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Individual Psychotherapy for Treating Schizophrenia

Individual psychotherapy involves regularly scheduled talks between the patient and a mental health professional such as a psychiatrist, psychologist, psychiatric social worker, or nurse. The sessions may focus on current or past problems, experiences, thoughts, feelings, or relationships. By sharing experiences with a trained empathic person – talking about their world with someone outside it – individuals with schizophrenia may gradually come to understand more about themselves and their problems. They can also learn to sort out the real from the unreal and distorted.

Mental health professionals often do not suggest psychotherapy for individuals with schizophrenia, thinking that it is not effective. That is probably true of the insight-oriented psychotherapies that are non-directive, and rely on the client to spontaneously identify problems and discuss them. However, recent studies indicate that supportive, reality-oriented, individual psychotherapy, and cognitive-behavioral approaches that teach coping and problem-solving skills, can be beneficial for outpatients with schizophrenia. However, psychotherapy is not a substitute for antipsychotic medication, and it is most helpful once drug treatment first has relieved a patient's psychotic symptoms.

Cognitive-Behavioral Psychotherapy

Cognitive psychotherapy, often incorporating behavioral therapy techniques, has been found to be more effective than other types of psychotherapy in treating several specific types of psychological problems, including depression and panic attacks. Sometimes this treatment approach is called cognitive-behavioral psychotherapy because of the ease with which the two approaches combine to effectively treat a variety of psychological problems. This combination of treatment techniques is also effective in the treatment of schizophrenia.

The basic premise of cognitive therapy is that beliefs, expectations, and cognitive assessments of self, the world, and the nature of personal problems in the world affect how we perceive ourselves and others, how we approach problems, and ultimately how successful we are in coping in the world and in achieving our goals. Schizophrenia results in distorted perceptions of the world, including self, and disordered or disorganized thinking. It seems reasonable that a cognitive treatment approach would be helpful in treating schizophrenia, assuming that medication is also employed to alleviate psychotic thought processes which would interfere with any psychotherapeutic interventions.

Behavioral therapy has been used in the treatment of schizophrenia for many years, but usually within a structured psychosocial rehabilitation program, rather than a part of an individual treatment approach. There are many reasons for this. First, schizophrenia is seen as a life-long illness, and few insurance plans were willing to provide coverage for treatment in the private sector because of the anticipated expense. This continues to be true, especially with managed care. The psychosocial rehabilitation programs that incorporated behavioral treatments were usually either hospital based, or funded by public money or non-profit grants. As such, budget constraints would encourage group behavioral treatment, offered by treatment providers with limited training or experience. These approaches demonstrated some success, but the potential value of behavioral treatment was often lost within the greater structure of the broad rehabilitation program. In other words, the program as a whole was evaluated, rather than specific components of the program. This is further complicated by the variety of rehabilitation programs that incorporate many different behavioral treatment modalities. If no two rehabilitation programs are identical, then it is difficult, or impossible, to evaluate the relative effectiveness of specific components. However, an assessment of the interpersonal deficits produced by schizophrenia predicts which behavioral treatments are most likely to be effective.

Cognitive Therapy with Schizophrenia

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Reviewed: 03/2006