Some Notes on Schizophrenia and the Strategic Psychotherapy of Direct Confrontation
Executive Director of the Anne Sippi Foundation for Training and Research
Schizophrenia is a condition that develops over a period of time. This condition may have an organic base but environmental conditions need to exist for the illness to eventually erupt, surface and become a single reality in that persons' life. The beginnings develop early and grows usually without it being perceived by the patient and/or her family. There are indications of some disturbances in that person, however, the problems and developing conflicts are difficult to isolate, not only by those around the patient, but even by the professional psychotherapist or psychiatrist. Schizophrenia is very poorly defined in the literature even though Morel, Kraeplain, Bleuler, Schneider and Langfeldt have classified and reclassified the symptoms and characteristics of schizophrenia, as has the DSM codes of the American Psychiatric Association. The symptoms and characteristics do not explain this human process, which has been defined more accurately as a syndrome or many related disorders that could be caused by a multitude of factors. It is vital that this condition is clarified in terms that suggests a sense of logic that demystifies the condition and allows all of us a better understanding of these individuals not only for treatment purposes, but for the sake of their humanity.
I will suggest a simple definition that might clarify the issues of schizophrenia after its apparent early onset. It should be understood that even though it seems to surface suddenly, that it has been growing in that person for years. So to repeat, the onset is not a quick reaction, but is preceded by a pre-morbid condition that is indicative of this serious mental disharmony. The beginning phase is one filled with terror. These are terrified human beings and that great fear leads to a disintegration and dissolution of that persons identity. She doesn't know who she is or where she comes from. She has annihilation fantasies and fears destruction. This enormous fear drives the person backwards until she can develop around her a system of defenses. The fear is processed by the person into a number of symptoms, such as delusions, hallucinations and paranoia. There are those who believe that this represents the organisms attempt to cure itself. It does serve to reduce that great fear and out of this comes a new identity with its own logic and language, that we call schizophrenia. This system of life is to that person a survival mechanism that becomes resistant to change, because it represents life to that person. With these thoughts in mind, it is imperative that we understand that the patient may see herself as being well and often denies that she is sick or needs help. How can we contact that human being in such a way that she will allow us into her life and the bond between psychotherapist and patient will grow strong enough to begin the process of recovery.
I will attempt to explain a psychotherapeutic method that points out one of the roads that we can take in sharing with the patient, the agony of her existence. However, we must make an honest evaluation of treatment and with an open mind allow ourselves to acknowledge our failures so we can create more effective treatment methods.
Traditional psychotherapy and other treatment modalities have not succeeded well enough with patients who are diagnosed as schizophrenic, because their approach has been focused on the patient gaining insight and dealing with intrapsychic conflicts. With the long term schizophrenic patient, we have found that in many cases, these patients cannot process insights well enough to effect behavioral changes. We are proposing a treatment, that is not a priori, but a result of many years of experience and that has as its first step the establishment of relatedness. If we do not succeed in this first step, treatment cannot go beyond the initial stage. Our active and direct treatment methods have a design that depends on this first step. It focuses on the present dysfunctional behaviors of the patient, so that reality has a stronger part in the life of the patient. We believe that an emphasis on problem solving and reality based goals lead to achievements that are ego building and tend to reduce delusional conflicts and effect a sense of relief, freedom and reward. Psychotherapeutic efforts are directed towards building on the positive and healthy parts of the patient, that aids in remotivating that person to look towards reality, rather than wallow in the defenses that the psychosis has persuaded her to build. If properly nurtured, this first step, the establishment of relatedness, leads to a collaborative effort that becomes an alliance between the patient and psychotherapist. Without this alliance, there is no treatment. However, it is essential that we understand the treatment alliance is not necessarily constant during the course of psychotherapy and the allied treatment modalities.
The psychotherapist and other members of the treatment team and the patient often, unconsciously, say or do things that rupture or break the alliance. The treatment team must always be alert and sensitive to these possibilities and should it happen, bend their collective efforts at repairing the breach in this critical relationship. This rupture in the alliance happens with some frequency as the struggle to change takes place. However, every time this breach in the alliance is resolved, the relationship becomes stronger.
I must repeat, it is critical for the psychotherapist to understand that treatment that leads to corrective behavioral changes cannot take place without making contact with the patient that leads to a therapeutic alliance. Let me add, that even those psychiatrists who prescribe medication, must develop such a relationship with the patient in order for medication to have a maximum effect.
Psychotherapy can be called strategic if the clinician initiates what happens during therapy and designs a particular approach for each problem. He must identify solvable problems, set goals, design interventions to achieve these goals, examine the responses he received to correct his approach and examine the outcome of his therapy to see if it has been effective.
During the first half of this century, clinicians were trained to avoid planning or initiating what was to happen in therapy and to wait for the patient to say or do something. Only then, could the therapist act. Under the influence of psychoanalysis, Rogerian (Carl Rogers) therapy and psychodynamic therapy, the idea developed that the person who does not know what to do and is seeking help, should determine what happens in the therapeutic encounter. The clinician was expected to sit passively and only interpret or reflect back to the patient what he was saying and doing. He could offer only one approach no matter how different the kinds of people or what the problems were. This passive approach lost for the clinical profession many effective therapeutic strategies. Strategic therapy is not a particular approach or theory, but it is simply a name for those types of therapy where the therapist takes responsibility for directly influencing people.
