Social Recovery Therapy
Social recovery therapy is a cognitive-behavioral intervention designed to help restore a more capable mental state to young people with first-episode or longer-term psychosis by improving social and vocational skills and encouraging more participation in social activities. The goal is to help people, especially those in the early stages of psychosis, increase the amount of time they spend actively involved in social settings to thrive in their community, rather than merely survive as “outsiders,” thereby preventing long-term social disability and/or the development of schizophrenia or other related psychiatric disorders.
Social recovery therapy, or SRT, was developed by psychologist David Fowler, who posits that directly targeting social and occupational withdrawal and/or avoidance can allow those with psychosis to find meaning and the drive to reengage with society. SRT focuses on identifying the patient’s social and/or occupational goals and the obstacles to achieving them, then uses behavioral and cognitive strategies to help patients overcome avoidance and develop a sense of hope about their future.
SRT is a relatively new modality, with preliminary evidence for its efficacy first published in the late 2000s. So far, research has shown some positive effects, especially immediately post-treatment; one 2017 study, for example, found that patients who underwent SRT spent significantly more time engaging in work and other meaningful activities than a control group did. However, these gains were not maintained at follow-up in that particular study, and more evidence is likely needed to determine whether social recovery therapy meaningfully changes the life course of individuals with psychosis, especially among those who are at risk of developing schizophrenia spectrum disorders.
Social recovery-oriented cognitive behavioral therapy is typically used to identify and address the needs of adolescents and younger adults in the early stages of psychosis, many of whom have multi-faceted comorbidities. It is most often used on older teens and adults in their 20s and 30s who struggle with social disability—isolation or withdrawal, difficulties communicating, and/or a demonstrated reluctance to engage in structured activities or seek support—during or after an episode of psychosis.
Social recovery therapy rests in large part on a therapeutic relationship that is supportive, hopeful, and flexible; Fowler and his collaborators note that the therapist should “walk alongside” the patient by being encouraging, persistent, and assertive in helping the patient to overcome his or her social challenges.
Once a baseline level of trust is established, patient and therapist work closely together to identify challenges and obstacles to social functioning, establish social goals and expectations, and match those goals to relevant agencies and activities. This could include referrals to vocational counselors, participation in educational groups, or seeking out and joining community centers that host sports and other social activities. Successfully engaging in these activities and navigating problems as they arise can help patients develop a sense of agency and promote optimism about their ability to function in the world.
In addition to helping people adjust to work, education, and leisure activities by learning and practicing necessary skills in a safe environment, social recovery interventions aim to ease any feelings of anxiety or hopelessness that may interfere with social success. To this end, therapists will help patients identify and connect with their values and recognize how reaching their social and occupational goals could help them better align with those values.
Psychosis is a broad term describing some loss of contact with reality. While it can have various causes, it is often associated with schizophrenia, a serious mental disorder that can have lasting, negative consequences. Despite recent advances in treatment, full recovery from schizophrenia remains difficult for many to attain. While many patients do receive early intervention services—which, in some cases, can promote significant gains—some struggle to adhere to conventional interventions (sometimes because of unpleasant medication side effects or difficulty finding and affording care); others may continue to have difficulty with social functioning even as they see improvement in other symptoms.
These early social difficulties often lead to long-term issues of isolation, alienation, or even a complete lack of integration into the community. Because motivation to change tends to be highest in the early stages of diagnosis, proponents of SRT suggest that intervening during the first episode of psychosis, and focusing on social functioning specifically, is critical for preventing the early social decline associated with a poor long-term prognosis.
In addition to the personal consequences of functional disability, proponents of social recovery therapy point out the financial strain on the community as a result of lost productivity. Early studies indicate that social recovery-oriented cognitive behavior therapy with early intervention is well received and helps increase the amount of time patients spend on structured activities by as much as eight hours a week. Ongoing research is helping to determine the long-term benefits and effects of social recovery therapy for people with psychosis and for society at large.
Because social recovery therapy is still in its early stages, it may not be available everywhere. Interested patients and their families should look for a licensed mental health professional with specialized training in cognitive-behavioral therapy, knowledge of social recovery interventions, and experience working with younger people during early psychosis or who are at risk of developing schizophrenia. In addition to these credentials, because a supportive therapist-patient relationship is a key component of SRT, it is especially important for prospective patients to find a therapist with whom they and/or their family feel comfortable working.