Supporting People in Getting Active in Their Own Recovery

Often, especially with big mental health problems like those we call “psychosis,” almost all the discussion and attention tends to revolve around what the rest of us should do to help the person, and not what the person could do to help himself or herself.

And often the “help” that is offered makes people less inclined to do things to help themselves than they would otherwise be.  People are encouraged to give up trusting themselves and instead to think of themselves as “mentally ill,” and they are encouraged to take drugs which have a general effect of making people more passive or “tranquilized.”

Of course, it can seem like a good thing to have people lose trust in their “crazy” ideas or perceptions, and to have people be passive rather than engaged in activity we see as “psychotic.”  But to really recover, people need to find ways to trust themselves again and to become active toward their own values.  So we need something different from standard kinds of “help” if we are going to really help people move into “agency,” or really taking responsibility for their own recovery.

In their presentation for the next ISPS-US online meeting/webinar, which will happen at noon EDT  on Friday 9/25/15, Lewis Mehl-Madrona MD and Barbara Mainguy MA will share their views on this topic.

In their own words, they plan to “explore the interface and the movement between at least two different worlds in which people diagnosed with psychosis interact. First and dominant is the biomedical world in which the solution to virtually all of life’s woes is to take a pill and not to make personal, relational, or lifestyle changes. Important to recognize, we believe, is that these beliefs are as prominent for medical illnesses as they are for the so-called psychiatric illnesses. Then comes the Recovery Community in which people work from passivity (the biomedical model) toward agency in which they can actively contribute and create their recovery.

“We want to suggest that most psychiatrists are so saturated in the passivity model that they do not recognize when patients present from the agency model. We suggest that the two models are more widespread than mental health and represent fundamental differences in approaching health and disease. We review some of our results in working within both worlds. Specifically, the people with whom we work within a Recovery model improve and those within the passive, biomedical model, do not.”

Lewis and Barbara will be discussing what they have found may assist people in making this shift from passivity toward agency, especially telling stories of characters with agency to indirectly implant ideas of the possibility of agency. With patience, and with the practice of “radical acceptance,” they have found that this can be very effective!

ISPS online meetings are free to ISPS members, with a donation of $5-$20 requested from others, though no one turned away for lack of funds.  Please do register, by going to https://from-passivity-to-agency.eventbrite.com if you want to attend!

(Some of you may also want to read a recent article by Lewis Mehl-Madrona, Working to Recover, or Adjusting to Illness?)

 

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Online Course, “CBT for Psychosis” Is Now Available

Udemy cbt imageCognitive Behavioral Therapy (CBT) for psychosis is an evidence-based method to reduce distress and disability related to psychotic experiences, and to support a possible full recovery. Psychotic experiences are conceptualized as being understandable in relationship to an individual’s life story, and capable of being altered when people experiment with different ways of thinking and behaving. Learn how to collaborate with people having these experiences, “exploring the evidence” rather than imposing beliefs, and developing coping options so people are not forced to rely entirely on the often limited effectiveness of medication to address problems.

This new online course starts by examining the nature of psychosis and CBT, providing a foundation for understanding how CBT can be helpful. Then the basic style of CBT for psychosis is introduced, followed by an introduction to two of the most important techniques. Finally, applications of CBT are explored for some of the main problem areas, such as hearing distressing voices, paranoia, delusional beliefs, disorganization, and negative symptoms.

Included in the course are video lectures, slides with some diagrams, video demonstrations of CBT for psychosis being practiced, and links to additional resources for further study. Periodically, there will be live question/answer sessions, and recordings of past question/answer sessions will also be available.

CBT for psychosis uses a minimal amount of jargon, and the concepts and practices tend to be easily understandable.

In this introductory seminar on CBT for psychosis, you can learn to:

  • Collaborate with people in exploring difficult experiences, helping people develop their own perspective and their own solutions rather than telling people what to think
  • Reduce fear of psychotic experiences, and build hope for coping and for recovery. using the CBT approach called “normalizing”
  • Help people develop a coherent story or individualized formulation of what led to psychotic difficulties, which then guides efforts toward recovery
  • Become familiar with a broad range of psychological strategies which have been found helpful for experiences such as paranoia, hearing voices or other “hallucinatory” experiences, delusional or disorganized thinking, and “negative symptoms.”

