Selected interpersonal interactions for regressed schizophrenics

Abstract

PROBLEMDiagnosticians, therapists, and research psychologists in institutional settings sooner or later are confronted with the stuporous, mute or severely regressed schizophrenic patient. A large percentage, 30% as reported by Adelson ('1, are untestable. The research psychologist, perhaps, suffers most by exposure to the extremes of pathology because the chronic schizophrenic must often be eliminated from studies which require minimal social or intellectual skills for participation. This study offers an approach which may enhance communication with such patients. The purpose of the study was to design interactions which are no more complex than simple motor responses and yet involve genuine interpersonal behavior. Further, an attempt was made to select interactions which reflect differential levels of pathology. METHODThe criteria for the interactions were: (a) Interactions must be non-verbal since many patients are mute or their verbalizations unintelligible. (b) They must minimize ego involvement on the part of the patient. ( c ) They must require no response which does not have a high probability of current existence in the repertoire of the patient, i.e., must not be novel situations or make any intellectual demands upon the patient. They must not require volition, should not meet with intellectual resistance, and should not appeal to logic or reasoning in effecting a response. (d) They should not entail a reward. (e) They should be objectively quantifiable. (f) They should be such that normals would respond near 100%. (g) They should be interpersonal, that is, they should require that the patient not simply do something, but rather, that he do something with someone. (h) Most important, they must involve or result in a communication with the patient so that an intrusion into the patient's autistic world results.The Interactions. Four simple interactions were finally adopted which conformed to the criteria given above. S waa ushered into a sparsely furnished room by a psychiatric aide and aaked to take a seat at a bare table opposite a female examiner. The aide had been instructed t o smile broadly as she brought the patient in. As the patient waa seated and for approximately 30 seconds thereafter, the E looked directly at her and smiled broadly. If the patient returned the smile a plus waa recorded. 2.Next E revealed a small rubber ball, hitherto concealed, and rolled it across the table to the patient. If the patient rolled the ball back a lus waa recorded. The task waa repeated twice. A plus or minus waa recorded for each of the t&ee trials.The E then removed the ball and placed a bowl of lemon drops on the table. First, she took one, placed it in her mouth and pushed the bowl toward the patient. If the patient took one or more lemon drops and placed them in her own mouth a plus waa recorded.Following this interaction the patient waa directed to watch two female assistants who sat knee to knee. While the patient watched, the two assistants performed a modified version of peas-porridge-hot. That is, they ...