psychopathology measured during an acute episode and future work performance (for a review, see Anthony and Jansen 1984). The disappointing failure of research studies to find correlations between impairments and disabilities might be a result of their having been conducted in an era preceding the availability of objective and reliable instruments for eliciting and rating psychopathology. Research using the standardization in diagnosis brought about by DSM-lll should yield studies that suggest a stronger relationship between syndromes and long-term outcome (Tsuang, Wooson, and Fleming 1979; Pfohl and Andreasen 1986). Remediation of Disabilities Through Skills Training. Once a patient has benefited optimally from psychotropic drugs and the therapeutic effects of brief hospitalization, rehabilitation strategies use skills training to remediate disabilities in social, family, and vocational functioning. Skills training as a principal strategy in psychiatric rehabilitation starts from the assumption that many patients will suffer persisting disabilities despite the best efforts at pharmacotherapy and hospitalization. A relatively new field, training of social and Downloaded from https://academic.oup.com/schizophreniabulletin/article/12/4/542/1874999 by guest on 23 November 2021 550 SCHIZOPHRENIA BULLETIN vocational skills has relevance for a wide variety of psychiatric patients and for the professionals who serve them. The psychiatric disorders with the greatest chromcity—schizophrenia, major depression, and organic syndromes—are those most in need of a skills-training focus. While appropriate drug treatment significantly reduces symptoms in most schizophrenics and depressives, many are refractory to drugs and others experience continuing social and vocational handicaps even with symptomatic improvement. The negative or deficit symptoms of schizophrenia, for example, pose a largely unanswered challenge to the pharmacopeia. Social withdrawal, apathy, energy, slovenliness, and anhedonia do not respond as well to neuroleptic drugs as do hallucinations, delusions, and thought disorder. Neither do drugs teach life and coping skills, except indirectly through removal or reduction of symptoms. Most schizophrenic persons need to learn or relearn social and personal skills for surviving in the community. Skills training can begin immediately after the stabilization of an acute episode or exacerbation of a psychiatric disorder which usually results in the loss of social and role functioning. The goals of rehabilitation professionals are to sustain symptomatic improvement over the long haul; establish or reestablish interpersonal and independent living skills; and help the individual reach a satisfactory quality of life. Because the goals of rehabilitation center on adjustment to everyday life, it is vital for the schizophrenic individual to participate maximally in the choice of objectives, and in the learning process. Comprehensive rehabilitation involves assessment, training, and modification of living environments in those areas relevant to personal and community life—selfcare, including medication and symptom management; family relations; peer and friendship relations; avocational and employment pursuits; money management and consumerism; residential living; recreational activities; transportation; food preparation; and choice and use of public agencies. Specific goal setting, within these generic areas, should actively involve the patient, his or her family, and significant others. Skills training has proved to be an effective way of increasing the coping and competence of chronic mental patients (Anthony 1979; Wallace et al. 1980; Liberman, Falloon, and Wallace 1984). There are several sources of empirical data that recommend skills training to improve patients' competence and coping ability. Many studies have highlighted the importance of premorbid and postmorbid social competence as a predictor of outcome in major psychiatric disorders (Liberman 1982a; Presly, Grubb, and Semple 1982; Hirschfeld et al. 1983). This suggests that socialskills training might improve the long-term prognosis by upgrading the postmorbid social competence of chronic