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Section 14
Enhancing Skills with Schizophrenia

Question 14 | Test | Table of Contents

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In the last section, we discussed a model for helping clients understand the experience of enjoyment.  This discussion was based on Bryant’s three stages of enjoyment.  These three stages of enjoyment are anticipation, savoring the experience, and reminiscing.  We also discussed six steps for improving leisure and recreation.

As you know, some clients diagnosed with schizophrenia may be adept at independent living.  However, other clients continue to need help with independent living. Therefore, this section will focus on independent living and self-care. Seven basic guidelines can assist either the therapist or a family member in improving independent living and self-care.

The seven guidelines for improving independent living and self-care that we will discuss in this section are discussing the reasons a specific skill area is important, agreeing on specific steps of the skill to work on, setting goals, demonstrating skills, practicing the skill, agreeing on a plan for the client to try the skill on his or her own, and planning follow-up. As you listen to this section, you might consider playing it for a family member or your client, if he or she is receptive. 

Maynard, age 26, was hospitalized at age 17 after the manifestation of psychotic symptoms.  Maynard stated, "I remember thinking about having AIDS.  I thought I was Jesus. I thought the whole world knew me. Then I thought I was psychic, like I could control people by putting thoughts into their heads. Later, I thought the radio was giving me messages, like the bands were playing just for me. So I turned the music up real loud.  I felt frenzied, and started breaking things in my room.  I tore my door off its hinges, and that really freaked my mom out. She called the cops, and they took me to the hospital." 

Maynard then spent several years in and out of hospitals, undergoing treatment for schizophrenia.  After Maynard’s last release, he began to cope with his symptoms.  At age 26, nine years after his first hospitalization, Maynard lacked necessary independent living and self-care skills.  When Maynard decided that he was ready to try to move out on his own, his mother and I discussed ways to improve his independent living and self-care skills. 

7 Guidelines to Improving Independent Living and Self-Care

♦ #1  Discussing the Reasons a Specific Skill Area Is Important
First we examined discussing the reasons a specific skill area is important.  I stated to Maynard’s mother, "Although pointing out advantages of learning specific skills can be useful, it may also be effective to ask Maynard questions to get him to consider how learning new skills can help him with independent living."  Maynard did not know how to cook, so his mother asked him questions about the effects of not being able to cook, such as having to spend more money eating out.  Maynard’s mother also explored the long-term consequences of not learning the skill.  For example, she mentioned that lacking basic cooking skills would limit Maynard’s options for more independent living. 

♦ #2  Agreeing On Specific Steps of the Skill to Work On
The second guideline for improving independent living and self-care is agreeing on specific steps of the skill to work on. I stated to Maynard’s mother, "Help Maynard identify the steps of the skills that are the biggest problem. You can decide together which areas need the most work."  For example, Maynard had difficulty managing his time. Maynard’s mother asked him what he thought was most important regarding time management. She asked, "Is it using an alarm clock to get up on time, keeping to a regular schedule, writing down appointments and important events, or making a schedule for tasks that need to be done daily?"

♦ #3  Setting Goals
In addition to discussing the reasons a specific skill area is important and agreeing on specific steps of the skill to work on, the third guideline is setting goals.  Maynard aimed for attainable goals and avoided being overly ambitious at first.  Maynard was also very specific when he set his goals. Criteria Maynard used for goal setting included specific times at which he would work on each goal. For example, Maynard set a goal to improve his personal hygiene. He set a realistic goal of showering every Tuesday and Friday before breakfast and brushing his teeth every morning and every night.

♦ #4  Demonstrating Skills
 The fourth guideline for improving independent living and self-care is demonstrating skills.  Maynard’s mother helped Maynard by demonstrating skills for him that he had no experience with due to his hospitalizations.  For example, one of Maynard’s goals was to keep his bathroom clean.  However Maynard had no experience scrubbing a sink or cleaning a toilet.  Maynard’s mother demonstrated how to clean the bathroom.  She also made sure that Maynard had the necessary cleaning supplies to do it himself.

