Although cognitive-behavior therapy (CBT) can be effective in reducing delusional thinking in schizophrenia, many patients are considered poor candidates, typically because of a lack of distress from the delusion and resistance or low motivation to challenge its validity. Recent developments in CBT for schizophrenia, however, stress the need to move from a sole focus on challenging beliefs toward a person-based model in which recognition of the vulnerability of the self guides treatment and the content of therapy is perceived as personally meaningful by the patient. This article demonstrates how the Jungian technique of archetypal amplification was modified and used within the structure of CBT treatment of a young man with schizophrenia with a religious delusion who refused to engage in standard CBT. His case demonstrates that schizophrenia patients who initially refuse to question the validity of their delusional beliefs can nevertheless be successfully engaged in CBT when the focus promotes alternative understandings of the self and preserves self-esteem.
Attkisson, R.F., Crook, J., Karno, M., Lehman, A., McGlashan, T.H., Meltzer, H.Y., et al. (1992). Clinical services research. Schizophrenia Bulletin, 18, 561-626.
2.
Bachmann, S., Resch, F., & Mundt, C. (2003). Psychological treatment for psychosis: History and overview. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 31, 155-176.
3.
Benedetti, G. (1980). Individual psychotherapy of schizophrenia. Schizophrenia Bulletin, 6, 633-638.
4.
Bleuler, E. (1950). Dementia praecox or the group of schizophrenias . New York: International Universities Press. (Original work published 1911)
5.
Bukkyo Dendo Kyokai (2001). The teaching of Buddha (1045th ed.). Tokyo: Author.
6.
Cather, C., Penn, D., Otto, M.W., Yovel, I., Mueser, K.T., & Goff, D.C. (2005). A pilot study of functional Cognitive Behavioral Therapy (fCBT) for schizophrenia. Schizophrenia Research, 74, 201-209.
7.
Chadwick, P., Birchwood, M., & Trower, P. (1996). Cognitive therapy for delusions, voices, and paranoia . New York: John Wiley.
8.
Davidson, L. (2003). Living outside mental illness. New York: New York University Press.
9.
Dickerson, F. (2004). Update on cognitive behavioral psychotherapy for schizophrenia: Review of recent studies. Journal of Cognitive Psychotherapy: An International Quarterly, 18, 189-205.
10.
Drake, R.E., & Sederer, L.I. (1986). The adverse effects of intensive treatment of chronic schizophrenia. Comprehensive Psychiatry, 27, 313-326.
11.
Federn, P. (1977). Ego-psychology and the psychoses. London: Karnac.
12.
Freeman, D., Garety, P.A., Fowler, D., Kuipers, E., Bebbington, P.E., & Dunn, G. (2004). Why do people with delusions fail to choose more realistic explanations for their experiences? An empirical investigation. Journal of Consulting and Clinical Psychology, 72, 671-680.
13.
Freud, S. (1962). Neurosis and psychosis. In J. Strachey (Ed.), Standard edition of the collected works of Sigmund Freud, Volume 19 (pp. 149-154). New York: Norton. (Original work published 1924)
14.
Fromm-Reichmann, F. (1950). Principles of intensive psychotherapy. Chicago: University of Chicago Press.
15.
Glass, L.L., Katz, H.M., Schnitzer, R.D., Knapp, P.H., Frank, A.F., & Gunderson, J.G. (1989). Psychotherapy of schizophrenia: An empirical investigation of the relationship of process to outcome. American Journal of Psychiatry,146, 603-608.
16.
Gunderson, J.G., Frank, A.F., Katz, H.M., Vannicelli, M.L., Frosch, J.P., & Knapp, P.H. (1984). Effects of psychotherapy on schizophrenia: II. Comparative outcome of two forms of treatment. Schizophrenia Bulletin, 10, 564-598.
17.
Hauff, E., Varvin, S., Laake, P., Melle, I., Vaglum, P., & Friis, S. (2002). Inpatient psychotherapy compared with usual care for patients who have schizophrenic psychoses. Psychiatric Services, 53, 471-473.
18.