5 CE credits are available for social workers, psychologists and nurses in the US.

Cost:  The regular cost for this seminar is $90, however, it’s being offered here for the discounted price of only $50.  Also, if you register here, 1/2 of your registration fee will go directly to ISPS-US (the rest will go to me, Ron Unger, since I am the author and producer of the course.)

To register, or for more information including a free preview of the section on “normalizing,” go to this link.

You might also be interested in a related online course, Working with Trauma, Dissociation, and Psychosis:  CBT and other Approaches to Understanding and Recovery.  This is also available for $50, with 6 CE credits.

(Also, you might want to be aware of other online courses that are now appearing through Mad in America.)

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“Self Psychology and Psychosis: The Development of the Self During Intensive Psychotherapy…’

There are many pathways to recovery, but one thing people have often been told does not work for “psychosis” and “schizophrenia” is intensive psychotherapy.

But many of those who research the effectiveness of such therapy, and those who practice it, would beg to differ.  (You can also hear the voices of two recipients of such therapy who speak out in Daniel Mackler’s film which you can watch on youtube, “Take These Broken Wings.”)

Self Psychology is one Self Psychologyapproach to intensive psychotherapy.   On Friday June 5, 2015, at 6:30 PM Eastern Time, there will be an opportunity to hear directly from, and interact with, Ira Steinman and David Garfield, who will be speaking about this approach during an online meeting/webinar.

Ira and David will be discussing their new book, “Self Psychology and Psychosis:  The Development of the Self During Intensive Psychotherapy of Schizophrenia and other Psychoses.”

This meeting is sponsored by ISPS-US, which does request a small donation for the meeting from non-members, but does not turn away anyone who can’t afford to or doesn’t want to pay.

Read on for more information about the book, and how to register for the meeting:

Continue reading

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Reflections on Compassion and Uncertainty at ISPS 2015

In the Mad in America blog posts by Noel Hunter and by Sandy Steingard, there have already been great reports on ISPS 2015, but I would like to share my own thoughts about what was most significant and directions for the future.

For me, the strongest emotional moment came when heard the presentation by Silje Marie Strandberg, an ex patient, and Lone Viste Fagerland, her mental health nurse.  Silje shared what began as a very dark story, about her being bullied as a child, then becoming extremely withdrawn, suicidal and “psychotic,” then being hospitalized for years without hope for anything better.   This began to change only after she met a new nurse, the co-presenter, Lone.  Silje shared how she first strongly disliked Lone, yet gradually learned to trust her as Lone persisted in efforts to make contact, and especially as she offered physical touch in a way that crossed what are usually seen as “good boundaries” in mental health treatment.

Silje shared that even in her withdrawn state she had a definite sense that in order to reconnect as a human being, she was going to need physical affirmation and touch from someone outside her family; yet she also knew that in the hospital “they don’t do that kind of thing.”  It was because Lone broke out of such hospital norms, and offered hugs, extended hand holding, backrubs, hair brushing and other kinds of non-exploitive physical contact, as well as efforts to be present beyond the demands of her normal duties, that Silje was able begin to believe in herself and to re-connect with the social world.  And reconnect she definitely did:  she presented with a warm vitality that was truly impressive!

To me, this story cut right to the heart of what real mental health “help” can be.  So it’s quite sad to contrast the story she and Lone told with a tale I heard just yesterday, of a worker in an hospital who was fired for extending just one hug to a patient the worker had seen for two years, at the point where they were having to say goodbye.  Physical contact like hugs were just against policy.  That, within an institution that claims it is for healing……

The idea of connecting around our basic humanity of course isn’t new; quite a few of the presenters for example reminded us of Harry Stack Sullivan’s reminder from early in the last century that we are all “more simply human than otherwise.”  Unfortunately, it is all too easy for the mental health system to forget this common humanity when a person is in a state that seems extreme or psychotic.  I believe it is the failure to focus on this common humanity that leads to the destructiveness of so much mental health work, but it doesn’t have to be that way.

