I wanted to get some feedback on workign with schizoaffective disorder and
its differences from schizophrenia.  I was seeing a patient the other day
and she said that the voices had
started to bother her again and she is feeling manic - overly excited is a
word she used also.
She agreed to see me and keep the appointment - our next one, if I don't
mind her when she is like this.  She ended up changing to a female doctor
when this happened last time with her.  This was in a public mental health
setting where she felt comfortable listening to the voice of the doctor.
She then asked for a female doctor at the center, which surprisingly they
had, I hadn't thought this center had a female doctor.
    She also does not want her husband in the sessions because he acts like
he can read her mind... which means he talks for her and doesn't let her say
what is going on inside her.  The idea of leaving therapy sounded like it
was because I wouldn't be able to handle her in a manic phase, which she has
noted with therapists or psychiatrists before.  She is on meds and is at a
therapeutic dose for her Lithium.  So the doctor is not going to change
that.
    Anyway, I have been able to help her since she told me this by using a
more self-psychology oriented experience-near type interpretations or
reflections of empathic attunement.   That seemed to help, to acknowledge
her feelings of vulnerability instead of earlier attempts that were less
empathic and more attunded to her surface level questions seeking
understanding of what is going on.
    I find only a few chapters in books on psychological treatment of schiz.
that deal with schizoaffective disorder or in journal articles here and
there, not as much as psychological treatment of schizophrenia, which is
sparse as it is these days, with more writing on the biology and
medicational aspects of tx.  Can anyone provide feedback or recommendations
for literature online or in journals etc.?  What seems confusing is the
delayed onset of the feelings of mania and overwhelm.  During the session
she was leaving with hope and a smile but she didn't appear uncomfortable or
manic.
Thanks in advance,
Bruce
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Bruce Whealton, MSW LCSW - Psychotherapist
Remember it's never ever ok to hit a child
spankings are not ok... the body remembers
even if it never even hurt.
http://wordsalad.net/psychotherapist/
Also check out: http://wordsalad.net/psyche/
Word Salad:
http://wordsalad.net/  online poetry magazine
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