Serious Mental Illness Blog

An LIU Post Specialty Concentration

Posts tagged psychoanalysis

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Psychoanalysis for Serious Mental Illness? YES!By Danielle Knafo, Ph.D., professor, Clinical psychologist and psychoanalyst; and creator of SeriousMentalIllness.net
Some people believe that psychoanalysis, a theory and therapy created over a century ago by Sigmund Freud, is not a treatment of choice for serious mental illness. I strongly disagree with this view. Here are ten reasons why:
1. Psychoanalysis is known for client-centered care. The client is considered the authority on him or herself and the psychoanalyst is attuned to listening to the client who, most often, takes the lead in the treatment. Unlike other therapies, here the client is at its center and the therapy takes place with a great emphasis on the client’s own experiences and expressions. Thus, importantly, there is a balance in power and responsibility. Unlike many forms of mental health treatment, which take authoritarian stands with clients, psychoanalysis is a collaborative process with each participant’s involvement forming a crucial part of the whole.
2. At the root of psychoanalytic treatment is the need to understand how and why people become the way they do. What circumstances in their lives caused them pain or trauma? Today we know that trauma is a leading precipitating factor in many forms of mental illness, including personality disorders and psychoses. Identifying the trauma, giving it a name, creating a narrative for it, and finding meaning in it all help people to heal and grow from disruptive and overwhelming forces in their lives. Key to psychoanalytic treatment is attention to the individual. Psychoanalysts know that every individual is different, and they listen to each person’s story to create with that person a treatment plan. It is the only treatment approach that begins with a questioning attitude rather than a knowing attitude. 
3. Psychoanalytic treatment is the only therapy that takes into account both conscious and unconscious forces. Most of the time, people do not know why they behave the way they do. This is because a large part of our knowledge is unconscious. When struggling with mental illness, it is important to help the patient surface the unconscious elements so as to understand the reasons for unusual, painful or uncontrollable behaviors.
4. Psychoanalytic methods pay attention to a person’s defense mechanisms. We all use defense mechanisms. This is part of being human. Yet some defenses are healthier than others and help us better adapt to and cope with the world. Psychoanalytic work aims at identifying harmful defenses and replacing them with healthier, more adaptive mechanisms. For example, a person might deny reality by refusing to believe that he was fired from his job. Imagine the problems this defense might cause. Such a person might return to the place of employment, develop a delusion about his boss and coworkers, or even believe God wants him to exact revenge. Psychodynamic therapists would help this person acknowledge the pain and helplessness he feels and replace the denial with constructive reality adapting defenses. 
5. Attention to symptoms is another feature that psychoanalysts hold dear. Most doctors and therapists working in the field of mental health pay attention to symptoms, but many of them do so to construct a diagnosis and/or eliminate the symptoms. Psychoanalysts do not rush to eliminate symptoms because they know that symptoms are meaningful, and one does not take away a person’s meaning without offering them something else in its place. Rather than cure someone, eliminating symptoms can deepen the illness and even cause a breakdown.  
6. Many people with serious mental illness are highly sensitive. Some of them feel too much and are overwhelmed by the world. They have trouble knowing, understanding and regulating their emotions. Psychoanalysts are experts at helping people identify and regulate what they feel. Patients learn to tolerate difficult emotions and to bear what is felt to be unbearable.
7. Many people who have serious mental illness go through states of regression. They stop taking care of themselves and become dependent on others. Unfortunately, many hospitals infantilize the mentally ill and treat them like children, which does not foster growth and independence. Yet, sometimes it is important to avert regressed states, and other times regression can bring us back to a place we need to know. Regression in a safe space and in a trusted relationship can at times be an extremely curative experience. British psychoanalyst and pediatrician, D.W. Winnicott spoke about the healing aspects of regression. Sometimes it is important to go back to move forward. Psychoanalysts are keen to this process because they have strong theories of development. They know what a child needs at different stages of development and what can happen if the child does not get its needs met. Psychoanalytic treatment has been called a “corrective emotional experience.”
8. Psychoanalysts explore a client’s problems as well as her strengths. Since Freud, we know that no one is only sick, pathological or engages in maladaptive behavior. Everyone has what Buddhist psychoanalyst, Edward Podvoll called “islands of clarity.” Analysts are well trained to identify and work with their client’s talents because it is these talents and skills that will help overcome the problems. 
9. Most importantly, psychoanalysis recognizes the value of relationships. The therapeutic relationship is a central component of the treatment and psychoanalysts allow themselves to be “used” in different ways in the therapeutic relationship. Persons who have had disorganized attachments or abusive or neglectful early relationships with their primary caretakers often develop mistrust in their relationships, or they repeat the abusive patterns they grew up with. This repetition also takes place in the therapy relationship and psychoanalysts are trained to recognize relational blueprints and not take things personally but, rather, to use the relationship to create new ways of relating. Sometimes clients feel they can trust for the very first time. This sense gets generalized to other relationships in their lives. 
10. Finally, psychoanalysis is not a rushed treatment. Some people make fun of the time it takes. In this age of short-term treatments and brief hospitalizations, psychoanalysis stands out as perhaps the only treatment that recognizes the time it takes to change life-long patterns. Psychoanalysts know that it takes time to uncover the roots of problems and to alter maladaptive behavior. They are prepared to invest the time it takes.