Jung, C.G. (1960). Schizophrenia. In The psychology of dementia praecox (R. F. C. Hull, Trans., pp. 178-193). Princeton, NJ: Princeton University Press. (Original work published 1958)
19.
Jung, C.G. (1963). Mysterium coniunctionis: An inquiry into the separation and synthesis of psychic opposites in alchemy. (R. F. C. Hull, Trans.). Princeton, NJ: Princeton University Press. (Original work published 1955-56)
20.
Kane, J. (1989). The current status of neuroleptics. Journal of Clinical Psychiatry, 50, 322-328.
21.
Kane, J. (1992). Clinical efficacy of clozapine in treatment of refractory schizophrenia: An overview. British Journal of Psychiatry, 18(Suppl. 17),41—54.
22.
Kane, J., Honigfeld, G., Singer, J., Meltzer, H., & the Clozaril Collaborative Study Group. (1988). Clozapine for the treatment-resistant schizophrenic: A double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789-796.
Karon, B.P., & VandenBos, G.R. (1981). Psychotherapy of schizophrenia. The treatment of choiceNew York: Jason Aronson.
25.
Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psychoanalysis, 27, 99-110.
26.
Kohut, H. (1977). The reconstruction of the self. Madison, WI: International Universities Press.
27.
Lehman, A.F., Steinwachs, D.S., & the Survey Co-investigators of the PORT Project (1998). Translating research into practice: The schizophrenia patient outcomes research team (PORT) treatment recommendations . Schizophrenia Bulletin, 24, 1-10.
28.
Lehman, A.F., Ward, N.C., & Linn, L.S. (1982). Chronic mental patients: The quality of life issue . American Journal of Psychiatry,139, 1271-1276.
29.
Liberman, R.P., Kopelowicz, A., & Silverstein, S.M. (2005). Psychiatric rehabilitation . In B. J. Sadock & V. A. Sadock (Eds.). Kaplan & Sadock's comprehensive textbook of psychiatry (8th ed., pp. 3884-3930). New York: Lippincott, Williams, & Wilkins.
30.
Lieberman, J.A., Stroup, T.S., McEvoy, J.P., Swartz, M.S., Rosenheck, R.A., Perkins, D.O., et al. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353, 1209-1223.
31.
Martin, B.C., & Miller, L.S. (1998). Expenditures for treating schizophrenia: A population-based study of Georgia Medicaid recipients. Schizophrenia Bulletin , 24, 479-488.
32.
Menditto, A.A. (2002). A social-learning approach to the rehabilitation of individuals with severe mental disorders who reside in forensic facilities . Psychiatric Rehabilitation Skills, 6, 73-93.
33.
Mentzos, S. (1997). Psychose und konflikt. [Psychosis and conflict] (3rd ed.). Göttinggen, Germany: Vandenhoeck & Ruprecht.
34.
Mojtabai, R., Nicholson, R.A., Isohanni, M., Jones, P., & Partennen, U. (1998). Role of psychosocial treatments in management of schizophrenia: A meta-analytic review of controlled outcome studies. Schizophrenia Bulletin, 24, 569-587.
35.
Paul, G.L., & Lentz, R.J. (1977). Psychosocial treatment of chronic mental patients: Milieu vs. social learning programs. Cambridge, MA: Harvard University Press.
36.
Paul, G.L., & Menditto, A.A. (1992). Effectiveness of inpatient treatment programs for mentally ill adults in public psychiatric facilities . Applied and Preventive Psychology, 1, 41-63.
37.
Policy Study Associates. (1989). Best practice study of vocational rehabilitation services to severely mentally ill persons . Washington, DC: Department of Education, Rehabilitation Services Administration.
38.
Rector, N.A., & Beck, A.T. (2001). Cognitive behavioral therapy for schizophrenia: An empirical review. Journal of Nervous and Mental Disease , 189, 278-87.
39.
Rupp, A., & Keith, S.J. (1993). The costs of schizophrenia: Assessing the burden . Psychiatric Clinics of North America, 16, 413-423.
40.
Shaw, J.A. (2000). Narcissism as a motivational structure: The problem of personal significance. Psychiatry, 63, 219-230.
41.
