The final two activities-in vivo and homework assignments-extend training into the real world. Participants complete the in vivo assignments accompanied by a trainer or support person. Once they demonstrate their facility in using the skills in a protected environment, they are asked to complete homework assignments on their own. The sequences of gradually learning more skills, success using the skills, and taking more responsibility for reaching personal goals combine to move the patient further along the pathway to empowerment, self-efficacy, and recovery.

Each module is packaged with a trainer’s manual, participant’s workbook, and demonstration videotape. The manual specifies exactly what the trainer is to say and do to teach all of a module’s skills; the videotape demonstrates the skills; and the workbook provides written material, forms, and exercises that help the individual learn the skills. A module can be easily conducted by one trainer with one to eight participants. More than eight, however, reduces the opportunities for each participant to answer the questions, and practice the skills and the problem-solving exercises. Therefore, larger groups require a cotherapist or cotrainer. This module can also be used effectively and for a briefer time with individuals or couples.

Of course, the teaching must be modified to fit and to compensate for the large variations in people’s functioning, symptoms, and capabilities to benefit from training. The modules’ repetitive, “tight” structures provide a completely reproducible starting point for these modifications. Experienced trainers can experiment with a variety of alterations, and inexperienced trainers can return to the structure should their modifications prove ineffective. The repetitive structure and social learning principles intrinsic to the modules compensate for most symptomatic and cognitive limitations, and form a constant background of psychosocial treatment against which the effects of other treatments (e.g., medications) can be determined.

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Alex Kopelowicz, M.D.^a
Robert Paul Liberman^b
Donald Stolar, PhD^c

^a Associate Professor of Psychiatry, David Geffen School of Medicine at UCLA
^bProfessor of psychiatry at the University of California at Los Angeles
^cDepartment of Psychiatry, University of California, Los Angeles,. Los Angeles, California

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REFERENCES

1. Assalian, P., Fraser, R. R., Tempier, R., & Cohen, D. (2000). Sexuality and quality of life of patients with schizophrenia. International Journal of Psychiatry in Clinical Practice, 4, 29–33.
2. Coverdale, J. H., & Turbott, S. H. (2000). Risk behaviors for sexually transmitted infections among men with mental disorders. Psychiatric Services, 51, 234–238.
3. Crenshaw, T. L., & Goldberg, J. P. (1996). Sexual pharmacology: Drugs that affect sexual functioning. New York: Norton.
4. Friedman, S., & Harrison, G. (1984). Sexual histories, attitudes and behavior of schizophrenic and “normal” women. Archives of Sexual Behavior, 13, 555–567.
5. Goisman, R. (2001). Choices: An educational program for AIDS prevention. Boston: MMH Reseach Corporation.

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