♦ #5  Practicing the Skill
In addition to discussing the reasons a specific skill area is important, agreeing on specific steps of the skill to work on, setting goals, and demonstrating skills, the fifth guideline is practicing the skill.  I stated to Maynard’s mother, "After you demonstrate a skill for Maynard, ask him to practice it.  Give him feedback."  For example, Maynard had set a goal to improve his skills at making appointments over the phone.  Maynard’s mother role-played the phone calls with him, and then gave him feedback regarding how well he performed the skill.  She stated, "Good job, Maynard.  You identified yourself first, and communicated a brief but thorough reason for requesting the appointment."

♦ #6  Agreeing On a Plan for the Client to Try the Skill On His Or Her Own
The sixth guideline for improving independent living and self-care is agreeing on a plan for the client to try the skill on his or her own. After Maynard practiced various skills with his mother, he began to feel more confident. Once Maynard felt confident with his ability to perform a skill, he and his mother set a time for him to try the skill on his own.  For example, Maynard was working on using public transportation. He and his mother had practiced taking the bus together until Maynard felt more confident. Then, Maynard rode the bus on his own. He stated, "I was still a little nervous, even though I was just going to the library, so I took a cell phone with me to call if I missed the bus or something. But everything worked out fine!"

♦ #7  Planning Follow-up
In addition to discussing the reasons a specific skill area is important, agreeing on specific steps of the skill to work on, setting goals, demonstrating skills, and practicing the skill, the seventh guideline is planning follow-up.  When Maynard and his mother first began improving his independent living and self-care skills, they met at least weekly to follow up on Maynard’s plan to practice his skills. When they met for follow-up, Maynard’s mother praised him for any positive steps. 

For example, Maynard was working on the skill of shopping for groceries. He purchased three out of the five items on his list.  Maynard’s mother praised the accomplishment of purchasing those three items. During the planned follow-up, Maynard’s mother helped him make a plan to increase the number of items purchased. I stated to her, "At times, you may need to modify the plan, either to work toward larger goals or set smaller ones." 

When Maynard’s mother set new goals for him after he had success with a previous goal, she took small steps to avoid overwhelming him. For example, when Maynard succeeded in picking up all five items on his grocery list, his mother added two more items to the list, rather than doubling the number to ten items. 

In this section we discussed independent living and self-care. Seven basic guidelines can assist either the therapist or a family member in improving independent living and self-care. The seven guidelines for improving independent living and self-care that we discussed in this section are discussing the reasons a specific skill area is important, agreeing on specific steps of the skill to work on, setting goals, demonstrating skills, practicing the skill, agreeing on a plan for the client to try the skill on his or her own, and planning follow-up. 
Reviewed 2023

Peer-Reviewed Journal Article References:
Bechi, M., Bosia, M., Agostoni, G., Spangaro, M., Buonocore, M., Bianchi, L., Cocchi, F., Guglielmino, C., Mastromatteo, A. R., & Cavallaro, R. (2018). Can patients with schizophrenia have good mentalizing skills? Disentangling heterogeneity of theory of mind. Neuropsychology, 32(6), 746–753.

Davis, L. W., Ringer, J. M., Strasburger, A. M., & Lysaker, P. H. (2008). Participant evaluation of a CBT program for enhancing work function in schizophrenia. Psychiatric Rehabilitation Journal, 32(1), 55–58.

Kamath, V., Crawford, J., DuBois, S., Nucifora, F. C., Jr., Nestadt, G., Sawa, A., & Schretlen, D. (2019). Contributions of olfactory and neuropsychological assessment to the diagnosis of first-episode schizophrenia. Neuropsychology, 33(2), 203–211.

Lampropoulos, D., Troïan, J., D'Amico, C., Bentata, L., & Apostolidis, T. (2018). Evidence for the influence of social dominance orientation and intergroup relations on the stigma of schizophrenia. European Journal of Health Psychology, 25(4), 133–139.

van Erp, N. H. J., van Vugt, M., Verhoeven, D., & Kroon, H. (2009). Enhancing systematic implementation of skills training modules for persons with schizophrenia: Three steps forward and two steps back? Psychiatric Rehabilitation Journal, 33(1), 50–52. 

QUESTION 14
What are three of seven basic guidelines that can assist either the therapist or a family member in improving independent living and self-care for a client with schizophrenia? To select and enter your answer go to Test.

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