For all these reasons, and more, psychoanalysis can be highly beneficial to those who suffer from serious mental illness. Prolific author and psychoanalyst, Christopher Bollas, in his most recent book titled Catch Them Before They Fall: Psychoanalysis of Breakdown, claims that psychoanalysis is the treatment of choice for psychosis. Not all psychoanalysts specialize in serious mental illness, but some do. For those who cannot afford private treatment, they can go to local psychoanalytic institutes or mental health clinics that offer low-fee services. Psychoanalytic treatment is conducted with or without medication, depending on what the therapist and client decide. If you are interested in finding a psychoanalytic therapist in your area, the following sites can be of help. 
International Society for Psychological and Social Approaches to Psychosis (ISPS)
International Psychoanalytic Association (IPA)
American Psychoanalytic Association (APsaA)
Division 39 of the American Psychological Association (APA)
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

Psychoanalysis for Serious Mental Illness? YES!
By Danielle Knafo, Ph.D., professor, Clinical psychologist and psychoanalyst; and creator of 
SeriousMentalIllness.net

Some people believe that psychoanalysis, a theory and therapy created over a century ago by Sigmund Freud, is not a treatment of choice for serious mental illness. I strongly disagree with this view. Here are ten reasons why:

1. Psychoanalysis is known for client-centered care. The client is considered the authority on him or herself and the psychoanalyst is attuned to listening to the client who, most often, takes the lead in the treatment. Unlike other therapies, here the client is at its center and the therapy takes place with a great emphasis on the client’s own experiences and expressions. Thus, importantly, there is a balance in power and responsibility. Unlike many forms of mental health treatment, which take authoritarian stands with clients, psychoanalysis is a collaborative process with each participant’s involvement forming a crucial part of the whole.

2. At the root of psychoanalytic treatment is the need to understand how and why people become the way they do. What circumstances in their lives caused them pain or trauma? Today we know that trauma is a leading precipitating factor in many forms of mental illness, including personality disorders and psychoses. Identifying the trauma, giving it a name, creating a narrative for it, and finding meaning in it all help people to heal and grow from disruptive and overwhelming forces in their lives. Key to psychoanalytic treatment is attention to the individual. Psychoanalysts know that every individual is different, and they listen to each person’s story to create with that person a treatment plan. It is the only treatment approach that begins with a questioning attitude rather than a knowing attitude. 

