Psychotherapy for schizophrenia in the year 2030: prognosis and prognostication

A number of psychotherapy techniques have been developed that, to varying degrees, have empirical support demonstrating favorable effects in the treatment of schizophrenia (or serious mental illness [SMI]). These techniques, and the research, vary with respect to theoretical origins, format, treatment targets, and expected outcome. A historical perspective informs understanding of this proliferation. One landmark in psychotherapy research was the recognition of common factors: different therapies embody common therapeutic factors not central to any one school. Importantly, insights about common factors reflected a better theoretical understanding of the psychotherapy process and led to the translation of learning and conditioning theories into the psychotherapy vocabulary. This resulted in the distinction between specific and nonspecific treatment effects, which pose present-day research questions such as how common and specific factors interact, and the differentiation of techniques for specific recipients. Because psychotherapy research progresses over the next 25 years, it will be important to develop a model that can answer such questions while incorporating the proliferation of specific modalities and the search for the "right recipe." This "search" will coincide with more attention to individual differences, it will incorporate quantitative modeling, and it will spawn an array of "tools" for treating problems associated with SMI. Because self-knowledge and personhood again become recognized dimensions of recovery, traditional psychodynamic principles and techniques will be revisited. This article explicates a 4-factor model that may be a view to the future.