Group therapy may play an invaluable role in the overall treatment approach for many schizoid and schizotypal patients. Their characteristic fearfulness and mistrust of others make most schizoid and schizotypal patients reluctant to participate in group therapy. Some preparatory work by the therapist in one-to-one sessions is often necessary. During this period, the therapist will have the opportunity to hear out and to allay the particular anxieties voiced by the patient.
Depending on the needs and psychological mindedness of the patient, either a chiefly supportive or a dynamic orientation may be preferable. The group can serve as an excellent crucible for the melting down of negative assumptions (“people won’t like me,” “nobody has as shameful fantasies and impulses as I do”) and for the formation of more realistic ones. The other patients will usually reveal that they, too, harbor strange and “unacceptable” thoughts, making it clear to the schizoid or schizotypal patients that they are not so alone or freakish.
Guidelines for group therapy of schizoid and schizotypal patients are to be found in the papers of Roth or Mosher and Gunderson; Appel and Azima concentrate on dynamic group therapy for schizoid patients. It will be true in some instances, as Gabbard and Leszcz point out, that schizotypal patients with extreme eccentricities may push the other group members beyond their flexibility, leading to dropping out or to expulsion by the rest of the group. This is more likely if very bizarre (and possibly repugnant) behavior is involved, rather than merely bizarre thoughts, because the other group members tend to be less tolerant and forgiving of certain behaviors. One schizotypal patient, as an example, got extruded when he mentioned that he and his wife kept the fetus of a miscarried pregnancy in a pickle jar filled with formalin atop their mantel.
Revision date: June 14, 2011
Last revised: by Sebastian Scheller, MD, ScD