I.

Psychosocial Intervention

1. Social Skills Training

Social dysfunction is a hallmark of schizophrenia. Impairment in interpersonal
relations is included as part of the defining diagnostic criteria for schizophrenia
in the DSM-5 (APA, 2013).

Social skills training has become one of the most widely used psychosocial
interventions in the treatment of schizophrenia. Mueser, Bond, and Drake
(2002) stated:
The basic premise of social skills training is that complex interpersonal skills
involve the smooth integration of a combination of simpler behaviors, including
nonverbal behaviors (e.g., facial expression, eye con- tact); paralinguistic
features (e.g., voice loudness and affect); verbal content (i.e., the
appropriateness of what is said); and interactive balance (e.g., response
latency, amount of time talking). These specific skills can be systematically
taught, and, through the process of shaping (i.e., rewarding successive
approximations toward the target behavior), complex behavioral repertoires
can be acquired.

II. Psychological Interventions

1. Individual Psychotherapy
Reality-oriented individual therapy is the most suit- able approach to individual
psychotherapy for schizophrenia. The primary focus in all cases must reflect
efforts to decrease anxiety and increase trust.

Ho and associates (2003) stated:

Although intensive psychodynamic and insight-oriented psychotherapy is
generally not recommended, the form of individual psychotherapy that
psychiatrists employ when providing pharmacological treatment typically
involves a synthesis of various psychotherapeutic strategies and interventions.
These include problem solving, reality testing, psychoeducation, and
supportive and cognitive-behavioral techniques anchored on an empathetic
therapeutic alliance with the patient. The goals of such individual
psychotherapy are to improve medication compliance, enhance social and
occupational functioning, and prevent relapse. (p. 419)

2. Group Therapy
Group therapy for individuals with schizophrenia has been shown to be
effective, particularly with outpatients and when combined with drug treatment.

Sadock and Sadock (2007) stated:

Group therapy for persons with schizophrenia generally focuses on real-life
plans, problems, and relationships. Some investigators doubt that dynamic
interpretation and insight therapy are valuable for typical patients with
schizophrenia. But group therapy is effective in reducing social isolation,
increasing the sense of cohesiveness, and improving reality testing for patients
with schizophrenia. (p. 492)

3. Behavior Therapy
Behavior modification has a history of qualified success in reducing the
frequency of bizarre, disturbing, and deviant behaviors and increasing
appropriate behaviors. Features that have led to the most positive results
include:
■ Clearly defining goals and how they will be measured.
■ Attaching positive,negative,and aversive reinforcements to adaptive and
maladaptive behavior.
■ Using simple, concrete instructions and prompts to elicit the desired
behavior.

III. Social Intervention

1. Milieu Therapy
Some clinicians believe that milieu therapy can be an appropriate treatment for
the client with schizophrenia. Research suggests that psychotropic medication
is more effective at all levels of care when used along with milieu therapy and
that milieu therapy is more successful if used in conjunction with these
medications.

Sadock and Sadock (2007) stated:

Most milieu therapy programs emphasize group and social interaction; rules
and expectations are mediated by peer pressure for normalization of
adaptation. When patients are viewed as responsible human beings, the
patient role becomes blurred. Milieu therapy stresses a patient’s rights to goals
and to have freedom of movement and informal relationship with staff; it also
emphasizes interdisciplinary participation and goal-oriented, clear
communication. (p. 970)

2. Family Therapy
Some health-care providers treat schizophrenia as an illness not of the client
alone, but of the entire family. Even when families appear to cope well, there is
a notable impact on the mental health status of relatives when a family
member has the illness.

Safier (1997) states:

When a family member has a serious mental illness, the family must deal with
a major upheaval in their lives, a terrible event that causes great pain and grief
for the loss of a once-promising child or relationship. (p. 5)