By Monica Vandyke

Even though the COVID-19 pandemic seems to be slowly fading into the background, safety precautions and physical distancing remain priorities for many. And throughout the pandemic, these priorities have helped to fuel the remarkable rise of telehealth –– with one report at PR Newswire citing a single Medicare provider that saw an increase of as much as 2000% in telehealth consultations alone. That’s a remarkable number, but it indicates just how thoroughly remote healthcare has been embraced, which in turn speaks to why it’s likely to stick around.

Make no mistake, this is likely to be the case where psychiatric and mental health matters are concerned as well. Just last spring, Medpage Today referred to psychotherapy as the “most common telehealth procedure, which means quite clearly that when the pandemic is finally behind us, and telehealth is still being practiced, psychotherapy patients will be among those benefiting.

Here, we’ll take a closer look at what exactly that means.

What Telehealth in Psychotherapy Looks Like

With regard to psychotherapy, telehealth is a way for people to have medical consultations with therapists, seeking advice and feedback via phone or video chat. Initially, it may seem strange to have a therapy session on a mobile device or computer if you are used to having face-to-face meetings. But many people who have tried telehealth find the experience to be very safe (particularly in light of the pandemic) and satisfyingly convenient. So long as a patient has an internet connection and a proper electronic device, they can see their therapist virtually from anywhere at an agreed-upon time.

While there are many advantages to telehealth, however there are also some challenges. For example, it is true that some mental health patients in particular might miss the empathy and compassion that are more easily conveyed through face-to-face, in-person interaction. However, with regard to issues like this it is important to note that the future of telehealth –– which we’ll speak to further below –– is very unlikely to remove the option of in-person consultation for most patients.

Why Telehealth is Likely to Stick Around

Whether or not telehealth is likely to stick around in general has become a common question of late. The online health resource SymptomFind took this question on in detail in a recent post, and concluded quite simply that most care that doesn’t require detailed exams or diagnostic testing is “optimal” for telemedicine. Virtual appointments, in other words, are not just practical and convenient because of the pandemic, but are actually ideal for the average check-in.

It is also the case, as has been indicated in numerous surveys, that the majority of people who have tried telehealth find it to be a very effective way of engaging with therapists. The fact is, as much as many patients value in-person care, most place a premium on convenience. If a given appointment doesn’t require any kind of physical examination or assessment, a patient is generally unlikely to prefer going out of their way for an in-person appointment if virtual care is an option. And given that so much of psychotherapy does come down to conversation and verbal assessment –– rather than physical examination –– these factors may be even more relevant in this specific area of care.

What the Future Looks Like

As we look to the future, the current trend tells us that telehealth must be available as an option for all future clients. Psychotherapists will continue to adapt to the trend as needed. However, that does not mean a slow and steady push ever forward toward complete telehealth. Rather, as with other areas of healthcare, it will mean a push toward hybrid care.

This is construct we’re hearing more and more about, which essentially describes what we’ve already come to see during the pandemic. Patients will have the primary option of scheduling telehealth appointments –– perhaps on a regular, recurring schedule in some psychotherapy situations. However, care plans will also provide for the scheduling of in-person appointments –– say, if a certain assessment or test is needed, or if either the therapist or the patient deems an in-person meeting to be necessary.

All things considered, telehealth has proven to be a valuable tool for psychotherapists and patients alike. This method of care connects patients with their therapists for their continued care –– a service that would otherwise not have been possible in the darkest days of the pandemic. Moving forward, it will make care plans more flexible and convenient, and may even help more patients to seek care when they would not otherwise do so.

Thank you for reading, and for more content on psychotherapy services, training, and a range of related topics, please visit us here at Tim Dreby again!

The post Is Telehealth The Future Of Psychotherapy? appeared first on Redefining "Psychosis".

In summing up my experience with psychotherapy, the last lesson is one I am still working through. It is a lesson I am learning as I am seeking trauma treatment for feeling numb and frozen when I am not at work. This involves rebuilding trust in psychotherapy. It involves building into psychotherapy a significant peer component.

During my first job working at McDonald’s, I worked around the food that I loved. It made it much easier to starve. Especially McDonald’s irresistible french-fries: the more I worked around them, the less appealing they were.

Perhaps that is all that is happening to me as a psychotherapist. I am just working around the lard in the industry and it makes me not want to dine. However, shall I really give up on trusting psychotherapy?

Now there is a new trend pioneered by figures like Bessel van der Kirk and Richard Swartz (Internal Family Systems,) and Karen Shapiro or Laura Parnell (EMDR) These involves new ways to address trauma that are based on “better” scientific understandings of trauma and how it affects the body.

Developing Treatment for Psychosis as a Provider:

When I finally recovered from two years of “psychosis” or what I’ve learned to call special message crisis, I took a long break from seeking psychotherapy services. Instead of receiving services, I provided services.

I worked with other people who suffer from what I went through. It took me six years, but I learned to use my own story and work mutually with program participants. Over time I learned to consider myself to be a wounded healer. I do not pretend that I am not wounded. I am authentic and I believe I get good results.

As a psychotherapist, I have trusted myself. I have learned and grown stronger giving myself and others the liberty to talk about experiences associated with hearing voices or being a targeted individual.

I pioneered professional group therapy for psychosis and developed eclectic strategies to help support people while in psychosis. I work primarily with people who have been severely affected by public warehousing and have suffered homelessness and been institutionalized in shelters and board and care homes.

Providing therapy has helped me more than receiving it. Returning to therapy has been something I have done for a targeted reason, to address trauma.

Here, summing it up will help provide perspective on the mental health system and ways psychotherapy may need to change to become more trustworthy.

Seeking Out Trauma-Treatment:

A year and a half ago, I suffered a back injury and had to be in bed for a week. Then I needed to be out of work as I rehabbed for a month. I decided to seek therapy to try to take the edge off my level of suffering when I didn’t have work to keep me occupied.

I often suffer on the weekends when I am not functioning in a professional capacity. Additionally, I often suffer because I have been unable to build social support that has enabled me to promote my therapy platform as an author.

Curious to learn about EMDR and other trauma therapies like Internal Family Systems, I chose to work with a therapist who appears to be my age and my training level.

This time my therapist acknowledged he has his own lived experience and is open about his religious background and our cultural differences. Finally, he was able to accept my insurance which meant I could afford to see him without feeling financially exploited.

Finding Myself Unresponsive:

In EMDR trauma treatment, there is a process called resourcing. The trainer helps the subject identify wise and protective people in their lives. Also in resourcing it is important to identify safe places. These figures and spaces are used to mentally support the sufferer during the process of bilateral stimulation.

Unfortunately, I found that this task does not come easily for me.

In trying to find supportive and protective people, I found that most people who have supported me have been a lot like the six other therapists I have critiqued up to this point.

While each therapist and support did help me, they also left me with a sense of betrayal. It has been hard for me to believe that my past is riddled with people who I don’t trust. Many have left me because of my mental health struggles and the stigma associated with schizophrenia.

What I found was that because I struggle with the task of resourcing, I am not responsive to the bilateral stimulation. Recently, I heard my therapist say he didn’t think I was a candidate for EMDR because I am not in touch with my feelings.

Lesson Sixteen: True Healers Don’t Make Fun of a Subjugated Group!

Simultaneously, I have taken training that supports my therapy efforts. For example, I took Emotional Freedom Techniques, a scientifically based treatment that incorporates the Eastern practice of tapping on energy meridians and repeating affirmations to help change the level of stress the body experiences.

During the Emotional Freedom Techniques training, I found that in a room full of therapists, I was not able to benefit. The instructor called people like me reversed. He expressed annoyance with such people. ‘Why can’t they just accept help!” “You can spot a reversed person when they come into these rooms from their energy they exude.”

