Surviving Psychosis: Providing the Best Care for Reality-Impaired Clients, Their Families, and Yourself
Alana Hendrix, MS, LMFT
This sometimes funny, always frank, and vitally important discussion covers all the basic principles on how to deal clinically and compassionately with the client who is out of touch with reality. It includes how to recognize the subtle signs that psychosis may be present in your client, how to help the family cope and provide appropriate support for the client, and how to provide clinically solid treatment for both client and their family while keeping your own sanity intact. It includes a wealth of good clinical information as well as lots of examples from Alana’s own case files.
Objectives:
1. How to recognize subtle signs that psychosis may be present.
2. How to assist clients and their family in accepting that part of their diagnosis involves reality impairment, and how to help them find the right support for it.
3. How to develop basic treatment plans for psychotic clients, and how to motivate them for treatment.
4. Steps to keeping your own sense of sanity alive while dealing with psychotic clients and their families.
Bio:
Alana has a rich history of counseling experience in the Inland Empire area and beyond. Her love for counseling began when she found herself in treatment as a teenager trying to deal with her father’s alcoholism and her brother’s drug & alcohol use. This interest in “managing realities” has continued over the years in the venue of lay-counseling when she worked with families of murder victims. Since becoming a professional therapist she has been assisting people of all ages and life paths to cope with their issues and to thrive in spite of those challenges. She received both her Bachelor of Science and Master of Science from California Baptist University in Riverside, CA. She is near completion of her PhD in Marriage & Family Therapy from Capella University. She works in private practice with New Hope Christian Centers in Covina and Moreno Valley offices. She specializes in family relationship issues, parenting concerns, addiction problems, grief & loss, and good self-care. She especially advocates good self-care for those in the helping professions,such as pastors, nurses, and mental health care providers.
Alana is often described as “honest, inviting, and very funny.” Her warm and engaging style has contributed to her success as a therapist and as a speaker at community events, spiritual retreats, and other venues where she conveys a variety of techniques available to help one live life to its fullest.
Synopsis:
In our August IE CAMFT meeting we had the pleasure of learning about working with psychotic patients from Alana Hendrix, MS, LMFT. Alana got into the world of counseling when she began lay-counseling with families of murder victims. Since then, she has grown into a seasoned Licensed Marriage and Family Therapist, working with a variety of populations including psychotic patients. Alana educated us about how to assess for psychosis in patients, how to work with and write treatment plans for psychotic patients, and how to work with the families of psychotic patients.
With regards to assessment for psychosis, it is important to note that newly psychotic patients often try to hide their psychosis because of the embarrassment it causes them. This can make it difficult to recognize and properly diagnose newly psychotic patients. Alana also discussed the following suggestions for assessing psychotic patients:
1. Assess for safety, the patient’s needs, and if you can work with this patient in your scope of practice. The assessment for your scope of practice should be an ongoing one as the patient’s needs may change.
2. Contact the patient’s psychiatrist. If they do not have one, refer them to one.
3. Perform reality testing on the patient to see if they are in touch with reality. The reality testing will help to determine how committed they are to their psychosis (or how real their psychosis is to them). It can also help to determine what kind of psychosis they are experiencing. Are they experiencing paranoid, catatonic, disorganized, etc. psychosis?
4. Assess the patient’s affect. Is their affect appropriate or inappropriate for the situation?
5. Always look for signs of the patient self-medicating. Many patients dealing with psychosis will self-medicate, making it essential to look for possible dual diagnosis so they can be treated properly.
When working with and writing treatment plans for psychotic patients, it is especially important to treat them with compassion. These patients are often disowned or shunned by society because they are considered crazy or scary. In her experience working with this population, Alana found that using humor with them whenever possible has positive effects. Alana also discussed the following suggestions for working with these patients:
1. Treat the psychosis (the symptom) before dealing with the underlying problem.
2. Case management is the best treatment for psychotic patients whenever it is feasible.
3. Write formal, specific treatment plans. It is helpful to have the patient and the patient’s family (if they are available and involved in treatment) sign the treatment plan so that everyone is working together towards the same goals.
4. The goals for psychotic patients should not always revolve around getting them in touch with reality; this may not be an attainable goal. The goals should be geared around raising the patient’s self-esteem and instilling hope in them that they can work through the illness.
5. When doing group work with these patients, they need all of the same things that non-psychotic patients need. They need hope, socialization, catharsis, universality, altruism, guidance, interpersonal learning, and self-understanding.
Alana also discussed how difficult it can be for the families of patients suffering from a psychotic illness. It can be stressful, frustrating, and draining on these families, which is why they often need help as well. Alana discussed the following suggestions to help these families:
1. First of all, educate the family about the necessity of good self-care, as well as good self-care habits. If they are healthy, they will be able to deal with the situation much better.
2. Get as many family members as possible involved in the care of the patient. The more support and help, the better.
3. Educate the family about the illness they are dealing with. Educated them about the symptoms, behaviors, medications, and what they can expect with the illness.
4. Provide many resources for the family such as referrals to a psychiatrist, support groups, other therapists, etc. Whenever possible, let them be involved with the care of the patient by giving them choices by referring to a variety of resources.