Schizophrenia follows a relapsing course for life in most sufferers. In one study almost 80% of patients relapsed repeatedly, and at five years half showed persistent handicap.1 Relapse takes a toll on patients and their families and imposes a financial burden on hospital and community services.2

Some patients relapse while taking maintenance medication,^3,4 and this stimulated a search for other contributory factors which has now led to an emerging consensus.*RF 5-10* What are the psychosocial factors, how do they operate, and what interventions are effective?

The chance of relapse in patients with schizophrenia living at home depends heavily on the emotional environment provided by the family.11 The concept of expressed emotion has evolved as an index of the quality of this environment.*RF 11-13* Expressed emotion covers many of the emotional responses by a key relative, usually the spouse or parent, towards the patient. The key relative's level of expressed emotion is classed as high or low on the basis of the frequency of critical comments and the intensity of hostility and emotional overinvolvement elicited during a structured interview …