Before and in the 1950's a number of strategic therapists began to grow. Family therapy and the conditioning therapies and the direct therapies started with the early Freudians and continues now with the work of a growing number of active psychotherapies.
Today, the issue of psychotherapy with schizophrenia is confusing to many people in the field, because of the conflict between active and passive methods of interaction. We should understand that decades ago, psychotherapists were persuaded to stop talking and start listening. So completely was this achieved, that the great need today is to start the psychotherapist talking again. It should be clear that the contributions that the older psychotherapies have made, need to be acknowledged, but experience has pointed out, I believe, that this is the time for active therapies that stand in the sharpest contrast to psychoanalysis, both in their techniques and in their claims to be seen, as a result of studies in many parts of the world. Psychoanalysis has proven itself remarkably able to understand patients, but point to the extraordinary difficulty it has changing the patients behavior, despite frequent and prolonged contact. Active therapists have been more successful in changing the patients without the same understanding of traditional psychotherapy and psychodynamics. We must always be open to change, as outcome and research studies mandate the need for change.
I will make an effort to point out some of the significant features of direct confrontation. However, it is critical that one understands that confrontation is more than an overtly aggressive method of dealing with the long term schizophrenic and that one understands that confrontation can be subtle, with many other variations. Also, that it is a unilateral effort on the part of the psychotherapist that is basically designed to intrude on the patients sick behavior and disrupt the psychosis and produce different sets of behavior that are more consistent with the expectations and demands of society. The following will include the strategies that both the patient and the psychotherapist use in their respective efforts. The patients efforts at retaining her psychotic equilibrium and the therapists efforts at breaking down these defenses.
Confrontation can be seen as a forceful intervention. The psychotherapist may make his remarks in a forceful rather than in a gentle fashion in order to make sure his patient hears what he has to say. However, depending on the patient as a unique individual, a gentle way of stating something or a bit of humor might confront her with something she has resisted.
The term "force" can disturb people if it is not understood as being demanding of the patient to meet the treatment criteria. It is not in any sense abusive or disrespectful of the patient. We can not forget that psychotherapy with long term schizophrenics is an influence process. We use psychotherapy to promote change. Many patients are not changed by insight, simply because the illness serves as a survival system and the patient refuses and fights against change.
The psychotherapist when he confronts, has in mind getting the patients' attention, producing a reaction in her and demanding that she change. The strategies the psychotherapist has at his disposal are his own emotions and his understanding that he needs to use language to create a sense of reality in the patient. The psychotherapist must use words, at times, to shock the patient and make her aware that she is facing a person who is different than the other psychotherapists she has seen in the past. One of the important points of confrontation is unmasking or uncovering denial, which can take many forms. Another important treatment issue is making the patient aware of any behaviors that lead to disrupting regressive reactions, letting the patient know how her regressive unappreciative demanding behavior effects other people, including the therapist and that their are conditions to a relationship and that some behaviorisms are just not acceptable. He must insist that the patient become responsible for her behavior and that she control her impulses.
As one uses confrontation methods properly, I believe they tell the patient that the therapist has a genuine interest in her and wants to help. Also that the psychotherapist is stronger than the overwhelming aspects of the patients' schizophrenia. There is a sense of safety and security in this realization. The character structure of a patient can determine her response to a confrontation, it is important to continue the confrontation as long as the patient distorts her perception of the psychotherapists meaning and continues to manipulate those people who are treating her in order to perpetuate her condition. Anger on the psychotherapists part is not necessarily counter- transference, but should also be seen as one human beings response to another persons unacceptable behavior. We must accept the reality of our emotions in the context of treatment and in an acceptable way permit the patient to know how we feel about her. Confrontation is helpful in establishing a therapeutic alliance and useful in reconstructing the healthier defenses in the patients' life when the disturbed defensive strategies of the patient are overcome.
This in brief are some ideas that can actively involve the schizophrenic patient in treatment.
For more information on treating schizophrenia with medication, minimum medication AND lots of therapy combined with humanity, please go to www.schizophrenia-help.com and www.schizophreniatherapy.com. Took me 8 years to find this place and it is well worth it for the treatment of schizophrenia.
Thursday, February 7, 2008
schizophrenia recovery - whay can't they recover?
WHY CAN’T THEY RECOVER?
Over the years victims of schizophrenia have been considered by many mental health professionals as being chronic with no hope for recovery. I believe chronic is an anchronism. There is a great deal of research that points out that individuals with schizophrenia can make good social recoveries.
However, psychiatrists, psychologists alike have abandoned these individuals and have relied primarily on the physical methods of treatment. Indeed, the old treatment models viewed patients as hopeless cases who needed to be stabilized with hospitalization, and then maintained with medications. The heavy tranquilizing effects of these drugs made management of patients easier, although they only masked the condition. The newer generation of medications do the same with less side effects even though those claims are disputed.
We know that denial is one of the major defense mechanisms of these patients. But this is also true of the professionals, i.e. psychiatrists and psychologists etc., who laugh at and deny the claims of those who have recovered from this dreadful disorder.
