Intensive clinical studies: the psychotherapy of schizophrenia

Although the value of intensive psychotherapy for persons with schizophrenia has been challenged (e.g., Gunderson et al. 1984; May 1968), there are still many clinicians and others who believe that some kind of interpersonal work with severely disordered patients, including people with schizophrenia, is extremely helpful and perhaps essential (Tomecek 1990). A crucial problem for exploring this contention is the complex interaction among four components: the measurement of efficacy, the specific nature of the interpersonal encounters, the patients' broader lives and treatment contexts, and the exact characteristics of the patients for whom these encounters may be helpful. The former blanket acceptance among many groups of the value of psychotherapy for schizophrenia is clearly not valid. But this by no means indicates that intensive interpersonal contacts of some kind for some people with schizophrenia are not important. For example, Bullard's (1960) classic paper on dealing with paranoid patients may still be extremely valuable for working with such people. In order not to bring excessively quick closure to this issue, there needs to be far more inquiry to identify specifically what kinds of contacts may be important for which people. Then the efficacy and optimal context of these contacts can be tested.