Psychotherapy Of Schizophrenia Research Articles

Applications of Trauma Treatment for Schizophrenia

Because of the high rates of trauma and posttraumatic stress disorder in individuals with psychotic disorders, there has been increasing emphasis on incorporating trauma treatment into comprehensive care for schizophrenia. Yet, despite heightened awareness of the need, limited information has been provided specifying an effective approach tailored to this population. Significant advances in trauma treatment have been made in recent years that can provide a general framework for guiding such interventions for individuals with schizophrenia. This article provides a brief review of the relationship between trauma and schizophrenia and offers a heuristic view of applications of current trauma treatment to psychotherapy for schizophrenia.

Adapted Metacognitive Interpersonal Therapy for Improving Adherence to Intersubjective Contexts in a Person With Schizophrenia

Deficits in the ability to make sense of mental states both of oneself and others, which we term metacognition, is a key difficulty in persons with schizophrenia and psychotherapy needs to address this deficit in order to be effective. We describe here the steps in the treatment of a young woman meeting the criteria for paranoid schizophrenia. Treatment was aimed at helping her to progressively improve her ability to comprehend mental states in order to reduce the intensity of her delusional beliefs and social withdrawal. She was treated with an adapted version of Metacognitive Interpersonal Therapy, the aims of which were to (a) encourage the reconstruction of autobiographical episodes in order to place symptoms in the context of life episodes; (b) stimulate an understanding of the link between problematic feelings and onset of symptoms; (c) build up psychological links between feelings, inability to understand others’ intentions and delusional reasoning; and (d) prevent social withdrawal. Implications for considering poor metacognition a key target of psychotherapy of schizophrenia are discussed.

Psychotherapy of Schizophrenia: A Brief History and the Potential to Promote Recovery

With growing awareness of the likelihood of recovery from schizophrenia, interest has arisen about the potential role of psychotherapy within emerging treatment regimens. Could psychotherapy uniquely promote recovery by addressing symptoms, the achievement of psychosocial milestones, and/or helping to enhance the extent to which persons diagnosed with schizophrenia experience themselves as meaningful agents in the world? As an introduction to a set of case studies of how psychotherapy can promote recovery this article briefly reviews the history of the psychotherapy of schizophrenia. In particular the appearance and course of psychoanalytically oriented treatments, as well as cognitively and interpersonally based treatments are detailed. Evidence supporting these approaches and remaining questions for research are discussed.

Progress Toward a Resurgence and Remodeling of Psychotherapy for Schizophrenia: Editors’ Introduction to Special Issue of Clinical Case Studies

This special issue of Clinical Case Studies focuses on recent developments in the psychotherapy of schizophrenia. Approaches such as these are needed to address the multiple rate-limiting factors for psychotherapy outcome in this population, such as poor insight, comorbid disorders, low motivation, cognitive impairments, and self and interpersonal disturbances. In this introductory article, each of the case studies is briefly reviewed, with the goals of: (a) noting how each therapeutic approach fills a gap in current practice, and (b) placing the focus of treatment within a larger context of relevant research on schizophrenia. Concluding comments note the implications of these multiple therapeutic developments for future psychological treatment of schizophrenia.

The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia

Background The consistent association between therapeutic alliance and outcome underlines the importance of identifying factors which predict the development of a positive alliance. However, only few studies have examined the association between pretreatment characteristics and alliance formation in patients with schizophrenia. Objective The study examined whether symptoms and insight would predict the therapeutic alliance in psychotherapy of schizophrenia. Further, the associations and differences between patient and therapist alliance ratings were studied. Methods Eighty patients with schizophrenia spectrum disorders received manual-based psychotherapy. Assessment of symptoms and insight was conducted at baseline, and questionnaire-based alliance ratings were obtained three weeks into treatment. Patient and therapist alliance ratings were examined separately. Results Patient and therapist alliance ratings were not significantly correlated ( r = 0.17). Patient ratings of the alliance were significantly higher than the ratings of their therapists ( d = 0.73). More insight in psychosis significantly predicted higher patient ratings of the alliance. Less positive and negative symptoms were significant predictors of higher therapist alliance ratings. Conclusion The findings indicate that symptoms and insight have an influence on the therapeutic alliance in the treatment of schizophrenia spectrum disorders. Patients' and therapists' perceptions of the alliance do not seem to demonstrate much convergence.

The Psychotherapy of Schizophrenia through the Lens of Phenomenology: Intersubjectivity and the Search for the Recovery of First- and Second-Person Awareness

Phenomenological analyses suggest that persons with schizophrenia have profound difficulties with meaningfully engaging the world and situating a sense of self intersubjectively, which leads to the experience of self as absent. In this paper we explore the implications of this view for understanding the workings and potential of individual psychotherapy. Following an examination of individual psychotherapy transcripts for over 60 persons with schizophrenia-spectrum disorders we offer four principles for psychotherapy and provide clinical vignettes to exemplify these points. We suggest that the psychotherapy of persons with schizophrenia may be conceptualised as a "dialogical prosthesis" that helps individuals recover past selves then kindle internal and external dialogue, which partially enables a sense of the self to emerge. The therapeutic process consists of assisting persons to move towards recovery by providing an intersubjective space where they can evolve the first-person perspective of themselves and the second-person perspective when encountering others.

