Recently I received a very good question from a DS member about the topic of therapy and chronic mental illness. With the member's permission I have reprinted the question here:

Many people (even psychiatrists) act like therapy won't help people who are schizophrenic or showing those signs and symptoms. They act like medication is the only option, the only thing that can help. But I've read in books and online, that therapy as well as medication had the best success rate than just medication alone. What are some options (in addition or perhaps in place of) to treating people who hear voices, experience paranoia, delusions and confusion, etc? And would therapy be helpful?

At the beginning of my career, I worked in a hospital setting and in various agencies that worked with patients who were chronically mentally ill. The type of work I did was exclusively talk therapy which, with these patients, was primarily behavioral therapies to help improve the quality of their life.

Since I am not a medical doctor, I am not able to prescribe medication but all of these patients were on some type of medication on a consistent basis and being seen regularly by a psychiatrist. Chronic mental illness, such as schizophrenia, is marked by an extreme departure from reality and an inability to function effectively in everyday life. There are wide variations in the type and severity of this illness but it usually includes some type of hallucination, such as auditory or visual hallucinations or some distortion in cognitive abilities.

The appearance and diagnosis of this illness is devastating and life-altering and, in many cases, alienating. I can say with great certainty from my own professional experience, as well as the knowledge I have gleaned from the work of other therapists, that in conjunction with medication, talk therapy is a crucial part of the treatment and management of any chronic mental illness.

To date, I have not encountered any professionals, psychotherapists or psychiatrists, who feel differently about this although I am sure there are those who doubt the efficacy of talk therapy. Most psychiatrists welcome the addition of a therapist to the treatment team because it is typically the therapist who helps the patient remain consistent with their med protocol. There are also many life skill issues that can be quite difficult for the chronically mentally ill such as hygiene issues or basic household management. These are all important topics for discussion during a therapy session.

For those of you who are unfamiliar with the illness, it is important to know that there is no correlation between intelligence and the presence of a chronic mental illness. In fact, I have met some brilliant and talented individuals who suffer from schizophrenia but this type of disease can make social interactions trying and loneliness can be a factor that exacerbates symptoms. A regular meeting with someone who is familiar with the disease and who is knowledgeable about the patient's needs and aversions can go a long way to normalizing the patient's life and helping that individual feel cared about and understood. I have personally seen great progress in individuals who are consistent about coming to therapy.

In addition to individual therapy, group therapy can also be very effective and serve as life-affirming and spirit-lifting experiences for those who suffer from a chronic mental illness. It has been my experience that these therapies are most effective when combined with skillfully monitored medication and a treatment team consisting of different types of mental health professionals.