CLINICAL HANDBOOK OF SCHIZOPHRENIA

59. Sexuality 609abundant positive reinforcement for patients who approximate criteria of competence.• Teach patients to employ the skills in everyday life and gain reinforcement fromthe group, the trainer, and people in the natural environment.Developing the curricula to teach friendship and intimacy skills is neither quick noreasy. Moreover, the instructional techniques must compensate for individuals’ cognitivedysfunctions that might interfere with learning. Liberman and colleagues (1993) addressedthis difficulty by producing a series of eight “modules” that teach communityliving skills with thoroughly specified curricula and highly structured training steps: MedicationSelf-Management, Symptom Self-Management, Substance Abuse Management,Recreation for Leisure, Basic Conversation, Workplace Fundamentals, Community Reentryand, most recently, Friendship and Intimacy. All use the same behavioral learning activitiesand problem-solving exercises to train each skill in each module. Only the contentvaries among modules, and the repetition of the learning activities provides a predictableteaching environment that enables trainers to conduct the modules and individuals to acquirethe skills.The Friendship and Intimacy module uses a plot line that follows a couple whose relationshipdevelops from friendship and dating to the considerations and problem solvingregarding the pros and cons of engaging in sex. In the context of a maturing relationship,the partners demonstrate appropriate communication skills with each other, with trustedfriends and relatives, and with health care professionals. After evaluating their relationshipand how it might change if they engaged in sexual intimacy, they decide gradually toengage in physical affection and ultimately sexual intercourse.It is important to note that the latter skills areas of the module contains sexually explicitmaterial, thus requiring trainers to obtain essential education and supervision as ameans of becoming confident, assertive, and comfortable in discussing intimate sexualmatters with patients. The earlier skills areas are organized in one videocassette, trainer’smanual, and participants’ workbook, whereas the more sexually explicit skills areas thatteach how to engage in mutually satisfying sex are presented as a second volume, with itsown videocassette, trainer’s manual, and participants’ workbook. Thus, it is possible touse the initial volume to teach dating and friendship skills, safe sex, and how to considerthe advantages and disadvantages of having sexual relations, without including the morephysically explicit skills areas that teach participants how to have satisfying sex and overcomesexual problems.In Skills Area 1, Establishing a Friendship, the focus is on teaching participants howto begin friendships. Participants learn how to meet people with similar interests, whilepracticing and polishing their conversational skills. They are taught how to express feelingsabout the importance of a relationship, and how to ask someone out on a date. SkillsArea 1 ends with a demonstration of a typical date, including how to begin, maintain,and end a conversation. There are also scenes that present problems depicting awkwardmoments in conversations on a date and the dilemma of whether or not to kiss a dategoodnight.Skills Area 2, Obtaining Information about Safe Sex, introduces the participant tosome basic information about sexuality. This skills area includes four vignettes that focuson conception, contraception, sexual desire, and sexually transmitted diseases. In the firstvignette, the main characters, Jim and Katie, visit a physician to elicit the informationthey need prior to including sex in their relationship. The next vignette features threeyoung people, like the main characters, who have their own discussion about contraceptionand the notion of shared responsibility between partners in a loving relationship.