3. Psychoanalytic treatment is the only therapy that takes into account both conscious and unconscious forces. Most of the time, people do not know why they behave the way they do. This is because a large part of our knowledge is unconscious. When struggling with mental illness, it is important to help the patient surface the unconscious elements so as to understand the reasons for unusual, painful or uncontrollable behaviors.

4. Psychoanalytic methods pay attention to a person’s defense mechanisms. We all use defense mechanisms. This is part of being human. Yet some defenses are healthier than others and help us better adapt to and cope with the world. Psychoanalytic work aims at identifying harmful defenses and replacing them with healthier, more adaptive mechanisms. For example, a person might deny reality by refusing to believe that he was fired from his job. Imagine the problems this defense might cause. Such a person might return to the place of employment, develop a delusion about his boss and coworkers, or even believe God wants him to exact revenge. Psychodynamic therapists would help this person acknowledge the pain and helplessness he feels and replace the denial with constructive reality adapting defenses. 

5. Attention to symptoms is another feature that psychoanalysts hold dear. Most doctors and therapists working in the field of mental health pay attention to symptoms, but many of them do so to construct a diagnosis and/or eliminate the symptoms. Psychoanalysts do not rush to eliminate symptoms because they know that symptoms are meaningful, and one does not take away a person’s meaning without offering them something else in its place. Rather than cure someone, eliminating symptoms can deepen the illness and even cause a breakdown.  

6. Many people with serious mental illness are highly sensitive. Some of them feel too much and are overwhelmed by the world. They have trouble knowing, understanding and regulating their emotions. Psychoanalysts are experts at helping people identify and regulate what they feel. Patients learn to tolerate difficult emotions and to bear what is felt to be unbearable.

7. Many people who have serious mental illness go through states of regression. They stop taking care of themselves and become dependent on others. Unfortunately, many hospitals infantilize the mentally ill and treat them like children, which does not foster growth and independence. Yet, sometimes it is important to avert regressed states, and other times regression can bring us back to a place we need to know. Regression in a safe space and in a trusted relationship can at times be an extremely curative experience. British psychoanalyst and pediatrician, D.W. Winnicott spoke about the healing aspects of regression. Sometimes it is important to go back to move forward. Psychoanalysts are keen to this process because they have strong theories of development. They know what a child needs at different stages of development and what can happen if the child does not get its needs met. Psychoanalytic treatment has been called a “corrective emotional experience.”

8. Psychoanalysts explore a client’s problems as well as her strengths. Since Freud, we know that no one is only sick, pathological or engages in maladaptive behavior. Everyone has what Buddhist psychoanalyst, Edward Podvoll called “islands of clarity.” Analysts are well trained to identify and work with their client’s talents because it is these talents and skills that will help overcome the problems. 

9. Most importantly, psychoanalysis recognizes the value of relationships. The therapeutic relationship is a central component of the treatment and psychoanalysts allow themselves to be “used” in different ways in the therapeutic relationship. Persons who have had disorganized attachments or abusive or neglectful early relationships with their primary caretakers often develop mistrust in their relationships, or they repeat the abusive patterns they grew up with. This repetition also takes place in the therapy relationship and psychoanalysts are trained to recognize relational blueprints and not take things personally but, rather, to use the relationship to create new ways of relating. Sometimes clients feel they can trust for the very first time. This sense gets generalized to other relationships in their lives. 

10. Finally, psychoanalysis is not a rushed treatment. Some people make fun of the time it takes. In this age of short-term treatments and brief hospitalizations, psychoanalysis stands out as perhaps the only treatment that recognizes the time it takes to change life-long patterns. Psychoanalysts know that it takes time to uncover the roots of problems and to alter maladaptive behavior. They are prepared to invest the time it takes.

