Reclaiming the Joy
By Chess Brodnick, Ph.D. and Leora Brodnick, Ph.D.

In a world where discipline, self-control, and hard work are valued among the highest attributes, it is easy to understand why the positive symptoms of schizophrenia are so resoundingly emphasized in standard treatment. Positive symptoms such as delusions and outbursts do, we admit, frighten both client and the public at large. However, in our opinion, schizophrenia is like a "great thief" that takes people away from themselves and their families. If we are to effect a true reintegration into society, the negative symptoms must be addressed.

Simply put, the negative symptoms are what schizophrenia has taken away from an individual: motivation, the ability to experience pleasure and maintain relationships, the quick smile and awareness of the world around one, indeed the spark that makes life worth living. Our goal at the ASC Treatment Group is to restore these vital components of life to people who are all to often viewed as "behavior management problems" rather than as a whole, complete human beings.

In general treatment terms, these negative symptoms are less well served by medications than are positive symptoms. However, combined group resocialization techniques and the individual therapies we utilize can be extremely helpful. The focus ingredient in all of this work is a strong, positive relationship between client and caregiver. While this caregiver, whether therapist or family member, must be a good listener in order to understand the client's plight, a larger more active role is required if the process of treatment is to reach beyond surface behavioral change. This involvement constitutes a mutual journey out through the opaque layers of illness that have painted over the person's true nature.

Such a journey would indeed seem formidable or even impossible were it not broken down into approachable and human-scaled segments. We well recognize the toll a responsive role can take on the caregiver. As a matter of fact, we have had to learn the hard way to take some of the advice we dispense: happiness is largely a cumulative result of efforts, not an illusive state of magical bliss. Therefore, we watch for and spot tiny gains and increments of affect and then maximize these into more socially recognizable progress.

Each journey begins as we assert ourselves into the client's own world. We balance a kind, helpful demeanor with the strength required to keep the person from slipping into fear-based avoidance patterns. Through active listening, an individual's strengths and weaknesses are discovered. These strengths are enhanced and positive roadblocks are set up against the weaknesses. During lags of motivation when a clients says the usual, " I can't because... it becomes the caregiver's job to apply the person's own strengths as a practical shield against negativity. However, this is not a one-shot express! Stamina is required, since the same tasks will need repeating over and over again.

We use humor in therapy, which some of you have already seen, as a deceptively simple tool against negativity both for our clients and for ourselves. Therapeutic tasks need to be fun, filled with encouraging and uplifting social interaction. We can then begin to set up plans for community reintegration based on the client's own personal interests. Constant balance is the key to effectiveness. Since progress is often uneven, it is vital to be creative enough to re-teach the same goals in new and exciting ways.