In the decades since I began my study of cognitive therapy, its relevance in the treatment of schizophrenia was been excitedly discussed. The idea, for instance, that hallucinations and delusions involved thinking distortions seemed appealing. Or that the absence of motivation, the hallmark of the negative symptoms (for more information read here), could be improved with cognitive therapy techniques seemed plausible.

Unfortunately, all of this early enthusiasm was misplaced. For the most part we’ve found that cognitive therapy has little impact on the symptoms of schizophrenia (for a review of the scientific literature see here). This may be due to the pervasive effect of the disease on the client’s metacognitive ability, or in simpler terms, to think about his thoughts. Or it may be the effect of the brain dysfunction on the client’s interpersonal connectedness which interferes in his ability to benefit from any form of psychotherapy. Lastly, the absence of illness insight, or the lack awareness of disability gets in the way of treatment. After all, if the client doesn’t think that there’s anything amiss there’s no need for treatment.

This is not to say that cognitive therapy has no place in the treatment of the symptoms of schizophrenia. It does. As you will read in coming posts, clients have benefitted greatly from outside the box uses of cognitive therapy techniques (as well as psychodynamic psychotherapy). What we must remember however is that the scientific community is a long way from understanding schizophrenia. In spite of the excitement about new drugs, which really do help, we are still far from understanding how an invisible pathological process can wreak such havoc on the brain.

Stay tuned though: all is not lost. Many people diagnosed with schizophrenia do fully recover. And those who don’t can still live lives of richness and joy.