Realistic Issues in the Treatment of Schizophrenia
By Chess Brodnick, MA

The treatment of severe long-term schizophrenia involves a unique approach to the treatment process. Dealing with intra- psychic issues to the exclusion of more practical problems is one of the main reasons most psychotherapeutic treatments fail. Insight will not stem the tide of confusion, helplessness and alienation this population experiences. It is only when looking at the person as a whole that constructive approaches to treatment emerge.

The first and perhaps most essential element in the treatment process is to establish a relationship with the client. It will be necessary for the therapist to initially assume responsibility for developing and maintaining this relationship.
The purpose of this relationship will be to establish the therapist as a meaningful fixture in the client's life. The client will then be able to build a new way of seeing him or herself based on this relationship. The therapist will also be able to see the client as someone who is able to make constructive changes. Productive communication will be possible. The therapist will now have an entry into the client's inner world.

The therapy or re- educative process can begin effective therapy consists of assisting the client to recognize his or her condition, and then to find ways to control it. Uncovering causal factors may not be very helpful to someone who doesn't recognize reality. Dealing with childhood memories may only serve to add confusion to an already disorganized life. If a solid relationship has been established, the therapist can begin to point out how the client's present thinking is standing in his or her way. An exploration of how stress exacerbates the thought disorder can begin. It can be pointed out how a client's fears will lead to feelings of alienation, and antisocial behavior consistent with that feeling. Social patterns can be evaluated. This type of practical information is highly valuable for effective therapeutic intervention.

Clients can be educated about their thought processes to the point that they recognize the difference between reality and unreality. The therapist can point out how the person jumps from a "reality" viewpoint to a psychotic one. Clients can then be taught to track this themselves. They will have a chance to see first hand how stress is a major factor in the acceleration of symptoms.

Therapy can then focus on behavioral changes. Clients can be shown how their behavior influences the manner in which others treat them. They can be assisted in implementing a healthier approach to life.

Therapy in practical application can teach them how to have fun, solve problems and get along with others. Progress in therapy can only occur when a healthy change of life style takes place. This means adopting a new way of living or doing. Insight, while a helpful component, is not enough to bring about a change of life style. It is important for the therapist to focus on more productive ways of living and to actually help the client explore new behavioral patterns.

It is imperative to begin seeing the treatment of schizophrenia from a more creative standpoint. Being mired in a stagnant system of treatment with this population is certainly not the answer. Rebuilding lives is indeed hard work, but it is work that is abundant with hope and life.

P.S. I am proud to announce the Anne Sippi Clinic "Help the Homeless" program continues to be a great success. At this time, residents have made and passed out approximately 9,000 sandwiches to the homeless population.