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Cognitive-behavioural family interventions for schizophrenia have demonstrated utility in reducing relapse rates and improving functional status, but there is little information on the routine application of this work. In the current study therapists in standard health care settings were trained in delivering a cognitive-behavioural intervention to clients and families. Six months to 3 years after the family training, 45 therapists reported the number of families they had systematically treated, and the difficulties they had encountered. Sixty-nine per cent reported giving three sessions or more of the intervention to at least one family, but only 18% had used it with three or more families. Therapists reported particular difficulty integrating the family work with their other responsibilities and interests: Allowance of time to undertake the intervention, afterhours scheduling, and illness or holidays presented particular difficulties. Only 4% reported that their knowledge of behavioural techniques was a significant problem, but in a written test most therapists did not display minimum recall of the material on cognitive therapy, social skills training, or behavioural strategies. Therapists also reported whether they had used segments of the intervention in their routine clinical contacts. Over 80% said they applied all segments of the intervention at least once a month, but the frequencies for cognitive and behavioural strategies fell below 40% when they were corrected for recall of the segments. This study demonstrated significant problems in disseminating cognitive-behavioural approaches to multidisciplinary settings.
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