Theory and Psychopathology

Lines of thought

Humanistic Intervention in Psychosis

Roger's theory and therapy, applied to the psychotic client

Sometimes people understand psychosis or schizophrenia to be unrelenting, even with the intervention of psychotherapy. It is contended herein that therapy, and humanistic therapy in particular, can be helpful to the psychotic individual, but, perhaps, the therapist may have difficulty understanding how this approach can be applied to the problems of psychosis. Although it is a prevalent opinion in our society that schizophrenics are not responsive to psychotherapy, it is asserted herein that any therapist can relate in a psychotic individual, and, if therapy is unsuccessful, this failure may stem from the therapist’s qualities instead of those of the psychotic individual.

Carl Rogers created a theory and therapy indicated by the terms “humanistic theory” and “person-centered therapy.” This theoretical perspective postulates many important ideas, and several of these ideas are pertinent to this discussion. The first of these is the idea of “conditions of worth”, and the idea of “the actualizing tendency.” Rogers asserts that our society applies to us “conditions of worth.” This means that we must behave in certain ways in order to receive rewards, and receipt of these rewards imply that we are worthy if we behave in ways that are acceptable. As an example, in our society, we are rewarded with money when we do work that is represented by employment.

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In terms of the life of a schizophrenic, these conditions of worth are that from which stigmatization proceeds. The psychotic individuals in our society, without intentionality, do not behave in ways that produce rewards. Perhaps some people believe that schizophrenics are parasites in relation to our society. This estimation of the worth or the lack of it regarding these individuals serves only to compound their suffering. The mentally ill and psychotic individuals, in particular, are destitute in social, personal and financial spheres.

Carl Roger’s disapproved of conditions of worth, and, in fact, he believed that human beings and other organisms strive to fulfill their potential. This striving represents what Roger’s termed “the actualizing tendency” and the “force of life.” This growth enhancing aspect of life motivates all life forms to develop fully their own potential. Rogers believed that mental illness reflects distortions of the actualizing tendency, based upon faulty conditions of worth. It is clear that psychotic people deal with negatively skewed conditions of worth.

It is an evident reality that the mentally ill could more successfully exist in the world if stigmas were not applied to them. The mentally ill engage in self-denigration and self-laceration and these culminate in the destruction of selfhood. This psychological violence of the mentally ill toward their selves is supported by non-mentally ill others. The type of self-abuse by psychotic individuals would certainly abate if the normative dismissal of the mentally ill as worthless was not perpetuated.

In spite of a prevalent view that psychotic individuals are unsuccessful in the context of psychotherapy, Roger’s theory and therapy of compassion cannot be assumed to be unhelpful to the mentally ill. The key components of Rogers’ approach to psychotherapy include unconditional positive regard, accurate empathy and genuineness. Unconditional positive regard, accurate empathy and genuineness are considered to be qualities of the therapist enacted in relation to the client in terms of humanistic therapy. These qualities are essential to the process of humanistic therapy.

In terms of these qualities, unconditional positive regard is a view of a person or client that is accepting and warm, no matter what that person in therapy reveals in terms of his or her emotional problems or experiences. This means that an individual in the context of humanistic psychotherapy, or in therapy with a humanistic psychologist or therapist, should expect the therapist to be accepting of whatever that individual reveals to the therapist. In this context, the therapist will be accepting and understanding regardless of what one tells the therapist.

Accurate empathy is represented as understanding a client from that person’s own perspective. This means that the humanistic psychologist or therapist will be able to perceive you as you perceive yourself, and that he will feel sympathy for you on the basis of the knowledge of your reality. He will know you in terms of knowing your thoughts and feelings toward yourself, and he will feel empathy and compassion for you based on that fact. 

As another quality enacted by the humanistic therapist, genuineness is truthfulness in one’s presentation toward the client; it is integrity or a self-representation that is real. To be genuine with a client reflects qualities in a therapist that entail more than simply being a therapist. It has to do with being an authentic person with one’s client. Carl Rogers believed that, as a therapist, one could be authentic and deliberate simultaneously. This means that the therapist can be a “real” person, even while he is intentionally saying and doing what is required to help the client.

The goal of therapy from the humanistic orientation is to allow the client to achieve congruence in term of his real self and his ideal self. This means that what a person is and what he wants to be should become the same as therapy progresses. Self-esteem that is achieved in therapy will allow the client to elevate his sense of what he is, and self-esteem will also lessen his need to be better than what he is. Essentially, as the real self is more accepted by the client, his raised self-esteem will allow him to be less than some kind of “ideal” self that he feels he is compelled to be. It is the qualities of unconditional positive regard, accurate empathy and genuineness in the humanistic therapist that allow the therapist to assist the client in cultivating congruence between the real self and the ideal self from that client’s perspective.

What the schizophrenic experiences can be confusing. It is clear that most therapists, psychiatrists and clinicians cannot understand the perspectives of the chronically mentally ill. Perhaps if they could understand what it is to feel oneself to be in a solitary prison of one’s skin and a visceral isolation within one’s mind, with hallucinations clamoring, then the clinicians who treat mental illness would be able to better empathize with the mentally ill. The problem with clinicians’ empathy for the mentally ill is that the views of mentally ill people are remote and unthinkable to them. Perhaps the solitariness within the minds of schizophrenics is the most painful aspect of being schizophrenics, even while auditory hallucinations can form what seems to be a mental populace.

Based upon standards that make them feel inadequate, the mentally ill respond to stigma by internalizing it. If the mentally ill person can achieve the goal of congruence between the real self and the ideal self, their expectations regarding “what they should be” may be reconciled with an acceptance of “what they are.” As they lower their high standards regarding who they should be, their acceptance of their real selves may follow naturally.

Carl Rogers said, “As I accept myself as I am, only then can I change.” In humanistic therapy, the therapist can help even a schizophrenic accept who they are by reflecting acceptance of the psychotic individual. This may culminate in curativeness, although perhaps not a complete cure. However, when the schizophrenic becomes more able to accept who they are, they can then change. Social acceptance is crucial for coping with schizophrenia, and social acceptance leads to self-acceptance by the schizophrenic. The accepting therapist can be a key component in reducing the negative consequences of stigma as it has affected the mental ill client.

This, then, relates to conditions of worth and the actualizing tendency. “Conditions of worth” affect the mentally ill more severely than other people. Simple acceptance and empathy by a clinician may be curative to some extent, even for the chronically mentally ill. If the schizophrenic individual is released from conditions of worth that are entailed by stigmatization, then perhaps the actualizing tendency would assert itself in them in a positive way, lacking distortion.

In the tradition of person-centered therapy, the client is allowed to lead the conversation or the dialogue of the therapy sessions. This is ideal for the psychotic individual, provided he believes he is being heard by his therapist. Clearly, the therapist’s mind will have to stretch as they seek to understand the client’s subjective perspective. In terms of humanistic therapy, this theory would applies to all individuals, as it is based upon the psychology of all human beings, each uniquely able to benefit from this approach through the growth potential that is inherent in them. In terms of the amelioration of psychosis by means of this therapy, Rogers offers hope.

Note: This article was originally published on the website, Brainblogger.com

 

Ann Olson is a doctor of psychology, a writer of fiction, creative nonfiction and poetry.

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