Social Skills Training for Schizophrenia
Social Skills Training for Schizophrenia: A Step-by-Step Guide
Bellack AS, Mueser KT, Gingerich S, Agresta J
New York: The Guil-ford Press; 1997. 288 pp with index
ISBN 1-57230-177-5 (cloth)
This book is a practical guide to the delivery of skill training to patients with schizophrenia. It is one in a series of treatment manuals for practitioners and, as such, will be immensely useful in teaching rehabilitation students and refreshing the skills of practising clinicians. As the title promises, it is a step-by-step guide whose method of teaching parallels the techniques recommended for teaching patients with schizophrenia: establishing a rationale, breaking the task into small steps, modelling, engaging, reinforcing, over-learning and generalizing. These are tried-and-true educational methods and can be applied, as the book suggests, to the teaching of any number of skills: social and vocational skills, medication management, safe sex, relapse prevention, and drug and alcohol avoidance — all skills necessary for the survival of patients with schizophrenia. Navigating the complexities of the mental health, legal and financial-benefits systems, learning how to parent and volunteer — these are other essential skills that the book does not mention but which, by extension, can be taught through the same methods.
The authors are acknowledged experts in the field and have had years of experience in this area. One problem with the book is that it is dreary to read and leaves the impression that the method may also be dreary for patients to experience. The repetition becomes oppressive. Putting myself in the patient’s shoes, I would not enjoy this form of constantly enthusiastic, encouraging, optimistic, repetitive role playing. I think I would be one of the early drop-outs. But individuals differ, and many people (the large majority who like group activities, camp songs, marches and bands) would probably be pleased to be included in these uplifting, persevering, unconditionally positive efforts.
A second problem with the book is that it does not provide any evidence that these efforts actually accomplish their ends. My own clinical experience over the years, with thousands of patients with schizophrenia who attended hundreds of skill-training groups, is that they are no more skilled in the long run than those who stayed at home and watched television. On the other hand, because the patients spent more time out of the house, their families have experienced definite relief, hope for improvement has been consistently nurtured, and the patients have formed acquaintanceships and even friendships. On the whole, therefore, there is much to be said for social-skills training. One wonders, however, if there is not a large segment of the population with schizophrenia, loners by nature, who would not benefit more from the delivery of information through individualized programs via television or home computer, now that these technologies are available. Are we doing people with schizophrenia a favour by emphasizing social skills as the cornerstone of mental health? These skills do not come easily to this group of individuals. Would it not be preferable to place “official” value on the skills in which many people with schizophrenia are innately expert: the lonely but potentially rewarding pursuits of art, music, literature and fantasy?