Skills training has been found effective in group and individual therapy, family therapy, milieu therapy, and vocational settings (Anthony, Howell, and Danley 1984; Liberman et al., this issue; Strachan, this issue). The point of training interpersonal skills is to improve the individual's ability to master the challenges and problems inherent in daily life. It is assumed that, within Downloaded from https://academic.oup.com/schizophreniabulletin/article/12/4/542/1874999 by guest on 23 November 2021 VOL 12, NO. 4, 1986 545 genetic and constitutional constraints, each patient tries to do his or her best, so that the problem lies not in resistance or lack of motivation, but in a deficit of some sort. The source of deficit is regarded as less important than using remedial training methods to enhance the individual's ability to cope. Successful coping leads to attainment of social and emotional goals that define competence and adjustment. While skills-training approaches have shown much promise and empirical efficacy (Carkhuff 1972; Paul and Lentz 1977; Carkhuff 1983; Liberman 1984), they have been adopted by practitioners very slowly because of the demanding competencies required of those who seek to do such training (Backer, Liberman, and Kuehnel 1986; Cohen et al., this issue). Conceptual Model for Rehabilitation Within the last several decades, a consensus has developed about what constitutes a conceptual model for rehabilitation and its underlying philosophy, as well as what constitutes appropriate rehabilitation practice. (See table 1.) The conceptual model was introduced by leaders in physical medicine and rehabilitation and later extended the mental health disciplines (Anthony 1980, 1982). Both physically and psychiatrically disabled persons exhibit disabilities in social function; handicaps in role performance; needs for a wide range of services, often for a long period of time; and frequent failure to experience total recovery. Rehabilitation of psychiatric disorders, as with physical illnesses, begins when the pathology and impairments of the acute stage stabilize. In cardiac rehabilitation, then, intervention begins after the myocardial infarction and its associated pain and stress have resolved. Similarly, rehabilitation for a person with schizophrenia begins when the acute and florid psychotic symptoms recede or stabilize. Even if symptoms persist, rehabilitation can proceed within the limits of the individual's capability to respond to Table 1. Stages In the rehabilitation of chronic mental patients, with examples of the elements in each stage Stage: Pathology Impairment Disability Handicap Definition: Example: Interventions: Lesions or abnormalities in the central nervous system caused by agents or processes responsible for the etiology and maintenance of the blobehavioral disorder Brain tumors or infections etlologically linked to psychotic symptoms Laboratory and radiographic tests Any loss or abnormality of psychological, physiological, or anatomical structure or function (resulting from underlying pathology) Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being Positive and negative Deficient social skills symptoms of schizophrenia (delusions, anhedonia) Syndromal diagnosis, Functional assesspharmacotherapy, ment, skills training, hospitalization social support A disadvantage for a given individual (resulting from an impairment or a disability) that limits or prevents the fulfillment of a role that is normal (depending on age, sex, social, cultural factors) for that individual Unemployment, homelessness, National and State vocational rehabilitation policies; Community support programs Downloaded from by guest on 23 November 2021 546 SCHIZOPHRENIA BULLETIN training and supportive interventions. The focus of the rehabilitation practitioner is on remediating disabilities and compensating for handicaps (Wood 1980; Frey 1984). The pathology in schizophrenia is still poorly understood, although brain-imaging techniques are revealing intriguing leads for structural and functional abnormalities in certain brain regions (Weinberger and Kleinman 1986).