Editors' Concluding Remarks: Psychosocial Treatment: More Than Compassion and Common Sense?

Are new pharmacological treatments so effective that it is time to close the shutters on our treatment centers, dispense medication, and assume that psychopharmacologists will develop appropriate cocktails to address all the problems that schizophrenia presents? If not, what can specific psychosocial treatments offer above and beyond medicine prescribed with patient education and a bit of compassion and common sense? Articles in this issue of the Schizophrenia Bulletin (1) review evidence supporting the efficacy of psychosocial treatment approaches in schizophrenia, (2) focus attention (no pun intended) on neurocognitive deficits as a moderating variable in psychosocial treatment delivery, and (3) address an increasingly important population: those with comorbid substance abuse. Our discussants broaden the agenda and bring important new questions to the table. Each directs our attention to the importance of practical problems of treatment delivery and the role that psychosocial treatments play in the increasingly complex world in which both patients/clients/consumers and psychotherapists/treatment providers function. Some readers of this issue will remember earlier Schizophrenia Bulletin issues focused on psychosocial treatments and will note changes in topics, emphasis, and perspective (Mosher and Meltzer 1980). For example, no article addresses group therapy as a formal treatment. Groups now appear to have become a venue (or a route of administration) through which other more specific interventions are provided. Social skills training (Cook and Razzano, this issue), family psychoeducation, and vocational rehabil i tat ion (Heinssen et al., this issue) are often delivered in group formats. Cognition is now a focus, both in schizophrenia-specific versions of cognitive-behavioral therapy (Garety et al., this issue) and as a functional attribute of individuals with schizophrenia that can influence treatment outcomes (Green et al., this issue). Comorbid substance abuse disorders are also viewed as a class of moderating variables that will influence choices of psychosocial treatments and their outcomes (Drake and Mueser, this issue). While earlier appraisals of psychosocial treatment often assumed that greater exposure to treatments was more likely to be effective (Mosher and Keith 1980), current approaches attempt to avoid potential toxicity by providing "just enough. " Another important change is that no current research reflects "horse races" between psychological and pharmacological treatments (and our discussants haven't raised this issue, either). Thirty years ago, in his introduction to Philip May's landmark comparison of psychotherapy, medication, and electroconvulsive therapy, Jonathan Cole commented that the May study answered the psychotherapy versus pharmacology question decisively: Psychotherapy alone was less effective than pharmacological treatment (Cole 1968). Then, this answer was clear to some. Today, it is quite clear to all (Fenton, this issue). From a time when the risk to patients was that medication would be eschewed in favor of talking therapies, we may have come full circle to the point that talking to patients may be eschewed because the new medications— it is assumed—will provide all the treatment that patients need. In one of the first studies exploring the interaction between new medications and psychosocial approaches, Rosenheck and his colleagues found that treatment with one new medication, clozapine, increased patients' demand for and use of psychosocial treatments. This enhanced use in turn maximized the long-term benefits of clozapine (Rosenheck et al. 1998). Several important issues face the field of psychosocial treatment for schizophrenia. Virtually all the articles call for further research. What further research do we need? How can that research build on the impressive body