from my own experience of psychotherapy with psychotic patients can confidently talk about the possibility of successful psychotherapy patients, when it is possible to fully or partially embed them into the society.
However, every case is unique.
And impossible at the first meetings to determine how the patient is available for psychotherapeutic intervention, except, perhaps, cases of psychosis, which became a reaction to heavy one-time stress. The state of psychosis might bring people for 1 session. Experience shows that if you are not able to do it for 1 session, it is not necessary to continue since it is, rather, will not yield results.
as for the problems derealization, auditory hallucinations ("voices") as well as the problems of the so-called basal (base) anxiety in some types of mental disorders, then the therapist it is important to identify:
- intellectual safety;
- the ability to at least a partial criticism of his fortune;
- the role of trauma in childhood, associated with a family history and upbringing;
- the presence of birth trauma (problems of pregnancy, delivery).
During psychotherapy these types of mental disorders it is advisable to start (after carefully studying the features of perception of the patient) to overcome specific fears. Even if you can deal with a few specific fears that can significantly reduce situational anxiety, it makes sense to continue psychotherapy with the aim of reducing General anxiety.
In this sense is quite revealing psychotherapy a young man who is 7-8 pages absolutely illogical describe your problem. From lengthy letters to highlight the main problems, which subsequently managed to cope, step by step, overcoming specific fears (to communicate, to bathe, brush your teeth, hang, become homeless...). The history of psychotherapy began with the letters on the psychological site, after which took place the psychotherapy on Skype with a length of per year.
so very short.
the Client asked for psychological help with the issues, "angry at the world drinking"; "inability to meet girls"; "the impotence and stupidity because of obsessive Masturbation".
the Client is 25 years old, graduated from College, worked periodically. Dismissed the cause of their problems, so often unemployed. She lives with her mother. Your diagnosis of "schizophasia" learned the code of the ICD. After severe stress 3 times for 2 months were treated permanently. Drugs basically do not accept, the disability has not. The birth of a baby with severe hypoxia. The burdened heredity: my father hung himself when he was 3 years old, the mother is an alcoholic, but a few years does not drink. An outcast from his school years, everywhere feels like an outcast. Dependence on computer games since I was 12. Thinking abstract, with elements of magic. The tests and questions adequately, the description of sensations, experiences, metaphorical, long-winded.
All customer problems are somehow connected with obsession of the dangers of alcoholism. At the beginning of psychotherapy the client has noted the complete absence of criticism of their actions: blame the country (chaos, rudeness, drinking mass), society people (aggression and pressure), "primitive" mother (humiliating, morally kills).
it Was carried out 20 hours polymodal psychotherapy via Skype for 1 year with the aim of reducing basal anxiety by overcoming specific fears, which were Intrusive ideas, thoughts, hallucinative experiences panic attacks client. To check the changes 3 times (beginning, middle, end), tests were carried out Sachs Levi "Incomplete sentences", icons.
All client requests were successfully solved: disappeared obsessions on the subject of alcohol, there is no compulsion Masturbation panic attacks when communicating with the girls.
the father went from hated to neutral. Towards mother remains strained, but the client stopped beside her to experience a panic attack. Painful experiences of the past forgotten, "not mine." Changed attitude: "I'm me and not a hamster under the baseboard, not the mouse under the current". No suicidal thoughts. Real began to perceive their problems. Believes that received the "male initiation" (began to feel himself a man, and before that wanted to change gender).
However, given the difficulty of diagnosis of the client, it is important to further observe its reactions in stressful situations and, if possible, the consolidation and generalization of positive changes in subsequent psychotherapy sessions.
If, immediately after the end of the session the client said, "Yes, I'm not made of pain and fear, but now what to do?" then 6 months after psychotherapy, he got a job. It is further possible resumption of psychotherapy in accordance with the desire of a young man who understands that there is still a need for continued psychotherapy.
Any occurrence described in the article with someone's life story consider casual.
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