Personal Therapy for Schizophrenia and Related Disorders: A Guide to Individualized Treatment [Hardcover]

Gerard E. Hogarty MSW (Author)

Book Description

Publication Date: August 15, 2002

This book presents the first evidence-based psychotherapy with demonstrated effectiveness for persons with schizophrenia and related disorders. Designed to help patients both achieve and maintain clinical stability, personal therapy combines psychoeducation; internal coping skills training; and enhancement of interpersonal, social, and vocational functioning. The volume describes how to integrate the approach with medical management and provides a practical, three-phase therapy manual, fully documented with findings from the author's influential research program. Detailed information is presented on the application of graduated strategies as the patient moves from a recent psychotic episode, through the process of optimal stabilization, to the resumption of community life outside the home. Also featured are tools for monitoring progress and suggestions for tailoring interventions to the specific needs of each patient.

Editorial Reviews

Review

"Spanning four decades, Gerard Hogarty's research into the treatment of schizophrenia and related disorders has been remarkable both for its scientific elegance and its practical utility. This volume puts it all together for practitioners, providing a readable, comprehensive, evidence-based model to guide clinical work. The book makes complex methodological material (as well as medication information) understandable to readers with varying levels of expertise, without talking down to them. Reading this book is like being in the presence of a wise, savvy, and experienced practitioner, not an ivory-tower researcher. What a rarity when the author is the field's most esteemed clinical researcher! An invaluable guide for practitioners, this book is also a landmark text for social work courses on mental health. It offers perhaps the best illustration to date of the importance of evidence-based practice, and what it looks like in action."--Allen Rubin, PhD, School of Social Work, University of Texas at Austin

"This book presents the first empirically based, research-established protocol for providing individual psychotherapy for schizophrenia. It provides remarkably valuable clinical tools. Theoretically grounded, the book describes a sequence of graded interventions geared to the patient's stage of recovery. Further, the therapeutic techniques are sufficiently flexible to accommodate the varying needs, deficits, and preferences of patients with this infinitely complex and heterogeneous disorder. This is an excellent text that will be immediately useful to large numbers of clinicians."--Wayne S. Fenton, MD

"A landmark contribution. Developed out of years of experience in the treatment of schizophrenia, as well as painstaking psychosocial intervention research, personal therapy is an integrated approach to helping people learn how to manage their mental illness and reenter the community. This practical guide provides clinicians with the knowledge they need to engage clients with schizophrenia, identify individual goals critical to the mastery of their illness, and track progress towards these goals. It belongs on the shelf of every clinician involved in providing psychological treatment for schizophrenia."--Kim T. Mueser, PhD, Professor of Psychiatry, Dartmouth Medical School

About the Author

Gerard E. Hogarty, MSW, is Professor of Psychiatry in the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center. He has been active in schizophrenia treatment research and clinical practice since early in his career. His current National Institute of Mental Health funded research program centers on the study of disorder-relevant, individual psychosocial treatments for schizophrenia, including a novel cognitive rehabilitation approach. Professor Hogarty has authored numerous articles, book chapters, and books, and has lectured extensively throughout the United States, Canada, and Europe. He is an elected member of the American College of Neuropsychopharmacology and a fellow of the Association for Clinical Psychosocial Research, and has served as advisor or consultant to numerous agencies. His contributions to research and practice have been recognized with numerous awards, including, most recently, the Paul Hoch Award for lifetime achievements from the American Psychopathological Association.

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Product Details

• Hardcover: 332 pages
• Publisher: The Guilford Press; 1 edition (August 15, 2002)
• Language: English
• ISBN-10: 157230782X
• ISBN-13: 978-1572307827
• Product Dimensions: 9.5 x 6.3 x 1 inches
• Shipping Weight: 1 pounds (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #935,224 in Books (See Top 100 in Books)

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17 of 17 people found the following review helpful:

5.0 out of 5 stars New Hope for Schizophrenia!, March 27, 2003

By 

Joel Kanter (Takoma Park, MD United States) - See all my reviews
(REAL NAME)   

This review is from: Personal Therapy for Schizophrenia and Related Disorders: A Guide to Individualized Treatment (Hardcover)

Gerard Hogarty's new volume, Personal Therapy for Schizophrenia and Related Disorders, is a groundbreaking work which presents an empirically-validated psychotherapeutic approach for schizophrenia based on a contemporary biopsychosocial understanding. Hogarty, a Professor of Psychiatry at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center, has a long and distinguished career as a clinician/researcher with schizophrenia.

For over 30 years, Hogarty and his colleagues have developed a series of psychososcial interventions (major role therapy, family psychoeducation, social skills training, personal therapy , and, most recently, cognitive enhancement therapy) and submitted each to rigorous empirical trials. After each trial, he carefully examines the data and formulates new approaches which incorporate his prior research findings and empirical data from other sources.