Meanwhile, I progressively realized I was being referenced by these comments. I recognized this as an idea of reference of the sort I experienced during psychosis.

In my own system of treatment, I would call this kind of message a trickster. If I believe in a trickster, it likely to come true. Instead, much like I must do to survive psychosis, I need to use spirituality and exude alternative energy through prayers and mantras and hope that the trickster doesn’t come true.

Even though I knew that I needed to ignore this real situation and change my energy to change the outcome, I fumed. I bitterly stopped hiding the fact that the tapping wasn’t working for me. I noticed that the instructor seemed to avoid my hand and further reject me with angry comments about dissenters and I felt hurt and angry.

As a result, I have surmised that I may live in a slightly disassociated state, perhaps because of my medications, that prevent me from being in touch with my feelings. I believe this state is something I have developed as a psychotherapist who had to work particularly long hours for my license.

For a long time, I told no one about my history until I got my license. Perhaps my supervisors just saw someone who worked seven days a week if they even saw me at all.

I believed if I disclosed, my supervisors would refuse to let me work under their license. It so happened that many of my supervisors said horrible things about people who experience schizophrenia to which I had to silently bear witness.

In like manner, for many years I struggled to get along with my colleagues. First, I tended not to trust other therapists when they complained about people like me who have been institutionalized.

Then, when I self-identified as a therapist with lived experience with psychosis, there were times ridicule made it back to me. Politically I was attacked when I took a job as a peer administrator. One colleague saw this and said I was like Tupac with all eyes on me. I left administration when I was demoted. I went back to my old job and was able to survive the nickname, “Crazy Tim,” and continued working.

The same thing had happened when I sought training years earlier from Bessel van der Kirk, a man touted as the world’s leading trauma expert. In a room of hundreds of upper-middleclass caucazoidal clinicians, he made fun of people who were psychotic. He didn’t do this once. He did it repeatedly. I felt extremely alienated and it follows me into all the trainings I subsequently attend.

Making the Connection:

I think of my behavior in group therapy when psychosis is freely referenced: I am animated, engaged, funny and in touch with my feelings.

I think of the one-time my therapist really tested me to be in touch with my feelings. It was at the end of a long disturbing week.

Even though I can acknowledge that I failed miserably in describing my feelings, I realize I need to contest him that his experience of me doesn’t mean that I am incapable of benefitting from EMDR!

So here, I make the connection that a part of me is putting my therapist in the category with all the trauma experts and past therapists who have rejected me.

I am aware to some extent that I bring significant therapy baggage or negative transference to this therapeutic relationship. As I draft this blog. I never really considered how bad therapy has been for me.

There have been many times in psychotherapy over the past year and a half that I have felt judged or misunderstood. I have worked hard to overlook it and advocate for a better relationship.

While I have tended to give my therapist the benefit of the doubt, I also realize that I am hypervigilant about being judged. Sometimes I have walked away thinking he thinks of me as a narcissist.

Outcome:

When I recently confronted my therapist about his conclusion that I cannot benefit from EMDR, I learned that he is not like the trauma trainers and other therapist colleagues from whom I have observed prejudice against psychosis. My therapist may have been trained by them but he might have alternative views.

I tested him to see if he really thinks I am a narcissist. He did not seem to feel that way about me. I realized that I am blaming him for all he bad therapy I have received over the years. I have not been warm to him. His assessment of me was not his fault.

I think throwing my therapist under the bus and saying that all he ever did was judge me when he said I could not benefit from EMDR is not very rational.

Therapy is not an all or nothing thing. Therapists have strengths and weaknesses just like people who experience “psychosis” or special message crisis. Maybe to find a person who really believes in me, it takes firm self-advocacy!

Therapy that Heals Beyond Social Control:

I think most therapists I have examined in this series have looked at me and felt there is a need to fix something. Many people do not need to be fixed, need only be supported. When I interviewed with Malik Shakur (Tupac’s cousin) on the Knowledge Show to promote my book that was his assessment of me. I was a structured kid, he said. There was nothing wrong with me.

While I don’t feel good about my experiences with therapy, I am responsive to curanderos and other types of healers who try to help me be the kind of person I want to be. I may not choose to need mushrooms or other natural psychedelics, but I like traditional cultures. I have learned that my goal is not to fit in but rather to endure.

Like a good curandero I will help individuals find health despite the goals of the Cabals who advocate for social control and conformity for their own security.

I will persist and trust my therapist who also identifies as a wounded healer. I will try to add music artists who I appreciate to my resource list of people who have not let me down.

I can learn healing skills to regulate my emotions so I can explore traumatic memories and find out more of what I experienced during times of disassociation.

I Am Not Alone:

In the health system there is a new movement to bring peers into the workplace. Indeed peer support and a culture of sustainable recovery suggests that people who have been institutionalized can find meaning and purpose by helping out their brethren in the system.

At the current time, many wise peers are expected to train young staff members just out of school and help each other out without getting any compensation.

For twenty-six years I have seen this go on and I feel that if those wise peers are given training and the right kind of support, they can complete tasks and they have a right to compensation. That’s what I do. I may endure ridicule, but I respond by seeking to outperform my colleagues and sometimes I get respect.

As the Hearing Voices Movement demonstrates, lived experience and stories about managing psychosis and other struggles can be very helpful when shared amongst sufferers. More and more the clinics are hiring peers and including them as members of the treatment team.

Indeed, there are a lot of people like me who know what it is like to repeatedly fail in treatment. I believe we can be utilized to improve services for others. Many others like me have training about what not to do:

1. Lesson Number One–Don’t Side with Society Over the Sufferer;
2. Lesson Number Two–Don’t Ignore Problems;
3. Lesson Number Three–Don’t Engage in Dual Relationships that May Interpreted as Exploitative;
4. Lesson Number Four—It Is Important to Set Reasonable Expectations;
5. Lesson Number Five—It is Not Helpful to Make Negative Predictions;
6. Lesson Number Six—It is Important Not to Ignore Signs of Abuse in Relationships;
7. Lesson Number Seven—It is Important Not to Attack a Spiritual Tradition;
8. Lesson Number Eight—Don’t Use Treatment to Attack a Political Ideology;
9. Lesson Number Nine–Don’t Let the Basis of Your Trust Be Credentials;
10. Lesson Number Ten–Don’t Make Decisions for the Client;
11. Lesson Number Eleven–Don’t Presume Everything in a Paranoid Person’s Life is Paranoia;
12. Lesson Number Twelve–Don’t Predict Permanent Warehousing for a Person in an Emergency;
13. Lesson Number Thirteen—Don’t Collaborate with Imposed Treatment;
14. Lesson Number Fourteen—Don’t Expect Psychosis to be Suppressed:
15. Lesson Number Fifteen—Don’t Impose Your Economic Reality on Your Patient;
16. Lesson Number Sixteen—True Healers Don’t Make Fun of a Subjugated Group!

The post In Psychotherapy We Trust: Part Four– Trauma Treatment appeared first on Redefining "Psychosis".

Although it may seem like binging and purging down a sink in a roach infested apartment is a likely a low point for a Where’s Waldo person born to such mainstream, Caucizoidal privilege, it wasn’t really that dire. Indeed, it would take me seven years for a catastrophic incident to happened. Then, I would find myself buried me in a state hospital as I suppose the psychometric testing predicted. So, the question remains: did the psychotherapy help, or was psychotherapy part of the problem?

Though I had some hard times, psychiatric medications and life-term psychodynamic therapy worked for seven years. Psychopharmacology was a booming industry and there was a big push to get people on medications. My goal was to fit into the mainstream and be like everybody else. It was as if I could take medications and wear name brands and maybe some people would tolerate me. I worked and worked at it. I guess the premise of this therapy was the same as it was in phase one and two, fir a square peg into a round hole.

