Counseling psychotic patients

[1985psych]

If this information is in another thread, please forward me to it. However, I'm very intrigued with various forms of psychosis (schizophrenia, etc.) and know that I want to have a career counseling these types of patients. What is the best way to do this? It seems that clinical psychologists mostly counsel more neurotic patients, is this true? Thank you for any information you could tell me or forward me to.

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[Therapist4Chnge]

Clinical psychologists work with a range of patients. I've worked with my fair share of actively psychotic patients, and while challenging at times....it is still very possible.

Much of it depends on their Sxs....as some make it harder than others. For instance, I worked with someone who had auditory hallucinations, and sometimes we'd be able to do our work....and other times he'd need to take some time because they were so loud/intrusive.

It is important to have a good relationship with their prescriber, as good meds management can really help curb some of the Sxs. A lot of the time the work focuses on coping skills and management, as it can be a struggle just going day to day for the pt.

 

[WannaBeDrMe]

Agreed with everything t4c says and want to add that if it seems like other disorders are predominant in the field because they are more frequently occurring. I can't remember percentages, but psychotic disorders are a minority in existence and obviously, presentation.

I think you'd be more likely to see the psychotic symptoms of bipolar in most settings. A successful treatment for people w/schizophrenia is psychosocial rehab which really has little to do with individual counseling -- much more case management... so some of them never make it to that treatment referral.

This is just in my experience, obviously, I'm sure it differs based upon your region and the accepted treatment protocol in that area for a particular population. My state tries to manage ALL severely and persistenly mentally ill via home based treatment services so continual therapy is reserved for high functioning people who can sort of fight the system and seek their own resources... or ones who have really good advocates.

Also, I think your setting will determine who you see... If you choose inpatient, you will see a LOT of psychotic disorders with wide ranging characteristics... there are even many speciality schizophrenia treatment programs (STEP @ UNC).

The treatment for every client you see will be different depending upon their level of functioning and as t4c says... med management is critical!! Although, I've had some clients who managed well off-meds at various stages of their illness... especially a few of my schizoaffectives.

Good luck! It's one of my favorite populations!

 

[PsyDr]

freeman, a cbt big name, works in a psychiatric nursing home with many psychotic patients in chicago. i guess there is a market for it if he can have a career, or part of one, doing this.

last time i heard, he had an internship (the 5th formal training year NOT an internship in the colloquial sense) doing this type of work, so there is definitely training going on in this area.

i also think frank searles, a psychodynamic guy, has written some stuff about doing therapy or analysis with psychotics but i could be wrong as i haven't read psychodynamic stuff in years.

i don't know how much career counseling you are going to do with this patient population though. in my experience, we live in an age wherein getting social security disability for psychosis is the norm. the ones that can function are usually advised by their case manager as to what job to do. the much much higher functioning ones are reluctant to admit they are experiencing symptoms and manage to cope somehow. exner, the rorschach guy, told some funny stories about this in his classes before he died.

 

[glasscandie]

I'm an undergraduate intern at a psychiatric rehabilitation center, where the population is mostly schizophrenic (though some with major depression, others with bipolar w/psychotic symptoms). I don't personally see a lot of psychosis at the clinic, mostly because the clinic encompasses people who can be rehabilitated to go back into the community - I actually teach an employment class. But there are definitely facilities in the area that treat less managed cases, and there are some people who come through that just can't get the medicine right or don't believe they have a diagnosis - then there's psychosis. I really enjoy my time there.

 

[cara susanna]

Isn't ACT used to treat schizophrenia as well?

 

[WannaBeDrMe]

Isn't ACT used to treat schizophrenia as well?

Acceptance & Committment Therapy or Assertive Community Treatment?

If Acceptance & Committment, I have no idea, I've never heard of it used in that way and I don't really follow it yet either... so not sure.

If Assertive Community Treatment, yes, at least in my region, that's really the only wide reaching effort to help the severe and persistently mentally ill.