For all these reasons, and more, psychoanalysis can be highly beneficial to those who suffer from serious mental illness. Prolific author and psychoanalyst, Christopher Bollas, in his most recent book titled Catch Them Before They Fall: Psychoanalysis of Breakdown, claims that psychoanalysis is the treatment of choice for psychosis. Not all psychoanalysts specialize in serious mental illness, but some do. For those who cannot afford private treatment, they can go to local psychoanalytic institutes or mental health clinics that offer low-fee services. Psychoanalytic treatment is conducted with or without medication, depending on what the therapist and client decide. If you are interested in finding a psychoanalytic therapist in your area, the following sites can be of help. 

International Society for Psychological and Social Approaches to Psychosis (ISPS)

International Psychoanalytic Association (IPA)

American Psychoanalytic Association (APsaA)

Division 39 of the American Psychological Association (APA)

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under treat treatment hope recovery therapy psychology psychiatry counseling psychoanalysis freud mental illness mental health mental illness health knafo mind body brain healthy wellness feeling feelings emotion emotions thought thoughts med meds medication

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Farther down the Rabbit Hole with Paula Gloria: Schizophrenia Treated without Medication
As seen on the Paula Gloria Show

Description: Now with an entire 58 minutes time slot of her daily public access TV show in Manhattan Paula Gloria can better take advantage of guests like Dr. Lucy Holmes whose knowledge is all too often ignored by mainstream institutions and certainly mainstream media. Consider all the ads for pharmaceuticals during the Olympics alone. When her mentor, Hyman Spotnitz (1908 to 2008) was a practicing psychiatrist at the Jewish Guardian Board such ads would never have been considered ethical. More academic institutions should develop these critically important breakthrough theories AND clinical experience such as schizophrenia cured without medication. Indeed medication represses the very feelings needs to be expressed into language which was the basis for Dr. Spotnitz’s “talking cure”.

Lucy Holmes, PhD is a NAAP and SMP certified psychoanalyst. Dr. Holmes has been the Executive Director of the Center for the Advancement of Group Studies since 1997. She lectures widely on women and family issues and is the author of The Object Within: Pregnancy as a Developmental Milestone, The Internal Triangle: New Theories of Female Development, and Women in Groups and Womens Groups. Dr. Holmes is in private practice in New York City and Ridgewood, NJ working with individuals, couples and groups and as an educational consultant.

 



For more mental health resources, Click Here to access the Serious Mental Illness Blog.

Click Here to access original SMI Blog content

Filed under schizophrenia psychosis psychotic psychoanalysis psychology counseling psychiatry treatment recovery hope mind brain body medication med meds medications drug drugs pill pills therapy mental health mental illness mental health illness healthy wellness therapist