Discharged from the state hospital to the streets with a month worth of medication, I learned that professional work was out of the question for a homeless, drifting, targeted individual. When I finally managed to arrange a life sustaining situation for myself fear of failure and chronic homelessness prompted me to reconnect with family. In order to receive financial support that could make a low-wage job sustainable, I was forced into a dehumanizing rendition of narrative therapy for three or four years.

There are many things I learned during this decade of treatment for binging and purging and schizophrenia. Was it really wise to trust psychotherapy during these twists and turns? I highlight eight things that particularly hurt me during this time.

Lesson Number Eight—Don’t Use Treatment to Attack a Political Ideology:

In my senior year in college, I went voluntary to the hospital at the urging of my new therapist because I just could re-calibrate myself into my school routine. In the hospital I was able to contain my raging eating disorder, so I avoided that diagnosis. Instead, I was diagnosed with Schizotypal personality disorder and started on three medications.

In another sense was a trusting and genuine fellow. I took the Rorschach and expressed Marxian concepts. I continued to say “yo” and dress in casual inner-city garb. One might argue these just aren’t wise things to do in an American Psychiatric Hospital.

But the worst thing I did was challenge the AMA for banning Thomas Szasz. This really concerned my doctor and he started me on medications before the results of my tests were up.

The doctor said I was impulsive! I had never heard myself being referenced in that way. It is true my emotions go from one to one-hundred, but I usually don’t act on them unless I am in life or death circumstances.

Upon my release, my therapist told my parents that I really wasn’t college material and encouraged me to go on SSI. She put me into a very repressive day program with extremely oppressed and mistreated people from a state hospital. Instead I took on a couple of seasonal jobs and got back into the next semester. I ignored the quality of her advice. I felt like I owed her for putting me in the hospital.

Lesson Number Nine–Don’t Let the Basis of Your Trust Be Credentials:

In my gut, I never trusted my therapist of seven years even though I made strides in my professional and social life under her care. I stayed with her because she had a Ph.D. from Cornel University and because I was afraid to hurt her by cutting her loose. I was dependent on her as a sounding board while I waited for the next medication cocktail to kick in.

Perhaps if I had known what she told my parents about me when I gave her permission to talk to them, I would have fired her. However, my parents and I had poor communication that even if they told me, I don’t even know if I would have believed them.

I recall repeatedly talking back to myself about my care during this time and deciding to use my mind to trust the credentials. My intuition told me I shouldn’t trust her from the start.

Case in point: I didn’t trust the entitled way she treated the security guards at the site where she first worked. I’d worked in the inner-city and seen that kind of arrogance lead to beloved cars getting keyed. I felt going up the chain and getting all dysregulated about the lack of response it in front of me was treating the security officers like slaves. I knew she’d be more successful if she talked to them like human beings. But she was the Ph.D. And she eventually found an office where she didn’t have to fight that losing battle.

Lesson Number Ten–Don’t Make Decisions for the Client:

Over the seven years, therapy never went into my past. This was my choice, but maybe it could have been contested. Instead, therapy was only about my current depression which was always getting worse and worse. As I stated before, we were constantly waiting for her latest psychopharmacology professional to fix me.

I would need therapy and medication the rest of my life. “The only way to manage a personality disorder is through an intensive psychodynamic relationship,” she would say. She lowered her price, so I could afford the sessions myself. I saved all my decisions for her to make.

Meanwhile I excelled in my profession of a mental health counselor and put myself through graduate school with accommodations for diagnosed ADD and Dyslexia. Persistent hard work always kept me out of trouble. Even though my GPA dropped from 3.9 in undergraduate to a 3.7, things were different because I also put energy into creating a social life.

Still, it was very hard to wake up through the medication fog in the morning and get into work. I would gulp 32 ounces of Coke, so I wouldn’t fall asleep at the wheel. But I was a good worker once I woke up. Also, I really worked hard on my social life and making relationships with people who rejected me. It was like the old Morrisey song: the more they ignored me, the closer I got.

Lesson Number Eleven–Don’t Presume Everything in a Paranoid Person’s Life is Paranoia:

When I graduated, I wanted to get into the Peace Corps and many other alternatives, but every program rejected me after consulting with my therapist. I didn’t want to be paranoid, so I maintained faith in her. She taught me a lot about my paranoia. I stopped trusting my intuition.

Finally, I settled for moving to Seattle and continued my treatment via phone. Within six months I took a risky job in a high-profile section 8 housing authority job. I kept making legal and ethical decisions that guided my conduct amid extreme social violence toward going against the grain.

I would tell myself that I would be paranoid if I thought that what I was doing would be frowned upon. I told myself that drugs and violence were illegal and not sanctioned by the government! People like me were not bribed to look the other way!

Indeed, maintaining these delusions in this setting was very dangerous. However, I blamed my fear of retribution and defiant behavior on my paranoia and tipped off the press on several occasions.

Still, I became very popular among the residents. My boss who I lost respect for when she started showing up to work high, threatened to fire me. The management company spied on me. There were many veiled threats that I pretended not to understand. Case in point, they tried to bribe me with free concert tickets and I didn’t get it. I hosted a community event instead in which I invited the clients out to the concert.

Lesson Twelve–Don’t Predict Permanent Warehousing for a Person in an Emergency:

I finally started to question the reality of this hold my therapist had on me and went of my medication. The violence I encountered was real and was never resolved. When coincidences started to seem suspicious to me, and my best friend from college made a direct and credible threat on my life, my therapist contacted my parents and got them to put out a missing-persons report out on me. I fled towards Canada.

“Tim will be in and out of the hospital the rest of his life,” my therapist told my parents.

With that advice my father begged me to stay on the chronic ward in the state hospital for another nine months. He promised me that if I returned to the community, I would keep on getting followed.

After a three-month incarceration in Montana State Hospital, I took a Greyhound bus to Fresno California with four thousand and five hundred dollars of assets. My Mom refused to give me access to the ten thousand dollars I inherited from my Grandfather.

Still, I stayed in touch with my mother, but not my father. I wanted to be sure the following did not return as he had predicted. Indeed, I interpreted his words as a threat.

I managed to get a job and get housing until I ran out of medication. Then, I tried everywhere for any kind of legal income. I’d resisted many outlaw recruitment efforts in the state hospital. I was sticking to legal work!

I finally got a professional job when I was down to one thousand, five hundred dollars, but even I had to admit that I was not able to work in a professional capacity with what I’d been through.

Lesson Number Thirteen—Don’t Collaborate with Imposed Treatment:

To reconnect with family, I had to move to the bay area, get a job at an Italian Deli, and see a therapist. I had come to believe that my best friend from college was not only bipolar and an ex-addict, but also an Italian mafia boss. He worked as a longshoreman as a gang leader in the ports of Philadelphia. His stories of corrupt cops who paid his way through college for under-cover surveillance took on new meaning as did the coincidences that had followed me throughout.

Nevertheless, I was the delusional person working at an Italian Deli with a two-hour bike and BART commute. I concluded that my family was a mob family. I begrudged having to fit two hours of therapy into my busy schedule. But to eat I was forced to go to therapy. I sought work that would enable me to move away and start over again free.

I begrudged the small amount of financial support I received and led an impoverished lifestyle of twelve hour work days. At work my seventeen-year-old bosses would mock me. Many came from wealthy districts. And this therapist was part of Italian family practice. “I too shop at A.G. Ferrari’s she would tell me.

Lesson Number Fourteen—Don’t Expect Psychosis to be Suppressed:

I didn’t trust or like the therapist I was forced to see in the least because she was not interested in my experiences of being followed. I did everything I could to conceal them from her because I was afraid if she knew about them, she would hospitalize me.

