Handbook of Schizophrenia Spectrum Disorders, Volume I: Conceptual Issues and Neurobiological Advances by Michael S. Ritsner

Author:Michael S. Ritsner
Language: eng
Format: mobi
Publisher: Springer
Published: 2011-04-06T21:00:00+00:00

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Individual Psychotherapy for Schizophrenia

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similarly benefit from this type of intervention, though their needs may be different

from someone with a recent onset. For this patient, large gaps of time may have

passed unnoticed by the individual during a severe episode, leaving a sense of loss

that must be addressed as the patient attempts to regain a sense of control over his

or her own future. It has been suggested that the needs of older individuals with

schizophrenia are still not well understood and often go unaddressed [98]. Thus, narrative- and metacognition-based approaches may potentially be valuable for both

types of patients, but perhaps in unique ways.

In addition to duration of illness, there are several other individual factors that

may make the proposed type of psychotherapy more appropriate for some patients

than for others. For example, cognitive ability and the related socio-economic sta-

tus of the patient may influence the rate at which change can be expected in

the metacognitive- and narrative-based approach to psychotherapy. It is not yet

clear whether patients with higher levels of premorbid function may improve more

rapidly with individual psychotherapy than individuals who had lower levels of pre-

morbid function. Again, these individual characteristics of patients warrant future

study in evaluations of treatment effectiveness.

Summary and Conclusions

Recent changes in the conceptualization of recovery have given rise to a renewed

interest in the role of psychotherapy for treatment of schizophrenia. To explore this

issue we have described the evolution of the use of psychotherapy to target dimin-

ished sense of self in schizophrenia; we then reviewed evidence indicating that

impoverished sense of self, which is a potent barrier to recovery, can be targeted

and improved with psychotherapy. In particular, we have suggested that psychother-

apy can address the interrelated facets of self experience, personal narrative and

metacognition, by providing a space for clinicians and patients to explore and exer-

cise the skills necessary for a more complete, complex, and integrated sense of

self. With the attainment of a richer personal narrative and greater capacity to think

about thinking, evidence indicates that individuals with schizophrenia may feel suf-

ficiently empowered and able to envision a hopeful future. In contrast to symptom-

or problem-focused approaches, addressing these large-scale skills necessary for a

rich self-experience may enable individuals with schizophrenia to adaptively for-

mulate solutions to future challenges, and to withstand threats to self-esteem and

hopefulness about the future. By targeting the underlying skills, this approach may

lead to a sustained sense of wellness and assist persons to be in a better position to

both preserve hope and make reasoned decisions in the face of adversity.

References

1. Harrow M, Grossman LS, Jobe TH, Herbener ES (2005) Do patients with schizophrenia ever

show periods of recovery? A 15 year mutli-follow-up study. Schizophr Bull 31:723–734

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P.H. Lysaker and M.A. Erickson

2. Lysaker PH, Buck KD (2008) Is Recovery from schizophrenia possible? an overview of

concepts, evidence, and clinical implications. Prim Psychiatry 15:60–65

3. Silverstein SM, Spaulding WD, Menditto AA (2006) Schizophrenia: advances in evidence-

based practice. Hogrefe & Huber, Cambridge, MA

4. Silverstein SM, Bellack AS (2008) A scientific agenda for the concept of recovery as it applies

to schizophrenia. Clin Psychol Rev 28:1108–1124

5. Substance Abuse and Mental Health Services Administration (2005) National consensus state-

ment on mental health recovery.

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