A man has been insisting to everyone that he is pregnant.  What should be done?  Aaron Beck (known as the “father” of CBT, and now 93 years old) proposed a simple answer in his talk that opened the conference.  In the story Beck related, the man was first asked what was good about his condition.  He answered that being pregnant was good because it meant he would soon have someone to love.  He was then asked if he had ever had this before, and reported yes, when he had a pet dog – so the next step in “treatment” was to help him start a volunteer job in an animal shelter, thus helping him meet the actual human need that had been presenting as a “psychotic symptom.”  Simple, but so different from standard approaches that routinely miss the person in their effort to address the apparent “symptoms of an illness.”

I found one of the most promising approaches discussed at the conference to be compassion focused therapy (CFT).  Christine Braehler, our presenter, strongly suggested that anyone practicing this approach apply the techniques to themselves first (think how much different mental health treatment would be if it were routine for practitioners to apply the techniques to themselves first!)  I especially appreciate CFT’s multi-dimensional approach to compassion, aka love:  it’s not just about the therapist being compassionate with the clients, but also helping the clients learn to practice compassion toward themselves, toward dissociated parts or voices, and also giving and receiving compassion in relations with other people.

In the absence of warmth and compassion, rigidity sets in.  This is true not just for those who are failing to receive the compassion, but for those who are failing to give it.

One way professionals get rigid is by settling into theories, which then dominate how they see things.  An interesting presentation by Stephen Love explored “theory induced blindness” or the way having a theory often makes professionals ignore what may be key pieces of reality that don’t quite fit the theory.  Sometimes theory induced blindness in the mental health field gets pretty extreme; John Strauss for example shared his story from the 1980’s of trying to publish an outcome study showing lots of recovery after a “schizophrenia” diagnosis, and being rejected by a major journal that told him “we know this can’t be true.”  Unfortunately, there is still so very much that professionals think they know that just isn’t so.

My own presentation was on the importance of professionals admitting uncertainty about everything from the question of who is “ill” to the nature of reality itself.  Nick Putnam, involved in organizing training in Open Dialogue in the UK, said that the most challenging part of bringing the Open Dialogue approach into an existing mental health system seemed to be getting clinicians to become able to have the capacity to “not know” within their conversations.  Lewis Mehl-Madrona, a Native American psychiatrist with expertise in narrative approaches, spoke about a man he interacted with who had been hospitalized over a hundred times.  The man told Lewis that “you are the first person I’ve talked to who didn’t know what to do.”  Not surprisingly, Lewis was also more able to be helpful than those who had been so sure they knew what to do.

Of course, it isn’t as though the best helpers know nothing at all about what to do.   There are professionals who regularly don’t seem to know much of anything and don’t try anything beyond pills, and they tend to just become part of an atmosphere of hopelessness.  It seems to me that what probably what works best is when professionals have ideas, but also are able to be unsure if these ideas are correct, and so they can be available for a lively ongoing exploration.

While there were many valuable ideas offered at this conference, and while the exchange of ideas was very helpful, I was also bothered by the way a number of the plenary presenters seemed much too sure their ways of thinking were helpful, without awareness of possible down sides to their perspectives.  For example, many of the speakers were sure they were talking about something that could be safely described as “mental illness” and they were quite sure that this “illness” is something that can, without ambiguity, be thought of as something “bad.”  My belief, to the contrary, is that we will only be really good at helping people when we are less sure what is good and bad in people’s experience, and when we can engage with the openness that comes from that uncertainty.

I enjoyed Larry Davidson’s talk, and I understand he has made many positive contributions to our field.  But when he identified the scariest part of long term psychosis as the sense of losing one’s self (and seemed to imply that this experience is so devastating that it can only be understood as part of an illness) I was reminded of the period of my life when my own sense of self and my sense that anything had any meaning at all was falling apart – but the curious thing is that in my experience at the time, I found this loss of a sense of self to be profoundly liberating!

