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Clinical Social Work Journal

, Volume 37, Issue 2, pp 104–111 | Cite as

The Complexities of Change in the Psychotherapy of Serious Mental Illness: A Practitioner’s Reflections

  • Richard Horowitz
Original Paper

Abstract

The sweeping revisions in the understanding of major mental illness brought about by the biological revolution in psychiatry moved the spotlight away from the treatment relationship. In recent years, however, a resurgence of interest in subjectivity underscored the fact that despite dramatic scientific breakthroughs the existential realities of illness were largely unaltered. Even with this shift in inquiry, however, little attention was shown to the inner experience of practitioners engaged in long-term therapeutic relationships where movement of any kind was barely detectable. Clinicians and clients alike frequently travel a long and difficult road in search of pathways to recovery. Tracing their shared journey through a detailed case presentation illuminates the interior worlds of both travelers and illustrates that neither is left untouched by the complexities of change.

Keywords

Mental illness Psychotherapy Change Countertransference Recovery 

References

  1. Andreasen, N. (2007). DSM and the death of phenomenology in America: An example of unintended consequences. Schizophrenia Bulletin, 33(1), 108–112. doi: 10.1093/schbul/sbl054.PubMedCrossRefGoogle Scholar
  2. Barham, P., & Hayward, R. (1998). In sickness and in health: Dilemmas of the person with severe mental illness. Psychiatry, 61, 163–170.PubMedGoogle Scholar
  3. Bromberg, P. M. (1993). Shadow and substance. Psychoanalytic Psychology, 10, 147–168.CrossRefGoogle Scholar
  4. Bullard, D. (1960). Psychotherapy of paranoid patients. AMA Archives of General Psychiatry, 2, 137–141.Google Scholar
  5. Bürgy, M. (2008) The concept of psychosis: Historical and phenomenological aspects. Schizophrenia Bulletin. Advance Access published 3 January 2008. doi: 10.1093/schbul/sbm136.
  6. Celan, P. (2000). Glottal stop (trans: Popov, N., & McHugh, H). Hanover, N. H.: University Press of New England.Google Scholar
  7. Corin, E. (1998). The thickness of being: Intentional worlds, strategies of identity, and experiences among schizophrenics. Psychiatry, 61, 133–146.PubMedGoogle Scholar
  8. Davidson, L., Schmutte, T., Dinzeo, T., & Andres-Hyman, R. (2008). Remission and recovery in schizophrenia. Schizophrenia Bulletin, 34(1), 5–8. doi: 10.1093/schbul/sbm122.PubMedCrossRefGoogle Scholar
  9. Dimaggio, G., Salvatore, G., Azzara, C., Catania, D., Semerari, A., & Hermans, H. (2003). Dialogical relationships in impoverished narratives: From theory to clinical practice. Psychology and Psychotherapy: Theory, Research and Practice, 76, 385–409.CrossRefGoogle Scholar
  10. Fonagy, P., & Target, M. (2007). Playing with reality: IV. A theory of external reality rooted in intersubjectivity. The International Journal of Psycho-Analysis, 88(4), 917–937. doi: 10.1516/4774-6173-241T-7225.PubMedGoogle Scholar
  11. Horowitz, R. (2006). Memory and meaning in the psychotherapy of the long-term mentally ill. Clinical Social Work Journal, 34(2), 175–185. doi: 10.1007/s10615-005-0007-3.CrossRefGoogle Scholar
  12. Jobe, T., & Harrow, M. (2005). Long-term outcome of patients with schizophrenia: A review. Canadian Journal of Psychiatry, 50(14), 892–900.Google Scholar
  13. Lysaker, P., & Daroyanni, P. (2006). Facilitating the emergence of interpersonal relatedness in individual psychotherapy of schizophrenia: A case study. Bulletin of the Menninger Clinic, 70(1), 53–67. doi: 10.1521/bumc.2006.70.1.53.PubMedCrossRefGoogle Scholar
  14. Lysaker, P., Davis, L., & Lysaker, J. (2006). Enactment in schizophrenia: Capacity for dialogue and the experience of the inability to commit to action. Psychiatry, 69(1), 81–93.PubMedGoogle Scholar
  15. Lysaker, P., Johannesen, J., & Lysaker, J. (2005). Schizophrenia and the experience of intersubjectivity as threat. Phenomenology and the Cognitive Sciences, 4, 335–352. doi: 10.1007/s11097-005-4067-1.CrossRefGoogle Scholar
