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Psychotherapy for Schizophrenia

Learn how psychotherapy is used to treat schizophrenia from psychiatrist Jeanie Tse in this Howcast video.

Transcript

There are a number of therapies that are being tried in schizophrenia. The most evidence for effectiveness on both the positive and the negative symptoms of schizophrenia, so the delusions and hallucinations and the lack of motivation and lack of affect in schizophrenia, the large majority of the research supports cognitive behavioral therapies as being effective.

With any therapy, the key, really, is a therapeutic relationship between the person and their therapist, one that is based on trust and a desire to work together on something. For people with schizophrenia, who sometimes are mistrustful, the most important job of the therapist is to engage that person and build trust and develop a sense with that person that their goals and dreams are achievable and that they can make it from where they are now, in the midst of their suffering with schizophrenia, to where they want to be, to where they had hoped to be before they became ill.

That process is negotiated by motivational interviewing, which is a technique of therapy that's based on change theory, based on the idea that there are stages of change that everybody goes through, and that focusing on your goals and your values helps you to make the decisions along the way, make the choice to change, so that you can achieve your goals and values. Engagement motivational interviewing is very central to therapy for schizophrenia.

The next extremely important piece is for someone with schizophrenia to be educated about their disorder, so for them to learn about the fact that schizophrenia is a brain development disorder, that it's not their fault, that it's really nobody's fault, that it's a genetic disorder, and that these are your symptoms. What are the things that trigger my symptoms? What are the earliest symptoms so that I can nip them in the bud? What are the things that best help me to become well? That sort of education and self-management process is central to psychotherapy for schizophrenia as well.

Then, for somebody who has schizophrenia, often, because of the negative symptoms that made them not want to do anything for a long time, they have missed opportunities along the way to learn important skills: how to live independently, how to cook, how to clean, how to interview for a job, how to resolve conflicts and build good relationships, how to date. All of those things are things where skills training might be helpful to someone with schizophrenia.

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