Of course, when a person grows up with lots of trauma and shame as I did, it isn’t surprising that one’s sense of self and system of making meaning is very oppressive, and so it can be liberating to have it all break down.  It is also true that such a breakdown can create huge problems, but we need mental health helpers who get that this whole process may be something other than “illness,” and who understand alternative perspectives such as spiritual approaches that see possible value in getting beyond the illusion of being a fixed “self.” In my journey I was lucky enough to find these perspectives and get the help I needed outside the system, but this kind of help should also be available inside the system.

Ultimately, I don’t think we can have a competent mental health system till we have one that can look at both the positive and the negative sides of extreme states.  We need a mental health system that can understand the human concerns that lead people, especially young people, into wild and paradoxical mental and emotional terrain, so we can help people move toward what makes sense to them in a safer way rather than insist they always stay within the boundaries of conventional society.

Karen was one person who spoke about the importance of mental health workers learning to do this.  She shared some of her own difficult yet valuable experiences, the importance of learning to affirm what was good about them, and in regards to normality commented that “I don’t have anything against normal, it’s just that I’ve always had my missions and being normal has not been one of them.”

It seems to me we are just starting to imagine what mental health services will be like if we learn to really listen to people like Karen, if we truly collaborate with people in extreme states, helping them discover their own version of health and progress, and ways to accomplish their own missions, rather than impose our own definitions and certainties about the superiority of “normal” ways of experiencing the world.  I did appreciate ISPS 2015 as one place where multiple views were considered, and my hope is that as we continue to dialogue, within ISPS and MIA and elsewhere, new ways of accomplishing the vision I have outline will emerge and will then increasingly reshape mental health practice, which is still so badly in need of a “non-violent revolution.”

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Developing a Compassionate Voice as a Step Toward Living With Voices

I’ve previously written about the possible role of compassion focused therapy in helping people relate better to problematic voices, in my posts Could compassionate self talk replace hostile voices?Feed Your Demons!, and A Paradox: Is Our System for Responding to Threats Itself a Threat?

I’m happy to see more interest being taken in this kind of approach, and a video has just become available which, in 5 minutes, very coherently explains how a compassion focused approach can completely transform a person’s relationship with their voices and so transform the person’s life!

The video is an animation developed by Charlie Heriot-Maitland working with Eleanor Longden and Rufus May who do the voiceovers.  Check it out, let me know what you think:

(You can also go straight to www.compassionforvoices.com and give feedback to the people who made the video.)

You can learn more about compassion focused therapy at the following workshop which precedes our ISPS International Conference:

Compassion Focused Therapy for Recovery after Psychosis, with Christine Braehler  18th March 2015, ISPS Conference workshop, New York, US. http://www.isps2015nyc.org/pre-conference-workshops

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Get Trained in CBT for Psychosis, and Attend the ISPS International Conference Just Afterward!

Here’s an announcement sent by Karen Stern that I am reprinting in full:

The Institute of Cognitive Therapy for Psychosis (ICTP) is very excited to announce an upcoming training in CBT for Psychosis (CBTp).  It will take place March 14-17, 2015, right before the ISPS International Conference, at nearby NYU.

This course will provide clinicians with advanced understanding and skills in using CBTp. CBTp is an evidence-based treatment,  which complements pharmacological and other psychological treatments. Its goal is to create a collaborative treatment alliance in which patient and therapist can explore distressing psychotic experiences and the beliefs the patient has formed about these experiences, in an effort to reduce suffering and improve functional capacity in the recovery process.

The course will be taught by ICTP faculty including: Page Burkholder, MD; Michael Garret, MD; David Kimhy, PhD; Yulia Landa, PsyD, MS.

Didactic training will take place over 4 consecutive days, and will be followed by 30 hours of weekly group supervision (via phone or skype).

Didactic training will take place from March 14th to  March 17th, 2015. Training will be located in the Kimmel Center (60 Washington Square South, New York, NY).

Applicants must meet the following requirements:

1.    Hold one of the following degrees: PhD or PsyD (clinical or counseling psychology), MD (in psychiatry), MSW, LCSW, NP (nurse practitioner), OT (occupational therapist), AT (activity therapist).

