CLINICAL HANDBOOK OF SCHIZOPHRENIA

59. Sexuality 611vignettes, explicit sexual behavior, including intercourse, is graphically depicted. Jim andKatie meet in their friend’s apartment. They acknowledge both their eagerness for sexualintercourse and their nervousness about adding that new dimension to their relationship.Safe and appropriate use of a condom and spermicidal jelly is modeled as this series of vignettesis concluded. The final vignette of this skills area focuses on Jim and Katie aftertheir sexual relationship has matured for a few months. They acknowledge their initialawkwardness and the importance of communicating their sexual needs. This skills areacloses with a sexual encounter that “puts it all together” as Jim and Katie demonstratethe skills they have learned. The component skills (giving and receiving permission, assertiverequests, guided hands) are combined into a free flowing, loving, and tender sexualencounter.Skills Area 7, Communication Skills after Sexual Intercourse, involves two briefvignettes. In both, Jim and Katie engage in appropriate verbal and nonverbal communicationafter they have had intercourse. They mutually reinforce each other for their decisionmaking, for being able to give specific instructions about how they like to be touched,and for pleasing each other.Skills Area 8, Sexual Problems: Desire, Arousal, and Orgasm, uses a number ofvignettes to present common problems related to the phases of sexual response, namely,desire, arousal, and orgasm. The purpose for including this section is to provide educationabout sexual functioning; to normalize problems of desire, arousal, and orgasm; andto teach effective problem-solving methods when sexual dysfunctions occur. Vignettesinclude scenes of Jim and Katie talking with their respective male and female friends/confidants, and Jim and Katie alone.The training methodology comprises the seven learning activities detailed in Figure59.1. The introduction sets the stage for the learning; it tells the learners the “payoff”they can expect from their investment of time and energy. The demonstration videotapeprovides a clear presentation of the skills that can be easily and consistently presentedacross diverse staff and settings. The videotape’s periodic stops and the questions to assessviewers’ comprehension are essential to ensure that the training achieves its instructionalobjectives. The role-play practice is similarly critical, because learning is not justcomprehension; it is ultimately the enactment of a skill. Furthermore, the more often participantspractice enacting the skill, the more polished their performances when the actualopportunities arise.The problem-solving activities are the first steps in helping participants to transfertheir skills to their natural, living environments. Two types of problems are considered:how to obtain the resources required to perform a skill, and how to overcome the obstaclesinherent in situations and environments when others do not respond as expected.The final two activities—in vivo and homework assignments—extend training into thereal world. Participants complete the in vivo assignments accompanied by a trainer orsupport person. Once they demonstrate their facility in using the skills in a protectedenvironment, they are asked to complete homework assignments on their own. The sequencesof gradually learning more skills, success using the skills, and taking more responsibilityfor reaching personal goals combine to move the patient further along thepathway to empowerment, self-efficacy, and recovery.Each module is packaged with a trainer’s manual, participant’s workbook, and demonstrationvideotape. The manual specifies exactly what the trainer is to say and do toteach all of a module’s skills; the videotape demonstrates the skills; and the workbookprovides written material, forms, and exercises that help the individual learn the skills. Amodule can be easily conducted by one trainer with one to eight participants. More thaneight, however, reduces the opportunities for each participant to answer the questions,