Commentary: can intensive psychosocial treatments make a difference in a time of atypical antipsychotics and managed care?

There seems to be both excitement and dissatisfaction in the air when psychiatrists gather to talk about treating one of their greatest challenges, schizophrenia. The excitement began at the start of the 1990s, when clozapine, the atypical antipsychotic medication, was introduced in the United States. In less than a decade, three other first line atypicals had been approved, and more are expected soon. With this antipsychotic revolution underway, why does dissatisfaction seem to linger in the psychiatric field along with excitement? Some point to managed care's increasing pressures to treat all patients as med checks and abandon our 100-year tradition of talk therapy. In this issue of the Schizophrenia Bulletin, experts in the field review psychosocial treatments for schizophrenia, including state-of-the-art studies supporting their use. In this article, we offer a contrary, devil's advocate view of psychosocial treatment, a view that questions the impact of intensive psychosocial treatments. Specifically, we question how applicable the research is to everyday practice, and why it is so hard to sell this mode of treatment to potential payers. We focus on two kinds of psychosocial treatment: individual psychotherapy and family therapy to reduce relapse.