Psychotherapy for schizophrenia in the year 2030: prognosis and prognostication.

A number of psychotherapy techniques have been developed that, to varying degrees, have empirical support demonstrating favorable effects in the treatment of schizophrenia (or serious mental illness [SMI]). These techniques, and the research, vary with respect to theoretical origins, format, treatment targets, and expected outcome. A historical perspective informs understanding of this proliferation. One landmark in psychotherapy research was the recognition of common factors: different therapies embody common therapeutic factors not central to any one school. Importantly, insights about common factors reflected a better theoretical understanding of the psychotherapy process and led to the translation of learning and conditioning theories into the psychotherapy vocabulary. This resulted in the distinction between specific and nonspecific treatment effects, which pose present-day research questions such as how common and specific factors interact, and the differentiation of techniques for specific recipients. Because psychotherapy research progresses over the next 25 years, it will be important to develop a model that can answer such questions while incorporating the proliferation of specific modalities and the search for the "right recipe." This "search" will coincide with more attention to individual differences, it will incorporate quantitative modeling, and it will spawn an array of "tools" for treating problems associated with SMI. Because self-knowledge and personhood again become recognized dimensions of recovery, traditional psychodynamic principles and techniques will be revisited. This article explicates a 4-factor model that may be a view to the future.

Evidence-Based Psychotherapy for Schizophrenia

Many patients with schizophrenia have psychological distress and receive some form of psychotherapy. Several different psychotherapeutic approaches for schizophrenia have been developed and studied. Of these approaches, cognitive behavior therapy has the strongest evidence base and has shown benefit for symptom reduction in outpatients with residual symptoms. In addition to cognitive behavior therapy, other approaches include compliance therapy, personal therapy, acceptance and commitment therapy, and supportive therapy. Although usually studied as distinct approaches, the therapies overlap with each other in their therapeutic elements. As psychotherapy for schizophrenia further evolves, it will likely be informed by other psychosocial interventions used with this clinical population. In particular, techniques of remediating cognitive deficits, teaching behavioral skills, and educating about schizophrenia may be incorporated with psychotherapy. Future research may also consider three different goals of psychotherapy with this population: to provide emotional support, to enhance skills for functional recovery, and to alter the underlying illness process.

Psychosocial Treatment Often Missing From Schizophrenia Regimens

Psychosocial Treatment Often Missing From Schizophrenia Regimens

Medical Psychotherapy of Schizophrenia—A Dynamic/Supportive Approach

Split psychiatric treatment-a psychiatrist prescribing medication while a nonphysician provides or coordinates psychosocial treatments-is common practice, especially in the managed care setting. This influence, along with a focus on the biology of mental illness, has shifted the emphasis in psychiatric education and practice away from psychotherapy. In particular, "psychotherapy" of schizophrenia has gotten short shrift. Since our drugs for schizophrenia do not cure, but only ameliorate, it would be unfortunate if psychiatrists were to become marginalized in a largely prescriptive role. This paper discusses medical psychotherapy of schizophrenia-an integrated treatment in which the psychiatrist provides the comprehensive care that such a chronic biopsychosocial illness requires.

Narrative transformation as an outcome in the psychotherapy of schizophrenia

Assertions that changes or transformations in narratives contribute significantly to recovery from schizophrenia persist as a cornerstone of some psychotherapies. Yet when narrative transformation occurs in schizophrenia, what is there about the client's story that tangibly changes, and how might that be measured? To address this issue, we review literature on the importance of narrative transformation and identify narrative qualities that might theoretically change. We then report content and thematic analyses of the qualities of narratives that might potentially change over 14 months of psychotherapy. These analyses suggest that narratives in schizophrenia may gain complexity and dynamism, but the changes do not entail the creation of a new story or the 'awakening' of an 'old' self. From these analyses, the hypothesis that narrative transformation may occur in terms of growth in the richness of the internal dialogue that produces narrative is posed for future research.

Movement towards coherence in the psychotherapy of schizophrenia: a method for assessing narrative transformation.

Lysaker, Paul H. PhD*†; Wickett, Amanda M. MS‡; Campbell, Kikuko MPH, MS§; Buck, Kelly D. MSN, RN* Author Information

The psychotherapy of schizophrenia: its place in the modern world.

This article advocates for training in interpersonal insight-enhancing psychotherapy of schizophrenia, and recommends against chronic reliance on medications. It presents efforts in progress which debate the message of pharmaceutical initiatives.

