012) Family interventions: fundamental considerations when developing routine and formal family interventions services. In Psychosis: Causes, Diagnosis and Treatment (ed Anastassiou-Hadjicharalambous, X): 207–28. Nova Science Publishers.
Burbach, FR (2013a) Towards a systemic understanding of family emotional atmosphere and outcome after psychosis. In Psychosis and Emotion: The Role of Emotions in Understanding Psychosis, Therapy and Recovery (eds Gumley, A, Gillham, A, Taylor, K, et al. ): 116–35. Routledge.
Burbach, FR (2013b) Developing Systemically-Oriented Secondary Care Mental Health Services (PhD thesis). University of Plymouth (archived in PEARL:
Burbach, FR (2015) The development of efficient family intervention services: a whole systems approach. Clinical Psychology Forum, (271): 3641.
Burbach, FR (2016a) Co-work: working in pairs enables effective whole family sessions. In Parental Mental Health and Child Welfare Work (vol 1) (ed Diggins, M.): 135–40. Pavilion Publishing.
Burbach, FR (2016b) Brief family interventions in psychosis: a collaborative, resource-oriented approach to working with families and wider support networks. In Brief Interventions for Psychosis: A Clinical Compendium (eds Pradhan, B, Pinninti, N, Rathod, S): 119–37. Springer.
Chadwick, PD, Birchwood, MJ, Trower, P (1996) Cognitive Therapy for Delusions, Voices and Paranoia. John Wiley & Sons.
Chadwick, P (2006) Person-Based Cognitive Therapy for Distressing Psychosis. John Wiley & Sons.
Cheng, AT (2002) Expressed emotion: a cross-culturally valid concept? British Journal of Psychiatry, 181: 466–7.
Cohen, AN, Glynn, SM, Murray-Swank, AB, et al. (2008) The family forum: directions for the implementation of family psychoeducation for severe mental illness. Psychiatric Services, 59: 40–8.
Cooke, A (ed) (2014) Understanding Psychosis and Schizophrenia: Why People Sometimes Hear Voices, Believe Things That Others Find Strange, or Appear out of Touch with Reality, and What can Help. British Psychological Society, Division of Clinical Psychology.
Dallos, R, Draper, R (2010) An Introduction to Family Therapy: Systemic Theory and Practice. McGraw-Hill International.
de Shazer, S (1985) Keys to Solution in Brief Therapy. Norton.
Dixon, LB, Dickerson, F, Bellack, AS, et al. (2010) The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin, 36: 4870.
Doane, JA, West, KL, Goldstein, MJ, et al. (1981) Parental communication deviance and affective style: predictors of subsequent schizophrenia spectrum disorders in vulnerable adolescents. Archives of General Psychiatry, 38: 679–85.
Fadden, G, Bebbington, P, Kuipers, L (1987) The burden of care: the impact of functional psychiatric illness on the patient's family. British Journal of Psychiatry, 150: 285–92.
Falloon, I, Mueser, K, Gingerich, S, et al. (2004) Family Work Manual. The West Midlands Family Programme.
Gingerich, WJ, Peterson, LT (2013) Effectiveness of solution-focused brief therapy: a systematic qualitative review of controlled outcome studies. Research on Social Work Practice, 23: 266–83.
Gleeson, J, Jackson, HJ, Stavely, H, et al. (1999) Family intervention in early psychosis. In The Recognition and Management of Early Psychosis: A Preventive Approach (eds McGorry, PD, Jackson, HJ): 376406. Cambridge University Press.
IRIS (2012) IRIS Guidelines Update: September 2012. IRIS.
Kuipers, E, Onwumere, J, Bebbington, P (2010) A cognitive model of caregiving in psychosis. British Journal of Psychiatry, 196: 259–65.
Lobban, F, Barrowclough, C (2016) An interpersonal CBT framework for involving relatives in interventions for psychosis: evidence base and clinical implications. Cognitive Therapy and Research, 40: 198215.
McFarlane, WR, Cook, WL (2007) Family expressed emotion prior to onset of psychosis. Family Process, 46: 185–97.
Mihalopoulos, C, Magnus, A, Carter, R, et al. (2004) Assessing cost effectiveness in mental health: family interventions for schizophrenia and related conditions. Australian and New Zealand Journal of Psychiatry, 38: 511–9.
National Collaborating Centre for Mental Health (2014) Psychosis and Schizophrenia in Adults: The NICE Guideline on Treatment and Management (updated edn) (National Clinical Guideline Number 178). National Institute for Health and Care Excellence.
Onwumere, J, Kuipers, E, Bebbington, P, et al. (2011a) Coping styles in carers of people with recent and long-term psychosis. Journal of Nervous and Mental Disease, 199: 423–4.