In 1957 Karl Menninger wrote “The psychotherapy of schizophrenia is, in my opinion, as much in the mind of the observers as in the mind of the patient. We must change before he can change. He has long been incurable because we have been hopeless.”
Psychotherapy is one treatment tool. I have practiced it for 48 years with success. Not all the patients I treated have recovered, however, many have and I believe many more could have if the atmosphere was more hopeful and there were better community resources.
Between 1913 and 1923 and 1943 through 1952 significant changes in patients with different levels of schizophrenia were made in some American hospitals leading to discharge - some 55 to 71% of patients recovered well enough to be discharged back into their communities. I believe this was due to better patient care. After the medications became the primary treatment effort - the human part of treatment - the hope and optimism diminished. It was widely reported that by 1970 there would be no more schizophrenia because of the medications and psychiatriatric hospitals would not longer be needed for that perpose, i.e., to house schizophrenic patients.
I am not opposed to the use of medication as one treatment tool however, what we are doing is abnormalizing the patient by using the traditional forms of treatment and over using medication. What we need to do is normalize treatment by dealing with reality issues and determining when and how much medication is therapeutic. Research points out that reducing medication by two thirds in many patients combined with other treatment methods is successful in the recovery process, and contrary to popular belief individuals with schizophrenia have, do and will recover providing that there is a hopeful attitude in the treatment milieu.
Freda Fromm Reichman who was one of the three earlier contributors to the psychotherapy of schizophrenia, said years ago - “What is effective in therapy is patients experiences of therapy as a helpful and constructive human relationship that reinforces their efforts to come to terms with a troubled past, not an explanation of how and why they became the kind of people they are”.
The term treatment resistance by definition means that there are patients who do not respond to some treatment methods, it does not suggest and it should not be understood as saying that those individuals cannot make changes with changing treatment approaches. Yet the term treatment resistance is used commonly amongst professionals in the field, suggesting that individuals with schizophrenia cannot change. In 1990, I wrote a paper with a colleague entitled, The Use of Direct Confrontation in the Treatment Resistant Schizophrenic Patient, it was published in the Journal Acta Psychiatric Scandinavca, 1990: 81;352-358. What it stated with emphasis was that we felt that treatment resistant applied more to the professional that it did to the patient. As a psychotherapist, I cannot think of such a term as being relevant if I intend to work with the long term schizophrenic. If I need some reason to avoid the treatment of the individual who has this very difficult condition called schizophrenia - then of course this term is a very convenient retreat route for me.
What I set forth in this Newsletter, is not only true in the USA, I have visited and worked in 16 countries frequently and with some exceptions the same is true throughout the world. The failure, of treatment is international. Not because of the severity of the conditions of the serious mentally ill individuals but because of the failures in the professional world. The pessimistic outlook regarding treatment for schizophrenia has influenced the professional world to retreat from developing training centers - for students and professionals to acquire treatment skills for the person with schizophrenia and other serious mentally ill patients. Stigma is not only part of the lay public but also is rampant amongst psychiatrists, psychologists and other mental health personnel. This is also a treatment tragedy. The ignorance of the field in such areas as psychosocial rehabilitation and psychotherapy is epidemic.
It has been some years past that the principles and or ideas of psychosocial rehabilitation have been introduced. Even though there is some recognition of its value - on an international scale - there are not enough treatment centers established to meet the needs of the millions of individuals world wide. Is it the money? Isn’t it true that not affording proper care costs much more not to ignore the cost in human suffering.
There is no doubt that this treatment effort is a critical part of the overall approach to the serious mentally ill. We hear much about biopsychosocial treatment and its value - but how much of it is being done? Also, I have emphatically stated that this approach will be more successful with an active psychotherapy to support its gains. But how do we press home the importance of training medical and psychology students in these areas. Certainly psychologists and students of psychology should be introduced to the fact that people with these disorders can recover given the “right” kind of treatment. To quote William Anthony Ph.D. at Boston University, a distinguished contributor in psychosocial rehabilitation “Psychology as a field has not focused its training in the area of serious mental illness. This is a message that consumers have been bringing to us but we haven’t been listening. Too many psychologists remain unaware of the new hope and have shown little interest in working in schizophrenia”.
In 1999 Ronald F. Levant EdD told a group of fellow psychologists how recovery from a major disorder such as schizophrenia was not only possible, it was happening regularly. “Recovery from schizophrenia: a colleague snorted, “Have you lost your mind too”?
Those of us who have spent years working with schizophrenia and know those who have recovered - have heard so many times - “that person must have been misdiagnosed”. What a terrible declaration. Those who think this way and convey this as professionals - whatever their discipline - do indeed created a self - fulfilling prophecy!
Courtney M. Harding Ph.D. - University of Colorado did a research study of a group of patients released from Vermont State Hospital between 1955 and 1960 in a state funded, early model bio-psycho-social rehabilitation program. The 269 patients chosen for the Vermont model study, were classic back ward cases - those diagnosed with chronic schizophrenia and deemed unable to survive outside of a hospital.