I was extremely angry about the $225 weekly cost of therapy when I was making nine dollar’s an hour. My therapist would sense this and get defensive. This would force me not to share any experiences of being targeted with her in a genuine way. I had some very disturbing things happen that I was forced to conceal from her.

In fact, when I finally admitted to her eight months in that I believed I was being followed and called the FBI, she became fiercely angry and threatened me. She looked like she was considering the hospital. Oops!

Lesson Number Fifteen—Don’t Impose Your Economic Reality on Your Patient:

Fundamentally, this therapist had no empathy for how hard my twelve-hour days were and how my paycheck barely covered rent. She insisted on the two-hour amount of time she felt I needed. I told her that the sessions were of no use to me. Yet they continued.

My therapist did not encourage me to find a professional job even though I sprayed resumes and had many interviews. She said, “I believe you are working hard in your head, but believe me working at a Deli for nine dollars and hour is not so hard,” “What is really happening is you are letting teenage kids bully you, you shouldn’t give away your power.”

Can I get a witness? I had a right to be angry.

This therapist didn’t believe in medication and expected me to fix things on my own. Then, she judged me a failure when progress went at a snail’s pace. She seemed to feel bad for herself and the poor kids who had to work with me. The harassment and abuse was intense because I was intense. Some of it was so bad that it would probably make anyone wonder.

When my year of support was getting close, she finally referred me to a psychiatrist and my work performance vastly improved. Then, she criticized my success, “I think you’ve lost your creativity.”

After ten months, I started to use my medications to more effectively snow her. Additionally, I needed her for rational support as I tried to get back into the professional world. Acting with professional entitlement didn’t come easy to me with rules that didn’t match the defenseless abuse I received in my state hospital training.

“Your parents are paying for these sessions because they love you, why sweat the small stuff,” she argued. “I am not being a greedy capitalist,” she said, “I have an ethical responsibility here.” “Don’t be a wounded healer,” she said.

Luckily, she wasn’t around for future family financial discussions. It wouldn’t matter. I would be financially stable by then, just hurt and angry.

The post In Psychotherapy We Trust: Part Three– The Psychopharmacology Craze appeared first on Redefining "Psychosis".

I went through five years of treatment for the treatment of anorexia that added to the negative transference I have for psychotherapy. This included three therapeutic relationships, three hospitalizations, and three therapeutic trends that were utilized back in the early nineties. I participated in mandatory family therapy, behavioral inpatient eating disorder therapy, and addressing the problem through a twelve step tradition.

As a result of these relationships I learned four additional lessons:

• lesson four, it is important to set reasonable expectations;
• lesson five, it is not helpful to make negative predictions;
• lesson six, it is important not to ignore signs of abuse in relationships; and
• lesson seven, it is important not to attack a spiritual tradition.

Again, although I am glad that this treatment helped me survive a life-threatening condition, reflecting on these experiences has always led me down a path of madness. I am left wondering if I am safe in therapy.

“Of course, you are safe in therapy,” I can hear the choir sing!

“Stay on the streets of this town, and they’ll be carving you up alright . . .” I hear Bruce Springsteen retort.

Oh, how I hate choir music, but what do you think?

Structural Family Therapy:

I instantly liked my second therapist just like I liked my first therapist. He was affiliated with Salvador Minuchin’s reputable Child Guidance Clinic. It would be intensive Structural Family Therapy for me.

My parents tried to drop me off with my suitcase and he said, “Wow, that suitcase is very heavy!” Then, he ordered my family to have daily sessions to save my life.

There were a lot of tense family sessions in which my father bullied me to eat and I hated myself for acquiescing. In fact, this made it harder to swallow my pride and eat even though part of me was hungry and wanted to do better. Instead, I learned to throw-up in trash cans to object to my father and the family drama that unfurled.

I was expected to gain a half pound a day or we were failures. I researched an article in academic journals in the hospital library that suggested that this was not a good plan for the long-term needs of eating disorder patients. My therapist did not respond to my effort to self-advocate.

Indeed, when I would fail treatment at this facility and get transferred, I would learn that six thousand calories a day would not enable me to gain so rapidly.

It was true this therapist that I had for one month was good at calling my parents on their shit. At the same time, he also would punish me for not gaining enough weight by not letting me speak in the session. He really liked my sister, he said.

It may not be fair to blame the next ten years of family cutoff on the distress caused in those intense sessions. The therapist told my parents that I would run from home. This was often thrown in my direction. My mother sounded good in therapy and clearly felt my struggles were my fault and let me know it a great deal over the years. My sister always made it onto the folklore of the family Christmas cards, but not me. My room would be converted into a study and I moved in with a high school friend.

There was ongoing contact, but I did what I could to divorce myself from my family. Particularly when I reconnected with them ten years later, they chose to listen to the negative prognosis of the psychology tests, called the police, supported, and in one case openly prayed for longer-term hospitalization. Up until then, my psychotherapists functioned as my parents.

Inpatient Behavioral Treatment:

It took me a while to get my next therapist because the hospital assigned someone who was incompetent. He was not an eating disorder specialist and didn’t get it, even though he wanted to work with me. The new hospital made me fire this man to get the specialist that all the women on the unit loved and recommended. If it were not for some assertive anorexic females who were appalled that my family was paying out of pocket and I wasn’t working with a specialist, I wouldn’t have had the pleasure.

I could tell this man was curious to work with a male and that felt good. However, his strategy seemed familiar: he encouraged me to be corrupt by talking about how bad his sons were. I tried to be influenced by this gender manipulation technique. “Be a man, be bad,” he seemed to say. “And continue eating through the night.” These quotes seemed to be his mantras.

I did manage to gain weight and cheat at my diet. I was clearly addicted to starving but locking me up and forcing me to eat by changing my environment worked. Oh, I suffered. I kicked and screamed more than most. But I changed. One day I objected to eating Brussel sprouts and pulled out the blue chair and the tube that was to go up my nose and I listened. Fucking Brussel sprouts, how stupid! When I gained privileges I cheated frequently, but I was prescribed so many calories I still made gains.

Starting to hook up with all the women on the unit took a second hospitalization because I was extremely sexually repressed. I guess having a girlfriend or two wasn’t so bad, really.

While I experienced an influx of polyamorous flirtations on the unit during my second hospitalization, I also met a twenty-five-year-old newspaper reporter on the outside who didn’t mind robbing the cradle. I think she liked me because she hated her father who was an alcoholic. I was basically discharged to her care. “Loose the raincoat,” was the professional advice to me with my inability to copulate.

Right before I was discharged, I had a female social worker acknowledge my situation and warn me not to fall for any women when I was in such a vulnerable position. I was stunned. My parents and my MD didn’t care to warn me in such a manner!

According to the MD, the treatment worked! He would discharge me a year and a half later as a success. However, in the process, the MD stopped validating me and supporting me. He didn’t seem to care about what I was going through with the solution to my problems, the relation with my girlfriend.

You see, my girlfriend got extremely controlling. I was not allowed to have external friends. He just didn’t seem to acknowledge the pain her silence treatment and abuse caused. My first family had failed me, but certainly this new solution had to work. He was proud of me for gaining weight, but he knew nothing of the world I entered living in Camden, New Jersey at a commuter campus.

Through it all, real disassociated trauma went unexplored. When I finally after two years got so fed up that I had to cut ties with the older woman, I started violently binging and purging in the roach infested apartment I managed to afford on my own.

The Twelve Step Traditions:

My mother saw my fourth therapist for a while and said she was, “really good.” She was like my first therapist in that she was less credentialed and saw paying middle-class clients. My Mom paid for the sessions.

This therapist liked John Bradshaw who was a lot like me in terms of rage and shame. I saw him speak in a video clip and saw he also had been through eating problems. Still, I just thought he was fat and sloppy looking. Still, when I was told that families were like water torture dripping on your forehead, it did make sense. As such, she seemed to understand and care about my suffering.

