There is a long history of research into the attributes of carers of
people with psychosis, but few interventions target their distress or
To describe an empirically based model of the relationships of those
caring for people with psychosis to inform clinical and theoretical
We developed a model of informal carer relationships in psychosis, based
on an integration of the literature elaborating the concept of expressed
emotion. The model accounts for divergent outcomes of three relationship
types: positive, overinvolved and critical/hostile relationships.
Good evidence supports a number of hypotheses concerning the origin and
maintenance of these relationship outcomes, which relate to specific
differences in carer attributions, illness perceptions, coping behaviour,
social support, distress, depression and low self-esteem predicted by our
model. We propose that interventions aimed at modifying the specific
maintenance factors involved in the different styles of relationships
will optimise therapeutic change both for service users with psychosis
and for their carers.
Family work in psychosis, which improves relationships through
problem-solving, reduces service user relapse. It is now time to consider
theory-based interventions focused on improving carer outcomes.