In the past, some treatments deservedly received a bad name for their ineffectiveness or actual harm in helping people with serious and persistent mental illness. There were efforts to treat people with schizophrenia without antipsychotic medication (available since the 1950s) and with only psychotherapies, such as traditional insight-oriented individual and group therapy. These resulted in very poor outcomes for the treatment recipients (Hogarty, 1993; Lehman & Steinwachs, 1998).
Insight-oriented, psychodynamic therapies can be defined as those that use interpretation of unconscious material and focus on therapeutic transference. In the treatment of serious mental illnesses of all types, this form of psychotherapy has been found to be generally ineffective. Actually, some studies have found psychodynamic treatments to be harmful. The consensus is that these therapies should no longer be used to treat schizophrenia (Lehman & Steinwachs, 1998), bipolar disorder (Keck & McElroy, 1998), or major depression (Craighead et al., 1998a). There is, however, a role for providing support through individual counseling identified in the research of Hogarty (1993). Effective individual counseling with people who have severe mental illness generally focuses on support, the person's present life situation (rather than past experiences), and problem solving.
Psychodynamic therapy is not the only treatment approach that may have a negative impact. Therapeutic settings that seem very positive might actually promote relapse in some individuals with schizophrenia, especially if they are very high in intensity and expectations (Hogarty, 1993). For example, as will be addressed in Chapter 6, programs that combine intensive group therapy with a short length of stay are associated with more hospitalization and longer relapses (Linn, Caffey, Klett, Hogarty, & Lamb, 1979).
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