The Annual Review of Clinical Psychology presents a review by Boston University’s Center for Psychiatric Rehabilitation (and others) of “Psychosocial Treatments for Schizophrenia,” encompassing the recovery model of mental health and a range of evidence-based practices including “promising” practices such as cognitive adaptive therapy, CBT for post-traumatic stress disorder, first-episode psychosis intervention, healthy lifestyles interventions, peer support services, supported education and supported housing.
Why do I continue to get so cynical when I read stuff like this:
“Evidence-based practices include assertive community treatment (ACT), cognitive behavior therapy (CBT) for psychosis, cognitive remediation, family psychoeducation, illness self-management training, social skills training, and supported employment. Promising practices include cognitive adaptive therapy, CBT for posttraumatic stress disorder, first-episode psychosis intervention, healthy lifestyle interventions, integrated treatment for co-occurring disorders, interventions targeting older individuals, peer support services, physical disease management, prodromal stage intervention, social cognition training, supported education, and supported housing.”
ACT – forced drugging in the community!!
CBT for Psychosis – telling someone the voices are not real and they should not listen to them. First and foremost you are never ever allowed to talk about the voices, you are banned from doing it. It is about telling you that wanting to talk about them or listening to them is wrong.
Cognitive Remediation – teaching someone how to think about everything. Sorry, but thoughts are based on experiences and thinking should not be a crime. Acting on some thoughts sure is a crime. But the thoughts themselves are not. Where does it begin and end
Family Psychoeducation – educating the family about the importance of the person taking medication every day for the rest of there lives for a fictional brain disease
Illness self management training – teaching the individual about the importance of taking medication every day for the rest of there lives for a fictional brain disease.
Social skills training – teaching them to say hello and goodbye. Perhaps if they were not so doped up on medication they would be able to participate in social activities. No evidence that they luck skills, evidence that they loose them due to being so doped up they can barely move or the brain damage the drugs cause them. No training is going to be of any real use in those situations. But of course they learn to be polite to nurses and doctors when being forcibly drugged, so they consider that a positive!!
Supported Employment – they are so defective with this fictional brain disease that we can’t possibly give them a job in the real world, so we give them a job in a sheltered workshop and we expect them to get down on there hands and knees and say thankyou, and yes on average they get paid 50 cents an hour!!
I wont continue with the analysis of the treatments and interventions showing promise, the so called evidenced ones are bad enough. It is the same old crap and shows just how much the psychiatric profession has hyjacked the word recovery or psychosocial and taken it on in a very different way to what we want and above all need. None of these things help people to heel, they all keep people as eternal victims of a system that is hell bent on killing them. What they do is to keep them more managable while in the system, and means they need less forced treatment orders as they can get complaince in a million other ways.
Lot’s of good stuff here. My only clarification is regarding Supported Employment. I’ve seen this in practice and it makes a huge difference. The way you describe it though isn’t Supported Employment (SE). The goal of SE is competitive employment, so-called regular work just like everyone else, NOT sheltered workshop settings. If folks are saying they’re doing SE and placing people in sheltered workshops doing piece rate work, they’re not doing SE. Having met the pioneer of this model, I can tell you he views SE as an alternative to medications. If more people were involved in meaningful activity, there would be far less need for meds or counseling or “the system”
Some of the other psychosocial approaches can be helpful to many but they have to done in a context of recovery, informed consent, an appreciation of trauma, culture, etc. Supported Education for example can help those who want to either finish high school or go on to college or develop a trade. This can be just want some people are looking for.