Psychological Treatment For Schiz

Question 1

Psychodynamic therapy - psychoanalysis

Answer 1

Based on assumption individual is unaware of influence of unconscious conflict - helps bring into the conscious where they can be dealt with

• need to build trust and rel with therapist to replace harsh and punishing conscience
• Freud himself believed schiz could not be analysed as they could not for transference

STEPS:

• establish rapport
• transference
• identity unresolved issues from the past
• repair ego

Includes free association, TAT tests, dream analysis etc

Question 2

Psychoanalysis effectiveness and appropriateness

Answer 2

Effectiveness -
Gottdiener - reviewed 37 studies covering 2642 patients - overall 66% improved after treatment - shows similar results as CBT

Appropriateness -
Dialogue unreliable - psychoanalysis techniques overstimulate which can worsen symptoms and increase hospitalisation

Question 3

Behavioural - Social skills training

Answer 3

“Token economy” - positively reinforce appropriate beh so the person is prepared for release - initially awarded for not displaying schiz symptoms, then for normal beh

Question 4

Social skills training effectiveness and appropriateness

Answer 4

Appropriateness- allows more freedom and experience which helps the therapeutic process considerably

Paul and Lentz - as a process of managing beh it is a form of manipulation and encourages suppression - ethical?

Effectiveness - learning group, milieu therapy and control group 90% on antipsychotics - 4 1/2 years later token economy dropped to 11% and control rose to 100%

Allyon and Azrin - sig decreased bizarre beh and increased norm beh

Question 5

CBT

Answer 5

NICE “offer CBT to all people with psychosis or schiz”

• establish rapport
• identify life history
• understand faulty thinking leads to emotional resp leads to inappropriate beh
• understand connection
• challenge faulty thinking

Question 6

CBT appropriateness and effectiveness

Answer 6

Appropriateness

• schiz characterised by incoherent thinking so cog therapies inappropriate
• CBT used to change patients minds about antipsychotics so beneficial in this way

Effectiveness - effective in 50/60% of cases but only when combined with drug therapy
- challenges catastrophic beliefs about schiz and reduces risk of relapse as can see stressors coming