Transcript Spirituality, Religion and Psychosis

What is real & what is not?
Isabel Clarke
Consultant Clinical Psychologist
What is real & what is not?: about the
programme.
• A 4 session group programme for an Acute inpatient
setting.
• Run by a clinical psychologist and one or two others –
trainees, nurses, OT etc.
• Builds on the Romme and Escher ‘Voices Group’
tradition
• Is different from other CBT approaches in normalizing
the difference in quality of experience in psychosis, as
well as thinking style.
• This normalization attacks stigma by associating
psychosis with valued areas such as creativity and
spirituality.
• Attempts to mitigate the damage to self concept of the
traditional, diagnosis, based approach.
The Project
• We have been running this group for a
couple of years, and are convinced it has
an impact
• We are using the grant to evaluate and
write it up
• We hope that the approach will be
adopted more widely – so that people with
psychosis can be given a more balanced
and hopeful message than at present.
This approach is based on my work on
Psychosis and Spirituality
Both spiritual experience and psychosis are
different in character from everyday
experience.
Instead of psychosis and spirituality, I propose
two ways of operating: two modes of
experiencing:
• The everyday
• The transliminal
Both of these are available to all human beings.
(but some people can access the transliminal more easily than
others – sensitivity; vulnerability; high schizotypy).
Both are incomplete.
The Everyday
• Ordinary
• Clear limits
• Access to full memory
and learning
• Precise meanings
available
• Separation between
people
• Clear sense of self
• Emotions moderated and
grounded
TheTransliminal
• Numinous
• Unbounded
• Access to ordinary
knowledge/memory is
patchy
• Connections abound - or
all is meaningless
• Self: lost in the whole or
supremely important
• Emotions: swing between
extremes or absent
Taking Experience Seriously in
Psychosis
• What is the nature of experience in
psychosis?
• Normalising the difference as well as the
continuity
• Sensitivity and openness to anomolous
experience – continuum with normality
• Understanding the role of emotion – where
expression of emotion is not
straightforward.
Evidence for the new Normalisation
• Schizotypy – a dimension of
experience: Gordon Claridge.
• Mike Jackson’s research on the overlap
between psychotic and spiritual
experience.
• Emmanuelle Peter’s research on New
Religious Movements.
• Wider sources of evidence – e.g.Cross
cultural perspectives; anthropology.
Therapeutic Alliance
• As this approach represents a new
normalisation, it can greatly aid the therapeutic
alliance
• The individual’s experience is taken seriously
and valued – at the same time as working on a
better relationship to shared experience
• It is possible to get away from illness language –
and arguments about diagnosis
• The schizotypy continuum is a good normaliser
– association of high s. with creativity etc.
The group programme: Session 1.
• Introduce Romme and Escher
• Extending from voices to other experiences that
people in general do not share.
• Idea of openness to voices and strange
experiences. Schizotypy spectrum. Artists etc.
David Bowie example.
• Examples from the group – what do they want to
get out of the sessions. Fill in goal form.
Session 2. The role of Arousal
shaded area = anomalous experience/symptoms are more accessible.
Level of
Arousal
High Arousal - stress
Ordinary, alert, concentrated, state of arousal.
Low arousal: hypnagogic; attention drifting etc.
Session 2 cont. DIALECTICAL BEHAVIOUR
THERAPY: Linehan’s STATES OF MIND applied
to PSYCHOSIS
Shared and Non-shared Reality
reasonable mind
Ordinary thinking
Shared reality.
wise
Mind –
in touch
With both
emotion mind
or open to other ways
of experiencing
Non-shared reality
in the present
in control
Discussion of Ways of coping suggested by this approach –
management of arousal and distraction.
Session 3: mindfulness & 4: making
sense.
• Introducing Focussing. Haddock research on
Focussing and Distraction.
• Mindfulness and focussing.
• Mindfulness exercise.
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How do people make sense of their
experiences? Disussion of different ways of
making sense of them.
• Clue: what was happening when they first
started?
• Feedback, summing up and completing the goal
sheet again.
The Challenge of Evaluation in the
Inpatient Setting
• People in crisis are not keen to fill in a lot
of questionnaires – and are not very good
at it.
• Even with only 4 sessions, consistency of
attendance and retention are a problem
• Qualitative methods would be ideal – but,
the Ethics Committee……..
Work in progress
• We have recruited an excellent researcher for
one day a week for 6 months
• She has attended the programme and
researched the literature.
• We are considering combining a couple of
questionnaires (a coping style questionnaire and
the standard CORE) with the ideographic goal
setting measure and a satisfaction
questionnaire, modified to measure impact on
self image.
• Service user and carer interviews might be
admissable without Ethics involvement.
Contact details, References and Web
addresses
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[email protected]
Hannah [email protected]
AMH Woodhaven, Calmore, Totton SO40 2TA.
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Clarke, I. & Wilson, H.Eds. (forthcoming) Cognitive Behaviour Therapy for
Acute Inpatient Mental Health Units; working with clients, staff and the
milieu. London: Routledge.
Clarke, I. (Ed.) (2001) Psychosis and Spirituality: exploring the new
frontier. Chichester: Wiley
Durrant, C., Clarke, I., Tolland, A. & Wilson, H. (2007) Designing a CBT
Service for an Acute In-patient Setting: A pilot evaluation study. Clinical
Psychology and Psychotherapy. 14, 117-125.
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www.SpiritualCrisisNetwork.org.uk
www.scispirit.com/Psychosis_Spirituality/