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Freud stated that one component of happiness is love. Correspondingly, one aspect of wellbeing is appropriate emotional attachment. Relationships, especially when they reflect the needs of the mentally ill individual, can counteract the problems of alienation and a lack of relational success, which typify mental illness, to a significant extent.
Essential to success in the arena of love and attachment depends on the appropriate “fit” of relational activity with respect to the unique needs, abilities, and skills of that individual. The need for practical success in relational spheres is paramount to the wellbeing of all people, but this need is seen most poignantly in the mentally ill.
Often, relational activity is compromised in the mentally ill. This is true of various psychological and psychiatric disorders that include psychotic disorders and borderline personality disorder (BPD).
These symptoms can include sporadic and spontaneous anxiety, ongoing subjective distress, impulsivity, mood fluctuations, flat affect and dissociation or emotional withdrawal, and symptoms of paranoia. Note that these disorders have components of anxiety and disrupted social relationships, especially in terms of the realities of distorted interpersonal boundaries. Note, also, that emotional attachment and detachment signified by very weak and insecure boundaries, such as seen in BPD, and the very strong and isolative boundaries associated with psychotic disorders, will profoundly affect negatively these individuals’ ability to negotiate relationships.
Mental illness may evolve or mutate most prominently with the circumstances of changing interpersonal activity. It is important to have a significant other in one’s life, such an individual may be characterized by a caretaker, a friend who accepts the truthful realities of one’s mental illness, or a spouse who understands the extremes of one’s illness.
The benefits of group intervention
Moreover, the mental or the behavioral health system often conducts groups for even severely mentally ill individuals. Group and individual psychotherapy with these people is paramount in treating the emotional and the relational components of these disorders.
One aspect of group intervention with psychotic clients, who often have trouble connecting with caregivers and therapists, may be the cultivation of an atmosphere in the group that allows for the honest expression of an
individual’s hallucinations and delusions, allowing for an explanation of how these thoughts and feelings are construed by that individual.
The actual intervention in this scenario would be to ask the peers of the divulging client to express how he or she thinks it feels to hold the beliefs of that individual. This is an example of how to treat psychotic disorders, and a lessening of paranoia may emerge in the psychotic client.
Impulsivity and subjective distress, in addition to disrupted and diffuse boundaries, characterize borderline personality disorder. Linehan’s Dialectical Behavioral Therapy (DBT) has been shown to be effective in treating this disorder. The curative essence of this theory and therapy seems to be the cultivation of an accepting relationship with the client and the treatment of the client’s stated needs and concerns with respect. By asking the client what she needs “right now”, the client is much more likely to conceptualize her issues as surmountable, at least in terms of the immediacy in meeting her needs.
This juxtaposition of ”process” and “content´ represents the dialectical component of this therapy. It contains the practice of treating the client with implacable goodwill, and this component of DBT is both innovative and illuminating.
The links between psychopathology and interpersonal relationships
It is interesting and it may be the case that psychotic disorders and personality disorders may reside on a continuum of more or less psychopathology and functional relational connectedness. While both types of disorders are severe, they entail differences in terms of relational closeness with others: friends, significant others, family members and caregivers, clinicians, psychologists and psychiatrists.
Essentially, the individual with BPD may have insecure attachments with other people, who may be perceived as significant or not so in the life of the individual, by that individual, consciously or unconsciously. It is the perception of the client with BPD that his relationships are unreliable and untrustworthy. Treatment for BPD should be enacted with implacable good will, and, while the BPD client may founder in distress and distrust of her clinician, eventually, perhaps, that client will begin to stabilize in valuing and devaluing the clinician in a balanced way.
Implications for therapy and treatment
In terms of psychotic disorders, the individuals manifesting them are much less treatable by means of traditional individual psychotherapy. It should be noted that the emotions in those with psychotic disorders may be dormant, unconscious and trampled into oblivion by the realities of punitive symptoms culminating in learned helplessness.
Their thought processes also may be compromised by limited frontal lobe activity, either as a direct causal element in the presentation of psychotic disorders, or emerging from the psychotic individual’s inability to
think logically about his non-normative experience.
However, while they may be much less able to express their feelings than those individuals with BPD, there are ways to elicit expression of their feelings. Creative self-expression may be at least a partial means of allowing the psychotic individual to find a recapitulation of her internal feelings. By means of visual art and creative writing, the psychotic client may be able to express dormant feelings that allow her to project onto her artwork a reflection of her internal state.
As is known, projection of one’s internal state in terms of self-reflection is crucial to effective psychotherapy. Art therapy serves this need as well.
Overall, relationship and interpersonal connectedness are essential to psychological wellbeing. Freud stated that love is an aspect of happiness. While many interpersonal relationships do not equate with love, more or less, relationships with others signify an important treatment concern, and this concern should be translated into action by establishing endeavors to reach the client in terms of his core – sometimes utilizing creative methods.
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