Forum: Psychotherapy is part of treatment for schizophrenia
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We thank Ms Fawziah Selamat for her letter (Can therapy be part of treatment for schizophrenia?, June 3), and commend her for her advocacy of her brother and others living with schizophrenia.
Her reflections echo the concerns of many families. We want to assure patients and caregivers that we adopt a holistic treatment approach for patients with psychosis (including schizophrenia) at the Institute of Mental Health (IMH).
While medication is the cornerstone of treatment for psychosis, we also provide case management, psychotherapy, family intervention, peer support, social rehabilitation and support for community reintegration, depending on the patient’s needs and stage of recovery.
Medication helps to reduce symptoms like hallucinations, delusions or disorganised thinking. Stabilising the individual’s condition will allow him to better engage in therapy and other forms of support.
Psychotherapy can be helpful for persons with conditions such as schizophrenia, anxiety, depression, trauma, or co-morbidities of these conditions. It supports the development of coping skills, insight and personal recovery. That said, therapy often needs to be introduced with sensitivity to the individual’s readiness and adapted to his or her unique needs, goals and readiness to change. At IMH, we have therapy programmes led by psychologists and Advanced Practice Nurses, who work with patients on strategies to reduce their distress linked to their condition, while supporting recovery goals such as returning to work or rebuilding relationships.
From our experience, therapy may be more suitable for persons who are experiencing emotional distress that can be alleviated through psychological support. On the other hand, therapy may be less effective, or even distressing in certain situations: when the immediate needs are medical or safety-related (for example, during acute psychosis), when cognitive or emotional capacity is limited.
Our clinicians will evaluate the usefulness of psychotherapy for persons with psychosis or schizophrenia as a complement to their overall treatment plan. However, not everyone may be ready to benefit from therapy at all points in their recovery. In some cases, while loved ones may hope for therapy to be part of care, the individual may not be ready or willing.
We recognise that more can be done to communicate our treatment decisions to caregivers, and have reached out to Ms Fawziah to follow up on her brother’s care plan.
Recovery from schizophrenia is a journey. We will continue to work in close partnership with patients and families to provide personalised, holistic and evidence-based care — including psychotherapy when it is likely to help.
Charmaine Tang (Dr)
Senior Consultant & Chief, Department of Psychosis
Institute of Mental Health
Jeanette Lim
Lead, Cognitive Behavioural Therapy for Psychosis Service
Senior Clinical Psychologist
Institute of Mental Health