It is important to note that the latter skills areas of the module contains sexually explicit material, thus requiring trainers to obtain essential education and supervision as a means of becoming confident, assertive, and comfortable in discussing intimate sexual matters with patients. The earlier skills areas are organized in one videocassette, trainer’s manual, and participants’ workbook, whereas the more sexually explicit skills areas that teach how to engage in mutually satisfying sex are presented as a second volume, with its own videocassette, trainer’s manual, and participants’ workbook. Thus, it is possible to use the initial volume to teach dating and friendship skills, safe sex, and how to consider the advantages and disadvantages of having sexual relations, without including the more physically explicit skills areas that teach participants how to have satisfying sex and overcome sexual problems.
In Skills Area 1, Establishing a Friendship, the focus is on teaching participants how to begin friendships. Participants learn how to meet people with similar interests, while practicing and polishing their conversational skills. They are taught how to express feelings about the importance of a relationship, and how to ask someone out on a date. Skills Area 1 ends with a demonstration of a typical date, including how to begin, maintain, and end a conversation. There are also scenes that present problems depicting awkward moments in conversations on a date and the dilemma of whether or not to kiss a date goodnight.
Skills Area 2, Obtaining Information about Safe Sex, introduces the participant to some basic information about sexuality. This skills area includes four vignettes that focus on conception, contraception, sexual desire, and sexually transmitted diseases. In the first vignette, the main characters, Jim and Katie, visit a physician to elicit the information they need prior to including sex in their relationship. The next vignette features three young people, like the main characters, who have their own discussion about contraception and the notion of shared responsibility between partners in a loving relationship.
Schizophrenia and Sexuality
- Sexual activity of persons with schizophrenia
- Sexual dysfunction affecting persons with schizophrenia
- Vulnerability of this population to sexually transmitted diseases
- Psychoeducational programs for teaching safe sex
- Friendship and intimacy module
- Clinical Experience with the Friendship and Intimacy Module
- Training the trainers
- - Key Points
This second vignette reinforces the use of contraception as the means of avoiding unwanted pregnancy and maintaining good health. Abstinence from sex is also included as a viable option.
The third and fourth vignettes in Skills Area 2 demonstrate how the knowledge presented earlier can be used in a practical and realistic situation. In the third vignette, Jim goes to a pharmacy to purchase condoms. A pharmacist reminds him why condoms are recommended: “to prevent pregnancy and to avoid sexually transmitted diseases.” In the fourth vignette, the scene is repeated, except that Katie goes by herself to the pharmacy to purchase condoms.
Skills Area 3, Identifying the Benefits and Risks of Having Sex, follows the protagonists as they discuss the consequences of including or not including sex in a relationship.
These conversations elaborate on both the positive and negative aspects of the physical, financial, familial, employment, relationship, and emotional consequences of engaging in sexual behavior. Sexual decision making is demonstrated in seven vignettes, including conversations between two male friends, two female friends, Jim and Katie (a couple in a serious relationship), and between Jim and Katie and a second couple with a young child.
This final vignette places sexual decision making in a real-life context as unmarried partners discuss the consequences of having a child whom they both love, but who was not planned. The parents discuss, and at times argue about, the pressures they face. From losing sleep, having to take a second job, and lack of support from the baby’s grandparents, to relapse of psychiatric symptoms and increased alcohol use by one of the parents, both acknowledge that “having sex just one time without a condom” can have significant adverse consequences.
Skills Area 4, Sharing Concerns, Consequences, and Cautions about Sexuality, introduces the very contemporary and vitally important topic of giving one’s own history and eliciting a sexual history from a partner. Jim and Katie exchange information about their previous sexual contacts. Emphasis is placed on self-disclosure, particularly with respect to past and current partners, and the recognition that one cannot safely assume the absence of sexually transmitted disease because of a current lack of symptoms. Jim and Katie acknowledge that they are both willing to be tested for sexually transmitted diseases and agree to make their relationship monogamous.
Skills Area 5, Sexual Decision Making, uses nine brief interactions between Jim and Katie to introduce an essential set of communication skills. These so-called “go/no-go” signals include the subtle and not so subtle cues that people use to indicate interest in a two-way conversation or an exchange of information. Go/no-go signals are used by the partners to communicate a lack of interest in pursuing sexual activity or to reinforce a partner’s sexual advances. Acquiring the skill to accurately read a partner’s go/no-go signals is a prerequisite to good communication and to achieving a satisfying sexual relationship.