Does Family-Therapist Alliance Affect Symptoms of Schizophrenia?

Schizophrenia is a psychological problem that can cause symptoms of decreased cognition, delusions, and paranoia. For family members of people with schizophrenia, managing the symptoms and maintaining healthy relationships can be particularly difficult. However, behavioral family management (BFM) therapy, when based on a positive family-therapist relationship, has been shown to be an effective form of treatment to address these challenges. Phyllis E. Smerud and Irwin S. Rosenfarb, both of the California School of Professional Psychology, Alliant International University at San Diego, recently conducted a study to evaluate the effectiveness of BFM. The researchers said, “The development of a positive alliance has been identified as a central component of effective family psycho-education, and research suggests that the development of a positive alliance plays a critical role in determining the outcome of both individual psychotherapy and family treatments, in general.”

To measure the results of BFM the team enlisted 28 schizophrenic clients and their families who were part of larger study, the National Institute of Mental Health’s Treatment Strategies in Schizophrenia. The researchers used the System for Observing Family Therapy Alliances (SOFTA), which identifies 44 specific behaviors as positive or negative, to evaluate the data. They found that the families that developed positive relationships with the therapist early in the treatment process saw their loved ones exhibit fewer symptoms and lower incidents of hospitalization during the two year following treatment. “When patients developed a positive therapeutic alliance early in treatment, relatives tended to become less rejecting of patients and tended to be less likely to feel burdened in caring for patients over a 2-year period,” said the researchers. They added, “Thus, the data suggest that it may be important for clinicians to engage relatives early in family treatment to prevent the subsequent escalation of psychotic symptoms, and it may be important to engage patients in family treatment to decrease negative family interactions and family burden.”

Smerud, Phyllis E., and Irwin S. Rosenfarb. “The Therapeutic Alliance and Family Psychoeducation in the Treatment of Schizophrenia: An Exploratory Prospective Change Process Study.” Couple and Family Psychology: Research and Practice 1.(S) (2011): 85-91. Print.

© Copyright 2011 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • judy


    August 29th, 2011 at 3:52 PM

    It would seem like a winning situation all the way around when you are able to get the family involved in the treatment and therapy of any patient. I know that there are probably times when it best for the family to be on the sidelines and stay out of it but at some point those who are deemed to be in a caregiving role would have to get involved. This would help them to be better educated about the situation that they are facing but also more involved in a positive way.

  • D hall

    D hall

    August 29th, 2011 at 7:23 PM

    when you’re comfortable with your doctor the treatment seems that much easier and’s all on our mind.

    but this definitely gives a good idea for therapists to follow with patient and family members so that the patient benefits as much as possible.

  • erin


    August 30th, 2011 at 4:20 AM

    I know that having the family involved can be a plus but. . . is n’t the mental ilness just going to progress, even though the family is involved? maybe it would slow the progression a bit, but the eventuality of the situation is always going to be there.

  • jude


    August 30th, 2011 at 8:08 AM

    surprised to know even te family members’ equation with the therapist plays a role.they would get the same advice whether they know the therapist well or are new I’d what is the change-causing factor?

  • G.Murdoch


    August 30th, 2011 at 11:56 PM

    I think if the family members are close to the therapist they will be able to understand what is told in a much better way and will be able to implement the same at home for the benefit of the patient.

    This is one way I think it could effect. other than this, its a doctor-patient relationship and family has nothing other than what I have mentioned.

Leave a Comment

By commenting you acknowledge acceptance of's Terms and Conditions of Use.

* Indicates required field.

GoodTherapy uses cookies to personalize content and ads to provide better services for our users and to analyze our traffic. By continuing to use this site you consent to our cookies.