I believe some of us have spiritual emergencies which can be treated with psychotherapy alone or even with the support of a peer who has similar lived experience. I am also a therapist who knows when someone is in a psychiatric crisis, either acute or the onset of chronic symptoms re-activating. What I don’t understand is why the line is so misunderstood by practitioners?
The line has been and continues to be outlined by the letter of the law and mental health laws in the US, which make it clear as day that when someone is at immediate risk of serious harm to himself or others, they need to be hospitalised and assessed for further risk of harm. There really is no grey area here. To do otherwise is negligence. Of course, sometimes someone can be at risk of harming themselves, having a spiritual emergency, and still not require in-patient hospitalisation or a psychiatric evaluation and observation. It doesn’t matter, though. When the risk is that high, we simply shouldn’t be gambling with life.
Think about it: as therapists, we assess for risk all the time. If we are doing our jobs right and are truly person-centred, we should be using every technique in our toolkit to treat our patients where they are at, regardless of how society views mental health diagnosis. Again, it doesn’t matter what the world believes a psychiatric label means in the context of providing therapy, so long as that works and is the right fit for our clients in the context of their disorder and circumstance. However, somewhere along the way, these new hot emerging trends in psychotherapy and peer work are being thrown around. They are the ‘in’ therapies, the hot new miracle modalities which are going to bring about better outcomes and are more humane.
Yet, when you break these new therapies down to their core theoretical underpinnings, they are no different, new or unique than what we already do as therapists. Unless you are grossly incompetent or were trained 50 years ago, who are these webinars and conferences for anyway? I just don’t get this hot fuss going around the practitioner community. Let me put it into greater context if it isn’t clear. I just read that another training session is being offered, this one is called: ‘Making meaning from visions and voices: Supporting altered states’ in NYC.
The theory behind this training is to provide therapy and services for patients and peers, which support their so-called altered states, and understand that in some cases these seemingly difficult spaces for patients can be beneficial and powerfully creative, having the potential to yield insight into their condition or particular circumstances. The training flyer makes it clear too that, for some folks, these situations can be quite disturbing and dangerous.
I seem to be unclear again as to what’s new here in terms of practising person-centred therapy? Are training sessions, like this one and so many offered out there, truly for the public and not geared or targeting clinicians at all? If so, which I believe, they should be targeting the public. They need to be clear that this is for the general public and everyone can benefit from attending. Otherwise, clinicians like myself will find themselves sitting at the same round table discussing the same techniques and theories from graduate school.
Stigma is not just real – but is covert, overt, and insidious. I have experienced it first hand. The public really needs to understand mental health diagnoses for what they are and not label and ridicule people with psychiatric disabilities. However, we really truly do need to do some homework and conduct new and authentic valid research before saying this or that therapy is going to change the way we practice in this field. Otherwise, you are just offering vapid and vacuous CEU (continuing education units) and miscalibrating the message to those in the field that we really need to revamp the manner in which we practice and provide the work that truly is being done for our patients or peers.
Maybe the misperception or misunderstanding of what is really ‘new’ is my own. I really haven’t met too many people who have my diagnosis of schizophrenia and practice psychotherapy. But other people have had similar symptoms and have gone ahead and become practitioners too. Maybe these people I am referencing have never vocalised their lived experience due to the same stigma I just talked about. If this is true, then I suggest you need to be more open about your lived experience.
Your self-awareness and insight into your disorder should be advancing research. As far as I am concerned, if you aren’t furthering the work that needs to be done, then you shouldn’t be in this profession which exists to help others. If you are holding back knowledge that can benefit others, why and how could you possibly profess to be helping them?
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.