Silverstein, S.M., Wong, M.H., & Bloch, A. (2002). a second chance for people with “treatment-refractory” schizophrenia. Psychiatric Services, 53, 480.
42.
Silverstein, S.M., Wong, M.-H., Wilkniss, S.M., Bloch, A., Smith, T.E., Savitz, A., et al. (in press). Behavioral rehabilitation of the “treatment-refractory” schizophrenia patient: Conceptual foundations, interventions, interpersonal techniques, and outcome data. Psychological Services.
43.
Silverstein, S.M., Wong, M.H., Wilkniss, S., & Lapasset, J. (2004). Techniques interpersonnelles pour optimser les résultats positifs de la réhabilitation psychiatrique [Interpersonal techniques for optimizing outcomes in the inpatient psychiatric rehabilitation of schizophrenia] . Santé Mentale au Quebec, 29, 45-64.
44.
Silverstein, S.M., Wong, M.H., Wilkniss, S., Lapasset, J., Bloch, A., & McCarthy, R. (2004). Gestion clinique et réhabilitation du patient souffrant de schizophrénie et réfractaire au traitement: Foundements conceptuels et resultants [Clinical management of the treatment refractory schizophrenia patient: Conceptual foundations and outcome data]. Santé Mentale au Quebec, 29, 15-44.
45.
Silverstein, S.M., Wong, M.H., Wilkniss, S., Lapasset, J., Landa, Y., Uhlhaas, P., et al. (2004). Techniques pour améliorer l'attention et l'engagement dans le traitement des patients souffrant de schizophrénie avec de graves déficits cognitifs [Techniques for improving attentiveness and treatment engagement among “treatmentrefractory” schizophrenia patients with severe cognitive impairment]. Santé Mentale au Quebec , 29, 65-88.
46.
Simpson, G.M., Josiassen, R.C., Stanilla, J. K., de Leon, J., Nair, C., Abraham, G., et al. (1999). Double-blind study of clozapine dose response in chronic schizophrenia. American Journal of Psychiatry,156, 1744-1750.
47.
Spaulding, W.D., Storms, L., Goodrich, V., & Sullivan, M. (1986). Applications of experimental psychopathology in psychiatric rehabilitation. Schizophrenia Bulletin, 12, 560-577.
48.
Sullivan, H.S. (1947). Therapeutic investigations in schizophrenia. Psychiatry, 10, 121-126.
49.
Turkington, D., & McKenna, P.J. (2003). Is cognitive-behavioural therapy a worthwhile treatment for psychosis?The British Journal of Psychiatry , 182, 477-479.
50.
Wahlbeck, K., Cheine, M., Essali, A., & Adams, C. (1999). Evidence of clozapine's effectiveness in schizophrenia: A systematic review and meta-analysis of randomized trials. American Journal of Psychiatry, 156, 990-999.
51.
Wilkniss, S.M., Hunter, R., & Silverstein, S.M. (2004). Traitment multimodal de l'agressivité et le la violence chez des personnes souffrant de psychose [Functional assessment and treatment planning procedures for reducing seclusion and restraint] . Santé Mentale au Quebec, 29, 143-174.
52.
Willis, R. (Ed.). (1996). World mythology. London: Duncan Baird .
53.
Wirshing, D.A., Marshall, B.D., Jr., Green, M.F., Mintz, J., Marder, S.R., & Wirshing, W.C. (1999). Risperidone in treatment-refractory schizophrenia. American Journal of Psychiatry, 156, 1374-1379.
54.
Witkin, M.J., Atay, J., & Manderscheid, R.W. (1996). Trends in state and county mental hospitals in the U.S. from 1970 to 1992. Psychiatric Services, 47, 1079-1081.
55.
Wolkenstein, D., & Kramer, S.N. (1983). Inanna. Queen of heaven and earth. New York: Harper and Row.
56.
Wu, E.Q., Birnbaum, H.G., Shi, L., Ball, D.E., Kessler, R.C., Moulis, M., et al. (2005). The economic burden of schizophrenia in the United States in 2002. Journal of Clinical Psychiatry , 66, 1122-1129.
