An empirical and theoretical investigation of psychodynamic psychotherapy and neuroleptic medication for the treatment of schizophrenia

Since the early 1950s, biopsychiatric conceptualizations have dominated empirical, theoretical and therapeutic efforts to understand the treatment of schizophrenia. The contemporary preeminence of biopsychiatric conceptualizations of schizophrenia have overshadowed other perspectives that might contribute fruitfully to our capacity to understand and aid individuals suffering with this devastating emotional disorder. The origin of modern biopsychiatric conceptualizations is deconstructed by illuminating the non-epistemic underpinnings of Emil Kraeplin's dementia praecox concept, which is the forerunner of the modern schizophrenia construct. Two widely held assumptions of the biomedical model, namely: 1) that schizophrenia is a degenerative, organic brain disease; and 2) that neuroleptic medications are the most effective and safest treatment of schizophrenia are empirically reviewed. Psychodynamic theory and therapy alternatives are also reviewed empirically and theoretically.The comparative effectiveness of Psychodynamic Psychotherapy-only (n = 9) and Medication-only (n = 12) was investigated using an experimental design (Karon & VandenBos, 1981). All patients were administered the Thematic Apperception Test (TAT) at pre- and post-treatment (20 months). Westen's (1995; Hilsenroth, Stein, & Pinsker, 2004) Social Cognition and Object Relations Scale (SCORS) was used to rate pre- and post-treatment TAT narratives in order to assess changes in the cognitive and affective aspects of patients' object relations throughout treatment. Jacobson and Truax' (1991) Clinical Significance methodology was used to detect clinically significant change for each individual patient. Results show the SCORS is a reliable and valid instrument for use with a schizophrenia sample.Treatment outcome results suggest that patients receiving psychodynamic psycotherapy exhibit clinically significant change in a variety of object relations domains when assessed at the group and individual levels. Comparative analyses indicated that Psychodynamic Psychotherapy-only patients outperformed Medication-only patients in regard to changes in a variety of object relations domains. Medication-only patients did not outperform Psychodynamic Psychotherapy-only patients in any domain of object relations. Significantly more Medication-only patients exhibited clinical regression compared to patients receiving psychodynamic psychotherapy. (Dr. Leonard Handler served as the chairperson of this dissertation committee.)