Riitta Rasimus

Psychotherapeutically Oriented Treatment of Schizophrenia: Results of 5‐year‐follow‐up

The authors have developed a psychotherapeutic approach to schizophrenia within the community psychiatric health care system. The orientation is psychodynamic but global in the meaning that the therapeutic plans are made on the basis of case‐specific need of the patients and of their families and include both individual psychotherapy, family therapy and therapeutic communities.

Psychotherapy of Schizophrenia in Community Psychiatry

In 1976 we began a project in Turku, Finland, for developing treatment of schizophrenic patients within the framework of the community psychiatric health services of our country (Alanen et al. 1979, 1980, 1982). The project was based on a broad psycho-therapeutic treatment approach previously developed in the psychiatric teaching hospital of the University of Turku over several years. It was facilitated by the fact that this teaching hospital is also part of the community psychiatric treatment system of the Mental Health District of the City of Turku (population 165,000), and works in close cooperation with the other treatment units of the district. Ideologically we had two chief goals: that the efforts of our four-member team, although based on an integrated illness model of schizophrenia, should be directed so as to strengthen and to especially develop psychotherapeutic and family-centered treatment activities; and that they should be directed in a way suitable to the community psychiatric framework.

Problems Inherent in the Study of Psychotherapy of Psychoses

The methodological problems inherent in the study of psychodynamics and psychotherapy of the psychoses deserve a critical examination because of the influence they have on the results achieved. Our research culture, based, as it is, on the methodologies of natural science, easily devaluates observations which rest on a case-specific approach difficult to confirm by experimental methods. Still, much of the most creative and clinically useful work in this field has been based on penetrating observations of individual cases relatively few in number; an excellent example of this being the classic study of seventeen families of schizophrenic patients carried out at the Yale University Department of Psychiatry by Lidz, Fleck, and Cornelison.1 Such a study, inseparably linked with an extended clinical situation, would not have been possible to execute by making use of simultaneous and matched control material. Employing a natural scientific method, the observational angle would have been more narrow and superficial, of necessity. While saying this, we do not deny the significance of experimental research design (e.g. in verifying the observations based on a case-specific approach).

Psychotherapie der Schizophrenie im Rahmen der Gemeindepsychiatrie Ergebnisse einer 2-Jahres-Nachuntersuchung. Der Einfluß von Selektionsprozessen auf die psychotherapeutische Behandlung

Seit 1976 arbeiten wir in Turku/Finnland an einem Projekt zur Behandlung der Schizophrenie im Rahmen der Gemeindepsychiatrie unseres Landes (Alanen et al. 1979, 1980, 1982). Der Arbeit liegt ein breites Spektrum psychotherapeutischer Ansatze zugrunde, die sich im Laufe der Jahre an der Psychiatrischen Universitatsklinik von Turku entwickelten. Die Tatsache, das diese Klinik auch ein Bestandteil des gemeindepsychiatrischen Behandlungsnetzes der Stadt Turku (165000 Einwohner) ist und dadurch mit den anderen Behandlungseinrichtungen des Kreises eng zusammenarbeitet, machte das Projekt moglich.

Towards Need-Specific Treatment of Schizophrenic Psychoses:Summary

The present monograph includes the findings from a study of action research type, whose purpose is to develop the treatment of patients of the schizophrenia group within the system of community psychiatryon the basis of an integrated illness model of schizophrenia.

Development of Need-Specific Treatment of Schizophrenic Psychoses

What kind of global model for the treatment of schizophrenia our experiences seem to suggest and what kind of therapeutic activities appear indicated for the different patient groups within this model?

Prognosis and the Effect of Therapies on It

We will now examine the prognosis of our patients and the question of what were the outcomes of the different modes of therapy. In this connection it should be pointed out once more that the focus of our investigations lies on the development of the therapeutic activities. We were not carrying out a “controlled” prognostic investigation. Compared with their methods, our study of prognoses has its limitations. But, as we demonstrated above, the studies aiming at methodologic correctness also have their restrictions as regards the practical conclusions to be made from their results.

Findings of Psychiatric Basic Examination. Indications of Therapeutic Plans

We will here describe the findings of the psychiatric basic examination. The main emphasis will be laid on those included in the psychosocial and clinical background variables constructed for statistical analysis in subsequent accounts of therapeutic practice and prognosis (Appendix 1). At the same time, the definitions connected with these variables and their categorization are clarified. In later chapters, the connections of these variables with the implementation of different modes of treatment as well as with prognostic findings will become the focus of our interest.

Background and Goals of the Study

The risk of schizophrenic psychosis is generally considered to be about 1% for the part of the population reaching the age of 40–45 years. Some recent American studies based on three epidemiological catchment areas have shown the lifetime prevalence of schizophrenia to be even higher, 1.0–1.9% (Robins et al. 1984).

Study Project, Material and Methods

The economic possibilities of carrying out the project were based on a research contract made with the Academy of Finland for the period April 1, 1976 - March 31, 1980. It permitted the formation of a four-member team with Professor Yijo O. Alanen as the head and psychiatrist Viljo Rakkolainen, psychologist Juhani Laakso and specialized psychiatric nurse Riitta Rasimus as the members. Below they will be called the head of the project, the psychiatrist of the team, the psychologist of the team and the specialized nurse of the team. Alanen, Rakkolainen and Rasimus were members of the staff of the Clinic of Psychiatry - the first of them being the head of the Clinic of Psychiatry as well as of the Psychiatric Outpatient Department of the University Central Hospital of Turku - while Laakso was a staff member of the Turku Mental Health Office.