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Psychosocial Rehabilitation for Schizophrenia

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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



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