Negative Symptoms and Social Functioning in Schizophrenic Patients Addressed alongside Medication by Psychosocial Interventions

Negative symptoms and impaired social functioning are aspects of schizophrenia that are particularly difficult to treat. Psychosocial interventions play a major part in attempting success in treating both these areas of schizophrenic illness, together with medication. Psychoanalytic psychotherapy is the form of treatment which, though long term, may potentially bring about the greatest healing accessible patients, i.e. those who are receptive and responsive in their communications with their therapist, a psychoanalytic psychotherapist, can achieve. Their negative symptoms, which are very resistant to treatment, may sometimes improve, and their social functioning is likely to respond eventually in most patients, particularly those who are accessible in their communications with therapists. Hard work with the patients is required to bring about both these improvements, and psychoanalytic therapeutic work must be sustained for years before its effects are clearly seen. But when progress occurs this will imply definite shifts in accessible patients’ minds towards improved consciousness, understanding, awareness of other people and, eventually, a degree of autonomy. Dr Michael Robbins has identified 7 Stages of this recovery [1], though not with patients manifesting negative symptoms. CBT may be used in place of psychoanalytic psychotherapy but is less effective in the long term, both for negative symptoms and social functioning. Cognitive Remediation Therapy (CRT) and Social Cognition and Interaction Training (SCIT) are, however, particularly effective forms of CBT. Psychodynamic group therapy, family therapy, and anticipatory skills training may all be used as adjuncts to psychoanalytic psychotherapy, with good effect. Need-Adapted treatment is quite effective for improving social functioning in milder forms of schizophrenia, but only within the family [2]. Negative symptoms respond less significantly well to all forms of treatment than social functioning, which may improve with adjunctive therapy once the underlying illness has been addressed with psychoanalytic psychotherapy.