Skills Training or Occupational Therapy for Persistent Schizophrenia

To the Editor: We are writing to register our disapproval of the article by Robert Paul Liberman, M.D., and colleagues. The first objection we have is that the authors’ definition of psychosocial occupational therapy—“the prevailing psychosocial treatment is occupational therapy in which expressive art and crafts and recreational activities are the media through which therapists build self-esteem and productivity” (p. 1087)—is too narrow and does not accurately describe occupational therapy as it is practiced today.

A more accurate definition of psychosocial occupational therapy includes 1) the development of cognitive, social, and organizational skills; 2) the ability to perform self-care skills such as personal hygiene and grooming; 3) the skills of home management, such as budgeting, cooking, and cleaning; 4) the skills of successful community living, such as the use of public transportation and community resources; and 5) the recognition of stress indicators and how to cope with stress.

The failure of social skills paraprofessionals to recognize “the learning disabilities of schizophrenic patients” is an example of a case in which professional occupational therapists can recognize a disability, while knowing methods of treatment to overcome it. A paraprofessional does not have the knowledge base to respond to unique situations in logical, scientific ways.

The title of the article does not represent the fact that both groups were essentially supervised by occupational therapists. We believe that this article misrepresents the occupational therapy profession.