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Living with SchizophreniaBy Mike Hedrick Living with SchizophreniaI’m sitting in a coffee shop at 7:53 a.m. and I’m minding my own business but I hear barely audible chatter and laughter from the baristas behind the bar and I can only think that there’s something about the way I’m sitting here on my computer writing that’s making them laugh at me.I wonder if I look OK, if the way my hoodie sits on my shoulders looks funny or if I said something and sounded weird or if the way I’m typing with only the middle fingers on both of my hands warrants some kind of ridicule.The truth is, I know they’re not laughing at me but every waking hour of every day I’m plagued by the notion that I’m an object of ostracism.This is a little thing called paranoia and it’s become my bittersweet companion in the last eight years since I was diagnosed with schizophrenia.It started when I was 20, first with paranoia in college and developing from there until I was getting secret messages from the TV and radio, afraid even to leave my house and consumed by conspiracy theories.It all came to a head when I somehow became convinced that I was a prophet and undertook a spur-of-the-moment trip across the country to the U.N., convinced that I would be ushered in as the next president or king or something like that.The trip took me from New York to Boston as I followed meaningful colors and secret messages in street signs and nonverbal communication from random people on the street.From Boston I took a Greyhound bus to a small town called Woods Hole, where I was convinced there was a hole through the woods to Canada where I could live and work on a farm and grow pot for the remainder of my life.Unfortunately, there was no hole to Canada. After a few days with a well-meaning stranger I took a train back to Colorado, where my parents picked me up and dropped me off at the psych ward of the Boulder Community Hospital. I spent the next week there.I’ve made strides in the last eight years to a place where I’m comfortable. I’ve also gained 60 pounds because of the side effects of powerful antipsychotic medications coursing through my bloodstream. I’ve become a hermit because I know the only place I’m really, truly free from ridicule or the very possibility of ridicule is alone in my second-floor apartment on the edge of town.I’m also still afraid. I’m afraid to make eye contact because I know if I do you’ll see something weird about the way I do it and laugh about it the rest of the day with your friends. I’m afraid to even consider a relationship because I know that if I broach even the subject of vulnerability with someone, they’ll inevitably use it against me and make fun of me and destroy whatever reputation I think I may have.I know the truth is simpler. I know people are generally pretty good and pretty nice but there’s a devil on my shoulder that will always whisper otherwise whenever things start to go well.There are countless times I’ve sacrificed any notable improvement as a human being because it took away somehow from my sense of ease, from the quiet, simple, albeit lonely life I need to stay centered.Among the things I’ve sacrificed are meaningful career opportunities where I’m fully capable of doing whatever job they ask of me — but I know that if I continue to do it I’ll have another nervous breakdown.Most recently I adopted a dog named Bella. I took her back a week and a half later because I couldn’t handle constantly considering the needs of another living creature. She was a great dog and didn’t have any considerable problems. But because I’m an insecure, paranoid shell of a man who needed personal space to stay sane, she had to go back to the pound.I’m nowhere near as crazy as I was but I still hear voices and sounds sometimes and they scare the hell out of me.I’m still delusional that things mean more than they actually do — body language, smiles, voice inflections, behavior intonations. I’m always worried about these things but the worry has become so second nature to me that I don’t think about it.I’ve gotten to the point where I’m no longer worried about worrying so much and that’s about the best I can ask for.The point I’m trying to make is that schizophrenia is a hell of drug. It’ll throw a wrench in any notion of a normal life you’ve ever had but it will also make you thank Christ, the universe or Satan for the simple things like a warm cup of coffee in the morning as the sun rises, the strength of a family that’s seen pain, and the joy of a good cigarette.Some days are good and some days are bad but that’s life, right?



For more mental health news, Click Here to access the Serious Mental Illness Blog

