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Post by alison on Mar 8, 2016 14:47:59 GMT
I would not use hypnosis if I suspected psychosis. However, I feel it is not always ‘clear cut’ in terms of whether or not we choose to/are qualified to work with clients experiencing psychosis – as psychosis is not always immediately apparent.
This has been my experience once. (The client’s presenting issue was OCD). It was not until session 3 that my supervisor and I identified ‘warning flags’ that might suggest psychosis. Under frequent supervision I continued to work with the client with a focus on building good rapport (not using hypnosis). I did feel qualified to this, because with good supervision it felt safe, ethical and in the best interests of the client. Because we had good rapport we were soon able to work effectively with the client’s GP who made an appropriate referral and I had no further contact with this client.
Before this experience I was quite ‘clear-cut’ with a view that ‘I’d never work with psychosis’ that ‘it’s beyond the limits of my training/experience’.
Reflecting on my work with this client, I understood I was working with THE CLIENT, who was experiencing psychosis. As opposed to WORKING WITH PSYCHOSIS – which for me, is quite different. I never ‘set out ‘ to work with psychosis. It became evident through the course of therapy. And in this particular example, it was absolutely in the best interests of the client to offer support, within a clear framework of the limitations of my practice, whilst working to ensure safe referral. As ever, supervision: ESSENTIAL!!!
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Post by liliana on Mar 8, 2016 17:35:25 GMT
I am not qualified to work with psychosis. And it’s not only a matter of qualifications, working with psychosis from a hypno-psychotherapeutic stance also requires a lot of experience, and I am not in that position yet. I don’t mean that I wouldn’t want to be in a position to help people suffering from certain mild forms of psychosis, and indeed I am sure that hypno-psychotherapy has a lot to offer to them, at least to those that are not very ill, and that they can greatly benefit from it. But this is a very delicate area, and let’s not forget that hypnosis is generally contraindicated for psychosis, for some good reasons. Working as a part of a health team is perhaps the right answer when working psychotherapeutically with any form of psychosis. But before getting there, as Alison mentioned earlier, supervision is indeed the first port of call, essential when a client, who is unaware of being psychotic, shows signs of hallucinations and delusions, and a clear break with reality while receiving therapy.
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Post by alison on Mar 9, 2016 12:52:53 GMT
Good points liliana, I couldn't agree more that it's not just a matter of qualifications - but experience. I also don't consider myself experienced or qualified to work with psychosis. If a client, aware of psychosis, contacted me (or the individual's family member/other form of referral) I wouldn't take the referral. (And of course in relation to hypnosis it's important to be aware of contraindications).
But, as per the above example, psychosis isn't necessarily obvious to client or therapist and we may find ourselves 'unexpectedly' working with a client that 'with the benefit of hindsight' we would not have not taken on. An earlier thread has reminded me of a phrase my Stage 2 tutor used often: Make sure you're always working with the client in the room and not the client in your head. I can't tell you how often that phrase is useful! Of course every case has a unique set of circumstances, but 'on paper' the case I experienced would have had me thinking 'no way, absolutely beyond my experience, can't possibly see this client again etc'. THAT was the client in my head. However, the client 'in the room', was somebody that I was in good rapport with and could offer short-term support to before accessing more appropriate treatment.
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Clare
New Member
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Post by Clare on Mar 9, 2016 13:45:25 GMT
If I had a clear choice then I would not work with clients presenting psychosis, I would insure they are supported with mental health team through the GP.
However, I agree with Alison with regard to presenting issue and underlying red flags. Almost an identical experience to Alison, a client presented with OCD but it soon became clear that there was much more going on which I needed to handle sensitively and carefully with the GP involvement. In this example my role became very important to b support the client through the transition to the Mental Health Team, this client had lost faith in the system which is the reason for private therapy.
I think it is important, with help of a supervisor, as therapists we are prepared to deal with a situation that may occur and be confident in our approach with these potential clients. I essentially repeating what Liliana & Alison has already discussed.
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tutor
New Member
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Post by tutor on Mar 10, 2016 7:58:05 GMT
Hi Everyone
The value of supervision is seen particularly when there is complexity or an unusual constellation of symptoms.
Tutor
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Post by alison on Mar 10, 2016 10:10:50 GMT
Clare it's very interesting to hear of your similar experience. It sounds like you handled it really well and offered great support to that person  |
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Post by Chris on Mar 12, 2016 14:27:57 GMT
There have been some interesting counter-claims made against the use of mindfulness: basically, it can trigger depression, anxiety and psychosis. It is worth considering that hypnosis may trigger a similar response in previously undiagnosed clients... so yes, careful supervision may be crucial while the therapist develops his/her own gut-instincts and monitoring processes.
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