The more we work with individuals with severe mental illness, the more it becomes clear that these individuals have the same needs, yearnings, and proclivities that we have, but these are accentuated to the paradoxes:
a)These all too human tendencies are often submerged by the “pathological” aspects, such as delusions, hallucinations, disorganized speech, and the whole array of negative symptoms.
b) The one wall separating these individuals from ourselves is their dysfunctional attitudes: beliefs that they do not belong, that nobody cares about them, and that they do not fit into society. Their functional withdrawal is accelerated by the negative beliefs, such as avowed with expectations of failure, beliefs in their lack of energy, power, efficacy, or control.
c) The wall has two sides, the internal scribed above, and the external. This consists of society’s demeaning rejection and control of the individuals.
d)The way to break through the wall is, first of all, to do things with the individuals that they find appealing (ie. Talking a walk and looking at the scenery, having a cup of coffee together at Starbucks, singing a song together, or manicuring the individual’s nails). These activities not only give the individuals a modicum of pleasure, but they can help to refute beliefs, such as, “I cannot get any pleasure out of life.”
e) Doing pleasurable things with the individuals also serves as a “leveler.” The individual can now see himself as at the same rather than inferior level with the staff.
f)Community activities in which the staff participates with the individuals are also a powerful instigator of the individuals’ needs and instill pleasure at the satisfaction of these needs.
g)The prevision of variety of clubs, such as a crocheting club, decorating, discussion group, etc. also serve as levelers.
h)The individuals have a number of modes which coalesce into the self-image of being alone, weak, helpless, vulnerable.
i)A clue to the dominant mode or the presenting mode may be obtained from the patient’s behavior or delusion
a.For example, several individual who have continuously made phone calls to law enforcement agencies felt helpless and vulnerable. When they became engaged in a variety of activities, mainly, helping other people, they no longer made the phone calls and became ready for discharge from the hospital.
b.Vulnerable individuals believed they were being poisoned. When they became engaged in other activities, such as cooking for other people, this delusion disappeared.
c.One way to get at the underlying concern, or unpleasant feeling is to ask the patient directly, Do you feel lonely (problem is social isolation underneath that), Do you feel helpless (underlying problems is vulnerable or threatened), Do you feel weak (underlying problem is physical withdrawal).
j)Finally, the therapist is humanistically engaged when he/she can empathize with the individual’s plight and can think of normal experiences that will enable the individual to feel normal.