2.    Hold the appropriate license or certification to practice.

3.    Have familiarity with CBT theory and principles.

4.    Actively treating or have access to treat clients with schizophrenia spectrum disorders.
Applicants are accepted on a rolling first-come, first-serve basis until the workshop is full. We strongly encourage early applications for this program.

The cost of the training will be $3,850 for non-ISPS members, and $3,500 for ISPS members. This fee includes didactic presentations and supervision. All trainees receive a certificate of completion at the end of training.

For more information please visit:  https://www.sites.google.com/site/ictpsychosis/training

To register please contact the ICTP coordinator at info.ictp@gmail.com

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Listening for the Person within “Madness”

As we struggle to invent a humane approach to the extreme states that get called “psychosis” or “madness” or “schizophrenia,” it may be helpful to investigate some of the better approaches developed in the past.

While these approaches are not without their flaws, they are often surprisingly insightful.  (It can also of course be depressing to notice how truths once more widely known were so easily “forgotten” as compassionate approaches got ditched in favor of the latest coercive innovations.)

One of the pioneers in actually listening to those in extreme states was Frieda Fromm-Reichmann.  She advocated assuming that every communication from those in extreme states contains meaning, and for appreciating that there is an “ego,” however beleaguered, within even the seemingly “hopelessly deranged.”  She believed that if therapists would persist in reaching out, while respecting the person and his or her struggle, then communication would gradually become clearer, and the person’s special perspectives and talents could emerge and flourish.

Fromm-Reichmann is perhaps best known as being the therapist for Joanne Greenberg, who wrote a fictionalized version of her story of psychosis and recovery in the novel “I Never Promised You a Rose Garden,” and whose story was also covered in Daniel Mackler’s documentary “Take These Broken Wings.”

One person who has extensively studied the work of Fromm-Reichmann and others like her is Ann-Louise Silver, MD.  In the short clip below, taken from the “Broken Wings” documentary, she contrasts the kind of recovery that can come from psychodynamic therapy with what happens when people are offered what she calls the “scotch tape” approach of medication:

So how does this psychodynamic approach work, and what parts of Fromm-Reichmann’s approach could be helpful to us as we design alternatives for today’s world?

Ann will address that topic at an ISPS online meeting on Friday 2/13/15, at 3 PM EST.  This meeting is free to ISPS members, with a donation of $5-$20 requested from others, though there is also an option to register without donating if that works better for you.

You can register at https://ispsonlinewithann-louisesilver.eventbrite.com

Ann will also be a keynote speaker at the ISPS International Conference in NYC March 18-22, 2015.

Ann was the first president of ISPS-US, an organization started by people who were mostly psychodynamic therapists.  This organization has since broadened, as awareness increased about the need to collaborate with those who have lived experience, and as knowledge expanded about the effectiveness of other kinds of approaches, and of the need to have different approaches available for people who may respond better to something other than long term therapy.

It certainly isn’t too late to register for http://www.isps2015nyc.org/ where you can hear from leaders such as Mary Olson (of Open Dialogue), Aaron Beck and Tony Morrison (of CBT and CBT for psychosis), and of special importance, lots of people with both lived experience of psychosis and expertise in other areas, such as Ron Coleman, Pat Deegan, Noel Hunter,  Sascha DuBrul, and Oryx Cohen among many others.

I will also have a presentation there, titled “Admitting Uncertainty about “Illness” and “Reality” is Essential for Dialogue.”

Of course, many of you aren’t going to be able to attend big conferences like this – which is why I hope to keep working with others in ISPS to make available online meetings, accessible to all, which give people a chance to hear from leaders in our field in a live format that includes interaction with the audience.  Expect to hear more about these meetings on MIA, and/or you can always hear about what’s coming up by going to http://isps-us.org/blog/online-meetings/

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Finding the Gifts Within “Madness”

When people are seeing the world really different than we do, it’s often reassuring to think that there must be something wrong with them – because if they are completely wrong, or ill, then we don’t have to rethink our own sense of reality, we can instead be confident about that own understandings encompass all that we need to know.

