C. Peter Rosenbaum
Stanford University School of Medicine
This chapter is intended to help you enter into conversations with patients who have schizophrenia (referred to more briefly, if less accurately, in the remainder of this chapter as schizophrenic patients), conversations that will allow the two of you to begin to get to know each other and that might hold the promise of developing the therapeutic alliance on which successful treatment so heavily depends. Treatment includes individual psychotherapy (Chapter 9); structured living, learning, and working situations, such as day hospitals and psychosocial and cognitive rehabilitation (Chapter 9); use of medications (Chapter 7); and working with patients and their families (Chapter 13).
For therapists new to working with schizophrenic patients, the prospect of entering into an intimate conversation with the patient can be anxiety-provoking. Medical students starting their first psychiatry rotations are almost uniformly scared of patients, of craziness and unpredictability, of contact with the unreal and the bizarre. Some (or more than some) psychiatrists remain uncomfortable working with such patients on a psychological level, preferring to serve only as psycho-