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How Can Professionals Learn to Reduce Fears of Psychotic Experiences Rather Than Emphasize Pathology?

The kinds of experience we call psychotic are often incredibly scary: people feel they are being persecuted by strange forces, or that their brains have been invaded by demons or riddled with implants from the CIA….. the list of possible fears is endless, and often horrifying.

While standard mental health approaches counter many of these fears, they often create new fears of a different variety.   People diagnosed with schizophrenia for example may be led to believe that they will definitely be mentally ill for life, that this illness controls what happens in their brain and not themselves, and that there are few or even no alternatives if drugs don’t work for them.

This can be extremely demoralizing.  Oryx Cohen graphically described his own reaction to the standard mental health psychoeducation he received after his first psychotic experience:  he reported it made him feel he had lost his membership in the human race!  As a result of it, he felt caught up in a pathologized understanding of himself, he lost his expectation of being capable of learning from experience and shaping his future, and he now felt defined by his abnormality rather than by his humanity.

Despite rather than because of what the mental health system taught him to believe, Oryx later discovered other ways of understanding his experience, and he made a full recovery.  But wouldn’t it be better if people like Oryx were helped to find a more humanistic understanding of themselves within the mental health system and from the very beginning of treatment?

Wouldn’t it be helpful if professionals were trained in an approach that could help people shift away from both dangerous psychotic ways of thinking and also away from the sometimes equally terrifying explanations which emphasize pathology?

Further, what if such an approach could also build a foundation for learning effective coping skills, and also help a person build hope and a road map toward a possible full recovery?

And wouldn’t it be nice if this approach was already proven to be “evidence based” so that both people learning the methods and their supervisors and colleagues could have confidence in its effectiveness and safety?

Fortunately, at least one such an approach exists, and it is called CBT for psychosis.  This method allows professionals to collaborate with people in developing understandings of their psychotic experiences that neither minimize problems nor emphasize pathology, but instead help make sense of extreme human experiences in a way that is grounded in more everyday human experience and issues.

And better yet, those of you who are interested don’t need to go out and buy something, or travel to a seminar somewhere, in order to learn this method:  instead, an online training module on normalizing is now being made available, for free!*

To access this training, I’m asking that you first register with my email list at this link, then you will be instructed how to sign up for the training module itself.

Here’s an outline of what you can learn from participating in this training module: [click to continue…]

CBT for Psychosis, and the Hearing Voices Movement – Can They Be Friends?

Doug Turkington

Doug Turkington

When Doug Turkington, a UK psychiatrist, first announced to his colleagues that he wanted to help people with psychotic experiences by talking to them, he was told by some that this would just make them worse, and by others that this would be a risk to his own mental health, and would probably cause him to become psychotic!  Fortunately, he didn’t believe either group, and in the following decades he went on to be a leading researcher and educator about talking to people within the method called CBT for psychosis.

I’m writing about Turkington because I just spent a week learning more about CBT from him at a training in California.  This training was part of a bigger effort to bring this psychological approach into wider use in the western US.  Attending this training and seeing the interest and passion in those who attended got me reflecting on what the role of CBT might be in changing our mental health system overall.  A key question related to that, it seems to me, is the question of how CBT can improve its relationship to another key change effort in the field of psychosis, that of the Hearing Voices Movement (HVN).

I have a lot of interest in the possible improvement in that relationship between CBT and HVN, because for quite a while I have had my “feet in both worlds.”  My first involvement with the mental health system was as an activist for change and increased choice, then I became a mental health professional so I could work to provide some of the alternatives I believed should exist.  The first alternative approach to voices I heard about was the CBT approach of Paul Chadwick, so I started with that, and went on to become a CBT practitioner and educator.  Then, when I heard about the HVN, I adopted many of its ideas as well, arranged for Ron Coleman to come to my town of Eugene Oregon to do some trainings, and got an HVN group going here.

While I have always interpreted CBT for psychosis in a flexible way, integrating it with HVN ideas, I have sometimes been unsure how well that would fit with the approach of the CBT for psychosis establishment.  So it was really interesting to spend a week with Turkington, and to have a chance to explore his views in depth.

