In CBT, patients are usually prompted to trace the genesis of their symptoms, so as to get a grasp of how they may have occurred and how they might be treated and are then encouraged to evaluate any internal voices they may hear, delusions or hallucinations and so on. As their behaviour is thought to stem from distorted beliefs, they are prompted to find alternative patterns or ways of thinking to their maladaptive one. CBT generally tries to generate less distressing symptoms to arise, rather than completely eradicating the symptoms, as some, in particular negative symptoms, may well prove beneficial. The idea is the negative symptoms could arise as a way of preventing the sufferer from making positive symptoms worse or to ensure that they do receive help.
In order to test whether CBT works, outcome studies following the treatments have been conducted, and in such one made by Drury et al. (1996), it was found that there had been a reduction in positive symptoms, as well as a 20-25% reduction in recovery time, whose CBT treatment had been combined with antipsychotics. Of course, lower drop-out rates were also recorded which could also be behind the more successful treatment. Studies generally support the CBT treatment, as evidenced by Gould et al., whose meta-analysis showed that CBT generally tends to work, but unfortunately, most CBT is done in combination with antipsychotics, which means that the recovery of the patients could just as well be owed to the medicine as it could the therapy or combination of the two.
Psychodynamic Therapy: Psychoanalysis
Psychoanalytical therapy builds on the idea and assumption that patients are often unaware of the conflicts that take place in their subconscious and how they affect their mental state. Psychoanalysis aims to bring these conflicts into the conscious, so that they can be dealt with. This psychoanalytical approach states that all symptoms are relevant to patients’ mental disorder and that so is their entire life history.
Psychoanalysis goes about treating their patient by forming a relationship with them and by establishing a trust between the two. This stems from Freud’s idea of transference (Who himself didn’t believe that it could be used on schizophrenics) which aims to get the patient to project his emotions upon the therapist and in the same way, that is what modern psychoanalytical therapists try to achieve by replacing the harsh conscience, which is supposedly the cause behind the disorder, with a more receptive figurehead. The more harsh the case of the schizophrenia is, the more the therapist needs to be involved, until the patient can start taking an active role on their own, at which point the therapist stop being as active in the treatment.
It’s long been highly disputed whether or not this type of therapy actually works or if it’s beneficial to patients who suffer from schizophrenia. The PORT (Patient Outcome Research Team – Schizophrenia) argued that it could well be harmful to people with schizophrenia and studies by such people like May (1968), found that antipsychotic medicine alone was more effective than combined with psychotherapy. Conversely, studies like VandenVos (1981) show the opposite and a study by Gottdiener (2000) who conducted a meta-analysis of 37 studies, found that it was actually an effective study. All in all, studies have been contradicted continuously, which leads to question whether the psychotherapy is worth the money, as it’s generally quite expensive and long-term, and since patients from schizophrenia are often unemployed, it’s questionable whether they could afford it.
Niels Gade