Behavioral rehabilitation of the “treatment-refractory” schizophrenia patient: conceptual foundations, interventions, interpersonal techniques, and outcome data

This article describes an intensive, inpatient behavioral rehabilitation program for patients with schizophrenia who have been considered “treatment-refractory ” at state hospitals. The program is a public–private partnership involving state and private hospitals and community residence providers. The essential elements of this program are described, along with the conceptual and philosophical bases of its treatment and examples of staff behaviors critical to treatment success. Outcome data are then discussed to emphasize the point that when evidence-based psychological treatment is implemented with this population, outcomes can be positive in most cases, and therefore, the number of treatment-refractory patients is actually far less than is estimated on the basis of response to medication alone. Schizophrenia is a serious mental disorder that affects approximately 1 % of the population worldwide, with a current global incidence cal-culated at over 20 million people (Jablensky, 2000). The consequences of schizophrenia, i