Cognitive Therapy with Schizophrenics?

Article excerpt

Cognitive Therapy with Schizophrenics? Cognitive Therapy with Schizophrenic Patients Carlo Ferris. New York: Guilford, 1989,240pp., $32.00

From the title, one might assume that this is another book by Aaron Beck, in the tradition of Cognitive Therapy of Depression (1979) and Cognitive Therapy of Personality Disorders (1990), but this book is by Carlo Ferris, who is an Italianborn psychiatrist at Umea University in Sweden. It is, however, in the Beckian tradition.

One's next impression of the title is that it is a rather unusual population to which to apply cognitive therapy. Schizophrenia is a thought disorder, but usually of a different kind of "irrational thought" than Beck or Ellis were addressing. Indeed, the distinction is sometimes made between the content and the process of thinking. Cognitive therapy usually treats the former, and schizophrenia is usually a disorder of the latter. However, this is a somewhat blurred distinction, and it is at least possible for there to be such an enterprise as the title suggests.

The author states that he was trained in an eclectic school, and it is apparent in this book. Indeed, "eclectic" may have been more appropriate in the title than "cognitive," because he draws from psychoanalysis, object relations, Sullivan, Piaget, behaviorism, and many other theories. He claims that this is what "cognitive" means, but most people use it in a more restricted sense.

The literature review is very comprehensive. The only obvious omission that offers many parallels to the present book is Rogers, Gendlin, Kiesler, and Truax's (1967), The Therapeutic Relationship and its Impact: A Study of Psychotherapy with Schizophrenics. Ferris mentions humanistic and existential approaches, but never relates them to cognitive therapy, although Rogers' theory is often called phenomenological. Rogers' attempt to do client-centered nondirective therapy with schizophrenic patients was rather unsuccessful, because the patients were not enough in contact with reality to perceive the Rogerian "therapeutic conditions." This would also seem to be a problem for cognitive therapy. Rogers reported much process and outcome data, and this is how he knew that the therapy had been unsuccessful (outcome) and why (process). Ferris does not report any process or outcome data, or indeed, any empirical evidence, for the claimed success of his cognitive therapy with schizophrenic patients. One wonders whether, if he had done so, he would have gotten the same disappointing results that Rogers did.

It may be difficult to get such data because the number of patients that are treated in Penis' facilities is quite small, six to eight at a time, for an extended time, although he has been doing it for many years. …