In the 1980’s when Harding and her colleagues tracked down and interviewed all but 7 of the original 269 patients - 32 years in most cases, after their first admission to the hospital. Hardings study in The American Journal of Psychiatry (Vol. 144, No.6 p.718-735) showed that 62% to 68% of those former back ward patients showed no signs at all of schizophrenia. There have been many studies in the USA and other countries that point out that treatment - if practiced in a way that provides patient training leads to a normal life style - that includes jobs, education, and social skills training and relieves the guilt and loneliness associated with these conditions - then even the lowest level of schizophrenia can change and be reduced or eliminated from the lives of those who suffer this condition. The tragedy is that somehow - professionals - all over with some exceptions do not believe this is a reality. What’s wrong with them?
Now for many success stories, 60 minutes profiled the Anne Sippi clinic in California, schizophreniatherapy.com and schizophrenia-help.com. The founder Jack Rosberg is truly one of the few who has had success treating people suffering from schizophrenia combining therapy with medication. I can tell you it works because my brother Dan has benefitted from it. the journey has been long, the steps are short, but in the right direction. My brother Dan is treatment resistant, yet he has been able to claim some of his life back thanks to the Anne Sippi Clinic.
Over the years victims of schizophrenia have been considered by many mental health professionals as being chronic with no hope for recovery. I believe chronic is an anchronism. There is a great deal of research that points out that individuals with schizophrenia can make good social recoveries.
However, psychiatrists, psychologists alike have abandoned these individuals and have relied primarily on the physical methods of treatment. Indeed, the old treatment models viewed patients as hopeless cases who needed to be stabilized with hospitalization, and then maintained with medications. The heavy tranquilizing effects of these drugs made management of patients easier, although they only masked the condition. The newer generation of medications do the same with less side effects even though those claims are disputed.
We know that denial is one of the major defense mechanisms of these patients. But this is also true of the professionals, i.e. psychiatrists and psychologists etc., who laugh at and deny the claims of those who have recovered from this dreadful disorder.
In 1957 Karl Menninger wrote “The psychotherapy of schizophrenia is, in my opinion, as much in the mind of the observers as in the mind of the patient. We must change before he can change. He has long been incurable because we have been hopeless.”
Psychotherapy is one treatment tool. I have practiced it for 48 years with success. Not all the patients I treated have recovered, however, many have and I believe many more could have if the atmosphere was more hopeful and there were better community resources.
Between 1913 and 1923 and 1943 through 1952 significant changes in patients with different levels of schizophrenia were made in some American hospitals leading to discharge - some 55 to 71% of patients recovered well enough to be discharged back into their communities. I believe this was due to better patient care. After the medications became the primary treatment effort - the human part of treatment - the hope and optimism diminished. It was widely reported that by 1970 there would be no more schizophrenia because of the medications and psychiatriatric hospitals would not longer be needed for that perpose, i.e., to house schizophrenic patients.
I am not opposed to the use of medication as one treatment tool however, what we are doing is abnormalizing the patient by using the traditional forms of treatment and over using medication. What we need to do is normalize treatment by dealing with reality issues and determining when and how much medication is therapeutic. Research points out that reducing medication by two thirds in many patients combined with other treatment methods is successful in the recovery process, and contrary to popular belief individuals with schizophrenia have, do and will recover providing that there is a hopeful attitude in the treatment milieu.
Freda Fromm Reichman who was one of the three earlier contributors to the psychotherapy of schizophrenia, said years ago - “What is effective in therapy is patients experiences of therapy as a helpful and constructive human relationship that reinforces their efforts to come to terms with a troubled past, not an explanation of how and why they became the kind of people they are”.
The term treatment resistance by definition means that there are patients who do not respond to some treatment methods, it does not suggest and it should not be understood as saying that those individuals cannot make changes with changing treatment approaches. Yet the term treatment resistance is used commonly amongst professionals in the field, suggesting that individuals with schizophrenia cannot change. In 1990, I wrote a paper with a colleague entitled, The Use of Direct Confrontation in the Treatment Resistant Schizophrenic Patient, it was published in the Journal Acta Psychiatric Scandinavca, 1990: 81;352-358. What it stated with emphasis was that we felt that treatment resistant applied more to the professional that it did to the patient. As a psychotherapist, I cannot think of such a term as being relevant if I intend to work with the long term schizophrenic. If I need some reason to avoid the treatment of the individual who has this very difficult condition called schizophrenia - then of course this term is a very convenient retreat route for me.
What I set forth in this Newsletter, is not only true in the USA, I have visited and worked in 16 countries frequently and with some exceptions the same is true throughout the world. The failure, of treatment is international. Not because of the severity of the conditions of the serious mentally ill individuals but because of the failures in the professional world. The pessimistic outlook regarding treatment for schizophrenia has influenced the professional world to retreat from developing training centers - for students and professionals to acquire treatment skills for the person with schizophrenia and other serious mentally ill patients. Stigma is not only part of the lay public but also is rampant amongst psychiatrists, psychologists and other mental health personnel. This is also a treatment tragedy. The ignorance of the field in such areas as psychosocial rehabilitation and psychotherapy is epidemic.
It has been some years past that the principles and or ideas of psychosocial rehabilitation have been introduced. Even though there is some recognition of its value - on an international scale - there are not enough treatment centers established to meet the needs of the millions of individuals world wide. Is it the money? Isn’t it true that not affording proper care costs much more not to ignore the cost in human suffering.