Once a week, I took the train from the inner-city to the wealthy town of Haddenfield, New Jersey. I’d buy a weeks-worth of groceries most of which would only get vomited down the sturdy old sink pipes back amid the roaches.

Additionally, this therapist would occasionally challenge my spiritual beliefs in ways that seemed inappropriate. “Some things are worth dying for . . .” she would say with sudden rageful intensity. She once told me that she was attacked by a psychotic woman when she worked in community mental health and her primal response was violence, and that was okay.

She also clearly didn’t trust my mother and often asked me if I was sure my mother didn’t sexually abuse me. “I shouldn’t be telling you this, but I really don’t trust your mother,” she would say.

To her credit, she did see me outside my eating disorder. She encouraged me to pursue one of my interests outside the confines of the blocks on which I was immersed in work and school.

I was smart enough to make friends with the good people from the crack house, the ones who did not call me “Where’s Waldo.” I learned there are many respectful people who get caught up in that lifestyle. I also made friends with many of the local youth. I even made a friend with a fellow student who was in recovery from drugs and alcohol. Who else on the working-class campus would befriend a anorexic dude who had an attitude, who outlined everything he read, who was the only person willing of able to answer professors questions, and who tried to act like his weight and food didn’t matter?

It was the summer of my junior year and I quit my job and hiked six hundred miles of the Appalachian Trail. Even though I barely had enough weight on me, I binge ate a lot that summer and burned it hiking mountains. I was proud of myself for making the trek though it was a lot of alone time.

When I got back and started binging and purging again, I made the mistake of feeling the therapist had written me off. I guess I blamed her for the new-found fury in my binging behavior.

I found a new therapist with better credentials. I chose not to accept this therapists’ line of inquiry and views of the impact of sexual abuse. In fact, it became toxic to me. It would take twenty years and writing a memoir to recapture memories that helped me start to understand myself.

If it wasn’t for the fact she attacked my culture, she might have really helped me understand myself better. Instead, I sought refuge in the the medication craze . . .

The post In Psychotherapy We Trust: Part Two– Anorexia: appeared first on Redefining "Psychosis".

Some might point out that my experiences in therapy couldn’t have been so bad if I chose to go into therapy as a profession. Others might say it was my own damn fault I got hooked on the practice! Still others might point out that I have been privileged with the best help that money could buy and have been able to use it to avoid disability.

Despite what others might say, I am not sure whether to be grateful for the therapy I got. In my therapeutic journey, therapy makes me mad. I don’t think I have experienced a warranted sense of safety with the relationships in which I have been.

This and the next thee posts will span this journey through psychotherapy over the past thirty years. I will evaluate my experience with seven therapeutic relationships. There have been several generations of theoretical trends and changes to consider. There is also an assortment of distinctive conditions to treat even though I am still just a person.

Many argue that without having a therapist who really believes in you, it is hard to have a sense of safety! Ultimately, I share these experiences so that the reader can learn to navigate and advocate for the care they need. I will stop short of drawing conclusions. I am not here to turn off anyone’s light bulb! Just remember, the light bulb has to be ready to change.

Still, I think the conduct of modern-day healers need to be re-evaluated repeatedly regardless of degrees, the quality of training, or the amount of money they make. I persist with therapy because I am still unhappy and because I want to offer quality experiences to the people I serve. I persist because I believe other people who have experienced catastrophic trauma can learn to be healers. Stay tuned and learn more about the reason I have come to promote peer support as a legitimate form of therapy.

Early Intervention:  

I saw my first therapist starting at age thirteen. The first memorable thing we did together was write down what a popular kid looked like and what a nerd looked like. Then he asked me which one I was?

When I explained that my parents wouldn’t buy me popular clothing, he said, “that doesn’t sound right!”

He was right, they were paying him top dollar for these sessions.

When mom lied and said that my claims were inaccurate, I did get to go shopping as a result. Still, I didn’t take advantage of my Mom and wear designer clothing. That was not my style. But I did dress better, and it helped. I started to try to fit in and the bullying decreased.

I was also referred for psychometric testing. I did not have any idea why this was necessary. Indeed, at times in my journey, it has been a significant source of concern as to why this was suggested. I was simply coaxed into it saying that it might be helpful.

I came out of it with one or two pieces of feedback: that I was particularly good at describing and defining things; and I was smart.

I have learned over the years that psychometric testing does not get shared with the recipient accept to highlight a strength or two. I wouldn’t really know if it affected my treatment. In treatment, I was always encouraged to drink and break the rules. I never listened. My father and my shrink shared the theory that my problem was that my superego was too big.

Lesson Number One–Don’t Side with Society Over the Sufferer:

While it’s arguable that these early tactics helped me stop fighting back against the herd in a self-defeating manner, it’s also arguable that I also stopped celebrating myself. The story just wasn’t over with this intervention. I learned to blame myself for getting teased endlessly. My rage was turned inwards. Blaming myself has become quite a thing over the years.

Now with my master’s degree and twenty-five years of experience, I understand neurodevelopmental disorders enough to understand why this tactic was not advisable. I could recite all the disorders back in college, but it took me till age thirty to realize that neurodiversity needs to be celebrated, not punished.

I’d always played with kids who were older or younger. I’d been left back a year in kindergarten and nearly didn’t even get in because I cut paper in a unique manner. It is hard for me to understand why the info from the psychometric testing didn’t pick up the very clear signs of neurodevelopmental disorders. I would later confirm ADD, Dyslexia. Beyond that, I have surmised that I am on the spectrum. Against-the-grain behavior is not simply a choice. However, the road to ending the blaming the victim mentality would be a long one.

Lesson Number Two–Don’t Ignore Problems:

A year later I stopped sleeping for a year. The best I could do was maybe three hours a night. I’d sleep on the floor or in the closet because I had more success sprawled out in strange positions. I was unhappy about a move to a new house and wanted to paint my room black. I could not explain why this mattered to me so direly. The new house was a significant shift in values for my Mom who was coming out of her depression and starting to challenge the way Dad did things.

Why had I had to suffer all those experiences of ascetic deprivations only to end up living in a new house like everyone else? Money was never talked about and I couldn’t understand that my mother had just come into some. Plus, we were evicting the welfare family, my summertime friends, out of our summer home, “The Lodge” and selling it. Plus, our dog died. Plus, my Dad Quit his job. Oddly, the horrific fighting had halted. But I did not trust the move.

Because I was unlike other teens who were lazy and slept in, my therapist did not consider this to be a depression. My struggle went unacknowledged except by my mother who I woke up every night in tears. I fixed this at the end of my ninth grade year during an Outward Bound course during which we hiked late into each night. This got me back to sleeping after a tough year.

Lesson Number Three–Don’t Engage in Dual Relationships that May Interpreted as Exploitative:

When my parents divorced the next year, the advice my therapist had given them after years of working with them was to “Shit or get of the pot.”

When I finally found these things out, I felt as though I had intuitively predicted the fallout.

Now, as a professional, I have learned that working with three members of the same family individually and adding on couples, group, and family counseling is a bit of a set up. This may make you money, but it may cause conflict and fallout for the trusting relationships.

Unfortunately, this was only one aspect of the way dual relationships didn’t work on my behalf. Meanwhile I had a yard business. One might say the business was impaired by my fear of asking for payment. My father had always gone into rages when I asked to be paid for work that I did. He approved of me working hard for him all summer in return for a modest donation into my bank account at the end.

Meanwhile, my father convinced me to buy a used three-cycle lawnmower engine that didn’t work. Perhaps he wanted to teach me a lesson about business. Or maybe he just didn’t want the wear and tear afflicting his own cheap-ass lawn mower. It was totally his idea. I didn’t understand why a three-cycle motor was important. But I was dutiful and invested in a used three-cycle mower.

