A mentally ill patient in a strait-jacket attached to the wa Wellcome V0016643ER.
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Therapeutic Work Begins
Following hospitalization (usually involuntary) in the locked ward of the local state facility, clients are referred to the aftercare agency. The clinic, which houses a staffed drop-in center and an activities program, as well as a team of therapists (of which I was a member), which functions as a link in a larger network providing services to chronically ill clients. These include the locked ward of the state hospital, a quarter-way house on the grounds of the hospital, two open wards at nearby general hospitals, staffed and cooperative apartments in the community, a number of sheltered workshops, a day hospital, and a mental health clinic.
The therapy team itself utilizes a family system, psychoeducational model incorporating the recent research of Anderson et al., Dincin et al., Brown et al., and Bowen. This model is implemented via individual and family therapy as well as through a network of groups led by team therapists. (Currently, the network includes regular meetings of a "next step" group for clients preparing to leave the locked ward, a client education group for clients in the community, two multiple-family groups [composed of schizophrenic clients and their parents], a parent support group, a sibling group, and a family education evening).
Key aspects of work with clients include aiding them in accepting and taking responsibility for their illness, the provision of up-to-date information on the dysfunction itself, and open discussion of the feelings associated with rehabilitation. Important discussions for family members include sharing of research data concerning family management in chronic mental illness and provision of relevant data about the illness and current treatments.
A non-blaming attitude (both toward themselves or the affected family member) was stressed. Themes discussed include violence, negotiations with professionals, and the need for limit-setting with the ill member. Keeping an on-going, satisfying family life in the midst of financial and social disarray is another common topic. Providing warmth and sustenance to the ill family member without overprotection was yet another concern.
The self-help aspects of such groups provide immediate opportunities for family members to care for and to offer knowledge to others, as well as to receive them from others. Professionals play roles as facilitators, psychotherapists, and teachers. Yet a clear message is given: family members and agency clients have much to contribute to one another. Grief, rage, guilt, frustration, shame, and anguish are the difficult feelings often accompanying these discussions. "At least," family members comment, "we are not alone."
Aftercare programs for clients and families such as this one, are still quite rare. Financial and legislative realities often make for understaffed programs and overworked professionals. And as Torrey notes: "Those who defy the laws of social gravity and devote their careers to the seriously ill stand out as exceptions...they are however always considered somewhat aberrant by their peers." As Torrey also states, the majority of mental health workers, including psychiatrists, want to treat comparatively healthy and insightful clients. Schizophrenic patients tend to be seen as dull and difficult - their families unimportant.
Applied Psychosynthesis
In this section, an overview of the use of psychosynthesis principles is presented in three contexts: (1) as individual counseling with schizophrenic individuals; (2) as utilized with families; and (3) as employed within a milieu treatment setting for the benefit of both staff and clients. Basic to work at each of these levels is the need to mobilize the natural helping and healing energies within a network of people - be they impaired individuals, family members, or staff persons.
Creating an atmosphere of trusting communication, good will, and intensive learning is the primary mode by which persons are able to redefine themselves as resources for, and helpers of, one another.
Because the principles of psychosynthesis are embedded in the process of life itself - and only articulated and formalized through theory and practice - it need not come as a surprise that healers dedicated to meeting the challenge of chronic mental illness have come upon, without needing formal training, the pragmatic approach described below.
My individual work with clients has been informed by the conscious use of psychosynthesis as well as family systems and object relations theory; however, others who have contributed to the work with individuals and families and to the creation of the climate of the treatment setting have had no formal training in psychosynthesis. Rather, they have accumulated a rich fund of theory and experience through years of work with the mentally ill.
Individual work with schizophrenic individuals must be done on a scaled-down basis in contrast to work with individuals diagnosed as borderline or neurotic. Generally, work is much more concrete since, for many clients, attention span and abstract thinking are quite impaired.
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