There is no doubt that this treatment effort is a critical part of the overall approach to the serious mentally ill. We hear much about biopsychosocial treatment and its value - but how much of it is being done? Also, I have emphatically stated that this approach will be more successful with an active psychotherapy to support its gains. But how do we press home the importance of training medical and psychology students in these areas. Certainly psychologists and students of psychology should be introduced to the fact that people with these disorders can recover given the “right” kind of treatment. To quote William Anthony Ph.D. at Boston University, a distinguished contributor in psychosocial rehabilitation “Psychology as a field has not focused its training in the area of serious mental illness. This is a message that consumers have been bringing to us but we haven’t been listening. Too many psychologists remain unaware of the new hope and have shown little interest in working in schizophrenia”.
In 1999 Ronald F. Levant EdD told a group of fellow psychologists how recovery from a major disorder such as schizophrenia was not only possible, it was happening regularly. “Recovery from schizophrenia: a colleague snorted, “Have you lost your mind too”?
Those of us who have spent years working with schizophrenia and know those who have recovered - have heard so many times - “that person must have been misdiagnosed”. What a terrible declaration. Those who think this way and convey this as professionals - whatever their discipline - do indeed created a self - fulfilling prophecy!
Courtney M. Harding Ph.D. - University of Colorado did a research study of a group of patients released from Vermont State Hospital between 1955 and 1960 in a state funded, early model bio-psycho-social rehabilitation program. The 269 patients chosen for the Vermont model study, were classic back ward cases - those diagnosed with chronic schizophrenia and deemed unable to survive outside of a hospital.
In the 1980’s when Harding and her colleagues tracked down and interviewed all but 7 of the original 269 patients - 32 years in most cases, after their first admission to the hospital. Hardings study in The American Journal of Psychiatry (Vol. 144, No.6 p.718-735) showed that 62% to 68% of those former back ward patients showed no signs at all of schizophrenia. There have been many studies in the USA and other countries that point out that treatment - if practiced in a way that provides patient training leads to a normal life style - that includes jobs, education, and social skills training and relieves the guilt and loneliness associated with these conditions - then even the lowest level of schizophrenia can change and be reduced or eliminated from the lives of those who suffer this condition. The tragedy is that somehow - professionals - all over with some exceptions do not believe this is a reality. What’s wrong with them?
Now for many success stories, 60 minutes profiled the Anne Sippi clinic in California, schizophreniatherapy.com and schizophrenia-help.com. The founder Jack Rosberg is truly one of the few who has had success treating people suffering from schizophrenia combining therapy with medication. I can tell you it works because my brother Dan has benefitted from it. the journey has been long, the steps are short, but in the right direction. My brother Dan is treatment resistant, yet he has been able to claim some of his life back thanks to the Anne Sippi Clinic.
Schizophrenia withour medication
Is it possible to treat schizophrenia without medication?
The answer in my opinion is no. My brother is treatment resistant in the schizophrenia spectrum of a range that puts him in the minority, he is being treated with the minimum of medication. This is thanks to a wonderful program in California that treats schizophrenics with humanity and respect. The clinic mentioned below can be found at www.schizophrenia-help.com and www.schizophreniatherapy.com. IN NO WAY, am i being asked to solicit this clinic that treats people suffering from schizophrenia. My brother is a patient and I can vouch for the humanity and care he has been given, found NOWHERE else in the world. I searched far and wide and was lucky to have the funds to do it. After 8 years of searching, I found this clinic on 60 minutes, believe it or not. Went there the next day and hid in the bushes.
that's right... I wanted to see how people were treated that noone was looking. I found what I was looking for. The nightmares of the Menninger foundation were over. Here was a place that truly cared for people suffering from schizophrenia and I hope you read the story of this wonderful clinic that has allowed my brother to claim somewhat a life away from hallucinations, and just being so totally lost.
here is the story of the clinic in the words of his founder, Jack Rosberg.
The seeds of the Anne Sippi Clinic were sown long before its emergence in 1975. I began my career in 1954 supervised by John N. Rosen, M.D. in Bucks County, PA. Dr. Rosen was, along with Harry S. Sullivan and Freida Fromm Reichman, one of the earliest contributors to the psychotherapy of schizophrenia in the United States. He introduced a very active treatment for schizophrenia form with the most severely regressed schizophrenic patients. His approach aroused the curiosity of the professional world. To quote Lawrence Kubie:"if nothing else, he rocked the professional world out of its complacency." Rosen had his professional practice outside of hospitals and his patients resided in houses in a farming community, which in those days and even today, represents a unique treatment setting for schizophrenia .
I had the privilege of developing a treatment direction for schizophrenia during my work with Rosen that I later called Direct Confrontation. When I left Dr. Rosen in mid 1957 and entered into private practice in dealing with patients diagnosed as schizophrenic in private hospitals in Los Angeles, CA., it became increasingly apparent to me that treatment with the serious mentally ill was severely hampered by the restrictions imposed by a staff that focused treatment with these patients on the medical model. The physical methods of treatment, such as Electric Convulsive Therapy, the growing emphasis on medication for schizophrenia as a treatment of choice and the long periods of time spent in psychiatric hospitals were iatrogenic. Many great contributors including Eugene Bleuler, who coined the term schizophrenia, cautioned about the negative effects of long term hospitalization. My primary interest was and is the psychotherapy of schizophrenia. I found, much to my surprise, quite early in my career, the different and innovative directions in treatment other than traditional methods disturbed the professional world around me and many obstacles were strewn in my path. However, despite this I continued working with patients actively with the growing realization that effecting a relationship and a shared belief system, led to a more positive and lasting outcome than the palliative measures used by the majority of the professionals in the world of mental health.
