Family relationships in the context of psychosis

Abstract

Section A.
Psychosis is predominantly understood as an individual pathology, which directs research and clinical practice. Nonetheless, a growing body of research suggests that psychosis-related experiences shape, and are shaped by, the systems within which people who experience psychosis exist, particularly the family system. This narrative review explored how families respond when one member experiences psychosis, attending to relational processes. A systematic search of peer-reviewed qualitative research was conducted, focussing on families where an adult child, sibling or partner had experienced psychosis. Findings from 15 reviewed studies indicated that family systems undergo complex and dynamic reorganisation, shaped by longstanding patterns of relating. Within families, open communication and mutual acceptance were associated with wellbeing, whilst avoidance and stigmatising attitudes amplified distress and disconnection. Cultural scripts influenced how some families understood and responded to psychosis, alongside relationships with professionals. In the aftermath of psychosis, families continued to negotiate their relationships, often hoping to rebuild trust and shared understanding. Overall, the review demonstrates that psychosis-related experiences reverberate across the whole family system. Findings highlight the need for further research exploring different family members’ perspectives, alongside attuned, family-inclusive clinical practice offered as standard by psychosis services.

Section B.
Siblings of people who experience psychosis remain underrepresented within research and services. Though siblings are increasingly recognised as important figures within the support networks of people who experience psychosis, existing literature often conceptualises their experiences through ‘caregiver’ and ‘stress-coping’ paradigms, neglecting relational reciprocity. Adopting a constructivist grounded theory approach, 10 siblings of people who were experiencing/had experienced psychosis were interviewed about their relationships in the context of psychosis, generating a theory comprising three interrelated categories. The core category, change within the sibling relationship following psychosis, illustrated an ongoing meaning-making process alongside the renegotiation of relational patterns across psychosis-related experiences. Pre-existing contextual influences captured the contexts shaping sibling relationships prior to the emergence of psychosis, whilst psychosis was positioned as activating responsive contextual influences on relationships. Findings were interpreted with reference to systemically oriented ideas, and highlighted the need for greater recognition of siblings of individuals experiencing psychosis within services, alongside further relationally focussed research.

Date of Award	2026
Original language	English
Awarding Institution	Canterbury Christ Church University