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INQUIRY INTO THE USE OF PSYCHOTHERAPY FOR HOSPITALIZED SCHIZOPHRENICS
PAUL E. FELDMAN
Am J Psychiatry 1961;118:405-409.
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Director of Research and Education, Topeka State Hospital, Kansas.

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Abstract

Questionnaires were sent to hospital administrators who referred them to their clinical directors, chiefs of service or directors of professional services. The data thus obtained represent the judgements of psychiatrists with varying degrees of training, a variety of philosophies of treatment and a variety of types of hospital facilities.The data which have been collected constitute current judgement values. Those respondents who could not draw on specific experiences within their own hospitals did not offer judgement values. The opinions expressed–though sometimes based on impressions from experience rather than on organized evaluative studies–are essentially from hospitals where therapists have experience with both psychotherapy with schizophrenics and the somatic therapies.The data in this report are based upon a survey of more than 150,000 hospitalized schizophrenics in more than 300 psychiatric facilities of various types. The bulk of the schizophrenic patients in this sample ( 79%) are hospitalized in the various state institutions; the V. A. facilities account for an additional 17% and the remaining 4% are hospitalized in the private hospitals.The percentage of the schizophrenic population receiving psychotherapy is lowest in the state hospitals and highest in the private hospitals. The extent to which psychotherapy is employed in a given type of facility does not necessarily indicate the attitude of the personnel of that facility regarding its efficacy. Closely correlated with the extent to which psychotherapy is employed is the size of the psychiatrist's case load. The number of ancillary personnel trained in the use of psychotherapy appears to be negligible.Hypnotherapy and psychoanalytic therapy were found to be used in less than 1% of hospitalized schizophrenic patients. Of the few who receive these therapies, most of them are being treated in the private facilities.The judgements obtained view psychotherapy as more or just as effective as the vocational, recreational, occupational and milieu therapies, and on a par with ECT and insulin coma therapy. Pharmacotherapy is viewed as the superior treatment. The majority of respondents favor (in emphatic terms) somatic therapy in the treatment of schizophrenia. The data suggests that psychotherapy is infrequently employed as the primary or sole treatment. As an adjunct to other methods it enjoys wider (though limited) popularity and acceptance.This survey indicates that psychotherapy, in the treatment of hospitalized schizophrenics, is not used as extensively as other forms of therapy. The consensus suggests that it has little value as the sole method of treatment and that its merits may be only as an adjunct to the somatic therapies. Psychopharmacotherapy appears to be the treatment of choice for this group of patients, and this is reflected in the relatively small proportion of hospitalized schizophrenics receiving psychotherapy at any phase of their illness. An inference from the data may well be that the type of schizophrenic process found in the chronically hospitalized patients is not generally responsive in a major way to psychotherapy. Additional factors obviously are large caseloads and limited trained personnel to carry out psychotherapy. The small or private hospitals report a much more frequent use of psychotherapy.The findings of this preliminary survey describe in a general way a nationwide picture of the use of psychotherapy in the treatment of hospitalized schizophrenics and the attitudes, whatever their derivatives, towards its usefulness. Studies of a more definitive nature will doubtlessly become increasingly available. Even more necessary will be studies of the types of patients treated with psychotherapy, an exploration of the nature of the psychotherapy employed, and a more refined analysis of the derivatives of attitudes regarding the efficacy of psychotherapy.

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