According to Turkington, the very most important part of cognitive therapy for psychosis is “normalizing” which means framing psychotic experiences as understandable and as just a fairly common variation of normal human experience and issues.  This includes talking with people about how to get past fearing or “catastrophizing” such experiences, and even how to see them as possibly valuable, for example by seeing how such experiences can be part of a creative process or of a shamanic journey, etc.  I have always been open to talking about this positive, somewhat shamanic side of psychotic experiences, and discussion of such views is common within HVN, but it was nice to see Turkington teaching this approach as part of standard CBT for psychosis! [click to continue…]

From Protest to Taking Over: Using Education to Change Mental Health Care

As we develop critical awareness about the mental health “treatments” that don’t work and that often make things much worse, the question inevitably comes up, what can those who want to be helpful be doing instead?

I believe that one key to successful change is going to be making effective training in alternatives widely available, so that those working in the field who hear our protests and criticisms with an open mind will be able to get support in then transitioning to doing things differently.

One example of an initial effort in that direction is an “online conference” I’ve help produce titled “Therapy on the Wild Side – Depathologizing and Working with “Psychosis” and Extreme States of Consciousness“ I wrote about that some in an earlier blog post.

I’m hoping that in a few years, it will be possible for people all over the US to easily learn ways of helping that are both respectful and likely to lead to long term improvement.  Such forms of helping may include everything from setting up peer self help such as that provided by hearing voices groups, to one on one support such as the better forms of therapy, to more systematic/team approaches like Open Dialogue and Soteria houses.  Only when we have lots of people thoroughly educated in what to do differently will we be able to “take over” the mental health system and then more consistently provide real help instead of oppression to those who are distressed! [click to continue…]

Therapy on the Wild Side – Depathologizing and Working with “Psychosis” and Extreme States of Consciousness

Thanks to the work of those who have recovered and of those who have helped them, there now exists an ever growing resource of humane and humanizing strategies that can allow us to help those struggling with difficult experiences in ways that bring all of their uniqueness and personhood into the world – without “stigma” or pathologizing.

But it can often be difficult to make it to seminars where such strategies are taught.  To get over that hurdle, we’ve made available an “online conference,”  “Therapy on the Wild Side – Depathologizing and Working with “Psychosis” and Extreme States of Consciousness”  where you can pay one low fee, and access a variety of practical and amazing presentations from around the world.

For example, hearing voices can seem bizarre and disorienting, and the conventional approaches of trying to suppress or distract from them commonly fail, so it can help to have available the alternative of helping people to calmly explore the experience and its possible meaning.  In two different presentations, you can learn how to do a voice profile to understand the voice better, and how to carry on a dialogue with individual voices, in a way that increases coping and integration.  The presenters for this are Ron Coleman, Karen Taylor, and Rufus May, all of whom are leaders in the international Hearing Voices Movement.

Have you ever wondered what the relationship might be between the deliberately induced altered states and dissociation induced by hypnosis, and the more chaotic states called “psychotic”?  Gabrielle Peacock, MD from Australia is trained in Ericksonian hypnosis, but you don’t have to be a hypnotist to learn and benefit from the approaches she teaches, approaches that  honor these individuals abilities in ways that shamans or witch doctors do in other cultures, approaches that can “bring clarity, enlightenment and peace to an individual who feels lost in our western world devoid of such useful cultural guides.

I’ve got a presentation in the conference, it’s called “Understanding Extreme States and “Psychosis” as Attempts to Solve Problems:Integrating Perspectives on Trauma, Spirituality and Creativity.”

There are other presentations as well.  You can learn from Brad and Hilary Keeney about how to “minimize the handling of narrative, causal understanding, explanation, and sideline commentary in favor of plunging directly into the live, unfolding interactive stream of therapeutic interaction,”   Dr. Jeffrey Zeig offers ideas about how to work with the person and not the label, and Bill McLeod, MD shares advice about what does and doesn’t help derived from 50 years experience working inside mental hospitals.