  16. Lysaker, P., & Lysaker, J. (2004). Schizophrenia as dialogue at the ends of its tether: The relationship of disruptions in identity with positive and negative symptoms. Journal of Constructivist Psychology, 17, 105–119. doi: 10.1080/10720530490273890.CrossRefGoogle Scholar
  17. Mendel, W. (1976). Schizophrenia: The experience and its treatment. San Francisco: Jossey-Bass.Google Scholar
  18. Mitchell, S. (1993). Hope and dread in psychoanalysis. New York: Basic Books.Google Scholar
  19. Parnas, J., & Handest, P. (2003). Phenomenology of anomalous self-experience in early schizophrenia. Comprehensive Psychiatry, 44(2), 121–134. doi: 10.1053/comp.2003.50017.PubMedCrossRefGoogle Scholar
  20. Roe, D., & Davidson, L. (2005). Self and narrative in schizophrenia: Time to author a new story. Medical Humanities, 31, 89–94. doi: 10.1136/jmh.2005.000214.CrossRefGoogle Scholar
  21. Roe, D., & Lachman, M. (2005). The subjective experience of people with severe mental illness: A potentially crucial piece of the puzzle. The Israel Journal of Psychiatry and Related Sciences, 42(4), 223–230.PubMedGoogle Scholar
  22. Rudge, T., & Morse, K. (2001). Re-Awakenings? A discourse analysis of the recovery from schizophrenia after medication change. The Australian and New Zealand Journal of Mental Health Nursing, 10, 66–76. doi: 10.1046/j.1440-0979.2001.00196.x.PubMedCrossRefGoogle Scholar
  23. Saari, C. (1991). The creation of meaning in clinical social work. New York: The Guilford Press.Google Scholar
  24. Saari, C. (1993). Identity complexity as an indicator of health. Clinical Social Work Journal, 21(1), 11–24.Google Scholar
  25. Sacks, O. (1995). To see and not see. In O. Sacks (Ed.), An anthropologist on Mars (pp. 108–152). New York: Vintage Books.Google Scholar
  26. Searles, H. (1965a). Anxiety concerning change, as seen in the psychotherapy of schizophrenic patients––with particular reference to the sense of personal identity. In J. D. Sutherland (Ed.), Collected papers on schizophrenia and related subjects (pp. 443–464). London: Hogarth Press. (Original work published 1961).Google Scholar
  27. Searles, H. (1965b). Phases of patient-therapist interaction in the psychotherapy of chronic schizophrenia. In J. D. Sutherland (Ed.), Collected papers on schizophrenia and related subjects (pp. 521–559). London: Hogarth Press. (Original work published 1961).Google Scholar
  28. Searles, H. (1979). The schizophrenic individual’s experience of his world. In Countertransference and related subjects (pp. 5–27). Madison, CT: International Universities Press. (Original work published 1967).Google Scholar
  29. Sells, D., Stayner, D., & Davidson, L. (2004). Recovering the self in schizophrenia: An integrative review of qualitative studies. The Psychiatric Quarterly, 75(1), 87–97. doi: 10.1023/B:PSAQ.0000007563.17236.97.PubMedCrossRefGoogle Scholar
  30. Stanghellini, G., & Lysaker, P. (2007). The psychotherapy of schizophrenia through the lens of phenomenology: Intersubjectivity and the search for the recovery of first- and second-person awareness. American Journal of Psychotherapy, 61(2), 163–179.PubMedGoogle Scholar
  31. Strauss, J. (1994). The person with schizophrenia as a person II: Approaches to the subjective and complex. The British Journal of Psychiatry, 164(suppl. 23), 103–107.Google Scholar
  32. Strauss, J., Hafez, H., Lieberman, P., & Harding, C. (1985). The course of psychiatric disorder, III: Longitudinal principles. The American Journal of Psychiatry, 142(3), 289–296.PubMedGoogle Scholar
  33. Wagner, L., & King, M. (2005). Existential needs of people with psychotic disorders in Pôrto Alegre, Brazil. The British Journal of Psychiatry, 186, 141–145. doi: 10.1192/bjp.186.2.141.PubMedCrossRefGoogle Scholar
  34. Winnicott, D. W. (1971). The location of cultural experience. In D. W. Winnicott (Ed.), Playing and reality (pp. 95–103). London: Tavistock.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.ChicagoUSA

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