But it can be disorienting and damaging to others to have their experiences defined as “completely wrong” or “ill.”  And we ourselves become more ignorant when we are too sure that there is no value in other ways of looking or experiencing.

In a practical sense, there are often many ways for example to look at a particular object – we can look at it from various angles, and through different lenses for example, and what we see will be different depending on how we look.  In that sense, it’s actually ridiculous to see one way or another of looking or experiencing as “wrong” or “sick”; instead, it makes more sense to understand that different ways of looking may be useful for different purposes.

Looking at things the same way as others around us are looking at them can certainly be helpful if we want to understand what others are seeing and to coordinate with them.  Looking at things in more unique ways may be more helpful though if we have other purposes:  for example looking at part of a tree through a microscope may be very helpful for some purposes, even though it is unhelpful for seeing the tree in a conventional way.

In a fascinating recording titled OF MADNESS AND MAGIC: SHIFTING THE LENS TO UNDERSTAND THE MIND, Mischa Shoni shares both her own journey and also some great insights into how discovering new ways of looking at the world, or new “lenses” to look at it through, can be both disorienting and disabling, and then eventually enriching once one learns how to use those lenses in a good way.

Here’s the written description of her talk:

What differentiates what is labeled as mental dysfunction—mania, psychosis, seizures—from what is magic, spirit, or simply … beyond the scientific method? Mischa Shoni embarks on a journey to understand her own brain. On the path, she meets dragons, gryphons, crystal-eyed snakes … and some extraordinary people who see the mind beyond the limited lens of psychiatry.

Continue reading

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Online Meeting Focuses on “Responding to Extreme States with Loving Receptivity”

Northern California has played an important role in the development of “alternative” approaches for psychosis, especially with the establishment of madness sanctuaries like Soteria where people could undergo psychosis with very little use of drugs.

Our next ISPS online meeting will provide a chance to meet with modern day pioneers from Northern California, who along with others in the Bay Area Mandala Project, plan a number of alternatives, including a Soteria-like residence.

Cardum Harmon, Dina Tyler, Michael Cornwall, PhD are key members of the Mandala Project, and they will be the presenters for this meeting, which will address “Responding to Extreme States with Loving Receptivity: Honoring the Spirit’s Transformative Journey”  All three have lived experience of “psychosis” or “extreme states” as well as extensive experience helping others with those states.  (Michael also has had experience working in I Ward, one of those alternative facilities that helped people with psychotic experiences without using antipsychotics.)

In this meeting, they will share effective ways to be with people in intense spiritual experience by focusing on loving receptivity and the importance of honoring one’s spiritual journey. They will explore the strategy of “being with” instead of “doing to”, as an accessible tool for averting prolonged crisis and supporting healing. Continue reading

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Tony Morrison, another reason to register for #ISPS2015NYC !

 

  Plenary Highlight: Professor Tony Morrison

We are pleased to welcome Tony Morrison as a plenary speaker at the 19th conference of ISPS, to be held in March in New York City.

Dr. Morrison has been a leader in developing the application of cognitive behavioral therapy to the problems of psychosis (CBTp). His research has focused on delineating the elements of CBTp, examining links between trauma and psychosis, and exploring patient choice and user-led research, as well as research on the effectiveness of CBTp for people not on antipsychotic medication. He has written many articles, as well as treatment manuals, and is a professor at The University of Manchester, UK.

A link to a YouTube video of a keynote presentation at the British Psychological Society on “Cognitive behaviour therapy without antipsychotics: Is it effective across the continuum of psychotic disorders?”

https://www.youtube.com/watch?v=CFudCx868uw

For a selected biography:

http://www.psych-sci.manchester.ac.uk/staff/AnthonyPMorrison

A more extensive biography:

http://www.manchester.ac.uk/research/Anthony.p.morrison/publications

Read more about Tony Morrison http://www.isps2015nyc.org/tony-morrison

Note that Tony is also presenting a pre-conference workshop – one of a number of them!  And December 15, 2014 is the last day to get the Early Bird Discount when registering…..

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