Effects of Psychotherapy in Schizophrenia: I. Design and Implementation of a Controlled Study

Abstract

This article describes a 2-year, multi-hospital study on the effects of psychotherapy for nonchronic schizophrenic patients. The design and methods used to evaluate the relative benefits of exploratory, insight-oriented (EIO) psychotherapy and reality-adaptive, supportive (RAS) psychotherapy when both are provided by experienced therapists against the backdrop of good hospital and psychopharmacological management are presented. Similarities and differences between the two therapies and the therapists are outlined. Special attention is given to the problems in implementing research on long-term psychotherapy. Finally, the strengths and limitations of the present study are discussed.

Psychodynamic treatment of schizophrenia: is there a future?

“…This explanation would not explain why the correlations were negative for the psychodynamic treatment but positive for the reality adaptive treatment. In addition, patients who dropped out of either therapy within the first six months of treatment did not differ from patients who remained in treatment in pre-morbid adjustment, chronicity, or two-year outcome (Stanton et al 1984;Katz et al 1984), suggesting that less severely ill patients did not tend to terminate treatment prematurely.…”

“…Four studies have compared psychodynamic treatment with other treatments for schizophrenia, with the primary research workers including May (1968), VandenBos (1972, 1975), Grinspoon (Grinspoon et al 1972), and Gunderson (Stanton et al 1984;Gunderson et al 1984). Table 1 provides an overview of the four studies.…”

“…Included are: random assignment to treatment groups, patient chronicity (number of hospitalizations and time in hospital), treatment groups, length and duration of treatment, methodological weaknesses, and outcome results for four dimensions (symptomatology, rehospitalization, social adjustment, and vocational adjustment). While these studies have been reviewed before (Stanton et al 1984;Gomes-Schwartz, 1984), the present review goes beyond these by examining the results according to different dimensions of outcome, and evaluating the implications of the results for future treatment and research in view of advances in alternative treatment approaches.…”

“…Despite the failure of empirical investigations to demonstrate that psychodynamic treatment is effective for schizophrenics, and the development of other interventions that controlled studies suggest improve outcome, psychodynamic therapy continues to be offered as a treatment for schizophrenia. Stanton et al (1984) noted, 'Of the many institutions approached about possible collaboration, most of those that had the strongest identification and tradition with the practice of intensive psychotherapy still felt they could not randomly withhold this treatment from patients admitted to their institutions' (p. 524). Thus, psychodynamic therapy appears to remain an influential choice in the treatment of schizophrenia.…”

Psychotherapy in psychiatry: Integration and assimilation

“…The case history is not a method that can do justice to the potential impact of psychotherapy on mental function; reliance on the case history is inadequate and on its own it falls far short of the standards usually required for acceptance within the scientific community. This was demonstrated for psychodynamic therapy and schizophrenia by Gunderson (Gunderson, Frank, Katz, et al, 1984;Stanton, Gunderson, Knapp, et al, 1984) who compared the effects of exploratory, insight-oriented (EIO) and reality-adaptive, supportive (RAS) forms of psychotherapy on a sample of 95 schizophrenic patients after many practitioners had argued strongly for the use of psychodynamic therapy. Analyses of 2-year outcomes revealed a complex interaction between the type of psychotherapy provided and the domain of psychopathology affected.…”