Psychosocial Rehabilitation for Schizophrenia Essay

This essay has a total of 2401 words and 11 pages.

Psychosocial Rehabilitation for Schizophrenia

Psychosocial Rehabilitation for Schizophrenia
Psychosocial rehabilitation is a learning based approach using a token economy and social
skill training to help patients with schizophrenia develop adaptive behaviors (Nevid,
Rathus, & Green, 2003). To live successfully in the community, a variety of treatment
approaches are available to people with schizophrenia. A few of the psychosocial
rehabilitation options for people with schizophrenia include hospitalization, self-help
clubs, family intervention programs, drug therapies and psychosocial treatments. Many
treatments have been researched with the most effective being a combination of more than
one treatment being implemented simultaneously with others.

Schizophrenia is an illness. The symptoms of schizophrenia usually last a lifetime.
Persons suffering from schizophrenia have a distorted perception of reality which includes
hallucinations and delusions affecting their thinking. They also have what are called
negative symptoms; these include social withdrawal and blunted affect. Along with the
thought and affect, there is also cognitive dysfunction. Symptoms of cognitive dysfunction
are attention, memory, and learning difficulties. Although genetic vulnerabilities for
schizophrenia are believed to exist, they have yet to identify a single genetic
determinant (Tamminga, 2003). Earlier studies of interventions for schizophrenia were
almost entirely biological. These studies called controlled clinical trials were not
successful; the sample sizes were too small and did not provide useful data. Researchers
knew the studies designs and reporting of the results studies needed to be improved.
However, the studies did conclude, one very important aspect in the treatment of
schizophrenia had been left out. Researchers needed to include the evaluation of
psychosocial treatments of schizophrenia in order to show a complete picture (Wahlbeck,
Adams, & Thornley, 2000).

Understanding the social dysfunction of schizophrenia helps in the refinement of
psychosocial therapy. The ability of people with schizophrenia to give a coherent account
of their lives is severely impaired. The disruption in their stories could be due to an
organically based process that limits their interest in the external world or affects
their ability to make logical connections, and lastly this may affect their ability to
connect their intentions to their actions. A European standpoint "suggests that
schizophrenia reflects an autistic relationship to reality or lack of attunement to
others" (Lysaker, Wickett, Wilke, & Lysaker, 2003). All of the preceding factors
contribute to the difficulties many people with schizophrenia face functioning in social
and occupational roles. These difficulties, in turn, limit their ability to adjust to
community life, even in the absence of psychotic behaviors (Nevid, Rathus, & Green, 2003).
Self-help clubs commonly called clubhouses were created to help patients hospitalized with
schizophrenia transition from a hospital setting back into their communities.

These self-help clubs offered a more structured psychosocial rehabilitation centers. The
clubhouse's objectives are to help people with schizophrenia find a place in society. Many
of the clubhouses across the country and even in other countries such as Sweden, Japan,
and Australia were founded by the very people who needed them most. These people with
schizophrenia created environments where they could go and receive the supports necessary
to deal with their illness. This clubhouse movement began in 1948 after mental health
agencies failed to provide adequate services to people being released from hospitals with
schizophrenia and those suffering in the community. The first clubhouse, founded by
released patients was called Fountain House. Since Fountain House more than two-hundred
similar clubhouses opened. Although clubhouses do not provide residency to its users, they
do offer other benefits for these special citizens (Goldberg, Rollins, & Lehman, 2003).

Clubhouses offer their users a variety of useful benefits. The first is a type of self-
contained community within their own community. This smaller community provides a safe
environment for people with schizophrenia to go and be themselves; everyone is aware and
accepting of their impairments. Another very important component offered by the clubhouse
is social support. The benefit of social support depends on the level of impairment of the
individual and the utilization of services available (Goldberg, Rollins, & Lehman, 2000).
If a person with schizophrenia is able to use the clubhouse they can expect to show
improvement in their level of functioning. The social support network for people with
psychiatric disabilities is generally very low due to socially inappropriate behaviors.
This is understandable considering the hallmark characteristic of schizophrenia is
impairment in social functioning. Having social support and a larger support network
increases cognitive functioning, quality of life, and self- esteem in people suffering
from schizophrenia. People with even a moderate density of support benefit by having fewer
episodes of psychotic symptoms and higher IQ's. Social networks have three types of
characteristics, structural, interactional, and functional (Goldberg, Rollins & Lehman
2003).

"Structural characteristics include the size and composition of the network and or
frequency of contact. Interactional characteristics are defined as the extent to which
social network members interact with or know one another, while functional characteristics
specify the purpose served by the network members." Social networks provide instruction,
companionship, and advice in and outside of the clubhouse atmosphere. Participants receive
help finding employment and may also avail themselves of educational opportunities.
Research shows that social resources play a role in psychiatric rehabilitation. Social
skills and network size are positively correlated. When social skills are high so are
social networks, and the reverse is true; if one has few social skills, the social
networks is smaller. Small networks for people without a disorder may include twenty to
thirty members consisting of family, friends, neighbors, social and work acquaintances. On
the other hand, individuals with mental illnesses are able to name only about four or five
names, most of whom are relatives. People with mental illness have fewer networks than
substance abusers (Goldberg, Rollins, & Lehman, 2000). Factors contributing to smaller
social networks are two known characteristics of schizophrenia, social withdrawal and
blunted affect. Since social networks contribute to the quality of life for those
suffering with schizophrenia, it is important to ensure clubhouses continue to be
supported by medical professionals and the communities. Clubhouses and community mental
health centers provide clients a pool of people who may become part of their social
networks. Increased social networks contribute to higher levels of social functioning, due
to the skills attained while attending the center. While many aspects of a person's life
improve with larger social networks, the effect diminishes when the network size reaches
between ten and twelve members (Goldberg, Rollins, & Lehman, 2003). More is only better up
to a point.

Approximately one third of schizophrenics live with their families. Dealing with this
illness is not only a financial burden, it leaves the responsible care-takers physically
and emotionally exhausted (Harvard Mental Health Letter, 2001). Family dynamics play an
important role in the functioning of the family member with schizophrenia as well as the
functioning of the family dealing with this member. For loyal relatives, love and patience
are not enough to meet the patient's needs. Family intervention programs can help families
acquire information and advice to help them deal more effectively with their anxiety and
disappointments and also to deal with conflicts in the family due to this illness. Family
counseling, lectures, and videotapes can teach relatives how to recognize the signs of
relapse, how to respond to psychotic behavior, and possibly lower the risks of relapse. By
having learned strategies to deal with conflict more effectively, the family avoids
negative interactions, resulting in the maintenance of peace in their home. Knowing how to
supervise medications and avoiding negative interactions reduces stress for both the
family and the person suffering from schizophrenia. This in turn, leads to fewer psychotic
episodes. The opposite of such a supportive family would be a family in conflict,
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