CLINICAL HANDBOOK OF SCHIZOPHRENIA

59. Sexuality 613teaching the subject matter of the module in an active/directive mode is important. A varietyof individuals from various mental health disciplines have led the module, includingrecovered consumers who have “graduated” from the module and serve as coleaders.Susan was a 36-year-old, single woman with schizophrenia who lived with her parents.Her symptoms of psychosis had been in remission for over 6 years, and shefaithfully took her medication. After more than 5 years as a volunteer, Susan subsequentlywas hired by a local charity that valued her work highly. She was sociableand extremely attractive, well-dressed and -groomed, and sexually active. Herpattern was to meet men in bars and have frequent “one night stands,” much to thechagrin and worry of her parents. Many of the men she met took advantage of hernaivete, and her desire to have a boyfriend and be involved in a close relationship.She had several episodes of sexually transmitted diseases; fortunately, each was treatableand did not produce long-term sequelae.Susan was referred to the UCLA Psychiatric Rehabilitation Program by herpsychiatrist to help her acquire better judgment in her choice of sexual partners.Although initially querulous about how the Friendship and Intimacy Module mightassist her, Susan became highly motivated after attending the sessions on makingfriends and dating. When the group got to the skills area on “go/no-go” sex signals,Susan realized that she had been inadvertently encouraging men she met in bars byallowing them to touch her hand and by leaning toward them with her face in closeproximity to theirs soon after beginning a conversation. She also realized that therewere nonverbal no-go signals she could give that would limit her contacts with newmale acquaintances to more mundane, nonflirtatious conversation. As a result ofparticipating in the module, Susan became much more discriminating in her contactsand relationships with men, and developed a long-term, intimate relationship with aman who genuinely cared about her and understood that she had schizophrenia.The skills she learned in the module enabled Susan to improve her social judgment,interpersonal communication regarding romantic interests, and assertivenessin taking control of interactions with men. After employing the friendship and datingskill for 6 months, Susan met a man through a mutual friend and developed a companionablerelationship with him. They had much in common, and the conversationand friendship skills Susan had learned enabled her to maintain and enjoy their timetogether in the activities they had in common. Gradually, over a number of months,steady dating and then a long-term relationship ensued. This time, Susan and herboyfriend gave serious consideration before initiating a sexual relationship. Theirsuccessful interaction was made possible by Susan’s continuing contacts with hertherapist, who offered refresher training on a number of the skills areas in the module.TRAINING THE TRAINERSOne of the great therapeutic accomplishments of the second half of the 20th century wasthe establishment of legitimacy and efficacy in interventions exclusively targeting sexualdifficulties. Despite the availability of empirically validated techniques for helping patientswith sexuality, there remains a significant training challenge, namely, convincingmental health professionals that such treatment is appropriate, safe, and necessary forthis population. Some clinicians fear that people with schizophrenia, by definition, cannot“tolerate” such explicit discussion and graphic illustration of sex, and assume thatsuch exposure will cause patients to regress psychotically and/or engage in inappropriatesexual behavior.