When the therapist heard of my angst about the lawn mower that kept breaking down, he said he had a lawnmower for me. He sold it to me for about eighty dollars, almost the same price I paid for the used three-cycle lawnmower. I of course was afraid to tell him no.

Not only couldn’t I get my customers to pay me, I didn’t invest wisely in a good lawnmower. I tired of not getting paid. My therapist’s lawnmower was not much to my liking. I told myself another hundred dollars I could have bought a brand new three cycle engine. I threw in the towel and got a job at McDonald’s my junior year. It was a year I was exceptionally busy, starving, and working on homework into the wee hours of the night.

Then, I had to pay out of pocket for many missed appointments with the therapist that year. My Mom insisted that I make my appointment whether they helped or not. Perhaps it seems like I should have respected this, but she was out late partying every night. I was working hard and had lost all respect for her over this.

When I was put in a hospital, my therapist called and had the staff wish me well from him. Staff were all impressed with his follow through. “He seems to really care about you,” they said. I didn’t know how to feel about that. I still didn’t consider all the ways I felt exploited in the relationship.

The post In Psychotherapy We Trust: Part One– Decline appeared first on Redefining "Psychosis".

Since I started writing my memoir ten years ago, I have not struggled with writer’s block. It’s true, I have produced drafts of my second book that were so bad, I scrapped them. But I was always able to use writing to help organize my thoughts without feeling defeated. Sure, I have taken a few vacations, but I always did that with a project or two on my mind.

Today, however, I cannot get a project started. For the past few days, I have been chewing things over in my mind and I feel totally frozen. I retreat in great frustration with my wife Barbara and my dog Jayla through the smoke-filled Bay Area. We drive out to the coast adjacent to Half Moon Bay. As the Camp Fire rages hundreds of miles to the north, I spend the drive trying to figure out what was happening to me to get me feeling so stuck.

It is true I recently heard from a high school English teacher who used to support me who read my memoir. She made a point of sending word through my mother that she was impressed with how I was able to get into my own head: had I ever considered writing fiction?

Enthralled by the compliment (and yet challenged,) I spent the week thinking about how I might add fiction writing to my platform to help tell some of the untold stories of the urban world I know. Curious characters I have known flashed through my head and I struggled to figure out how to create a fictional story out of them. When it finally came to be time to write, I could not start a story or even a personal essay on psychosis-like I usually do.

When we arrive at the Butano State Park, I find myself sorting through a couple of different identities as a writer. I know I felt comfortable and artistic as the memoirist. I likewise have felt purposeful using my experience in group therapy to reconstruct psychosis into solvable components. It hasn’t been until I have been recently been struggling to get published on blogsites or magazines to increase my following that I have become down on my writing.

As I watch my dog saunter up the fire trail, I remind myself that if I am going to publish a book that helps change the way clinicians work with psychosis, my voice and identity is going to have to be quite different. I am currently practicing changing my audience to providers and occasionally to family members. However, as I have done this, I don’t really feel I fit as a psychotherapist with an academic voice.

It may sound strange, but I have an objection to the practice of using journal articles and research to reinforce what I say. I have learned that I don’t really learn well that way. I don’t trust research to tell the stories that I hear on the inner-city backward.

I prefer to write what I know from experience. This is the writing platform I have set up on my blog. In the fifteen years I have worked on a backward, I have become skilled at cracking open the real story in ways I don’t trust research to be able to do. When I write honoring academic tradition and research, I feel phony and disconnected. I feel I am not taking advantage of real-life knowledge and my career. Plus, I find I like to maintain the use of language such as “dumb-ass!”

We continue to ascend on a fire road until we reach a viewpoint we have been to some thirteen years ago. On that occasion, we had hiked with my father. I feel impressed that my father made it all the way up this road to the look-out back when he was sixty-five. It had been a lite day of hiking for me thirteen years ago but now I realize, I didn’t realize what I was putting him though.

I reflect on how I get much more of my learning from listening to music than I do from journal articles. I think that why I like to write in a way that honors lived experience. I acknowledge that I fear to write a successful book that changes the way therapists approach work with psychosis, I need to use some degree of research to be accepted. Although I have created a therapy platform, I know that I don’t know how to write a readable book that promotes it. I know I need to read more theoretical books to get ideas for how to approach the writing. I just don’t want to do it.

We continue to hike up the hill until we’ve been out for two hours. Our dog suddenly bounds after a chipmunk and disappears down the gulley through the brush and we call after her to get her to come back. I feel that age is slowing me down. I used to be far more fit. It is time to turn around.

When I read writers, who do get published in psychotherapy magazines, I feel like a different breed. Firstly, I am uncomfortable with writing a case study about the real experiences of my clients. Even if I disguise the name, it feels like a massive breach of their confidence. Additionally, when I hang out with therapists who might one day benefit from reading my book, I feel like a flagrant victim.

I have taken a couple of courses in trauma from industry leaders and have learned that I disassociate around other therapists. Listening to industry leaders, I have felt alienated when they have made fun of “psychosis.” One talked angrily about people who are “reversed” or unable to benefit. “Why can’t they just accept help!” The presenter had continued, “you can see them when they come into the room, they are as clear as day.” Of course, I was feeling like the presenter was referencing me because the techniques weren’t working for me. In this way, the comments coming from the trauma gurus only further alienate me.

I think about how I have sent essay after essay out for publication and received only rejections. It’s true sending stuff out is painful. I don’t like to wait 2-8 weeks or even four months for some journals to hear back. Sure, I could be more persistent. Still, some of my best personal essays are starting to feel like rehashing the same story again. And, no matter what angle I put on them, they don’t seem to make it into print.

In many ways I treat writing as though it is an equalizer. It is my response to feeling bullied and invisible to mainstream people. I didn’t go to an Ivy League school, I went to a commuter campus. Being invisible happened to me in my family, during schooling, at work (for example, after fifteen years of work, I just got my first five-year chip,) and in my volunteer efforts. I write dreaming that one day people will hear me.

In fact, this is the same weekend I have sent in edits to a well-known publisher to whom I have sent upward of fifty articles. Finally, they think I have put something together that they feel is worth a response. However, in doing so I face a challenge. Did I write to tell my true story, or did I write to tell the editor what I think they want to hear?

This the dilemma was exactly what happened with my memoir. I had a deal with a publishing company, but the editors were not forthcoming with the fact that they didn’t like my views on racial inequality or male sexual abuse.  In a sense, I saw it coming; but was living on a prayer. Then, in the last edit, they entirely removed those important themes from my work and I chose to break the contract and reclaim my work.

Back at the car, my wife drives. We drive through the shadows of the redwood trees. Out on the highway, the late afternoon sun shimmers through the smoke. We head for a dog-friendly beach.

I come across a Facebook dialogue in a group in which a group member was contemplating writing a fictional story about a childhood friend who was Native American. She received quite a talking to by the group about it being exploitative to tell a story about a marginalized culture when she was not from that culture.

Perhaps some of the reason I have struggled throughout the day is that I was thinking I should be able to write fiction when it isn’t a good fit for me. As a white male, I work primarily with people of color and although I know their lives intimately, their experience is just not my story to tell. I know they have more social barriers to overcome than I. It is ironic, I think, that the one Facebook story I looked up happened to tell me what I needed to hear.

I think for a spell about the lessons of the day. I write because I believe there is value in it. I likely have the smallest writing platform there is on the internet. I think I create quality content, but don’t attract followers. I know it is important not to let the expectations of others negate what one does and so I persist. I write to keep things simple and real.

