Treatment for schizophrenia is impossible without psychotherapy. Modern psychotherapy for schizophrenia is distinguished by a humane attitude towards the patient, an attitude towards him as a full and active participant in the treatment process, collaborating with a doctor. In the first stage of treatment for schizophrenia, her psychotherapy was usually carried out in an individual form, later there was an interest in group therapy for schizophrenia and, finally, in family therapy . This tendency was characteristic of the evolution of psychotherapy in general, and the development of psychotherapy for schizophrenia only repeated it in a more distinct version.
With the emergence of social psychiatry, one of the main tasks of which was to improve the patient’s relationship with his social environment, in the process of treating schizophrenia , interest in the education of the patient and his family members in the field of psychiatry increased, and the desire to teach the patient social skills and contacts was finally formed . Social psychiatry, in fact, expanded the boundaries of schizophrenia treatment, which became unclear, but more integrated into the rehabilitation process, directed the efforts of psychiatrists to combat the stigma of mental illness, with a negative stigma on a person associated with a diagnosis of schizophrenia. Significant progress in the treatment of schizophrenia has emerged after the publication of research results on environmental therapy and treatment of schizophrenia with the help of the therapeutic community. These forms of therapy improved the patient’s contact with the environment, giving him the opportunity to see himself from the outside. In addition, the patient began to understand that he was not alone in this world, that there were people who were eager to help him and empathized with him in his suffering.
At the present time in the treatment of schizophrenia, its individual psychotherapy continues to be leading in relation to the treatment of the results, in comparison with the group, and family therapy for schizophrenia. Psychological trainings: self-confidence training , training in acquiring communication skills, training in creative self-expression and others, general talk about the disease complement clinical psychotherapy for schizophrenia, but can not replace it.
Treatment of schizophrenia and, in particular, clinical psychotherapy of schizophrenia requires a deep knowledge of its symptoms and syndromes, the characteristics of the onset and mechanisms of development of this pathology, its course and outcome. Consequently, the full treatment of schizophrenia and psychotherapy for schizophrenia remains the prerogative of a doctor – a psychiatrist who has received the necessary training in the field of psychotherapy and psychology.
In the absence of full-fledged methods of treating schizophrenia, her psychotherapy began with psychoanalysis and was practically identified with this method of treating schizophrenia. At the same time, Z. Freud himself had a negative attitude towards attempts to treat schizophrenia with the help of psychoanalysis, believing that people suffering from this disease are not capable of full-fledged transference. Many followers of the father of psychoanalysis, in an effort to go further, modernized the options for the dynamic therapy of schizophrenia. Swiss psychiatrists (E. Bleuler, C. Jung, L. Binswanger, and others) have significantly changed the psychoanalytic treatment of schizophrenia, providing excellent illustrations of the way out of this disease. American psychiatrists (G. Sullivan, F. From – Reichman) continued this movement and, in fact, approached social psychiatry, focusing in the process of treating schizophrenia on the patient’s relationship with his close environment.
For a long time, individual psychotherapy for schizophrenia has been aimed at finding the causes of psychosis, at strengthening the boundaries of the individual, integrating her ideas about herself and the world around her. Treatment of schizophrenia seemed impossible without knowledge of the causes of its occurrence. The etiology of schizophrenia was associated with a mental trauma experienced at an early stage of development, primarily due to a distorted attitude towards the child by his mother. The consequence of such a mental trauma was considered to be regression to the early stages of development, a delay in the formation of “I” and fixation on an erotic attitude towards oneself. Some researchers suggested that the regression is only partial and concerns only certain personality functions – aggression and libido. One of the psychoanalytic techniques for getting out of regression was a method of treating schizophrenia, aimed at symbolic gratification of instincts, especially the need for maternal love and care. At the same time, this technique caused a number of fair objections, the main one of which was a negative attitude towards a patient with schizophrenia as a child, thereby increasing helplessness and limiting his independence in the course of attempts to treat schizophrenia.
According to some psychiatrists, the difficulty of treating schizophrenia and especially psychotherapy of a patient with schizophrenia lies in the fact that it is not only simultaneous work with children of different ages, but at the same time it is work with an adult. An important task of psychotherapy for schizophrenia, according to later psychoanalysts, is to overcome the fear that has arisen as a result of rejection by loved ones. The patient’s isolation, his immersion in his inner world turns out to be associated with the fear of repeated rejection.
In all cases of treatment of schizophrenia with the help of psychoanalysis, the importance of a working alliance with the patient, the formation of complete trust in the doctor and, at the same time, freedom of action, as the most important principles of interaction with the outside world, was emphasized . In this case, the psychotherapist had to overcome his age-old fear of the patient, before the wall of incomprehension and the instinct of danger, which was exacerbated before meeting with the patient. With this approach, the framework and setting of the psychoanalytic process began to disappear, to lose its significance. The psychoanalyst gave up his place at the couch, from the strict schedule of sessions, from free associations, from the analysis of dreams, from direct interpretations.
American scientists G. Bateson and D. Jackson developed a psychogenetic theory of schizophrenia, revealing the nature of relationships in families of schizophrenic patients (“double bond hypothesis”). Communication in the family in this case was carried out contradictory, the verbal requirements and the emotional subtext of the messages did not coincide, which led to constant internal conflict and tension in the child. At the same time, it was forbidden to discuss the current situation and demand an explanation of it. The child, as it were, was enslaved by his parents and felt safe only in their presence. These studies have increased interest in family therapy and family involvement in the treatment of schizophrenia.
On the basis of behavioral models, such methods of schizophrenia treatment as: “removal technique”, “enhanced correction”, “payment for misconduct”, “token policy” and others were developed . In the treatment of schizophrenia, creative expression therapy, art therapy, psychodrama, body -oriented therapy, integrative movement therapy, dance therapy and other existential methods have also found their place .