socialization activities can lead to acquisition of skills through incidental learning during spontaneous social interactions, they do not harness social learning and reinforcement techniques that may be required to promote the acquisition, generalization, and durability of skills needed in interpersonal situations (Liberman et al. 1975). The learning disabilities experienced by many persons with prolonged psychiatric disorders require the use of highly directive behavioral techniques for training social skills. For example, most psychiatrically disabled individuals have attentional and informationprocessing deficits. They show hyperarousal or underarousal in psychophysiological testing, and they experience overstimulation from emotional stressors or even from therapy sessions that are not carefully structured and modulated. These individuals often fail to be motivated by the customary forms of social and tangible rewards available in traditional therapy. In addition, they may lack conversational ability, a basic building block for social competence. Persons with schizophrenia, in particular, are deficient in social initiative and perception, and they have difficulty generating alternatives for coping with everyday problems such as missing a bus, making an appointment, or getting help with bothersome drug side effects. They tend to make less eye contact, have more verbal dysfluencies, and use less vocal intonation, all of which may impair social learning (Wallace et al. 1980). Skills training procedures must be tailored to the needs of the individual patient, as patients present different constellations of social abilities and deficiencies. Moreover, a comprehensive assessment of personal and community resources that can be tapped for promoting the learning of skills should be a prelude to goal setting and skills training (Cohen, Farkas, and Cohen 1986). Several training models are presently available to the clinician. Longest in use is a treatment "package" for training skills which includes specific, goal-oriented instructions to the patient, the therapist modeling appropriate use of the skills, the patient role-playing interpersonal situations, and the therapist reinforcing and providing corrective feedback to the patient (Liberman et al. 1975; Cohen, Danley, and Nemec 1986). Recently, training within an informationprocessing framework has been shown to be effective for patients capable of learning problem-solving strategies (Foy, Wallace, and Liberman 1983; Medication Management Module 1986). Disabled individuals are taught to improve their perception of information in immediate interpersonal situations, process that information to choose a response, and send a response back to the other person. However, both of these approaches are ineffective for patients with severe attentional deficiencies. A model using attentionfocusing procedures that simplify the learning of complex skills has been effective in training conversational skills in some seriously regressed, chronic psychiatric patients (Liberman et al. 1985). Remediating Disabilities Through Supportive Interventions. When restoration of social and vocational functioning through skills training is limited by continuing deficits and refractory symptoms, rehabilitation Downloaded from by guest on 23 November 2021 552 SCHIZOPHRENIA BULLETIN strategies aim at helping the individual compensate for the disability by (1) locating living, learning, and working environments that can accommodate to the residual deficits and symptoms; and (2) adjusting the individual's and family's expectations to a level of functioning that is realistically attainable. Thus, environmental modification and supportiveprosthetic social and vocational environments are complementary approaches to skills training in the reconstitution of social roles for patients with severe and chronic psychiatric disorders. Environmental interventions attempt to provide the patient with supportive persons, supportive settings, or both. A "support person" might reduce a person's disability and handicap through a number of different roles (e.g., advocate, companion, counselor, and advisor). Attempts at making the setting more supportive focus on the programs or