Looking at Schizophrenic Disorder and other forms of severe mental illness through the SSLD lens takes us beyond the confines of a medical-disease paradigm, even though we recognize the neuro-physiological correlates and the bio-medical realities associated with the experience. The SSLD analysis focuses on needs and functions of the individual, and thus offers a good alternative to the language of symptoms. Following social cognitive theory formulations, the SSLD approach considers human action or behavior as motivated or goal directed. They are, therefore, serving certain function, albeit ineffectively. When I made the claim that individual behaviors are mostly functional, a psychiatrist friend of mine challenged my position and asked how could symptoms such as delusional thoughts be functional. The following analysis was what I offered.

We never experience another person's delusional thoughts directly. We only experience a person's report of thoughts that we consider delusional. I took this from my earlier lectures on the psychoanalytic interpretation of dreams. I used to tell my audience that we could never interpret dreams, we could only interpret dream narratives. The patient's narratives are all we have got.

When delusional thoughts are reported, the person is at least doing a few things: (1) verbalization or some form of symbolic articulation/expression such as writing or drawing, (2) (re)construction of reality; and (3) interpersonal communication.

All these are agentive actions, and can be functional in a number of possible ways. Verbalization, even in the form of self-directed monologue, serves to discharge negative emotions, and can potentially reduce anxiety. Verbalization and other forms of symbolic expression put the person in an agentive or subject position. The person thus increases control over his or her experience. Secondly, the creation of a delusional system represents a cognitive attempt to construct or reconstruct reality. Delusional thoughts are often created around an issue or a theme that is of emotional significance to the individual. It can be fear of injury or abandonment, horror related to chaos or insecurity, or an attempt to protect aspects of self or deeply valued elements of one's life-world. Delusions can often be viewed as a desperate attempt to make sense of a psychologically overwhelming situation, or an attempt to protect oneself from threat and damage. Finally, most individuals experiencing delusional thoughts would share them with others, very often knowingly to mental health professionals. Such interpersonal sharing should at least be seen as moves to gain understanding or to seek help, although they are usually ineffective in bringing about the desired outcome. Here is where SSLD fits in.

A SSLD analysis pays attention to the needs behind functional behaviors. The person reporting delusional thoughts have the need to cope with overwhelming anxiety which may be associated with perceived impending chaos. There is the need to make sense of what is happening within one's life-world both externally and internally. One needs to protect one's sense of order, including one's sense of self and identity. There is also the need to seek interpersonal connection, understanding, and help. The only problem is that talking about delusional thoughts is usually not a very effective strategy.

In SSLD, the question is what alternative strategies can be more effective.

SSLD intervention starts with engaging with the individual. The practitioner will communicate understanding of the client's difficulty and suffering. Clinical engagement and therapeutic alliance are more readily established if we recognize the client's needs and can relate empathically to the client's emotional difficulties. Without agreeing with the facticity of the content of the delusional thought, the SSLD practitioner recognizes the underlying needs and attending emotional investment. Instead of ridiculing or disputing, the SSLD practitioner works with the client to develop more effective strategies and skills for attaining goals that correspond to the client's needs. In this case, what need to be learned and developed are strategies and skills that will help protect the individual from threats, real or imagined. The individual may need to develop more effective access to information, and increase the extent of control over external environment and internal processes. Anxiety reduction or management strategies are probable part of the package. Alternative strategies to cope with confusing or threatening aspects of reality have to be developed. When the client's level of trust in the practitioner increases, with associated improvement in terms of self-efficacy, it may be time to learn appropriate skills for articulating and expressing negative emotions such as fear, confusion, insecurity, and rage. Finally, people who report delusional thoughts more often than not isolated or withdrawn, and at some point they will have to learn, some for the first time in their lives, to build connection and affiliation with others, achieving positive attachment and even intimacy.

Such functional analysis of human experience and action seen as psychotic within traditional psychiatric thinking refocuses our attention on the client's needs and challenges us to come up with effective strategies and skills for them to learn and master, leading to attainment of personal goal through appropriate means. In practice, many individuals who have been through the mental health service systems, including those who have received pharmacotherapy, need to learn to perform personal and social functions in order to attain what they need within their social contexts, through means that are more readily understood and accepted by people around them.

SSLD procedures start with translating the client's "problem" into an assessment of needs and functions, and then into goals to be attained. This problem translation exercise guides the specific strategies and skills to be learned and developed. The SSLD process is systematic and incremental. Complex strategies and skills are broken down into small, manageable incremental steps. Learning initially takes place within the safe environment of the practitioner's office, but clients are always supported to practice what they have learned in their real life, ensuring transfer of learning and sustainable therapeutic gain.

Finally, it should be added that SSLD procedures usually work better in a group context. The group also provides emotional support and helpful feedback, while members can facilitate each other's learning. SSLD groups can also evolve into highly effective self-help groups, and members can learn skills related to group functioning, including coordination, organization and leadership skills.