The development of rapport and a trusting therapeutic relationship will likely be a slow, gradual process that may not ever fully develop as in seeing people with other disorders. Because people who suffer from this disorder often maintain a social distance with people in their lives, even those close to them, the clinician should work to help ensure the client's security in the therapeutic relationship. Acknowledging the client's boundaries are important and the therapist should not look to confront the client on these types of issues.
Long-term psychotherapy should be avoided because of its poor treatment outcomes and the financial hardships inherent in length therapy. Instead, psychotherapy should focus on simple treatment goals to alleviate current pressing concerns or stressors within the individual's life. Cognitive-restructuring exercises may be appropriate for certain types of clear, irrational thoughts which are negatively influencing the patient's behaviors. The therapeutic framework should be clearly defined at the onset. Stability and support are the keys to good treatment with someone who suffers from schizoid personality disorder. The therapist must be careful not to "smother" the client and be able to tolerate some possible "acting-out" behaviors.
Group therapy may be an alternative treatment modality to examine, although it is usually not a good initial treatment choice. A person who suffers from this disorder who is assigned to group therapy at the onset of therapy will likely terminate treatment prematurely because he or she will be unable to tolerate the effects of being in a social group. If, however, the person is graduating from individual to group therapy, they may have enough minimal social skills and abilities to tolerate group much better. People who suffer from this disorder see little to no reason for social interactions and often will be quite quiet in group, contributing little to others and offering little of themselves. This is to be expected and the individual who has schizoid personality disorder should not be pushed into participating more fully group until he or she is ready and on their own terms. Group leaders must be careful to help protect the individual from criticism from other group members for their lack of participation. Eventually, if the group can tolerate the initially-silent member with this disorder, the individual may gradually participate more and more, although this process will be very slow and drawn out over months.
Clinicians should be wary of too much isolation and introspection on the part of the patient. The goal is not to keep the individual in therapy as long as possible (although they may appreciate, if not fully utilize, therapy). As in group therapy, the individual who suffers from this disorder may engage in long periods of not talking and silence in session. These may be difficult to bear for the clinician. Phillip W. Long, M.D., also notes that the patient may eventually, "reveal a plethora of fantasies, imaginary friends, and fears of unbearable dependency - even of merging with the therapist. Oscillation between fear of clinging to the therapist may be followed by fleeing through fantasy and withdrawal." These types of feelings must be normalized by the clinician and brought into proper focus in the therapeutic relationship.
Patients can be encouraged to try out new coping skills and learn that social attachments to others don't have to be fraught with fear or rejection. They can be an important part of expanding the individual's skill set and develop new, healthier social relationships.
Last reviewed: By John M. Grohol, Psy.D. on 1 Jun 2010
Published on PsychCentral.com. All rights reserved.