CLINICAL HANDBOOK OF SCHIZOPHRENIA

376 VI. SPECIAL POPULATIONS AND PROBLEMSis a therapeutic intervention that can complement other interventions, such as individualand family work. Because a group leader may choose from a range of theoretical modelsthat might best meet the identified needs and goals of clients, he or she needs to knowand understand the practical application of the range of theories underlying group programs.Group process describes the “life” of the group—that is, what is happening in thegroup and how this changes over time. Group processes include aspects such as phases ofgroup development, communication patterns, group composition, energy level, grouproles, themes, and leadership style. Group processes are a function of group dynamics(the behavior of people within a group context). Group process can be considered fromboth an individual and a group perspective—that is, seeing the group “as a whole” andconsidering it an entity in and of itself. Skills and knowledge are needed to manage anygroup. Groups can provide targeted interventions that increase adherence or reduce substanceabuse. Additionally the therapist should consider key, implicit factors of any groupwork, such as universality, instillation of hope, cohesion, altruism, interpersonal learning,imitative behavior, socialization, catharsis, and corrective recapitulation of the primaryfamily group.Group therapy for multiepisode schizophrenia has been demonstrated to be effectivefor increasing medication adherence, although replication studies have not necessarilyconfirmed these results. In addition, group therapy has been shown to be effective forcomorbid addictions and for social skills training, both of which are indicated for individualswith specific problems, namely, addictions and social deficits.Integrated Addictions TreatmentSeveral reports from first-episode programs have reported high levels of comorbid substanceuse. Integrated treatment of addictions and psychosis, recommended as the optimalapproach for dealing with comorbid schizophrenia and addictions, is supported bythe majority of clinical practice guidelines. Although, there is little specific research onthis issue, there is no reason to think that this should not apply to the early-psychosispopulation. There is evidence from comprehensive treatment programs that comorbid addictionscan improve with time. The issue of treating comorbid addictions is particularlyimportant for the first-episode population, because it is easy to dismiss a first presentationof psychosis as a drug-induced psychosis, which often leads to a recommendation foraddictions treatment only. Because the majority of individuals with addictions never developa psychosis, it seems appropriate to refer routinely those who do to an early-psychosistreatment service.The critical components of integrated programs for psychosis and addictions includescreening; motivational interventions; a comprehensive, long-term, staged approach; provisionof help to clients in acquiring skills and supports to manage both illnesses and topursue functional goals, and assertive outreach, when required.Work and Education RehabilitationStudies of vocational programs in schizophrenia have demonstrated the efficacy of supportedemployment programs. There have been limited studies in early psychosis. Formany of these individuals, education is a more appropriate goal than employment. Somepatients who seek employment may qualify for disability benefits, which may include accessto formal organizational processes for graduated return to work or limited work.Others may more appropriately be referred to supportive employment programs if theyare unable to find and retain employment without assistance.