It occurs to me that this is my writing platform. In a few minutes, I will watch my dog spritz about in the sand. Now, I am using my writer’s block to sharpen it. I may have a long way to go but I have a lot of years to sharpen it until I get clicks and likes and the things I need to get published. Perhaps the stress of getting published is taking more of a toll than I like to admit. Perhaps, sometimes there is just too much going on to get a piece of writing completed.

The post Using Writer’s Block to Sharpen my Writing Platform appeared first on Redefining "Psychosis".

I have found that artful self-disclosure is a needed skill for cross-cultural work in psychotherapy. I am writing to assert and justify the use of self-disclosure particularly for people who experience “psychosis” in which complex cultural barriers appear to be present.

Historically, it has seemed that many in the psychotherapy establishment have tended to emphasize theories that are rooted in a history of blank slate transference. I have seen PhD and Psy.D. students get told that in their advanced studies they are going to need to study a complicated theory like psycho-dynamic or psychoanalytic. I am aware that some programs feature these schools of thought in their curriculum. When I ask licensed psychologists what they practice, I often hear they are trained in one of the above two disciplines. It’s true I am not studied in that way and may not understand multi-cultural aspects of those theories. Perhaps there is potential for sophisticated use of self-disclosure within.

However, I feel called to point out that the notion of a blank slate may get misused and fail to identify the therapist as a cultural player in the therapeutic reality that gets created. I tend to want to point out that many practitioners who hide their personal realities from the participant, also seem to say that I, the therapist, am not part of the problem or reason you are here. This may work for some people when harsh social and cultural barriers do not exist.

The Victims of Systemic Cultural Barriers: 

I write for a culture of people who are on disability or have lost sustaining social functioning, had to survive on the streets, or been treated forcefully in a psychiatric ER. I feel that often they have good reasons for resistance when it comes to psychotherapy. Moreover, additional cultural barriers like race, gender and class may involve historical oppression of slavery, confinement, or oppression through which the relationship needs to work. Additionally, it is arguable that many clinics stand to profit or sustain themselves when participants stay dependent.

The culture I am writing for appears to be expanding locally in homeless encampments, selective shelters, and unlicensed board and care homes as technology advances and local peoples get displaced.

The Danger of Wielding Ethnocentric Power:

As a privileged working white man educated in a Quaker private school and hired to work with people on public insurance in an urban California, one might think that I rarely work with people who share traditional cultural traits. I like most therapists who work with the underprivileged, am accustomed to crossing racial, gender, class, prestige, sexual and spiritual divides. However, I argue that as I have developed a practice that focuses on self-disclosure, that my ability to cross cultures in work with disadvantaged populations has deepened.

I regularly define elements of my own culture like my spiritual upbringing and the fact that I was raised on the East Coast. I openly reflect on my relevant experiences that define me, like moving into the ghetto to attend college and living and working in the community there. I also recount challenging the power structure that regulates section 8 housing and ending up incarcerated in a State Hospital, homeless, and vagrant. As I do this, I explain to my clients that this empowers them to understand my world view, so they can decide when to listen and when to teach.

I have come to feel that failure to do this enables me to wield ethnocentric power over the recipient that can result in misunderstanding, degradation or abuse. As therapists, it impossible to hide our skin colour, our gender, our way of speaking from marginalized individuals. We may be able to hide our own mental health struggles and class background to some extent but is that really fair? Acknowledging who we are even if it is not perfect (or too perfect) is respectful and authentic. I also think that therapists’ who work in such contexts need to have a reason for wanting to do so and acknowledge the potential that their education-influenced perceptions may do harm and mitigate the damage.

Ultimately, it’s hard to deny that psychotherapy work excavates a systemic reality for marginalized persons in which cultural elements play out. Ultimately, if our intention is to see the reality of the client as a cultural being, then, I argue the culture of the therapist or anthropologist is extremely important.

Artful Self-Disclosure in the Pursuit of Cultural Reality:

For the past ten years, I have been developing a transparent and experiential way of being a psychotherapist that artfully uses self-disclosure to explore and redefine what “psychosis” means. In doing this, I have used my own silenced stories to start reflection and discourse about what psychosis means and identify eight universal components. If I start to dominate the discussion in the group, I notice that and make amends.

In doing this, I readily reference my experiences as a patient in the mental health system and things I experienced during a two-year period of madness during which I struggled to establish a residence and employment. Sharing these experiences and lessons learned can help take away power dynamics in the helping relationship that can be a barrier for many vulnerable people in genuinely seeking and engaging in therapy at all.

I have worked hard during this time to define myself as a cultural being to the people I work with. This means I do my best to own and name my counter-transference instead of acting according to them. I act in ways that help the person work through their objections to create safety between us. I tend to do this by just being honest and interested to learn more.

When I think about what I have been doing, I go back to ideas that first emerged in my consciousness some twenty-five years ago, when I studied psychological anthropology.

The Value of Psychological Anthropology:

With a quick glance and Wikipedia, one can see that psychological anthropology is a sub-field that officially started in 1972 but has deeper roots. Founded by Francis Hsu, the psychological anthropology suggests that culture affects mental processes and the idea that belonging to a cultural group can shape processes of, “cognition, emotion, perception, motivation and mental health.”

The reading list I laboured to learn was put together by the Sociology and Anthropology Department at Rutgers in Camden and featured books like Coming of Age in Samoa, by Margaret Mead; Never in Anger by Jean L Briggs; and Saints, Scholars and Schizophrenics, by Nancy Scheper-Hughes.

I remember being impressed that particularly with Never in Anger. I found that when the author was transparent it gave the reader more power with which to understand the culture they were studying. I came to feel this was an extremely important step to take before trying to describe another culture. Some of the other books, like Coming of Age in Samoa, were less fearless in their introspection and led to errors that were based on the author’s judgments and desire to be popular. I came to trust narrators who decreased the power of what they reported by honestly acknowledging their limits. I felt that even though Jean L Briggs issues annoyed me, that being able to judge the writer as much as I might judge the society leads to a deeper reality of what transpired and ultimately gives me a better understanding of the culture. And, so, the disenfranchised can better understand themselves when differences are articulated.

I find that working through this process with people has helped me better understand a divided and disbanded culture of “psychosis.” Reconstructing a culture that includes people does affect psychological processes in a positive way. And for each participant sharing and understanding who they are culturally is very important. It enables people to see what they have in common with each other.

Exploring an individual’s disadvantaged cultural reality with an unidentified blank slate mentality who maintains the reality they are exploring is sick and doesn’t deserve to exist just doesn’t seem humane? Would you trust someone who tried to do that with you? This was the very nature of all the imposed psychotherapy I endured.

The Anthropological Reconstruction of the Oppressed Culture:

I moved through my dumbass western counselling psychology program and practised therapy in social work jobs. In doing so, I learned to understand the marginalized world view of the most vulnerable in our society. And then I became one of those most vulnerable people. I have come to believe that distinctive world views and realities can only be understood through the lens of a person’s experiences or subjective perspective. I believe the role of the therapist needs to be study and understanding of those world views. I put that together with sets of a cultural group’s experience and it has helped me develop in my practice towards establishing treatment for psychosis significantly.

The idea of using phenomenology to deconstruct illness constructs into clearly articulated experiences is a powerful one that enables a person to recovery. That is what DBT does! However, to recover, many people who are different suffer and need cultural support. Oppressed cultures impacted by slavery, war, genocide, or institutional incarceration need a sense of identity to overcome and support ending the oppression. Hence, what is needed is not only a deconstruction but a reconstruction of the “problem” so that it can persist without being so misunderstood.

Thanks to the DSM, we call oppressed culture a sickness and when it comes to the phenomenon of “psychosis, this ensures ongoing diagnostic differentiation, oppression and incarceration. If the problems are reconstructed into solvable components, the problem does not have to dominate the individuals’ life. In the case of “psychosis” misunderstanding the experiences and viewing them as a problem can enhance the suffering and lead to more and more accurate oppressed realities.

