ISPC/NWIDP Conference Report
Understanding the Experience of People with Psychosis. Chair: Frank Margison
Arbury Court, Warrington, September 2009
Linda Vickers, Psychotherapist (UKCP), Art Therapist (HPC)
Lothlorien Therapeutic Community, Corsock, Castle Douglas, Dumfries & Galloway DG7 3DR.
Email: lothlorien1@btopenworld.com
As a member of a therapeutic community nestled in the remote and rural Scottish Borders, the rare opportunity to spend a day deepening my understanding of the experiences of people with psychosis came as a welcome invitation.
Many of the residents at Lothlorien Therapeutic Community have a ‘schizophrenic’ diagnosis; and express despondency with mainstream treatment options, arriving with high, (and often unrealistic), expectations of therapeutic community. Whilst able to provide a reparative living situation, we are sadly unable to spontaneously ameliorate the suffering of psychotic experience; and as in any other clinical setting we grapple with finding meaning in, and solutions to, mental suffering. Until now, the bulk of my experience has been within the NHS, where I have been strongly placed in my professional role as ‘one who is supposed to know’. The new and recent experience of working in a therapeutic community setting, with its breaking down of distinctions between the ‘well’ and ‘unwell’, has challenged my well-established and secured professional identity. As a member of the community, I am present in a more commonplace way, and thus relating to residents far more frequently than the clinical settings I am accustomed to.
Consequently, Lars Thorgaard’s presentation of relationship treatment in psychiatry was timely, in addressing precisely those areas I am wrestling with. His diagnostic manual is based on empathic relationship, and an acknowledgement that the patient’s general life conditions are common to us all. Lars proposes that manifestations of psychosis are a person’s attempt to find security, and introduces a model which promotes security and self-mastery. Key to this is establishment of the patient’s attachment to the therapist, so that s/he may be persuaded to work with his/her mind. Lars’ manual is used by mental health workers in Denmark, and I am sure that a translation into English of his 5 volume work, ‘Relationship Treatment in Psychiatry’ would be widely appreciated – any linguists out there?
Lars’ live supervision session was an opportunity to see his model in practice, and I was moved by his skilful and sensitive approach. Lars encouraged us to give attention to the existential predicament of the patient. As observers we were invited to offer our interpretations. Many were offered, reflecting the diversity of the participants, (around a hundred people from many clinical settings around the UK). As Lars reminded us, we cannot know all the answers, and part of our work with patients is to be able to withstand the unknown. Lars’ incisive questioning and reflection certainly provided food for thought; and this introduction to his approach has since informed and enhanced my practice.
Parallel workshops were offered in morning and afternoon sessions, and I was not able to be present for them all: Harriet Fletcher’s ‘Using Psychodynamic Principles in Formulation’, and John Gale and Beatriz Sanchez’ ‘Using Lacanian Thinking in Working with Psychosis’. James van Lint presented NICE research findings of the efficacy of Arts Therapies in working with the negative symptoms in schizophrenia ; and afforded participants an experiential taster. Janey Antoniou gave a clear and thorough account of the NICE research procedures and outcomes from a service user prospective; and gave me an appreciation for the hard work put in, and the need for continued involvement in the research process. Last speaker of the day, Nigel Bunker, Consultant Clinical Psychologist, gave a realistic, as well as positive, overview of the place of psychodynamic practitioners within national mental health services; and reminded us of the necessity keeping our fingers on the pulse.