The developing course of my treatment direction stimulated the interest of professionals from the psychoanalytic to the reality oriented and even to the Orthomolecular world. These were mature individuals. People who could look at new ideas and treatment directions, without any preconceived ideas. Professionals, such as Martin Grotjahn, M.D. a distinguished training analyst. Psychiatrists, Humphrey Osmond, Abraham Hoffer, Harvey Ross and a host of those involved in other treatment directions, became supportive as they perceived my efforts influencing change with regressed schizophrenics. It was Dr. Harvey Ross who introduced me to Anne Sippi, a young woman, hospitalized at a small psychiatric hospital in Los Angeles. I was told by staff members that this woman was hopeless and that nothing could be done to help her. Dr. Ross asked me to do a consultation with Anne Sippi, who he had worked with for a considerable period of time. He believed that she could not be successfully treated and was about to recommend custodial care in a state hospital. I was the last stop it appears before that happened. I had developed a reputation of dealing with the most difficult population.
Anne Sippi had been sick, since childhood. She was treated and hospitalized many times with no significant relief from the ravages of her schizophrenic condition. She was violent much of the time and also restrained more often than not, in these hospitals. She was a terrified human being, when I met her. Her vocabulary had shrunk to several words. Her fear and resulting violence persuaded hospital staff to stay away from her as much as possible. In her terrified state, this woman, this human being, was left alone to deal with the nightmare of her existence. My first contact with her was a dynamic confrontation, which led me to believe that she was a very treatable person.
I discussed these issues with Dr. Harvey Ross and her mother, Jane Henderson. They agreed that I should work with Anne Sippi. I then began a psychotherapeutic assault on her illness and made rapid contact with her, that led to a therapeutic alliance. My efforts at controlling her schizophrenic impulses reduced her fears and she progressed enough to be moved to an open unit in the hospital, soon after treatment began. I then engaged Chess Brodnick and his wife - my first students - to begin a resocialization procedure with her by taking her out of the hospital on a daily basis. This was, at that time, unprecedented with patients who were severely disturbed schizophrenics , as was Anne Sippi. This procedure, supported by daily psychotherapy sessions with a very restricted medication regimen, began to produce behavioral changes in Anne Sippi.
For many years it has been clear to me that behavioral changes lead to insight, not the other way around. After all, the primary goal in treatment for schizophrenia is change and of course relief from the agonizing symptoms of this condition. It should be understood that many patients cannot process information because of the length and the severity of their illness. Because of this, insight oriented treatment has not succeeded in the psychotherapy of the long term schizophrenic.
I do not underestimate or minimize the enormous struggle that took place with Anne Sippi, however, we undertook the struggle because we believed that she was worth it and that it was our responsibility to help her, because she could not help herself. There was nothing expedient in our efforts. She was not overwhelmed with medication. We felt a sense of hope and as a result of our efforts, she began to feel a sense of hope as well. It began to express itself in her will to control her impulses and aggression - at last she felt safer and not alone. Our faith in her humanity and the belief that we had that there was more than pathology in this human being, began to give her a growing feeling of self worth. She improved gradually and the quality of her life was better and she was able to live with her peers comfortably and socially.
We met with Jane Henderson, her mother, and agreed that our respective experiences mandated that we find some way to develop a treatment alternative to hospitals. The Anne Sippi Clinic was born. Named after this woman, who came out of the depths of despair into a life that had love, laughter and peace. Out of this incredible battle with this so called hopeless human being came a treatment alternative that eventually became an example of a newer and a more hopeful direction in treatment.
The Anne Sippi Clinic began as a day care center, accepting the so called hopeless ones and having them live outside of hospitals, which by itself, improved the quality of their lives. After a well known rock star did a concert for us, we were able to purchase a facility that became The Anne Sippi Clinic, Residential Treatment Center. The Clinic exists in a community composed of single dwellings and we have been able to reach a sense of harmony with our neighbors. That by itself represents a significant lesson in the sense that people can learn to live with each other when respect leads to understanding.
Our psychosocial program was established in 1978 with myself as Clinical Director, Chess Brodnick as Treatment Director and eventually Michael Rosberg as Program Director. The treatment program had as its basis an active psychotherapy called Direct Confrontation. Also, included were retraining in some of the basic skills of living and introducing our residents back into the community, when they were able to successful interact with the world in a socially acceptable way. The Anne Sippi Clinic has 32 beds and is fully staffed on a 24 hour basis. However, the atmosphere is non-institutional. The Clinic is an open facility with large grounds that allows for physical activities. We have had the honor of hosting many distinguished visitors from the United States and abroad. The initial response from these visitors is enthusiastic remarks about the warmth and commitment of the staff with patients and the feeling of freedom that is in the atmosphere. Empathy and hope is the philosophy.
