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Working With the Person With Schizophrenia

Working With the Person With Schizophrenia

Michael A. Selzer
Timothy B. Sullivan
Monica Carsky
Kenneth G. Terkelsen
Copyright Date: 1989
Published by: NYU Press
Pages: 412
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  • Book Info
    Working With the Person With Schizophrenia
    Book Description:

    The person with schizophrenia poses a formidable challenge even to the experienced clinician. Bizarre, unpredictable behavior, disordered thought patterns, peculiar, even unintelligible speech, and extreme distrust can drastically limit the clinician's ability to conduct therapy. It is often seemingly impossible to determine the cause of these behaviors: Are they a result of the disease, the side effects of drugs, or the patient's efforts to cope?In this brilliant and insightful book, Dr. Michael Selzer and his colleagues offer a radical new perspective on understanding and treating the schizophrenic person. What is often lacking, they argue, is a clear understanding of the patient's own experience of his world. Without a realistic appraisal of the patient's physiological and psychological vulnerabilities, the effect of various stresses on him, and his own unique adaptation to these circumstances, no effective drug or psychotherapeutic treatment intervention is possible.This thoughtful, intelligent, and acutely perceptive book is a major breakthrough for working with persons with schizophrenia. The authors have shown that therapy with the schizophrenic person is not only possible but highly rewarding.

    eISBN: 978-0-8147-8881-3
    Subjects: Psychology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-viii)
    Michael Selzer
  4. Acknowledgments
    (pp. ix-xii)
  5. Introduction
    (pp. 1-14)

    The last thirty years have been a time of great progress in schizophrenia research and treatment. Advances in psychopharmacology have enabled patients who would have once been doomed to a lifetime of insanity to live with a minimum of psychotic symptoms. This development has transformed our view of the nature of schizophrenia and set in motion a wide-ranging reassessment of the arrangements of care. Once viewed as the result of external stress on an otherwise healthy psyche, the disorder is now seen principally as a biochemical illness. The great asylum hospitals, regarded for a century as optimal habitats for patients...

  6. 1 A Model for Understanding Schizophrenia
    (pp. 15-62)

    This book aims to provide clinicians with the means to understand their schizophrenic patients and the skills necessary to engage those patients in treatment. We do not intend to present a model for psychotherapy, although our views are based on work with chronic schizophrenic individuals in supportive psychotherapy, as well as in directing inpatient treatment programs. Our focus will be on the therapeutic relationship with the schizophrenic individual; its characteristics, vicissitudes, and idiosyncracies and its central importance to any therapy.

    Because of the disorder’s effect on thinking and behavior, the affected individual experiences and manages relationships in ways that provoke...

  7. 2 Understanding the Subjective Experience of the Person with Schizophrenia
    (pp. 63-116)

    Psychological responses reflect an individual’s unique experience as well as the skills and limitations of his or her innate mental capacities. These responses are products of an organ that operates according to natural laws, depends on physiological functions, and organizes its activity with discernable and predictable patterns. When an individual, whether schizophrenic or not, meets a challenge, he or she utilizes past experience to deploy behaviors and make decisions. If that past experience does not provide useful strategies or if, in the near-instantaneous processing of memories and imagined options, debilitating associations impair effective responses, the person falters. Our accumulated reflections...

  8. 3 From Understanding to Action: The Alliance and the Treatment Program
    (pp. 117-166)

    Our goal in emphasizing the nature of the treatment alliance with schizophrenic patients is to bring about the patients’ increased collaboration in and commitment to treatment and thus promote their effective coping with their illness (1–6). These aims are reflected in the first section of Table 3.1, which outlines the goals of treatment. Particular attention is given to the attitudes communicated to patients and to the understanding patients derive from the work. In this sense, these treatment goals are particular to our interest in the treatment alliance and its place in the implementation of any therapeutic modality.

    A recurrent...

  9. 4 The Man with a Bug in His Brain: An Initial Interview
    (pp. 167-232)

    This chapter presents and discusses an initial interview in the assessment of a chronic schizophrenic individual for the purpose of understanding his subjective experience so that a treatment partnership can be formed.

    Peter was interveiwed by an attending psychiatrist as part of a course on how to form an alliance with a so-called “hard to reach patient.” The interviewees, all inpatients, were selected by the treatment team because of their difficulty in making contact. The patient chosen for this particular session was described by both his therapist and head nurse as someone who “refused to participate.” Indeed, the staff felt...

  10. 5 The Case of Sharon: A Hospital Stay Involving Noncompliance, Violence, and Staff Conflict
    (pp. 233-268)

    In this chapter, we discuss the difficulties in treating schizophrenic individuals who require inpatient care because of noncompliance and potential for violence. We have taken the case of a woman named Sharon as an example. This case was noteworthy for many difficulties and failures, but we chose it to illustrate our approach to the troublesome management and therapy issues raised by violence and noncompliance. Hospitalization is a frequent solution, but hospital treatment raises issues of its own because of the complexity of the institutional and social systems it entails. How the hospitalization becomes part of the overall treatment is a...

  11. 6 The Case of Maryann: Psychotherapy and Community Management, Rehabilitation, and Rehospitalization
    (pp. 269-300)

    The individual with schizophrenia who is able to live in the community needs the help of family, friends, therapist, and community agencies. The collaboration with a client in such circumstances must take into account the involvement of others in the person’s life and, in particular, work with rehabilitation and other agencies, day hospitals, and residences. The patient’s wishes for the therapist to take a particular role vis-à-vis these others complicate this process. The patient’s need for other professionals in addition to the therapist affects the patient’s feelings and hopes with regard to the therapist. While other programs are not designed...

  12. 7 The Case of Roger: Outpatient Psychotherapy—From Apathy to Community Involvement
    (pp. 301-344)

    In work with inaccessible patients, there are times when it is necessary to relinquish one or more elements of the usual psychiatric stance in the service of establishing an ambience of trust and curiosity and thereby gaining entry into the patient’s inner world. In this case history, it quickly became clear to the therapist that the patient, having accumulated over twenty years of experience with mental health professionals, was impatient with and intolerant of the customary methods of clinical inquiry. He presented with a diagnosis of schizoaffective disorder with prominent negative symptoms, including profound apathy and indifference to any of...

  13. 8 Beyond Psychoeducation: Raising Family Consciousness About the Priorities of People with Schizophrenia
    (pp. 345-372)

    Work with families of the mentally ill has been transformed in the last decade in ways that are both favorable and problematic for clinicians treating the most seriously mentally ill patients. Before the mid-1970s, the prevailing clinical orientations to the family were based on interpersonal theories of the pathogenesis of schizophrenia (1–5) that shared a common emphasis on family interaction as an essential element in the pathogenesis of schizophrenia. Emerging from and consonant with a distinctly American belief in the primacy of environmental influences in human personality development, these theories possessed such powerful apparent validity that they were quickly...

  14. Notes
    (pp. 373-376)
  15. References and Suggested Readings
    (pp. 377-390)
  16. Index
    (pp. 391-403)
  17. Back Matter
    (pp. 404-405)