e months. Unfortunately two years after the fact, the relapse rates were not significantly different whether there was an intervention or not (Kuipers, 1996). However, Tarrier et al. (1994) found that after five and eight years patients who had a nine month family intervention still had a significantly lower relapse rate though relapses did accumulate.Interventions suffer from a few problems. While they help, they are time consuming, their effects are reduced over time, and finally, it is very difficult to recruit families while the patient is in remission and the family has a fairly stable situation. Non-engagement rates at these times are over fifty percent (Smith 1992) .As already noted, many ‘difficult to treat’ schizophrenic patients are disliked by hospital staff treating them. This hampers the therapeutic alliance greatly.Frank & Gunderson (1990) found that although even after six months only thirty percent of patients in treatment for schizophrenia were in good alliances, those that were were less likely to drop out and made more gains over the next two years. Good alliances led to greater acceptance of psychotherapy and pharmacotherapy (though less medication use).It has been found that the things that most lead carers to dislike a patient were repetition of inappropriate behavior and attention seeking. However apathy, slowness and poor self-care also lead to criticism from carers (Moore et al. 1992b). It was also found that those of the staff who criticize a lot are more likely to attribute patients’ difficulties to being under the patients’ control, and to have negative expectations of the patient.However, nothing suggests that patients with challenging behavior necessarily are disliked. The group which receives the most criticism and be disliked are those patients who are withdrawn and seemed to be cold and not very responsive to therapy.From this we can see that there are several things that staff ...
