Seven Strategies to Use that Help Avoid Retraumatization While Working with Psychosis:

The Mainstream Worry:

Stories related to psychosis can be intense and lead to traumatic recall when a sufferer retells them and does not feel contained or believed within the relationship. Perhaps this is the reason many therapists, family members, and psychiatric wards learn to shut down the telling of the story.

Shutting down stories protects the sufferer from unnecessarily reliving the experience and going through the distress again. Perhaps this is done to avoid a fight or yet another power struggle over reality. It certainly can seem like a good rule of thumb. Activating trauma that you can not stand to consider is a bad idea, right?

Imagine being a person and having the whole mental health system repeatedly stay on the same page. Suddenly all agree not to let you tell your story as a boundary. This strategy is employed over and over again despite the fact that thirty-five percent of recipients of this kind of care become progressively more isolated and distressed over time.

Perhaps no one in the system imagines what it is like to experience systemic indifference to potentially traumatic material. Indeed, is it really so impossible to believe that these experiences are real and there for a purpose? Is it really so hard to believe that the person in psychosis may have some perceptions that are spot on accurate? Not acknowledging them can be cause for further withdrawal and do further damage to the already ailing self-esteem and sense of hopelessness.

Staying on the same page as everybody else may teach a person to suppress their experiences. Symptom suppression can improve objective behavior and decrease social attacks and ridicule. However, I also believe symptom suppression is the wrong tact for many who isolate and withdraw from social functioning. Is it not possible to include spaces and relationships in which experiences can be dealt with in mindful manners?

I am not saying that such experiences cannot lead to faulty accusations that can be hurtful, they most certainly can. But if they can be believed by a few supporters to have profound, political, psychological, scientific traumatic, spiritual, and artistic meaning, perhaps outcomes could be better.

A New Strategy with Survivor Led Groups:

I have come to strongly believe that shutting down stories related to psychosis is the wrong thing to do. I believe this so strongly that I have come out as a therapist with lived experience with madness. I regularly share my experiences in group therapy to facilitate the telling of more stories and group reflection.

I credit the hearing voices network for prompting me to take this plunge. Word of survivor-led groups prompting remarkably different results prompted me to start a curriculum for professional groups. In the curriculum which I have turned into a training and a group therapy guide, I deconstruct what psychosis is into solvable components.

It’s true there are times I wonder if coming out mad was the best career decision. I have had to bravely admit my vulnerabilities which sometimes seem to hurt my credibility. And yet I find that being an artfully unreliable narrator helps guide people to their own truth more effectively. I feel I get better results having taken the plunge.

Being out has helped me exponentially in creating specialized care for sufferers. As a result, I have a number of suggestions for how to encourage the telling of stories without re-traumatizing sufferers in group and in individual encounters. Many of these suggestions are based on replicating realities that happen in survivor-led groups.

#1 Eradicating Stigma and Grounding Participants:

Many supporters actually believe that people who experience psychosis are fragile. It is one of the three most dominant stigmas about mental health challenges according to Patrick Corrigan’s research. As a professional, I have heard this said so many times and I am convinced that my colleagues say this because they don’t know what “psychosis” feels like. At times, simply reversing this this stigma can help ground someone in psychosis and reminding them about how tough they are to be handling such real trauma.

There are other grounding techniques that I have utilized when I sense the group is starting to feel traumatized. Often, acknowledging the trauma in the room and allowing the groups to socialize and focusing on related movies, music, or art can help. If group members initiate this process, it is good to compliment and acknowledge what they are doing as being helpful. Instead of controlling the group and staying on course, collaborating and enhancing these efforts is advisable.

#2 Believing that Psychosis is Happening for a Reason and Holds Truths:

I already said this. but it stands to be further emphasized.

I believe that if classifying experiences that trigger psychosis as an illness can re-traumatize many, finding value in those experiences will help ground many sufferers in distress. Thus, if the supporter believes they will be traumatized this outcome will likely come true. Instead, if the helper meets the content of their experiences with intrigue and interest—if reality testing does not rule the day—the sufferer may open up and express themselves, which is an important first step.

Often the survivor leader is excited to learn that others relate to them and has a high level of hope that others can achieve wellness in spite of disturbing material. Thus, getting naturally excited when a person is sharing details and having strong beliefs about recovery being possible helps deepen the threshold for what others can bear.

Additionally, studying different causation frameworks that sufferers hold give participants a basis for understanding how experiences that trigger psychosis are possible.

As I suggested earlier, I believe that there are six styles of causation frameworks that operate in different ways at different times. Sometimes the experiences may be caused for political, psychological, traumatic, scientific, spiritual or artistic reasons.

Knowing which framework explains a given trigger is often impossible! However, I believe the more types of frameworks the sufferer uses to explain the triggers, the more likely that the sufferer will be able to navigate the trigger in a functional manner. Positive knowledge about all explanations helps one find the value of each experience

The more explanations the helper learns, the better they can help make valuable meaning of these disturbing experiences. Giving up and calling the experiences meaningless does not help.

When there is a purpose for suffering it is far more helpful.

#3 Sharing Your Own Experiences with Psychosis

One of the huge benefits of survivor led groups is that the leader also shares their own experience with psychosis. This opens people up to telling their story because it defies the dysfunctional boundary that exists between clinicians and patients, the presumption that the clinician is well and the patient needs to learn wellness from them because they know better.