Living with Schizophrenia
By Mike Hedrick 

Living with SchizophreniaI’m sitting in a coffee shop at 7:53 a.m. and I’m minding my own business but I hear barely audible chatter and laughter from the baristas behind the bar and I can only think that there’s something about the way I’m sitting here on my computer writing that’s making them laugh at me.
I wonder if I look OK, if the way my hoodie sits on my shoulders looks funny or if I said something and sounded weird or if the way I’m typing with only the middle fingers on both of my hands warrants some kind of ridicule.
The truth is, I know they’re not laughing at me but every waking hour of every day I’m plagued by the notion that I’m an object of ostracism.
This is a little thing called paranoia and it’s become my bittersweet companion in the last eight years since I was diagnosed with schizophrenia.
It started when I was 20, first with paranoia in college and developing from there until I was getting secret messages from the TV and radio, afraid even to leave my house and consumed by conspiracy theories.
It all came to a head when I somehow became convinced that I was a prophet and undertook a spur-of-the-moment trip across the country to the U.N., convinced that I would be ushered in as the next president or king or something like that.
The trip took me from New York to Boston as I followed meaningful colors and secret messages in street signs and nonverbal communication from random people on the street.
From Boston I took a Greyhound bus to a small town called Woods Hole, where I was convinced there was a hole through the woods to Canada where I could live and work on a farm and grow pot for the remainder of my life.
Unfortunately, there was no hole to Canada. After a few days with a well-meaning stranger I took a train back to Colorado, where my parents picked me up and dropped me off at the psych ward of the Boulder Community Hospital. I spent the next week there.
I’ve made strides in the last eight years to a place where I’m comfortable. I’ve also gained 60 pounds because of the side effects of powerful antipsychotic medications coursing through my bloodstream. I’ve become a hermit because I know the only place I’m really, truly free from ridicule or the very possibility of ridicule is alone in my second-floor apartment on the edge of town.
I’m also still afraid. I’m afraid to make eye contact because I know if I do you’ll see something weird about the way I do it and laugh about it the rest of the day with your friends. I’m afraid to even consider a relationship because I know that if I broach even the subject of vulnerability with someone, they’ll inevitably use it against me and make fun of me and destroy whatever reputation I think I may have.
I know the truth is simpler. I know people are generally pretty good and pretty nice but there’s a devil on my shoulder that will always whisper otherwise whenever things start to go well.
There are countless times I’ve sacrificed any notable improvement as a human being because it took away somehow from my sense of ease, from the quiet, simple, albeit lonely life I need to stay centered.
Among the things I’ve sacrificed are meaningful career opportunities where I’m fully capable of doing whatever job they ask of me — but I know that if I continue to do it I’ll have another nervous breakdown.
Most recently I adopted a dog named Bella. I took her back a week and a half later because I couldn’t handle constantly considering the needs of another living creature. She was a great dog and didn’t have any considerable problems. But because I’m an insecure, paranoid shell of a man who needed personal space to stay sane, she had to go back to the pound.
I’m nowhere near as crazy as I was but I still hear voices and sounds sometimes and they scare the hell out of me.
I’m still delusional that things mean more than they actually do — body language, smiles, voice inflections, behavior intonations. I’m always worried about these things but the worry has become so second nature to me that I don’t think about it.
I’ve gotten to the point where I’m no longer worried about worrying so much and that’s about the best I can ask for.
The point I’m trying to make is that schizophrenia is a hell of drug. It’ll throw a wrench in any notion of a normal life you’ve ever had but it will also make you thank Christ, the universe or Satan for the simple things like a warm cup of coffee in the morning as the sun rises, the strength of a family that’s seen pain, and the joy of a good cigarette.
Some days are good and some days are bad but that’s life, right?





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under psychology psychological psych psy mental illness mental illness health mental health blog schizophrenia schizophrenic schizo schizoaffective schizofrenia schizotype psychoanalysis psychotic life survivor survive recover recovery rethinking madness mad madness crazy hospital hospitalize hospitalized

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Annita Sawyer - Is Diagnosis Destiny?
Posted on the Yale University Youtube Channel

From the related article, Sawyer, A. (2011). Let’s talk: a narrative of mental illness, recovery, and the psychotherapist’s personal treatment. Journal of clinical psychology, 67(8), 776-788: 

This article describes the author’s experience in psychotherapy, beginning as a suicidal teenager with a dismal prognosis, through 5 years of hospitalization, including shock treatment that erased most memory before age 20, through an Ivy League education, and successful professional career. Retraumatization triggered by reading her hospital records 40 years later adds a unique perspective, as the author watched, but could not control, a process within herself that she regularly addressed as therapist with her own patients. Healing aspects of relationships with three psychodynamic psychotherapists (two psychiatrists and a social worker), credited with her survival and success, are examined. A dramatic interview with Harold Searles, her psychiatrist’s supervisor, and its role in her recovery is considered. Lasting lessons concerning the healing aspects of psychotherapy, the effects of repressed early trauma encountered late in life, the need to counter stigma, and the value of personal psychotherapy are discussed.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under serious mental illness serious mental illness mental illness mental health health psychology psychologist psychoanalysis treatment psychotherapist therapist therapy psychotherapy psychiatrist psychiatry diagnosis diagnostic dsm dsm 5 dsm iv clinical psychology clinical psychological research science news suicide suicidal