Schizophrenia and Other Psychotic Disorders 561
Family therapy can also help high EE families change their pattern of interac-tion, so that family members are less critical of the patient, which can lower the
relapse rate from 75% to 40% (Leff et al., 1990). However, as noted earlier in this
chapter, not all families with high EE have such high relapse rates, especially in cer-
tain cultures (Cheng, 2002). Thus, treatment that changes a family’s high EE pattern
of interaction can help patients in some situations but is not always appropriate.
Group Therapy: Social Skills Training
Given the prominence of social defi cits in many people with schizophrenia, clinicians
often try to improve a patient’s social skills. Social skills training usually occurs in a
group setting, and its goals include learning to “read” other people’s behaviors, learning
what behaviors are expected in particular situations, and responding to others in a more
adaptive way. Social skills training teaches these skills by breaking down complex so-
cial behaviors into their components: maintaining eye contact when speaking to others,
taking turns speaking, learning to adjust how loudly or softly to speak in different situ-
ations, and learning how to behave when meeting someone new. The leader and mem-
bers of a group take turns role playing these different elements of social interaction.
In contrast to techniques that focus specifi cally on behaviors, cognitive tech-niques focus on group members’ irrational beliefs about themselves, their knowledge
of social conventions, the beliefs that underlie their interactions with other people,
and their ideas about what others may think; such beliefs often prevent people with
schizophrenia from attempting to interact with others. These social skills may be
applied to interactions with mental health professionals, such as discussing with a
psychiatrist the side effects a medication is causing. Each element of the training is
repeated several times, to help overcome patients’ neurocognitive problems when
learning new material. Research has shown that although social skills training does
improve social skills and daily functioning that depends on social skills, it is less ef-
fective in preventing relapse or directly increasing employment (Bustillo et al., 2001;
Kurtz & Mueser, 2008). Apparently such training is not suffi cient to remove enough
stress or reduce other contributing factors that may trigger a relapse.
Inpatient Treatment
Short-term or long-term hospitalization is sometimes necessary for people with
schizophrenia. A short-term hospital stay may be required when someone is hav-
ing an acute schizophrenic episode (is actively psychotic, extremely disorganized, or
otherwise unable to care for himself or herself) or is suicidal or violent. The goal is
to reduce symptoms and stabilize the patient. Inpatient treatment includes various
therapy groups, such as a group to discuss medication side effects. Once the symp-
toms are reduced to the point where appropriate self-care is possible and the risk of
harm is minimized, the patient will probably be discharged. Long-term hospitaliza-
tion may occur only when other treatments have not signifi cantly reduced symp-
toms and the patient needs full-time intensive care.
Legal measures have made it diffi cult to hospitalize people against their will (Torrey,2001). Although these tougher standards protect people from being hospitalized sim-
ply because they do not conform to common social conventions (see Chapter 1), they
also mean that people who have a disorder that by its very nature limits their ability
to comprehend that they have an illness may not receive appropriate help until their
symptoms have become so severe that normal functioning is impossible. Early inter-
vention for ill adults who do not want help but do not realize that they are ill is legally
almost impossible today. This issue will be discussed in more detail in Chapter 16.
Minimizing Hospitalizations: Community-Based Interventions
In Chapter 1 we noted that asylums and other forms of 24-hour care, treatment, and
containment for those with severe mental illness have met with mixed success over the
past several hundred years. Traditionally, people with chronic schizophrenia were likely
to end up in such institutions. However, beginning in the 1960s with the widespread
use of antipsychotic medications and building into the 1970s, the U.S. government