It doesn't work very well unless you have appropriate resources for continuous care... and my state doesn't... so, I won't elaborate because I'm not wanting to get frustrated.

Supposedly, all the research shows that ACT teams work wonders... When I was inpatient, I received just about all of the ACt team's patients and they came in totally psychotic, unbathed, usually unfed, without sleep, and no family had been notified. People don't get that way in just a week's time... they ACT team made constant excuses for why they hadn't had contact... Ok, so I did elaborate, GRRR.

I'm sure some ACT teams are great and function as designed... just depends on the reason.

 

[biogirl215]

If Acceptance & Committment

It is, or at ;east it is starting to be used--I know someone who is doing their diss on mindfulness-based therapies for treating clients with paranoid schizophrenia.

 

[Rapunzel]

My brother had schizophrenia, although my family feels that aspergers actually described him better if both could have been diagnosed. If one could make the diagnosis of "aspergers with psychotic features" that would be him. He had an evaluation by a psychologist, with treatment recommendations that really made sense, but unfortunately nobody bothered with following treatment recommendations, and my brother committed suicide a couple of years after that. I can't speak for all psychotic patients, but my brother could have benefitted from therapy and needed it, not so much to cure his psychotic symptoms as to help him overcome the family dynamics that taught him that he couldn't do anything for himself and shouldn't bother trying - the same thing that the rest of us got, only he got even more of it. We need more research showing that these patients benefit from therapy, so that it will be more available to him. Having a therapeutic relationship with someone outside the family who could have given him hope and noticed when he was going downhill probably would have saved my brother's life. He said that he wasn't okay, but couldn't get treatment when he needed it because he wasn't able to clearly explain how he was a danger to himself or anyone else. All the hospitals mom took him to turned him away. But he was, and didn't get help.

Some of the settings that might have been able to offer help would include research, and jails, as well as specific treatment programs.

 

[WannaBeDrMe]

My brother had schizophrenia, although my family feels that aspergers actually described him better if both could have been diagnosed. If one could make the diagnosis of "aspergers with psychotic features" that would be him. He had an evaluation by a psychologist, with treatment recommendations that really made sense, but unfortunately nobody bothered with following treatment recommendations, and my brother committed suicide a couple of years after that. I can't speak for all psychotic patients, but my brother could have benefitted from therapy and needed it, not so much to cure his psychotic symptoms as to help him overcome the family dynamics that taught him that he couldn't do anything for himself and shouldn't bother trying - the same thing that the rest of us got, only he got even more of it. We need more research showing that these patients benefit from therapy, so that it will be more available to him. Having a therapeutic relationship with someone outside the family who could have given him hope and noticed when he was going downhill probably would have saved my brother's life. He said that he wasn't okay, but couldn't get treatment when he needed it because he wasn't able to clearly explain how he was a danger to himself or anyone else. All the hospitals mom took him to turned him away. But he was, and didn't get help.

Some of the settings that might have been able to offer help would include research, and jails, as well as specific treatment programs.

First, I am so sorry for your loss. Still, I appreciate you sharing about your brother.

I find it very interesting that you mention jails as a positive treatment option. I'd love to hear more if you feel up to talking about it or have more you can share about your perspective.

There was a time when I wanted to work in a prison setting because of the many underserved mentally ill currently serving sentences. I thought it would be a great place to experience a wide range of clinical presentations. I was never offered a position, though, so I sort of let that fall to the side.

I agree with you that research could really help these individuals if it is focused on new treatment directions. I had a client in a similar situation as your brother when I was an intern and that's weighed fairly heavily on my mind throughout my young career.

Thanks again for sharing.

 

[Rapunzel]

I keep noticing my typos and freudian slips after I've been quoted.

*MOD NOTE: It sounds like you have had a lot of experiences in your life, and while I don't want to discount them....I don't think such personal information should be shared on a professional forum, which is why I deleted the remainder of this post. -t4c*