Psychologists, social workers and professional counselors in the US can earn up to 6 CE credits for no additional fee!

There is a lot  more information about the conference and the speakers, as well as some previews of what is offered, on the conference website, where of course you can also register.  Once you register, you can access the presentations whenever you want, or download them to your computer.

I hope you check it out!  Let me know about any questions you have.  And don’t procrastinate:  registration for this conference is likely to be available for only a few weeks.

Helping Children and Adolescents Deal with Voices

Rachael WaddinghamRachael (Rai) Waddingham has made available a presentation by herself with lots of good ideas for anyone trying to help a child or adolescent do better with the experience of hearing voices, here’s the link for that:

http://panopto.ucc.ie/Panopto/Pages/Viewer.aspx?id=273f2a59-b6e2-4a68-bbe3-a8adc7262956

If you like what Rai has to say, and if you live in one of the Northeastern states of the US, you might want to check out information about her tour this May, at http://isps-us.org/blog/?p=675

Also, you might want to check out my earlier blog post on this topic, What to do when children hear voices

Daniel Mackler’s Films are Now Free on YouTube

My friend Daniel Mackler has made films recognized around the world, covering a variety of psychological and social approaches to psychosis.  They are available in a number of languages, and now, thanks to his generosity, they can all be watched for free on YouTube!

They are as follows:

Take These Broken Wings centers on the lives of two women who both recovered from severe schizophrenia.  The film traces the roots of their schizophrenia to childhood trauma and details their successful psychotherapy with gifted clinicians.

Open Dialogue documents the  methodology of the world’s most successful approach to helping people with psychosis, and interviews many  of the clinicians involved.

Healing Homes chronicles the work of the Family Care Foundation in Gothenburg, Sweden  This organization, backed by over twenty years of experience, places people who have been failed by traditional psychiatry in host families — predominately farm families in the Swedish countryside — as a start for a whole new life journey, with intensive therapy, help for the families, and help for the person in getting off medication as part of the process.

Coming Off Psych Drugs offers a rare glimpse into the world of coming off psych drugs through the eyes of those who have done it.

Daniel explains his rationale for giving away these great films at http://wildtruth.net/my-films-are-now-free-on-youtube/

Madness as an Attempt to Heal from Dissociation?

One idea I’ve been intrigued by for awhile is the notion that psychosis can arise from attempts to heal dissociation.

Dissociation is all very ordered and structured.  But it doesn’t allow a person to function as a whole.  Trying to go from a really dissociated place, to putting things back together, can involve a loss of structure, which is “mad” or “psychotic” though also a step toward healing, if one can get through it successfully.

I read a blog post recently at http://www.pods-online.org.uk/notmadnotbad.html by Carolyn Spring on the “Positive Outcomes for Dissociative Survivors” website, here’s an excerpt from it that I think describes this step pretty clearly: [click to continue…]

Uses and Abuses of “Recovery” – A Review

The World Psychiatric Journal just published an interesting article, Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems .  It is available in full at that link.

One of the things it does is to outline “7 abuses of the concept of “recovery”.”  I think this effort to identify problems in the use of the term “recovery” is important, even though I believe their list of abuses is much too short, and some of their reasoning about those abuses, and what should be done instead, is flawed or incomplete.

One interesting issue they define as a problem is thinking that “RECOVERY IS ABOUT MAKING PEOPLE INDEPENDENT AND NORMAL”  They state that

But recovery is not about “getting better” or ceasing to need support – it is about “recovering a life”, the right to participate in all facets of civic and economic life as an equal citizen (33). This requires a framework predicated on a human rights and a social model of exclusion: “It is society that disables people. It is attitudes, actions, assumptions – social, cultural and physical structures which disable by erecting barriers and imposing restrictions and options” (34).

