Group Therapy With Schizophrenia Patients

To The Editor:

I read with great interest the review article by David L. Penn, Ph.D., and colleagues (1) concerning psychosocial treatment for patients suffering from first-episode psychosis, particularly those with schizophrenia. In their article, the authors concluded, “Group therapy is a widely used treatment modality for early psychosis, but to our knowledge, no randomized, controlled trials have been conducted” (p. 2229). This statement is based on their literature review, which targeted “first-episode schizophrenia,” “first-episode psychosis,” and “early psychosis” with “psychosocial treatment” (p. 2221)—the subjects of their article. However, I believe that their pessimistic conclusion regarding group therapy with these patients was an artifact of their focused review because a different picture emerges if one expands the literature search to include “group therapy” and “schizophrenia” more broadly.

Some years ago, I reviewed this literature looking for controlled studies that evaluated the usefulness of group therapy with schizophrenia patients who were also receiving antipsychotic medications (2 – 4) . To be included in my review, all studies had to compare at least one experimental condition with group therapy that involved schizophrenia patients with a control condition without group therapy. A total of 46 such studies were found from 1950 to 1991 that involved 57 therapy groups. Overall, 70% of the studies concluded that on the measures of outcome that were used, the schizophrenia patients in the therapy groups fared significantly better than their counterparts in the conditions with no group therapy. Group therapy was as effective or more effective than individual therapy for schizophrenia patients in the outpatient studies that made this comparison. More long-term inpatient groups were judged to be effectively treated (compared with those with no group therapy) than was the case for short- or intermediate-term inpatient groups. With Fisher’s exact test, significantly more interaction-oriented approaches that focused on interpersonal problems and relationship issues were effective than insight-oriented approaches that emphasized uncovering and psychodynamic issues, especially in the inpatient setting. Later studies have also supported the value of group therapy for schizophrenia patients (5, 6) . Encouraged by these findings, I developed an empirically derived method of treating schizophrenia patients in group therapy that aimed at helping them deal with psychotic experiences and interpersonal relationships. This integrative model uses educative, psychodynamic, and interpersonal techniques, and empirical work to date suggests that it is safe, beneficial, and cost-effective (4, 7 – 9 ).

Thus, a number of controlled studies involving group therapy with schizophrenics do, in fact, exist, and many of these studies likely include people experiencing their first psychotic break. This literature supports the value of group therapy with many schizophrenia patients when used as an adjunct to antipsychotic medications.