In the volume, Hogarty presents an approach to individual psychotherapy which he entitles "personal therapy" (PT). He describes his prior research efforts, most notably his two-year study of family psychoeducation which demonstrated a dramatic reduction in relapse in the first year of treatment, but a reduction in therapeutic efficacy as time passed. While observing that ameliorating family stressors reduced relapse, he also observed that family psychoeducation had no significant impact on the personal or social adjustment of schizophrenic patients.

Based on these prior experiences, PT uses a three-phase approach, the first focusing on clinical and environmental stabilization, the second on symptom management, and the third on developing new social and vocational initiatives. Throughout all phases, all patients were maintained on antipsychotic medications which were carefully titrated to minimize side effects. The progression of patients through these phases was determined by each patient's rate of progress, not by a prearranged protocol. Until the goals of one phase were accomplished, the goals of the next phase were not initiated. The research protocol followed patients for three years, an unprecedented duration for any intervention study in schizophrenia.

Before describing the three phases of PT, Hogarty devotes a chapter to outlining "essential prerequisites" for this intervention in considerable detail noting "that for decades are program has been guided by a silent mantra: innovative psychosocial treatment is for naught unless the fundamentals of good care are firmly in place (Hogarty's emphasis). His definition of "good care" includes psychological support (attentiveness, empathy, and encouragement), material support (financial support, stable housing, case management) and skillful medication management. Unique in the treatment literature, Hogarty addresses both the oft-ignored subject of obtaining government disability benefits and the intricacies of medication management. While the details of the former will be of little interest to most British readers, his attention to such seemingly mundane, yet essential, matters is impressive. (The clinic spent over $6000 annually for transportation subsidies when these costs were an impediment to clinic attendance.)

With these prerequisites in place, the first "basic" phase of treatment is initiated as a therapeutic team continues medications, "joins" with the patient and family, and educates patients about their illness using a stress-vulnerability model. In the second "intermediate" phase, patients examine their own illness is greater detail, exploring the precipitants of relapse, and finally coping strategies for symptom management are taught. Finally, in the third "advanced" phase, patients maintain stability and apply these coping strategies as they undertake new social and vocational initiatives.

Besides outlining the essential elements of PT, Hogarty describes the three-year controlled research protocol in considerable detail. In his discussion of the data, he carefully explores the considerable improvement of the control "supportive treatment" group, examining the therapeutic effects of "good care" and clinical management enjoyed by both experimental groups. However, while there was little significant difference between both treatment groups in both symptomatic presentation and functional adjustment at the one year mark (both groups improved significantly), the control group's progress leveled off while the PT group made impressive gains over the next two years.

However, examining patters of relapse, Hogarty observed that a subgroup of PT patients who lived alone actually had a far higher rate of relapse than did patients who received "supportive treatment" only. He commented that "we wondered whether these historical negative effects of psychotherapy might have had less to do with the intervention per se and more with cognitively overwhelming life experiences" (p. 64). Not surprisingly, patients with strong family support had much better outcomes.

This sort of multidimensional data analysis is perhaps unprecedented in the field of schizophrenia research, whether involving biological or psychosocial interventions. Hogarty sifts through his research data with a refreshing deftness and honesty; when the data does not support the efficacy of his intervention model, he straightforwardly acknowledges this and attempts to learn from negative as well as positive findings. In doing so, he briefly notes his most recent attempts to enhance the cognitive functioning of schizophrenic patients, an approach which is yielding impressive results.

In spite of this impressive empirical data, many psychotherapists may reject Hogarty's embrace of biological psychiatry and his neglect of psychoanalytic conceptualizations. He has little patience with intriguing metaphors or sophisticated interpretations. Yet, among the impressive array of data, Hogarty writes with a passionate concern for the well-being of persons with schizophrenia that is so often overwhelmed by statistical analysis. Researchers of schizophrenia would do well to learn from his sophisticated, yet readable, analyses. At the same time, psychotherapists treating schizophrenic patients will emerge with a better appreciation of the interplay of the biological, psychological and environmental dimensions of this complex disorder.

6 of 6 people found the following review helpful:

5.0 out of 5 stars A Great Book for the Practioner, December 16, 2004

By 

T. Scott "Tom Scott" (Baltimore, Maryland, USA) - See all my reviews
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Amazon Verified Purchase

This review is from: Personal Therapy for Schizophrenia and Related Disorders: A Guide to Individualized Treatment (Hardcover)

This is a tremendous book as it's written by a Social Worker who uses an over all biopsychosocial model. You do not see many social workers writing about therapeutic interventions who even consider biological components.

Additionally, Hogarty has included two components to the therapeutic strategy. He does a a concise review of entitlements with the proviso that its difficult to provide therapy when someone needs, food, medical care, and housing. The reader also gets a tool to understand the research in the appendices that reviews research terminology and methodology.

I have looked for years for a book that has a therapeutic technique for serious psychotic illness, accepts the biology of the illness, and recognizes the immediate needs of the client.

A book written by an obvious researcher whose heart comes through the pages.