Table of Contents
Broadly defined, rehabilitation includes a wide array of non-medical interventions for
those with schizophrenia. Rehabilitation programs emphasize social and vocational training
to help patients and former patients overcome difficulties in these areas. Programs may
include vocational counseling, job training, problem-solving and money management skills,
use of public transportation, and social skills training. These approaches are important
for the success of the community-centered treatment of schizophrenia, because they provide
discharged patients with the skills necessary to lead productive lives outside the
sheltered confines of a mental hospital.
Psychotherapy or other forms of talk therapy may be offered, with cognitive behavioral therapy being the most frequently used. This may focus on the direct reduction of the symptoms, or on related aspects, such as issues of self-esteem, social functioning, and insight. Although the results of early trials with cognitive behavioral therapy (CBT) were inconclusive, more recent reviews suggest that CBT can be an effective treatment for the psychotic symptoms of 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. 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 patients psychotic symptoms.
Very often, patients with schizophrenia are discharged from the hospital into the care
of their family; so it is important that family members learn all they can about
schizophrenia and understand the difficulties and problems associated with the illness. It
is also helpful for family members to learn ways to minimize the patients chance of
relapse for example, by using different treatment adherence strategies and
to be aware of the various kinds of outpatient and family services available in the period
after hospitalization. Family psychoeducation, which includes teaching various
coping strategies and problem-solving skills, may help families deal more effectively with
their ill relative and may contribute to an improved outcome for the patient.
Self-help groups for people and families dealing with schizophrenia are becoming
increasingly common. Although not led by a professional therapist, these groups may be
therapeutic because members provide continuing mutual support as well as comfort in
knowing that they are not alone in the problems they face. Self-help groups may also serve
other important functions. Families working together can more effectively serve as
advocates for needed research and hospital and community treatment programs. Patients
acting as a group rather than individually may be better able to dispel stigma and draw
public attention to such abuses as discrimination against the mentally ill.
Family and peer support and advocacy groups are very active and provide useful information and assistance for patients and families of patients with schizophrenia and other mental disorders. A list of some of these organizations is included at the end of this document.