Eugen Bleulers propositions to psychiatric treatment

The historical review of Eugen Bleulers concepts and proposals to treatment in psychiatry, generally and especially for schizophrenia, covers the years between his inaugural lecture 1898 as professor of psychiatry at the University of Zurich to his last edition of his textbook 1937. Already at the beginning of his career as professor in Zurich, he had a very intimate knowledge of psychiatric patients from his 12 years as director of the Mental Hospital Rheinau (near Zurich) where he lived as a bachelor with his patients in the same building. In his inaugural lecture, Bleuler already discussed very practical problems of psychiatric service. e.g. work, employment, marriage, situation in patient's family, housing, occupational therapy etc. Working in the group of other patients should help to re-establish the relationship to the common reality and the society. Psychotherapy for schizophrenics was mentioned in 1911 as the only serious therapy, but was not further elaborated. In 1939, Bleuler was much more sceptical concerning the realistic possibilities of an efficient psychotherapy of schizophrenia. Psychoanalysis would only allow a psychological understanding of some symptoms in schizophrenia but would be unable to contribute to a theory of the underlying pathogenesis. In his view, schizophrenia has its own inherent development. This resignation concerning constructive and efficient therapy dominates his confession even in his last lecture when retiring 1927. Considering the paucity of therapeutic possibilities, Bleuler underlined the importance of prophylactic eugenic strategies.

The Psychotherapy of the Schizophrenic Patient: an interview with Dr. Silvano Arieti

The Psychotherapy of the Schizophrenic Patient: an interview with Dr. Silvano ArietiMilton M. BergerMilton M. BergerSearch for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/jaap.29.1.1.17192PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Next article FiguresReferencesRelatedDetails Cited byCited by1. Arieti and Bowlby: convergence and direct influenceOnline publication date: 10 September 2015. Go to citation Crossref Google Scholar2. Online publication date: Go to citation Crossref Volume 29Issue 1Mar 2001 Information© Guilford Publications Inc.PDF download

Hope, Respect, and Flexibility in the Psychotherapy of Schizophrenia

Hope, Respect, and Flexibility in the Psychotherapy of Schizophrenia

Book Reviews

Book reviews in this article: Pre‐school Children in Troubled Families: Approaches to Intervention and Support. By Rory Nicol, David Stretch and Trian Fundudis. Nature's Mind: The Biological Roots of Thinking, Emotions, Sexuality, Language, and Intelligence. By M. S. Gazzaniga. The Effects of Mental Retardation, Disability, and Illness on Sibling Relationships: Research Issues and Challenges. Edited by Zolina Stoneman and Phyllis W. Berman. Maltreatment and the School‐Age Child: Developmental Outcomes and System Issues. By P. T. Sowing, J. S. Wodarski, P. O. Kurtz & J. M. Gaudin. Helping Bereaved Children: A Handbook for Practitioners. Edited by Nancy Boyd Webb. The Psychotherapy of Schizophrenia: Effective Clinical Approaches: Controversies, Critiques and Recommendations. Edited by G. Benedetti and P. M. Furlan Child and Adolescent Therapy: A Handbook. Edited by D. A. Lane and A. Miller. High Functioning Individuals with Autism. Edited by Eric Schopler and Gary B Mesibov. Managing Children with Psychiatric Problems. Edited by M. E. Gerralda.

What has become of the psychotherapy of schizophrenia?

The psychotherapy of schizophrenia has undergone major changes in the past two generations and mirrors larger paradigmatic shifts in thinking about severe mental illness and its treatment. Despite being endangered acutely by fiscal crises in our current health care systems, the psychotherapy of schizophrenia continues to evolve in a healthy manner as advances are made in our understanding of schizophrenia.

Intensive clinical studies: the psychotherapy of schizophrenia.

Although the value of intensive psychotherapy for persons with schizophrenia has been challenged (e.g., Gunderson et al. 1984; May 1968), there are still many clinicians and others who believe that some kind of interpersonal work with severely disordered patients, including people with schizophrenia, is extremely helpful and perhaps essential (Tomecek 1990). A crucial problem for exploring this contention is the complex interaction among four components: the measurement of efficacy, the specific nature of the interpersonal encounters, the patients' broader lives and treatment contexts, and the exact characteristics of the patients for whom these encounters may be helpful. The former blanket acceptance among many groups of the value of psychotherapy for schizophrenia is clearly not valid. But this by no means indicates that intensive interpersonal contacts of some kind for some people with schizophrenia are not important. For example, Bullard's (1960) classic paper on dealing with paranoid patients may still be extremely valuable for working with such people. In order not to bring excessively quick closure to this issue, there needs to be far more inquiry to identify specifically what kinds of contacts may be important for which people. Then the efficacy and optimal context of these contacts can be tested.

The use of direct confrontation: the treatment-resistant schizophrenic patient

Schizophrenics are often labeled treatment-resistant because the psychological treatment they receive is seldom appropriate for their needs. Specialized psychotherapy for schizophrenia is available but rarely used. Training in these methods is difficult to find. If we are to treat schizophrenia successfully, we must rethink the treatment and training process, modify our views and teach interventions that force the patient to respond to the demands of the therapist. Professionals must learn that change occurs because the therapist is stronger than the psychotic defenses of the patient, i.e., the patient's resistance to treatment.