Schizoaffective Disorder
Psychosocial Treatment of Schizoaffective Disorder
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How Therapy
Heals - Many doubt that "just talking about something" can really help
people, and are confused about the different therapies that are available today.
We explore how therapy helps people heal and are joined by a woman who managed
to resolve her own history of abuse and family alcoholism through long-term
therapy.
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Untreated schizoaffective disorder will often leave a patient friendless,
penniless, and homeless. Thus circumstances often force schizophenic
patients to rely heavily on their family or psychiatric group homes. There
is frequently an inverse relationship between the stability of their living
situation and the amount of antipsychotic drugs they require.
Traditional insight-oriented psychotherapy is not recommended in treating
schizoaffective patients, whose egos are too fragile. Supportive therapy,
which may include advice, reassurance, education, modeling, limit setting,
and reality testing, is generally the therapy of choice.
Psychotherapy can have toxic effects, especially when there is a negative
transference. One of the toxic effects of psychotherapy is dependency. A
pushing, intrusive approach may make withdrawn patients worse.
Group therapy, combined with drugs, produces somewhat better results than
drug treatment alone, particularly with schizoaffective outpatients.
Positive results are more likely to be obtained when group therapy focuses
on real-life plans, problems, and relationships; on social and work roles
and interaction; on cooperation with drug therapy and discussion of its side
effects; or on some practical recreational or work activity. This supportive
group therapy can be especially helpful in decreasing social isolation and
increasing reality testing.
Family therapy can significantly decrease relapse rates for the
schizoaffective family member. In high-stress families, schizophenic
patients given standard aftercare relapse 50-60% of the time in the first
year out of hospital. Supportive family therapy can reduce this relapse rate
to below 10 percent. This therapy encourages the family to convene a family
meeting whenever an issue arises, in order to discuss and specify the exact
nature of the problem, to list and consider alternative solutions, and to
select and implement the consensual best solution. Self-Help groups in which
family members of schizoaffective patients discuss and share issues, have
been particularly helpful in this regard.
Behavior therapy in hospital often involves rewarding desired behaviors
with specific privileges, such as ground privileges or weekend passes.
When the schizoaffective patient is no longer floridly psychotic or
distractible, behavior therapy usually can successfully teach much needed
social and occupational skills.
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