Paranoid Schizophrenia and Paradoxical Intervention

Psychotic ideation is delusional and illusory. One cannot simply convey to a psychotic individual that he has a valid perspective. To an extent, it has been traditionally asserted in the field of mental health that one should not affirm the psychotic beliefs of the schizophrenic. Contrarily, some clinicians believe that one should persistently deny the schizophrenic any validation in this regard.

If one considers treatment for other disorders, such as Narcissistic Personality Disorder and Borderline Personality Disorder, it is well-founded that sensible and ethical treatment for these disorders involves in some sense paradoxical interventions. Narcissism in a person with this disorder responds well to empathy, and borderline psychopathology responds well to implacable good will on the part of the psychotherapist. To empathize with a person who deals with narcissism allows that person to transcend the need for self-validation, and applying implacable good will to treatment of borderline personality disorder provides that individual with validation, as well. Such validation may seem counter-intuitive when one experiences the presentation of these disorders as a therapist.

While treatment with implacable good will may not be considered paradoxical, this kind of treatment is nevertheless quite different than the way someone with borderline psychopathology is usually treated. For this reason, in treatment for both of Borderline Personality Disorder and Narcissistic Personality Disorder, the aim is to provide these diagnosed individuals with experience that is different from what he usually experiences, and this is the essence of paradox in treating these disorders. It is for this reason that the experience of psychotherapy is therapeutic.

Psychotherapy, then, allows those who cope with these disorders to overcome the symptoms of their conditions that may be a consequence of labeling. Labeling derives its power from the assumption of an identity that is enacted in the sense of self-fulfilling prophecy. The seeds of the diagnosis may be, at least in part, within the label. It might be suggested that paradoxical treatment for schizophrenia implies treatment techniques are counter-intuitive, as well, and labeling plays a role in this type of psychopathology.

The paranoid schizophrenic’s hallucinated experience occurs in conjunction with isolation and fear. The paranoid schizophrenic will feel isolation and fear due to the fact that his reality is not affirmed by others. Anyone who has experience that is not considered to be real might react with these symptoms: isolation resulting from their aloneness in this experience, and fear because they are seeing or hearing or feeling something that others say is not real. Treating paranoid schizophrenics in a way that affirms their experience as illusory is fear-inspiring for them.

The psychotherapist who empathically enters into the paranoid schizophrenic’s delusional perspective may find themselves daunted by the vision of reality to which the psychotic individual adheres. Yet, why might the psychotic individual profess what are called “overvalued ideas”? This is because he has non-normative experience that he endures as visceral isolation in shame and fear. He is alone in this, and no one, even his psychotherapist, can understand what he is thinking and feeling.

Inside his alienation, he seeks a connection with others, including his treatment providers, and so he may insist on the validity of his perspective. Inside his fear, he seeks someone, especially his psychotherapist, to take him seriously. Alone, he feels unable to protect himself.

Carl Roger has stated: “Only when I accept myself as I am can I then change.” This statement is paradoxical, as well, and it points to an important treatment consideration. The fact of acceptance of the client by his treatment provider may culminate in the client’s self-acceptance. This means that the client may enact self-acceptance that is fundamentally curative, simply by having his perspective to any extent affirmed through mirroring of this perspective by his psychotherapist.

The acceptance that is entailed by appropriate treatment of narcissistic and borderline personality disorders may be curative in that acceptance of those with these disorders may allow for change. This essentially constitutes transcendence of the problems associated with these disorders. It may be argued that the paranoid schizophrenic will benefit from acceptance and empathy, as well.

In a famous interview with a psychotic client, R. D. Laing enacted a paradoxical intervention through a statement regarding that client’s belief system. Specifically, the client had asserted his belief in a conspiracy. Laing responded that perhaps there was a conspiracy, but was it a conspiracy for good or a conspiracy for evil?

It is obvious that there are conspiracies in our world. Some of these are unethical, immoral and perhaps illegal, but some of these are enacted or created for the sake of the good.  Society represents a pragmatic conspiracy for the common good. Laing exercised validation accompanied by creativity in responding to this client’s concerns.

When a paranoid psychotic individual becomes entangled with delusional beliefs, his delusional ideation may be a response to non-normative experience that he cannot make sense of. As indicated, having divergent experience of this kind clearly  may be frightening because one is alone with this experience, and one may emerge with a view of reality that is not affirmed by others. Indeed, this experience often may be dismissed by others in a cursory way.

It is not suggested that the psychotherapist, engaged in treatment with the paranoid psychotic client, should agree with the psychotic individual regarding whatever his delusional system is. It is suggested that they attempt to unders and the rationale for that client’s beliefs. This can mean affirming the possibility of what the psychotic person contends to be truth. Carl Sagan affirmed the possibility of extraterrestrial life forms, why should the psychotic individual not do so?

It should be asserted that the paranoid psychotic person may not feel as frightened by his own delusions if he is in some sense affirmed by the psychotherapist. The paranoia that the schizophrenic feels may reflect the alienation which accompanies him in his thoughts. Moreover, there are ways that the psychotherapist can mitigate their client’s fear sensibly.

The psychotherapist may let the client know that, whatever the reality or lack of reality of his situation, life events proceed somewhat normally. This can allow the psychotic client to feel more comfortable with his experience. The therapist can a ffirm  that the client does not know the truth about his experience, and this is a reality that the schizophrenic may be able to grasp. Given this fact, the schizophrenic should and may be able to get as comfortable as possible with simply not knowing.

This rationale behind empathic treatment of psychosis corresponds not only to attempting to affirm, within reason, the delusional beliefs held by the psychotic person. It involves the actual reasons behind what the psychotic individual thinks and feels. These individuals are people, and causal realities account for their self-presentations. They may think simplistically about their non-normative experience, and some psychotic people will never emerge from their delusional systems. Some such individuals will always be confused by their experience, bu t others will not be.

Many psychotic individuals do have the potential to transcend their non-normative and delusional belief systems. As a psychotherapist, the clinician must try to find the reasons why the psychotic person presents with his particular delusions, with his particular experience, and attempt to untangle the presentation of the psychotic individual based upon his own creative, imaginative and empathic view of the psychotic client.

Image via Emilia Ungur / Shutterstock.

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.
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