In other words, artful cultural self-disclosure helps bridge cultural divides that are necessary not only to help people recover but also to help research the social problems we experience as psychotherapists, philosophers and theorists. I think it is time for artful self-disclosure for psychotherapy when it comes to working with those who are institutionally oppressed. Additionally, people who have been oppressed and subjected to these circumstances can be very good at using their stories to help others. They need to be included in the treatment of these situations.

The post Ways Self-Disclosure Can Help Cross Systemic Cultural Barriers and Help People Who Experience Alternate Realities appeared first on Redefining "Psychosis".

When I experienced two years of psychosis early during my career as a mental health counselor, I was already getting good at managing trauma with my master’s level training. I always been pretty good at being safe for others.

I wanted some of that trauma support when I found myself confined to a ward on a State Hospital. I knew I needed to establish safety with someone but couldn’t find anyone who would deal with me. Instead, no one treated me as though I was traumatized because they didn’t want to reinforce my delusions. This only made the trauma of what I experienced worse. Invariably, hospital workers were punitive and denied anything unjust was happening to me at all.

Because I worked tirelessly and had family support, I was able to return to my career in mental health. I got my psychotherapy license ten years ago and since that time I have worked to create trauma-sensitive treatment to address the needs of individuals who experience psychosis. Here, I intend to convey two trauma-sensitive solutions I have developed, working with people in groups and in individual treatment.

The Challenge of Establishing Trust:

It’s true that it is hard to establish safety with someone when they think they are being followed. I felt I was being followed by the mafia via government surveillance; others feel they are in miraculous communion with a spirit world. Any therapist who works with individuals who have experienced psychosis can tell you that trust with any such prototype takes time.

However, too many practitioners do not feel that the stories of psychosis are worth engaging for the simple reason they might have delusions in them! It’s true delusional ideas can cause a great deal of problems. For example, maybe the police didn’t really taunt me like I reported they did when they bruised my wrists. Maybe I was too hard on the pony-tailed man who wouldn’t give me food and testified against me at my competency diagnosing me with schizophrenia. Maybe I wasn’t really being followed by the FBI like I thought I was. Maybe I was delusional when I said I leaked information from the section 8 housing authority I was working for. All that I knew for sure was that nobody cared to listen. I was on my own for quite some time.

Many practitioners reason that they don’t want to reinforce anything that isn’t real. Instead, the best practice, CBT for Psychosis, directs the clinician to separate their reality from the sufferer and teach the sufferer to evaluate their thoughts to make sure they are rational. I believe CBT for Psychosis may work at times. In fact, think there comes a time when cognitive therapy is necessary for rehabilitation. However, there are times this single strategy may not address trauma involved with the experiences of psychosis.

In contrast, I have had significant success in working with people with psychosis by finding powerful ways to validate the contents of an individuals’ psychosis to address real trauma that may have transpired. This approach is increasingly accepted now thanks to the spread of the hearing voices network support groups. Indeed, I have found that providing group support that allows people to explore psychosis, to be very helpful. Increasingly research is proving to validate the idea that treating psychosis as you would a trauma results in far better outcomes.

The Challenges of Validating All Parts of Psychosis

Of course, some might argue that the hearing voices network does not have a clear methodology for how to validate delusions when they are not caused by voices. It’s true that, some delusions are hard to validate in a genuine manner. For example, many people who hear voices believe that other people are hearing what they are hearing. Such individuals may accuse the practitioner or group leader of many things that they aren’t responsible for, making therapy and group sustainability a challenging endeavor.

My own experience in therapy was a nightmare because my therapist didn’t believe me. Thousands of dollars were spent and not an ounce of trust was achieved.

I have found it’s possible to validate things that aren’t true; however, I have had to take apart the delusional experience and look at them with a microscope. Then, I have found it is possible to validate a part of the psychosis process without validating all the mistakes that happen.

For starters, I coined the term special messages to describe experiences that trigger an alternative way of taking in information and connecting with the world. Thus, not only voices but other meaningful experiences like intuition, dreams, interpersonal interactions, and coded realities from media can trigger alternative views about reality.

Then, I developed seven other code words to represent distinct aspects of sufferers’ experiences. In sum, if the sufferer can become more aware of the process of what they are doing during a psychosis process and the way this process relates to fellow sufferers, they can become more mindful and validated and heal from trauma.

The Message Mindfulness Solution that Supports Trauma Informed Care:

Message mindfulness happens when the person in psychosis learns to see their process by describing it to another person or by hearing similar process that they can relate to in a group. I have found that people in psychosis can often recognize delusions when they are listening to someone. However, when they are not mindful of special messages, they react and cannot see their own process as being potentially delusional.

I believe that when message receivers become mindful of what is happening to them and their peers, they go towards experiences that terrorize, anger or excite them. Then they can acknowledge their emotions in a way that can help them let go of those triggering special message experiences. With awareness, those special message experiences become less judged and easier to let go of without having emotions and thoughts spike. And the sufferer can then acknowledge that they often will be right but don’t necessarily have the evidence to presume that their special messages are accurate all the time.

Helping a sufferer or message receiver become mindful of the experiences that give rise to alternate thoughts or what I call divergent views is not an easy process and can take time. Indeed, message receivers who listen and learn from each other are better able to admit that some special messages may turn out to be true and others false. Still, they can all be considered real and can be validated and better observed by the people who get them. Plus, becoming increasingly mindful of other message processes can significantly help a body reconcile with the ways they were wrong and had their emotions spike needlessly.

The Solution of Mastery Tasks or What I call Recovery and Reality Tasks:

A second trauma informed solution that has resulted from redefining psychosis into eight components, is to distract from distress when emotions spike by completing mastery tasks. I call these mastery tasks, recovery and reality tasks.

In this process, high emotions are soothed by what I have termed the act of sleuthing. Sleuthing is the act of collecting a series of messages and to trying to figure out what is really going on. This leads to all kinds of thoughts about the way the world works (divergent views.) Then, divergent views cause the message receiver to sleuth again and be on the lookout for more special message experiences. Thus, the message receiver often gets more different types of messages until they become entirely preoccupied with distressing or enthralling special message material.

Therefore, I believe that distracting from sleuthing by completing mastery tasks may significantly reduce distressing and intense emotions. When the message receiver sits and sleuths all day they expend a great deal of emotional energy without accomplishing anything. Then, social workers or supporters are more likely to push for warehousing them.

However, to distract from sleuthing, the message receiver needs to practice and strengthen the skill of distracting.

Often, distracting efforts go unacknowledged by others because they are judged negatively in comparison to what could otherwise be accomplished. At first, in my beliefs, the message receiver needs to accept and be supported for basic actions that are productive. Thus, appreciating mastery tasks as helpful for wellness and supporting them regardless of their social standing is another way to validate and support message receivers.

Moving through trauma in such a manner beats being isolated, locked up, or restrained, which teaches the message receiver a great deal of helplessness. Nothing could discourage mastery tasks more. Indeed, these kinds of traumatizing events make message receivers less mindful and elevate the unreasonable expectation that special messages be suppressed.

Conclusion:

While I have also developed six additional solution strategies, I consider the above two solutions to be specific to addressing the trauma that message receivers experience. The six other solutions I propose are experiential, spiritual (there are two of these,) behavioral, cognitive and narrative. These solutions likewise may be responsive to trauma in some ways but are linked to differing components of special message experience and tend to work in different manners. Stay tuned for future solution focused blog posts that may help describe a recovery process

The post Two, Trauma-Sensitive Solutions for Extreme States appeared first on Redefining "Psychosis".