Before the inception of the clinic, I began doing workshops in California and other parts of the United States. Because of the uniqueness of the clinics approach to treatment, there was a great deal of media coverage. Soon thereafter, came invitations from twelve countries wherein I had the pleasure of introducing the Anne Sippi Clinic treatment concepts. We have touched and influenced the lives of many human beings with schizophrenia and stimulated mental health professionals in the United States, Mexico, Scandinavia, Russia and other areas of the world. Out of these efforts arose the Anne Sippi Foundation, for Training and Research and the A.P.S., International (Association for Psychotherapy of Schizophrenia) for Training and Treatment on an International basis.
Currently, the Directors of the Anne Sippi Clinic are Chess Brodnick, PhD., Treatment Director, and Michael Rosberg, PhD. Program Director.
There is definite linkage between the three entities, The Anne Sippi Clinic, The Anne Sippi Foundation for Training and Research and the Association of Psychotherapy for Schizophrenia, International. My current interest has to do with training - as the Executive Director of the Anne Sippi Foundation and the Clinical Director of A.P.S. International.
Our aims, are convergent. Treatment for the forgotten and discarded. Our hope, that they can improve the quality of their lives, our efforts in informing the professional world and others, that people afflicted with this dreadful condition, called schizophrenia, can improve, if we have a sense of faith, hope and commitment. This is our belief and it has become a self fulfilling prophecy. of schizophrenia with allot of care and love for these individuals suffering from this mental illness.
The answer in my opinion is no. My brother is treatment resistant in the schizophrenia spectrum of a range that puts him in the minority, he is being treated with the minimum of medication. This is thanks to a wonderful program in California that treats schizophrenics with humanity and respect. The clinic mentioned below can be found at www.schizophrenia-help.com and www.schizophreniatherapy.com. IN NO WAY, am i being asked to solicit this clinic that treats people suffering from schizophrenia. My brother is a patient and I can vouch for the humanity and care he has been given, found NOWHERE else in the world. I searched far and wide and was lucky to have the funds to do it. After 8 years of searching, I found this clinic on 60 minutes, believe it or not. Went there the next day and hid in the bushes.
that's right... I wanted to see how people were treated that noone was looking. I found what I was looking for. The nightmares of the Menninger foundation were over. Here was a place that truly cared for people suffering from schizophrenia and I hope you read the story of this wonderful clinic that has allowed my brother to claim somewhat a life away from hallucinations, and just being so totally lost.
here is the story of the clinic in the words of his founder, Jack Rosberg.
The seeds of the Anne Sippi Clinic were sown long before its emergence in 1975. I began my career in 1954 supervised by John N. Rosen, M.D. in Bucks County, PA. Dr. Rosen was, along with Harry S. Sullivan and Freida Fromm Reichman, one of the earliest contributors to the psychotherapy of schizophrenia in the United States. He introduced a very active treatment for schizophrenia form with the most severely regressed schizophrenic patients. His approach aroused the curiosity of the professional world. To quote Lawrence Kubie:"if nothing else, he rocked the professional world out of its complacency." Rosen had his professional practice outside of hospitals and his patients resided in houses in a farming community, which in those days and even today, represents a unique treatment setting for schizophrenia .
I had the privilege of developing a treatment direction for schizophrenia during my work with Rosen that I later called Direct Confrontation. When I left Dr. Rosen in mid 1957 and entered into private practice in dealing with patients diagnosed as schizophrenic in private hospitals in Los Angeles, CA., it became increasingly apparent to me that treatment with the serious mentally ill was severely hampered by the restrictions imposed by a staff that focused treatment with these patients on the medical model. The physical methods of treatment, such as Electric Convulsive Therapy, the growing emphasis on medication for schizophrenia as a treatment of choice and the long periods of time spent in psychiatric hospitals were iatrogenic. Many great contributors including Eugene Bleuler, who coined the term schizophrenia, cautioned about the negative effects of long term hospitalization. My primary interest was and is the psychotherapy of schizophrenia. I found, much to my surprise, quite early in my career, the different and innovative directions in treatment other than traditional methods disturbed the professional world around me and many obstacles were strewn in my path. However, despite this I continued working with patients actively with the growing realization that effecting a relationship and a shared belief system, led to a more positive and lasting outcome than the palliative measures used by the majority of the professionals in the world of mental health.
The developing course of my treatment direction stimulated the interest of professionals from the psychoanalytic to the reality oriented and even to the Orthomolecular world. These were mature individuals. People who could look at new ideas and treatment directions, without any preconceived ideas. Professionals, such as Martin Grotjahn, M.D. a distinguished training analyst. Psychiatrists, Humphrey Osmond, Abraham Hoffer, Harvey Ross and a host of those involved in other treatment directions, became supportive as they perceived my efforts influencing change with regressed schizophrenics. It was Dr. Harvey Ross who introduced me to Anne Sippi, a young woman, hospitalized at a small psychiatric hospital in Los Angeles. I was told by staff members that this woman was hopeless and that nothing could be done to help her. Dr. Ross asked me to do a consultation with Anne Sippi, who he had worked with for a considerable period of time. He believed that she could not be successfully treated and was about to recommend custodial care in a state hospital. I was the last stop it appears before that happened. I had developed a reputation of dealing with the most difficult population.