Onwumere, J, Bebbington, P, Kuipers, E (2011b) Family interventions in early psychosis: specificity and effectiveness. Epidemiology and Psychiatric Sciences, 20: 113–9.
Padesky, CA, Mooney, KA (2012) Strengths-based cognitive–behavioural therapy: a four-step model to build resilience. Clinical Psychology Psychotherapy, 19: 283–90.
Patterson, P, Birchwood, M, Cochrane, R (2005) Expressed emotion as an adaptation to loss: perspective study in first-episode psychosis. British Journal of Psychiatry, 187(suppl 48): s5964.
Pharoah, F, Mari, JJ, Rathbone, J, et al. (2010) Family Intervention for Schizophrenia (Update). Cochrane Database of Systematic Reviews, 12: CD000088 (doi 10.1002/14651858.CD000088.pub2).
Priebe, S, Omer, S, Giacco, D, et al. (2014) Resource-oriented therapeutic models in psychiatry: conceptual review. British Journal of Psychiatry, 204: 256–61.
Razzaque, R, Stockmann, T (2016) An introduction to peer-supported open dialogue in mental healthcare. BJPsych Advances, 22: 348–56.
Rhodes, J, Jakes, S (2009) Narrative CBT for Psychosis. Routledge.
Rosenfarb, IS, Bellack, AS, Aziz, N (2006) Family interactions and the course of schizophrenia in African American and White patients. Journal of Abnormal Psychology, 115(1): 112.
Seikkula, J, Alakare, B, Aaltonen, J (2001) Open dialogue in psychosis 1: an introduction and case illustration. Journal of Consultative Psychology, 14: 247–65.
Seikkula, J (2003) Open dialogue integrates individual and systemic approaches in serious psychiatric crises. Smith College Studies in Social Work, 73: 227–45.
Seikkula, J, Aaltonen, J, Alakare, B, et al. (2006) Five-year experience of first episode nonaffective psychosis in open-dialogue approach: treatment principles, follow-up outcomes, and two case studies. Psychotherapy Research, 16: 214–28.
Stanbridge, RI, Burbach, FR (2007) Involving Carers (Part 1). In Families as Partners in Mental Health Care: A Guidebook for Implementing Family Work (eds Froggatt, D, Fadden, G, Johnson, DL, et al. ): 5065. World Fellowship for Schizophrenia and Allied Disorders.
Stanbridge, R (2012) Including families and carers: an evaluation of the family liaison service on inpatient psychiatric wards in Somerset, UK. Mental Health Review Journal, 17: 7080.
Stanbridge, R, Burbach, F (2014) Family needs, family solutions: developing family therapy in adult mental health services. In Creative Positions in Adult Mental Health: Outside In – Inside Out (eds McNab, S, Partridge, K): 167–86. Karnac Books.
Stratton, P (2011) The Evidence Base of Systemic Family and Couples Therapy. Association of Family Therapy. Association for Family Therapy & Systemic Practice.
Szapocznik, J, Williams, RA (2000) Brief strategic family therapy: twenty five years of interplay among theory, research and practice in adolescent behavior problems and drug abuse. Clinical Child and Family Psychology Review, 3: 117–34.
Tarrier, N, Harwood, S, Yusopoff, L, et al. (1990) Coping strategy enhancement (CSE): a method of treating residual schizophrenic symptoms. Behavioural Psychotherapy, 18: 283–93.
Telles, C, Karno, M, Mintz, J, et al. (1995) Immigrant families coping with schizophrenia: behavioural family intervention versus case management with a low-income Spanish-speaking population. British Journal of Psychiatry, 167: 473–9.
Trepper, TS, McCollum, EE, De Jong, P, et al. (2012) Solution-focused brief therapy treatment manual. In Solution-Focused Brief Therapy: A Handbook of Evidence Based Practice (eds Franklin, C, Trepper, TS, Gingerich, WJ, et al. ): 2036. Oxford University Press.
von Sydow, K, Beher, S, Schweitzer, J, et al. (2010) The efficacy of systemic therapy with adult patients: a meta-content analysis of 38 randomized controlled trials. Family Process, 49: 457–85.
Worthington, A, Rooney, P, Hannan, R (2013) The Triangle of Care – Carers Included: A Best Practice Guide in Acute Mental Health Care (2nd edn). Carers Trust.
Xia, J, Merinder, LB, Belgamwar, MR (2011) Psychoeducation for schizophrenia. Cochrane Database of Systematic Review, 6: CD002831 (doi:10.1002/14651858.CD002831.pub2).
Zubin, J, Spring, B (1977) Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology, 86: 103–26.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 2056-4678
  • EISSN: 2056-4686
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Family therapy and schizophrenia: a brief theoretical overview and a framework for clinical practice

  • Frank R. Burbach (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *