| Abstract |
The aim of the present dissertation was to study the interpersonal relationships in families of individuals exhibiting symptoms of paranoid type schizophrenia or schizoaffective disorder. Specifically, the dissertation had three research directions: a) the construction and standardization of research tools for the study of intrafamilial relationships, b) the examination of intrafamilial relationships in families with one individual suffering from psychotic symptoms, and c) the study of the effect of the quantitative and qualitative aspects of psychotic symptoms of the individual receiving Integrative Psychotherapy on various aspects of intrafamilial interactions.
The study population consisted of 116 individuals meeting the DSM-IV diagnostic criteria for schizophrenia paranoid type or schizoaffective disorder and their families. All patients were treated by an experienced psychotherapist with weekly 50 minutes sessions. This therapist employed a Greek approach to psychotherapy integration (Synthetiki Psychotherapia) and patients were assessed with systematic evaluations of their psychopathology. No systematic family therapy was employed. However, all families were seen occasionally in psychotherapy sessions focusing on explaining the nature of psychotic symptoms and exploring ways of handling them and on carrying out crises intervention. All family members were evaluated regarding their family relationships with the questionnaires constructed for the purpose of this research.
The research hypotheses of the present dissertation were the following: I) The intrafamilial relationships in the families of a patient under psychotherapy exhibiting psychotic symptoms are more disturbed (negative), compared to the intrafamilial relationships in families of a patient exhibiting symptoms of anxiety. Moreover, the intrafamilial relationships of the aforementioned families differ from the intrafamilial relationships of normal individuals of a control group, not receiving psychotherapy. Consequently, we hypothesized that the negative interrelating will concern: a) the patient’s relationship to his/her parents, b) the parents’ relationship to their children and c) the couples’ interrelating. Moreover, the negative intrafamilial relating will be recorded in the evaluation of each member’s relating to the other family members (how the person considers his/her relating to the other members, i.e. self-assessment) as well as in the evaluation of the relating to by the other member (how s/he evaluates the other members relating to him/her, i.e. assessment of the other member). II) Furthermore, we hypothesized that one of the disturbances in families with patients exhibiting psychotic symptoms will be the difference in perception of intrafamilial relationships between parents and patients, that is the discrepancy of the perception of intrafamilial relationships between the family members as far as their evaluation of their relationship was concerned. This discrepancy is hypothesized to be expressed in the relating of parents to their children and in the relating of children to their parents. III) Moreover, we hypothesized that the discrepancy in the perception of family members’ intrafamilial relationships will not be uniform, but it will be more profound in certain octants of the Interpersonal Octagon. IV) That in families with a patient exhibiting psychotic symptoms, the quality of normal children’s relating to their parents will correlate to their sibling’s psychotic symptomatology (positive and negative schizophrenic symptoms). V) That the characteristics of the patient’s intrafamilial relationships vary in relation to the severity of his/her symptomatology. Intrafamilial relationships are more negative in the acute phase of the psychotic disorder, compared to the intrafamilial relationships in the residual phase or in the remission phase. VI) That there is a discrepancy in the perception of intrafamilial relationships between family members, which relates to the severity of the symptomatology, and to the type of relationship reflected in certain octants of the Interpersonal Octagon. VII) That the quality of normal children’s relating to their parents and the quality of parents’ relating to their children differs in relation to patient’s phase of his/her disorder (acute vs residual and remission phase). VIII) The amelioration of patient’s symptomatology, as a result of the psychotherapy intervention applied, relates to the improvement of intrafamilial relationships. IX) The more intense the patient’s amelioration of his/her psychotic symptomatology, as a result of psychotherapy, the more improvement in the intrafamilial relationships is detected. X) Finally, we hypothesized that when the patient is treated successfully with integrative psychotherapy, there is a decrease in the discrepancy between the family member’s evaluation of their intrafamilial relationships.
The findings of the present dissertation offer support to many of the aforementioned research hypotheses, suggesting that the relationship between psychotic symptomatology in an individual family member and intrafamilial relationships is a complex one. 1) However, it appears that the higher the psychopathology in the individual undergoing Integrative Psychotherapy, the higher the degree of detected aberrations in family intrafamilial relating. 2) In the family of a patient with psychotic symptoms, a contradictory and inconsistent interactional model of relating was detected between family members. Specifically, the inconsistency concerned the perception of each other’s relating. 3) The quality of normal children relating to their parents depends on their siblings’ psychopathology (positive and negative schizophrenic symptoms). 4) Intrafamilial relationships depend on the severity of patient’s symptomatology. In the residual phase of the psychotic illness there is more aberration in intrafamilial relating than in the acute symptomatic or remission phase. Furthermore, discrepancy in their perception of each other’s relating was detected. 5) The amelioration of psychotic symptomatology in a person who is treated successfully with integrative psychotherapy correlates with the improvement of his/her intrafamilial relationships. 6) Finally, a decrease in the discrepancy in the perception of intrafanilial relationships between family members was detected, when the psychotic symptomatology decreased as a result of individual integrative psychotherapy intervention.
Based on the findings and conclusions of the present dissertation, a circular and multifactorial model for the study of intrafamilial relationships in families with a member exhibiting psychotic symptoms is proposed. Further research on the intrafamilial interactions, stemming from the integrative approach of the intrapersonal and interpersonal processes, may contribute to the understanding of the aetiology of schizophrenia and to the planning of more effective preventive and therapeutic interventions in families of patients with paranoid type schizophrenia or schizoaffective disorder.
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