Anne Sippi had been sick, since childhood. She was treated and hospitalized many times with no significant relief from the ravages of her schizophrenic condition. She was violent much of the time and also restrained more often than not, in these hospitals. She was a terrified human being, when I met her. Her vocabulary had shrunk to several words. Her fear and resulting violence persuaded hospital staff to stay away from her as much as possible. In her terrified state, this woman, this human being, was left alone to deal with the nightmare of her existence. My first contact with her was a dynamic confrontation, which led me to believe that she was a very treatable person.
I discussed these issues with Dr. Harvey Ross and her mother, Jane Henderson. They agreed that I should work with Anne Sippi. I then began a psychotherapeutic assault on her illness and made rapid contact with her, that led to a therapeutic alliance. My efforts at controlling her schizophrenic impulses reduced her fears and she progressed enough to be moved to an open unit in the hospital, soon after treatment began. I then engaged Chess Brodnick and his wife - my first students - to begin a resocialization procedure with her by taking her out of the hospital on a daily basis. This was, at that time, unprecedented with patients who were severely disturbed schizophrenics , as was Anne Sippi. This procedure, supported by daily psychotherapy sessions with a very restricted medication regimen, began to produce behavioral changes in Anne Sippi.
For many years it has been clear to me that behavioral changes lead to insight, not the other way around. After all, the primary goal in treatment for schizophrenia is change and of course relief from the agonizing symptoms of this condition. It should be understood that many patients cannot process information because of the length and the severity of their illness. Because of this, insight oriented treatment has not succeeded in the psychotherapy of the long term schizophrenic.
I do not underestimate or minimize the enormous struggle that took place with Anne Sippi, however, we undertook the struggle because we believed that she was worth it and that it was our responsibility to help her, because she could not help herself. There was nothing expedient in our efforts. She was not overwhelmed with medication. We felt a sense of hope and as a result of our efforts, she began to feel a sense of hope as well. It began to express itself in her will to control her impulses and aggression - at last she felt safer and not alone. Our faith in her humanity and the belief that we had that there was more than pathology in this human being, began to give her a growing feeling of self worth. She improved gradually and the quality of her life was better and she was able to live with her peers comfortably and socially.
We met with Jane Henderson, her mother, and agreed that our respective experiences mandated that we find some way to develop a treatment alternative to hospitals. The Anne Sippi Clinic was born. Named after this woman, who came out of the depths of despair into a life that had love, laughter and peace. Out of this incredible battle with this so called hopeless human being came a treatment alternative that eventually became an example of a newer and a more hopeful direction in treatment.
The Anne Sippi Clinic began as a day care center, accepting the so called hopeless ones and having them live outside of hospitals, which by itself, improved the quality of their lives. After a well known rock star did a concert for us, we were able to purchase a facility that became The Anne Sippi Clinic, Residential Treatment Center. The Clinic exists in a community composed of single dwellings and we have been able to reach a sense of harmony with our neighbors. That by itself represents a significant lesson in the sense that people can learn to live with each other when respect leads to understanding.
Our psychosocial program was established in 1978 with myself as Clinical Director, Chess Brodnick as Treatment Director and eventually Michael Rosberg as Program Director. The treatment program had as its basis an active psychotherapy called Direct Confrontation. Also, included were retraining in some of the basic skills of living and introducing our residents back into the community, when they were able to successful interact with the world in a socially acceptable way. The Anne Sippi Clinic has 32 beds and is fully staffed on a 24 hour basis. However, the atmosphere is non-institutional. The Clinic is an open facility with large grounds that allows for physical activities. We have had the honor of hosting many distinguished visitors from the United States and abroad. The initial response from these visitors is enthusiastic remarks about the warmth and commitment of the staff with patients and the feeling of freedom that is in the atmosphere. Empathy and hope is the philosophy.
Before the inception of the clinic, I began doing workshops in California and other parts of the United States. Because of the uniqueness of the clinics approach to treatment, there was a great deal of media coverage. Soon thereafter, came invitations from twelve countries wherein I had the pleasure of introducing the Anne Sippi Clinic treatment concepts. We have touched and influenced the lives of many human beings with schizophrenia and stimulated mental health professionals in the United States, Mexico, Scandinavia, Russia and other areas of the world. Out of these efforts arose the Anne Sippi Foundation, for Training and Research and the A.P.S., International (Association for Psychotherapy of Schizophrenia) for Training and Treatment on an International basis.
Currently, the Directors of the Anne Sippi Clinic are Chess Brodnick, PhD., Treatment Director, and Michael Rosberg, PhD. Program Director.
There is definite linkage between the three entities, The Anne Sippi Clinic, The Anne Sippi Foundation for Training and Research and the Association of Psychotherapy for Schizophrenia, International. My current interest has to do with training - as the Executive Director of the Anne Sippi Foundation and the Clinical Director of A.P.S. International.
Our aims, are convergent. Treatment for the forgotten and discarded. Our hope, that they can improve the quality of their lives, our efforts in informing the professional world and others, that people afflicted with this dreadful condition, called schizophrenia, can improve, if we have a sense of faith, hope and commitment. This is our belief and it has become a self fulfilling prophecy. of schizophrenia with allot of care and love for these individuals suffering from this mental illness.
Subscribe to:
Posts (Atom)