Schizophrenia

Psychotherapy is a type of treatment in which a mental health professional (psychiatrist, psychologist, or social worker) uses words and sometimes activities to help a person overcome psychological difficulties.

Before the discovery of antipsychotic drugs, psychotherapy by itself was not really helpful for people with schizophrenia. Most patients were just too far removed from reality to benefit from psychotherapy. Today, however, psychotherapy is an important part of treatment for many people with schizophrenia.

Medications help to relieve symptoms such as hallucinations, delusions, and disorganized speech. Psychotherapy helps patients to play an active role in the treatment process, think more clearly about themselves and their relationships, and make positive changes in their behavior. Three kinds of psychotherapy that are often helpful for treating people with schizophrenia are individual therapy, group therapy, and family therapy.

Individual Therapy

Individual therapy refers to psychotherapy in which the patient meets one-on-one with a therapist. There are many different kinds of individual therapy. Some individual therapists simply provide a safe place for patients with schizophrenia to talk about difficulties associated with their illness and to receive support. Other individual therapists may play a more active role in the therapy, providing advice and training in areas in which the patient needs help.

For example, a therapist might give Molly some suggestions about how to deal with the awkwardness that she feels around her parents. He or she may also explore with Molly the best way for her to express her feelings to her parents in a positive and helpful way.

Group Therapy

Many people with schizophrenia find it helpful to participate in group therapy. Group therapy usually consists of one or two therapists who work with a group of patients who share similar problems. Groups usually involve some sort of training for the patients in areas that create problems for them.

For example, many people with schizophrenia find it difficult to make friends. There are several reasons for this. First, some of the negative symptoms of the illness, such as poor eye contact and difficulty showing emotions, may interfere with social interactions. (Next time you see your best friend, try maintaining a flat expression and looking at the floor while you talk to him or her. It probably will not be long until your friend becomes very uncomfortable and asks you what is wrong!)

Also, some people with schizophrenia have trouble deciding how to appropriately initiate (start off) contact with other people. In addition, many schizophrenia sufferers have trouble dealing with the stigma (shame or disgrace) of being known as a mentally ill person. This stigma may cause a person to be rejected by old friends or others who are not mentally ill. Some schizophrenia sufferers may reject others who suffer from mental illness because they feel ashamed of their own illness and do not want to be around other “sick” people.

Therefore, one type of group therapy might focus on helping people with schizophrenia learn to act appropriately in social situations and make friends. The therapist running the group might do this by having two people in the group act out a social situation:

Therapist: OK, we're going to practice talk ing to someone with the goal of getting to know the person a little better. Darius, why don't you try it first with Janice. Pretend that she is standing by a bus stop and that you're both waiting to take the same bus. You want to try to talk to her a little.

Darius: Okay. Hi, do you want to go to the movies?

Janice: Well, I don't really know you.

Therapist: Start a little more slowly, Darius. Try to let Janice know that you know who she is and that you'd like to introduce yourself

Darius: Hi, my name is Darius. I've seen you waiting for this bus before.

Janice: Yes, I take this bus three days a week.

Therapist: That's a big improvement, Darius. Janice, if someone introduces himself, you should respond by telling him your name. Let's start again with Darius.

Darius: Hi, my name is Darius. I think I've seen you here before.

Janice: Yes, I take this bus three days a week. My name is Janice.

Therapist: Great job. That's much better. Janice, you might then ask Darius how often he takes the bus so that you'll have something more to talk about. Also, Darius, try to look at Janice when you talk to her instead of looking down at your feet.

Group therapy also provides an opportunity for people with schizophrenia to meet other people who are in a similar situation. They can often provide support and advice for each other. Group therapy often results in the formation of strong and lasting friendships.

Family Therapy

Approximately 65 percent of individuals with schizophrenia live with family members. This can create special pressures for both patients and their family members. As mentioned in chapter four, family stress does not cause schizophrenia. However, interactions with family members can affect whether a person experiences a relapse (return of symptoms) once his or her symptoms have been controlled with medication.

The most common cause of relapse is when a patient stops taking medication. However, a relapse can sometimes occur even when the person takes his or her medication faithfully. One factor that may increase the risk of relapse is living with family members who are critical of and hostile to the person with schizophrenia or who are smothering and overinvolved in the person's life.

One of the goals of family therapy is to help families learn to interact with their relative in a way that reduces his or her risk of relapse. Family therapy also provides an opportunity for all family members to learn more about schizophrenia. For example, family members often do not know much about the negative symptoms of the illness and may sometimes confuse them with laziness. In addition, family therapy provides support and guidance for family members who are worried about their relative.

Getting Help

A few weeks after returning home from the hos pital, Molly began seeing Dr. Kitay, a psychologist who specializes in working with people recovering from schizophrenia. Molly told Dr. Kitay about the difficulties she was having with her family and her old friends. She also expressed her frustration with taking a medication that caused her to feel sleepy and gain weight.

Dr. Kitay helped Molly to realize how important her medication was and that the side effects were not nearly as bad as having to go to the hospital again. Dr. Kitay also helped Molly to understand why relating to her parents seemed so difficult. Dr. Kitay even met with Molly's parents several times to help them learn more about her illness.

In addition, Dr. Kitay encouraged Molly to participate in a support group with other young people recovering from schizophrenia. Molly resisted at first because she wanted to leave her illness behind her instead of hanging out with other “sick” people. However, after a few ses sions, Molly discovered that she really enjoyed group therapy. She found it helpful to talk about her problems with other people in similar situa tions. Molly also realized that she was able to help others in the group to feel better, just as they were able to help her.