The precondition of communication with schizophrenics is knowing and understanding of their fragmented and chaotic world. Communication with the schizophrenics should respect their fear of fusion and disintegration, as well as the fear of abandoning. In communication with the schizophrenic two facts are important: the real support is accepting the bizarre existence of the patient, and the other side of the support is the capacity of the psychiatrist to understand and withstand the patient. This capacity is determined through the consistency of therapist's behavior, possibility to accept the patient's right on regression, but also the ability to offer the constancy of himself, too. The therapist is the representative of the reality whose consequence and constant presence enables him to grow up from the internal mixture of the mental presentations into an authentic, independent person, dedicated to the patient. The therapist is expected to tolerate the patient's alienation due to the fears from fusion or disintegration. A constant activity of reestablishing of contact and respect of a specific cognitive style are needed. Communication with the schizophrenics implies an explicit calling to a verbal communication that has to be understandable, and searching for the conceptual framework, which provides understanding. Basic characteristics of the adequate communication are persistence, consequence and simplicity of instructions with the norm of behavior control, as well as the clarity of the “here-and-now” situation. The therapist's understanding of the schizophrenics justifies his actions and allows taking the psychotherapeutic attitude.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Self-perception, as a part of self - concept, is a form of perception where the object being observed and the observer are one and the same. The self-concept is a cognitive structure and it mediates between social structures and behavior. In group psychotherapy, a therapist's interventions are focused on the replacement of a false paranoid identity (where the overestimation of one's own intelligence is part of the false image one has of himself) with a real one. Six psychotherapeutic groups of paranoid patients were studied. The methodological procedure known as the analysis of relations was used. It is a combination of the sociometric questionnaire and the test of social perception. The degree of appropriateness of auto-perception of intelligence is evaluated. The determination of the auto-perception of intelligence was carried out by comparing real ranks (from the real IQ) and the ascribed ranks (on the basis of the selected positions where the patient marked his own intelligence to be). The results for all the groups are consistent: there is a definitive (both in terms of the number and the degree) overestimation of one's own intelligence. It can be found at the basis of the paranoid pathology expression where we find the parallel nature of the projection of the introject of the aggressor and the introject of narcissistic superiority, partially incorporated into the unreal self concept. Psychotherapy at this level of solidly fixated conceptual categorization with a “falsification” of perceptual data is of crucial importance for the “dissolution” of the paranoid state.
In this paper it was investigated existence and prominence of dysfunctional attitudes at patients with depressive episode. Dysfunctional attitudes are, according to the cognitive theory, considered as an important promoter and conserver of the depressive disorder. Investigation encompassed 36 patients, 21 women and 15 men, with average age of 38.47, with a diagnose of the first episode of the depressive disorder, of mild or moderate degree by ICD 10 classification. The control group consisted of 30 subjects, 16 women and 14 men, with average age of 34.52, without psychiatric disorder history. Depression was determined by Beck's inventory for depression. Dysfunctional attitudes were measured with Dysfunctional Attitudes Scale (DAS) which is 40-item, seven point scale designed to identify and measure cognitive distortion. Items present seven major value systems: approval, love, achievement, perfectionism, entitlement, omnipotence and autonomy. Results indicate to the significantly higher values of dysfunctional attitudes at depressive patients (average score of 159.1) regarding the healthy persons (74.5). Dysfunctional attitudes are especially distinct in the areas: approval, achievement, and perfectionism. Besides the quantitative analysis of the dysfunctional attitudes, this scale showed as a good instrument for an individual analysis of the dysfunctional attitudes, that could be used in creation of a therapy plan.
Persons with mental illness may internalize mental illness stigma-self stigma. Perceived stigma results in lower self-esteem. Self-stigmatizated persons are unable to overcome negative expectations and stereotypes about mental illness. They constrict their social networks, stay isolated and frequently avoid treatment. On the other side self-esteem alone has been found to predict life statisfaction and is related with positive outcome among people with schizophrenia. Our study aim to determine level of internalized stigma and self-esteem in hospitalized schizophrenic patients at Psychiatric Clinic in Nish. Study encompasses 30 patients, 16 males and 14 females, average age of 38,6 years with diagnosis of schizophrenia. The internalized stigma is measured with The Internalized Stigma of Mental Illness Scale (ISMIS), the 29-item, 4 point Likert scale. Items are summed to provide 5 major scale scores: alienation, stereotype endorsment, discrimination experience and stigma resistance. The Rosenberg Self Esteem Scale (SEC) is used to measure self-esteem. It is 10-item, 4 point Likert scale. Scores range from 10 to 40 with higher scores indicating higher self-esteem. Our results on ISMIS show mean value for alienation 2,64, for stereotype endorment 1,84, for discrimination experience 2,48, for social withdrawal 2,36 and for stigma resistance 2,21. Mean value on SEC is 27,6. Results points to internalized stigma as important factor with influence on self esteem in patients with diagnosis of schizophrenia that that has to be reduced.
Group psychotherapy of paranoid patients implies gradualism in achieving therapeutic goals. Establishing reality is the first therapeutic goal, and acquiring insight and understanding of the current conflicts in the situation here-and-now connected with conflicts from the past in the situation there-and-then is the second one. Five Small psychotherapeutic groups of paranoid patients were included in our study. We measured the participation of the therapist's communications in group communication structure and the structure of the therapist's interventions. The therapist's communications in the group were determined using Bales’ category system. The therapist's interventions were determined according to the Scale of therapist's interventions. We made two measurements: at the beginning and after a period of two months. The total score of the therapists’ communications in the first measuring (38.2%) was significantly higher than in the second measuring (25.79%) (p < 0.01). In the structure of the therapists’ communications, a high level of the emotionally positive communications was maintained in the first (55.45%), as well as in the second measuring (41.17%). Explanations, clarifications and alternative solutions could be found in the beginning of the group therapist's interventions. The most frequent therapist's interventions in the second measurement were interpretations and confrontations. In the therapeutic process, members of the group were taught to observe communication and to search for its meaning together. The group responded to the reality of its world and defined reality for every single member. Communications brought new meanings to old experiences and enabled the acquisition of new experiences with meaning.
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