By Timothy Tunner, PhD, MSW
 

	Introduction		Group Therapy
	Individual Therapy		Assertive Community Treatment
	Family Therapy		Additional Services
	Vocational Rehabilition and/or Educational Assistance		A Final Note

Introduction

There are more and better treatments than ever before for schizophrenia, even though it has historically been one of the most difficult mental illnesses to treat. The result is that more and more individuals are recovering with the help of treatments that focus on the biological, psychological, and social aspects of their illnesses. Most individuals with schizophrenia today are able to live in and participate in the community. Helping them figure out what they need to do to accomplish this is something with which social workers can help.

Medications are almost always called for as a part of treatment, but for a full recovery it is equally important for most individuals to also participate in other types of treatments. Individuals with schizophrenia should see a psychiatrist so that they can decide together what medications are appropriate and at what doses, but medications are only one part of a comprehensive treatment program. A counselor or therapist should also be consulted to help decide what types of psychosocial treatments could be helpful. Depending on each individual’s different challenges with his or her illness, different treatments may be more appropriate at different times. A person, for example, may want to begin treatment with individual and group therapy, gradually transitioning to more of one than the other. Once he or she has the most pressing symptoms under control, vocational rehabilitation may also become useful.

Types of Treatment

Some treatments that have been consistently shown to be effective for people with schizophrenia include:

• Individual Therapy is an important opportunity for an individual to talk about struggles dealt with as a result of having schizophrenia—or struggles with life in general. Social workers are trained to take a broad perspective of what different factors might be contributing to a person’s struggles. He or she can help problem-solve, and help teach coping mechanisms for dealing with the various challenges involved in going through life. An important note though, is that psychoanalytic therapy, which explores problems and experiences a person may have had as a child, is most often not recommended for individuals with schizophrenia. Rather, individual therapy should focus on issues and concerns that an individual has experienced since first developing signs of schizophrenia, and how to address those problems. Having a non-judgmental individual, with whom one can confidentially share private concerns and problems, can be quite helpful when working towards recovery.
• Family Therapy can be very important for individuals who have contact with their families. This is usually not done in private therapeutic sessions in which the consumer and their family member(s) sit and talk with a therapist. Rather it is most often done in group settings, where family members talk with family members of other consumers. The consumers themselves may or may not also be a part of the group, depending on how a specific group is designed. Participants are educated about the illness, what to expect from a family member who has the illness, and how they can best help. There is also a strong focus on how to take care of oneself when caring for an individual with a chronic mental illness. This is because having a family member with schizophrenia can at times be very challenging, due to the need to cope with symptoms. Learning to care for oneself while helping someone else can reduce possible stresses created by being a caregiver, and can help foster better and healthier relationships between those involved. This in turn can help the individual with schizophrenia reduce the stress in his or her life, enabling him or her to focus time and attention on other aspects of life.
• Vocational Rehabilitation and/or Educational Assistance are often very important for an individual with schizophrenia. In most cases, the onset of an individual’s schizophrenia happens at such a time as to disrupt their high school or college education, or it disrupts their entrance into the workforce. Once they have become stabilized, they have often missed one or more years in which they would otherwise have been furthering their education and/or their work resumes. Furthermore the illness, and sometimes the medication side-effects, make it more difficult for an individual with schizophrenia to learn or complete tasks than other non-afflicted individuals. Vocational rehabilitation and/or educational assistance can help an individual learn to compensate for these challenges. This can help individuals with schizophrenia to complete their educational objectives, and to hold a job in which they want to work. Having a job that one wants to do and enjoys is important for everyone, but having such a job can be particularly rewarding for someone who struggles with the problems associated with having schizophrenia.
• Group Therapy has been shown to be effective for many different problems that a person might experience in life, and there is no exception for individuals with schizophrenia. This therapy may not even focus specifically on schizophrenia, but rather on whatever concerns group members feel are important. Topics can include most anything, so long as they are respectful and appropriate. An important benefit of group therapy is that it helps individuals to not feel alone in their struggles. Hearing how others have struggled and coped with problems similar to one’s own can be much more meaningful than discussing problems and struggles with people who have not had similar experiences. Sharing experiences can also be therapeutic and even cathartic for individuals who share. Not each group is appropriate for each person, however. Depending on the facility and resources available, there will usually be more than one group in which a person may participate. For example, one person may feel more comfortable in a group of younger adults, who might discuss concerns about growing up. Another individual, however, might feel more comfortable in a group with a slightly more mature age-range, where people might be talking about issues of working and living independently. Still other groups may have more specific foci, such as women’s and men’s groups. Each person should talk to a counselor about what group(s) and how often he or she may be interested in joining.
• Assertive Community Treatment is a treatment model recommended for individuals who have repeated hospitalizations, or who have a particularly difficult time functioning in the community on their own. A team of providers is created to serve a group of consumers. The team should have at least one psychiatrist, social workers, and other mental health professionals. These professionals, including case-managers, work as a team instead of each person only having responsibility for their specific consumers. This team should also be able to go into the community and reach out to consumers, if needed, instead of waiting for consumers to come to a clinic. Such programs are expensive, however, and so usually only modified versions are available.

For most individuals, a case manager can help them learn to handle most of the day-to-day challenges associated with having schizophrenia. The case manager can act as a counselor with whom one can talk regularly.  A case manager can help a person learn how to access services through public/private systems, and he or she can help communicate with other providers to ensure that everyone works together. Most mental health centers that provide case management services offer different levels of service intensity that a person may obtain, depending on their need. Some consumers may only need a check-in once per month, whereas others may need some contact several times per week.

Additional Services

Each individual is unique, and has unique needs. Different cultural, spiritual, and other considerations are always important when deciding what types of treatments are right for an individual. Having an individual care plan can provide a framework for how best to obtain and provide for an individual’s unique needs, and developing this plan with a knowledgeable professional can help ensure that it is comprehensive. Too often individual needs and differences are left out of consideration in our country’s mental health systems, and doing so can hinder an individual’s path to recovery. Make sure that your needs, or the needs of someone you care about who has schizophrenia, are heard and addressed in an individualized treatment plan.

A Final Note

It is critical to get diagnosed and to obtain treatment as early as possible. The earlier an individual is treated, the better their chance will be of having a complete recovery. Some researchers have even suggested that an early enough intervention may keep a person from ever having to experience a full-blown psychotic episode. If you suspect that you or someone you care about may have or be developing schizophrenia, seek help from a professional, who can help determine what treatments and services may be helpful.

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