From Theory to Clinical Practice: A Phenomenologically Inspired Intervention for Patients with Schizophrenia

Abstract

Background: Phenomenological conceptualizations of schizophrenia regard the fundamental transformation of self-experience as the central feature of the schizophrenic state of mind. Recently, self-disorders as subtle, trait-like, merely subjective alterations of self-experience have received vast empirical attention. However, the question of how to address self-disorders psychotherapeutically has remained neglected. Methods: From phenomenologically inspired analyses of self-disorders we derive a therapeutic intervention that focuses on the following: (1) verbalizing diffuse changes in self-experiences and (2) conceptualizing these self-experiences in terms of aggravating and relieving factors in order to stimulate coping and derive targeted therapeutic interventions. Results: The clinical implementation is illustrated by two case studies. The feasibility of our approach is preliminarily supported by an exploratory study. Conclusions: This intervention seems promising in assisting patients to develop an embodied and enacted understanding of self-disorders.

Overcoming fragmentation in the treatment of persons with schizophrenia.

“…These authors suggest that, “The patient experiences his I, self, or person as being divided or otherwise compartmentalized, disintegrated into semi-independent parts, or not existing as one unified whole” (p. 248). They also identify “bodily disintegration” as well as “demarcation/transitivism” disorders which involve, invoking language consistent with psychoanalysis, a “loss of permeability of self-world boundary.” Consistent with this, other phenomenologists have observed that, “The integrated and holistic organization of perceptions and habitualized motor patterns may fall apart into unrelated fragments” (Nischk, Nischk, Rusch, & Merz, 2015).…”

“…They also identify "bodily disintegration" as well as "demarcation/transitivism" disorders which involve, invoking language consistent with psychoanalysis, a "loss of permeability of selfworld boundary." Consistent with this, other phenomenologists have observed that, "The integrated and holistic organization of perceptions and habitualized motor patterns may fall apart into unrelated fragments" (Nischk, Nischk, Rusch, & Merz, 2015).…”

Der Psychose in der Soteria einen Sinn geben

“…Wir nehmen deshalb an, dass Versprachlichung und Konzeptualisierung helfen können, die innere Dialogfähigkeit wieder in Gang zu bringen, um ein vorläufiges Verständnis der psychotischen Erfahrungen zu entwickeln. Um dies zu überprüfen, führten wir eine kleine kontrollierte Studie an 32 Patienten mit (sub-)akuten Störun-gen aus dem schizophrenen Spektrum durch (19), die jedoch aufgrund ihrer klinischen Zielsetzungen auf einer konventionellen Akutstation durchgeführt wurde. Die Experimentalgruppe (EG) erhielt an fünf aufeinander folgenden Tagen eine Kurzintervention (10)(11)(12)(13)(14)(15), in der ein vorher miteinander festgelegtes Zielsymptom anhand eines formalisierten Vorgehens gemeinsam versprachlicht und anschließend konzeptualisiert wurde.…”