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See also lecture Nov. 2010 Milan Italy: Consequences for clinical practice

In psychiatry there is no sound relationship  between diagnosis and patient problems 
The  diagnostic categories of psychosis in psychiatry don’t show a relationship in content (in substance) with the person’s complaints. The complaints  are not coming forward from the diagnosed illness but the diagnosis is constructed on the base of available complaints not regarding the reasons for the complaints. The complaints have their own causes.

Treatment should not be oriented on the diagnosed illness
When the treatment is oriented on the illness, this indicates it is not oriented on the cause of the complaints. There is no  cause known of the different categorized psychotic  illnesses. There are however by now well known causes for the complaints, which need to be analyzed and treated.

The complaints should be given their reality name and not interpretative names

Complaints are called hallucinations instead of hearing voices, or seeing images. They are called delusions instead of unusual believes. This slight distortion gives an interpretation in the direction of not true and being a sign of psychopathology. This is unjustified while the person really hears voices,  really  sees images and has reasons for his unusual believes. This disturbs the relationship between the patient and the doctor because of not being believed. It mostly also threatens the self esteem of the patient “Am I crazy?”. And most harmful it the real problems are mystified. 

We should focus on the characteristics of the complaints. They  show the relationship with the patient’s problems.

The characteristics of the experienced complaints give  information about the person’s problems. Like with hearing voices, the identity of the voice as his age and sex can refer to a person involved in a traumatic experience. As most sexual abused persons who hear voices recognize the abuser’s voice. The age of the voice often indicate the time the traumatic experience started or changed, the voice  then stays the same age. The voice will tell about what had happened in the person’s life. Like when a situation has similarities with the traumatic situation the voice can warn: ”you know what has happened”. There are numerous interactions between the voice characteristics and what has happened in the person’s life but one need an interview schedule about the voice hearing or unusual believe  experience and to inform about each voice or paranoia separately. This also holds for unusual believes and negative symptoms. This needs the use of instruments and  training. If one only speaks about hallucinations or delusions as a symptom of an illness, their function is totally neglected and their background mystified.

Because of the missing link of accepting and making sense of the complaints thousands are not helped.
There are thousands who only get a diagnosis and get medication and are not helped to cope with their voices and the problems that lay at their roots. Their problems are not explored and the person is not helped with their distorted emotions which are the consequence of serious trauma and emotional neglect. So thousand are put on the wrong track and become chronic  patients, because they can’t live their own life but live a life of suppressed problems, in which full recovery becomes not possible and therefore stay on being dysfunctional. 

Long term Neuroleptic medication makes it worse.

The main effect of neuroleptics is the suppression of emotions. This can be welcome and helpful when one becomes overwhelmed by emotions. These are mostly distorted emotions  as a memory of  awful things that has happened in one’s life. However the suppression of emotions  also exactly stands in the way of learning to cope with these emotions which is necessary to function well socially.  Without learning to cope with ones emotions recovery or being able  function adequately is not possible. Medication only therefore is harmful and stands in the way of recovery. 

The purpose of counseling or psychotherapy with psychosis
The purpose of therapy is not to suppress the voices but to support the person in changing the relationship with them because they are signals of problems and not symptoms of illness. 

Differentiations in counseling and psychotherapy are necessary.
Psychotherapy only becomes effective when oriented on the problems that lay at the roots of the complaints of the psychotic illness. These have to be explored systematically and the therapy should follow the development of the coping process and not primarily the therapists theoretical method. This needs practicing different  interventions in different phases. When still overwhelmed by the anxiety towards the complaints reducing anxiety and getting more control will be adequate. Then learning coping strategies are important. While psychodynamic therapies are at their place when the  person recognizes the relationship with their distorted emotions as a consequence of what has happened. There is not one method useful during the whole recovery process. In the meantime social compensation has to be stimulated because self esteem is build upon positive experience not talk only.