It is true that all humans need support, and the exact kinds of support vary by individual, and sometimes people’s problem can be simply that the society fails to provide the kind of support they need, or they haven’t yet been able to find it, even though such support exists here and there.  The understanding that people have different abilities, and that a healthy society should include more people by removing barriers, comes out of the physical disability movement, where people often have physical differences which will last a lifetime and cannot change.  So for example a person requiring a wheelchair to get around may recover an active life when the society removes barriers to access, and provides supports like ramps and elevators.  An example in the mental health world may be where a sensitive person fails to thrive or breaks down in an ultra-competitive culture, but then is able to recover when helped to link up with a subculture that provides necessary supports needed by that person due to their sensitivity.

But it’s also true I think that for many, mental health recovery is very much about “getting better” and ceasing to need various forms of special support.   Mental health crisis, even of the most serious variety, is often temporary, and with the right kind of assistance at the time, people can often get back to being as independent as anyone else (though not “normal” as we all know by now that this only exists as a setting on a washing machine.)  I think we would do best to see that recovery comes in different varieties or flavors, sometimes it seems more about learning to live better with a particular disability, and sometimes learning how to no longer have that disability.  So I think for example counseling approaches which offer strategies aimed at helping people overcome, and not just learn to live with, specific mental health disabilities should remain a part of any recovery oriented system, even though these approaches should never be offered as the only possible route forward. [click to continue…]

Finding the Inner Wild

Modern “civilized” cultures do not have a good relationship with the wild.  It seems we are always doing everything possible to shut it out of our lives, or to kill or tame it to the point where it is unrecognizable.  Yet that which is wild is always still lurking, somewhere over the edge of our boundaries and frontiers, and also inside people, both inside the “others” we might approach warily on the street, and even inside our family members and ourselves.

Another name for the Wild is Mystery, or the Unknown.  We like to pretend that the Unknown is just a small affair of no great importance, but we are shadowed by a sense that the Unknown or Mystery totally dwarfs and makes a mockery of everything we think we know.  So we commonly act as quickly as we can to suppress that sense, to find whatever allows us to go back to thinking we know what we are doing.

And yet, as much as we try to suppress the Wild, we totally need it.  Sometimes we need it just as a location where we might find some missing ingredient that our tame world needs to function, and sometimes we need it when the contradictions in our “normal” world become too oppressive and we need to immerse ourselves, at least for a while, in something much vaster.

into the thicket

I am intrigued by the relationship between the experiences we call psychosis and wildness in general.  That’s why I especially enjoyed recently reading a book titled “Into the Thicket” by William Brundage, which tells his story of getting lost simultaneously in the wilder areas that existed near his home in Eugene Oregon, and getting lost in the wilds of his own mind.

“Madness” is often associated with one’s mind falling apart, but Will’s story is unique in that he recalls a specific time and place where he had an experience of his mind shattering.  It might be best to let him tell the story himself: [click to continue…]

An Opportunity for “Mad Caring”: David Oaks Needs Our Help

For decades, one of the most prominent voices for radical change, or  “non-violent revolution” in mental health care has been David Oaks, former director of MindFreedom International.  Many activists today were drawn into their work due to David’s influence.  Robert Whitaker for example has credited an interview he did with David in 1998 for propelling him into noticing and writing about the way psychiatric drugs were harming more than helping.   My own journey in becoming outspoken on these issues has also been massively influenced by David’s activism and ideas, which is one reason I care strongly about the issue I am bringing up here.

While David has been helpful, directly or indirectly, to so many of us, he now needs our help.  In December 2012, while attempting to retrieve his cat “Bongo” from a loft, he slipped and fell, breaking his neck (which was already very vulnerable due to a previously existing bone condition.)  He then teetered on the edge of survival for some months, setting the record at the local hospital for longest stay in the ICU.  An infection he suffered during this time resulted in a high fever which caused additional difficulties, partially impairing his ability to speak.  David has worked hard since in rehab to regain some use of his arms, but lacks control of his hands and legs.

Since David’s accident, he and Debra have exhausted their savings paying for bills not covered by insurance.  Friends and local agencies have donated some of the labor toward the remodel of their house to fit David’s wheelchair, but usually not the cost of materials. The cost of daily life has increased tremendously. And to continue working and to move freely about in the community, David will need technological help with the internet, a computer and a specially-equipped van. [click to continue…]

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