The recent literature on the treatment of schizophrenia is marked by an increasing emphasis on family therapy. Several new family therapy strategies have been developed which have produced dramatic reductions in relapse rates compared to control conditions. Each of these new therapies is based, in part. On the assumption that relapse can be precipitated by stress resulting from maladaptive patterns of communication within the home. Thus, a major focus of the interventions is to modify interactions between patients and key relatives. While the treatments have proven to be effective, there is little data to support the specific content of the treatments or the hypothesis on which they are based. The purpose of this study is to examine the operation and effect of behavioral family therapy, one of the most promising of the new family approaches. The study will be implemented in conjunction with the NIMH Collaborative Study on Treatment Strategies in Schizophrenia. Patients participating in the Collaborative study will be requested to engage in a naturalistic family problem solving task with a significant other before treatment, and again one and two years later. The interactions will be videotaped for subsequent rating on a variety of communication and problem solving measures. In conjunction with outcome data collected for the Collaborative study, the proposed study will enable us to determine: 1. if the skills targeted in treatment are learned, 2. if improved communication and problem solving is associated with positive outcome for the patient, and 3. what significant other and patient characteristics differentiate families who are able to change communication patterns from those who are unable to change. These results will have important implications for how family therapy is conducted, and identification of families who are (and are not) good candidates for this type of intervention.
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