Types of therapy for treatment of schizoaffective disorder (supportive, group, family, behavior) and their effectiveness.

Basic Principles

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.

Supportive Psychotherapy

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 A pushing, intrusive approach may make withdrawn patients worse.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

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

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

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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