Research suggests that we are different in a neurodevelopmental fashion. So how can learning from well people who don’t see us as equal really help?

Additionally, when a survivor leads the group and discloses their own experience it sets the stage for more sharing.

One reason I believe this works is that if group members are free to judge the leader as being delusional, (the “D” word) they get the chance to do some projective identification testing. If they do judge the leader as being delusional and see it doesn’t bother the leader, they will become more emboldened to take the same risks and withstand others who may try to reality check them.

Another reason self-disclosure in survivor-led groups works is because many in the group will not be in the place to test. Instead many will believe the leader and support them because that is the way they want to be treated if they talk. Therefore, the leader who is prepared to believe some pretty outrageous stuff in a reciprocal manner, it is generally appreciated by many in the group.

Whatever place the group participant may be in, the tendency is to become compelled to share. Sharing becomes like an admission that helps the participant let go of the traumatically reinforced material.

#4 Spotting and Sharing Related Experiences to Exude Cultural Competence:

Perhaps many workers in the mental health system might suggest they can’t share their experiences with psychosis because they haven’t had them. Though I agree that it can be harder to relate to psychosis material if you haven’t had those experiences of being in a crisis, I think workers likely have had some experiences (intuitions, dreams, interpersonal impressions to name a few) that can trigger alternate realities. If they learn to identify them and articulate them and share related thinking, it would be helpful for the sufferers.

If a worker sits in group and understands the experiences that trigger psychosis, they will probably learn to be able to relate. Additionally, being able to relate normalizes psychosis experiences makes it safer to disclose without feeling like others don’t believe you and don’t care. I have created a definition of psychosis includes consideration for how things like dreams, interpersonal interactions, and intuitions can trigger alternative realities. I think workers can learn to relate using those common experiences and learn to join the conversation.

I think this is a measure of cultural competence. If you can see serendipitous events and imagine thoughts that may come up from them, why not share those with the sufferer. Why not think about how you might explain those experiences in creative manners. Doing so isn’t going to hurt you. It is a sign of wellness and empathy.

#5 Knowing When the Story is Really There to Test You:

It is important to know when a sufferer is simply trying to establish her or his right to tell the story. In the past, sufferers may have been interrupted, they may just want to establish their right to tell the story. Some will tell fragmented stories to see if they can get away with it and keep your interest and concern. I have been known to get in there and fish for special message experiences to demonstrate that I am there with them. However, it can be important to notice when this isn’t wanted and just let the person tell their story without being judged for doing so.

In many cases the traumatic response may happen when the test has failed yet again. Indeed, I would be grateful for the day when getting caught up in the fact that a person’s psychosis experiences is leading to faulty accusations is seen as a mistake. Perhaps it is possible for the leader to make a few faulty accusations themselves even if they know they may be false. This helps normalize and permit those experiences and paradoxically challenges the sufferer to question themselves.

This is not to say that there is not a time to challenge a faulty accusation made against you, there is a point where this can be effective. But first you have got to repeatedly pass the tests. And acknowledging that you don’t understand everything about yourself and that they may be seeing something you are not aware of can help put off the challenge until the test is passed.

#6 Bringing Other People or Situations into the Discussion;

If I am afraid that a person is going getting triggered by the psychosis story because the group is inattentive or absent, I may try interrupting and identifying a triggering experience the participant has referenced and ask other group members if they can relate to the experience. If I am not in group, I may think of a similar experience I have heard before and share that experience to prove that the person is not alone. Usually, at least, I can relate to the triggering experience and share a story. This not only prevents the participant from feeling quite so alienated it reminds them that others can relate and deepens the support in the room.

Likewise, if I am able to listen and discern some conspiracy ideas that might explain some of the triggering experiences and I fear re-traumatization, I may propose that the group talk about that particular brand of conspiracy and how it really is possible. Again, this may help the participant feel like they are not alone. Group conspiracy talk is another way to deepen the threshold of what the group can tolerate and invite stories.

With other people relating and participating, the person telling the story is less likely to be re-traumatized and feel more supported. Then, it is a great idea to return to the story and hear it out intensely without having need for reality tests

#7 Addressing the Fact that You May be Recording What is Said:

In many countries where the hearing voices network has flourished, like England, the Netherlands, and New Zealand, socialized medicine enable support groups to be funded outside the system where there is no need for clinical notes. This also helps create a sense of safety that invites disclosure.

Indeed, if group records are going to be taken by the facilitator for reimbursement purposes that needs to be addressed in the room identifying the potential for conspiracy.

Letting the participants know what I believe about the notes and the potential that they can be used in an abusive manner without my knowledge is a strategy I often employ. I point to computer screens and light fixtures and suggest that they can put cameras down peoples’ colons, they can certainly bug the room without my ability to protect the group participants.

When I document, I also note that I have used my lived experience to crack open stories. I tell participants that I do that. I think it is ideal when these issues can be avoided, but I also think it is possible to address them if you have to bill in the system.

Specialized Care is Necessary:

I believe that utilizing these and other well documented suggestions that come out of the hearing voices movement can help clinicians grow and come to a point they can listen to stories and contain them just like survivors can. I think that people who chose to specialize in this type of care need opportunities to grow and learn to contain such stories and that survivors need opportunities to become specialists. Specialized care is most certainly needed.