Interpersonal Control and Expressed Emotion in Families of Persons With Schizophrenia: Change Over Time

This study examined communication patterns in 62 families of persons with schizophrenia, comparing families with relatives who were low expressed emo-tion (EE) at the beginning and end of a 2-year study, those who were high EE at the beginning and end, and those whose EE status changed. Interaction was coded with the Relational Control Coding System and ana-lyzed as a Markov process. Dialogues in the stable low-EE and stable high-EE families were rather simi-lar initially, and both groups showed increasing flexi-bility at year 1. However, at year 2, Iow-EE dyads showed increasingly complex structure and flexibility in control, but high-EE dyads showed simpler struc-ture and rigidly controlling patterns. When EE status changed, so did the structure of the dialogues and the patterning of control. Although earlier research found more "tightly joined " systems in families of high-EE relatives, it may be that over time, these family mem-bers distance from each other and so are less con-nected. It is also possible that relatives who remain high EE despite intervention are a subset of high-EE relatives who need more support or different thera-peutic approaches to maintain change