Schizophrenia is a disorder that has positive and negative symptoms. Rigby & Alexander (2008) states that positive symptoms are psychotic symptoms, and negative symptoms are depression type of symptoms (Rigby & Alexander, 2008). Negative symptoms are signs that schizophrenia is developing, but has not reached a psychotic state. Positive symptoms of schizophrenia are delusions and hallucinations. Schizophrenia also has shown possible cognitive dysfunction.
Psychosis is the most recognizable symptom of schizophrenia. Owen, Sawa, & Mortensen (2016) declares that schizophrenia is usually recognizable from the psychosis symptoms (Owen, Sawa, & Mortensen, 2016). Some aspects of psychosis that is associated with schizophrenia is: Delusions, hallucinations, and disorganized thinking. Within the category of delusions, there are many types of delusions. Some examples are: Grandiose delusions, referential delusions, persecutory delusions, etc (APA, 2013). A lot of these symptoms fit the positive symptom category. Schizophrenia has a big stigma attached to it, and labeling might be a concern for some clients.
Theoretical Models and Etiological Approaches
A biological approach to schizophrenia is looking at brain development. Owen (2016) posits that schizophrenia develops from brain development being disrupted (Owen, 2016). This model would encourage looking at what areas in the brain is not working properly. A biological approach would encourage medication as an intervention. Snyder & Murphy (2008) suggests that medication specifically antipsychotics are used to treat schizophrenia (Snyder & Murphy, 2008). Medication might help fix some of the synapses or neurotransmitters that are functioning abnormally.
The biological model would assert the possibility of there being a genetic component to schizophrenia. Park & KiPark (2012) states that there could be genetic risk factors (Park & KiPark, 2012). Another possibility is genetics and environmental factors contributes to the onset of schizophrenia.
Cognitive-behavioral therapy (CBT) is gaining more ground for use in working with clients diagnosed with schizophrenia. Dopke & Batscha (2014) states that CBT is a very useful approach to deal with schizophrenia and psychosis symptoms (Dopke & Batscha, 2014). CBT focuses on changing irrational thought processes, which can be helpful in changing problematic behavior. If an individual is struggling with paranoid delusions, then CBT might be useful to help the client see that person or item is not out to get them. That fear might be irrational but it is very real to the client. Another reason CBT might be useful is it can help process the experience the client has dealing with the stigma of schizophrenia. Dopke (2014) says that CBT can be helpful in improving self-esteem (Dopke, 2014).
Some common CBT interventions are: Role-play, ABC Model, goal-setting, etc. The ABC model requires the clinician to determine the activating event that triggered the psychosis. Role-play can be helpful in playing out possible situations that the client might face. Morrison (2009) acknowledges that Aaron Beck helped a patient suffering from delusions by using CBT (Morrison, 2009). CBT can be helpful by helping the client develop better coping skills. However, the learner does not know if CBT would be as effective with a client that is currently in a psychotic episode. Helping the client have healthier cognitions could help improve the schizophrenia, and lower the amount of stress that they deal with. It is also important to acknowledge how the client’s environment contributes to their condition and negative cognitions. Nowak, & Sabariego, & Switaj, & Anczewska (2016) states that CBT interventions primarily focuses on lessening the severity of the symptoms (Nowak, & Sabariego, & Switaj, & Anczewska, 2016). This makes sense because CBT focuses on changing irrational thoughts that contributes to mental health disorders.
Family systems approaches would mandate that schizophrenia should be viewed from a systemic perspective instead of as an individual program. A family perspective looks at different factors that contributes to schizophrenia, instead of placing the blame on the individual. Smerud & Rosenfarb (2008) states that providing psychoeducation to families about schizophrenia is helpful in treating the disorder (Smerud & Rosenfarb, 2008). A family systems approach would strive to educate the entire family system and lessen the stigma on the individual. It is important for the clinician to build and maintain a therapeutic alliance with each family member. Family therapy would also be effective for treating co-occurring disorders or dual diagnosis. Gottlieb, Mueser, & Glynn (2012) states that there is a high rate of co-occurring disorders among this population (Gottlieb, Mueser, & Glynn, 2012).
The learner would apply the biological model to schizophrenia by saying that it is caused by brain abnormalities. Antipsychotics is a method that the biological model would endorse. A cognitive approach would be applied by applying it to fix delusional thoughts. She would apply the family systems approach by approaching schizophrenia from a systemic issue rather than as an individual issue.
Forces Shaping the Development of <Your Selected Diagnosis>
Schizophrenia was first recognized as a mental illness in 1887. N.A. (2010) says that Dr. Emile Kraepelin was the one who discovered schizophrenia (N.A, 2010). Over time, the stigma associated with schizophrenia has increased. Society has placed a negative stigma on disorder to where there is a fear that individuals cannot live a functional life with this disorder.
Family could contribute to the fear or anxiety that a client experiences with the diagnosis. The family system is very important in that the dysfunction within the family dynamic needs to be addressed to treat the disorder. Smerud (2008) states we must develop a good clinical relationship with the clients for psychoeducation to be effective (Smerud, 2008). The family system is important in how the individual views their diagnosis.
Symptoms Observed by Therapist
The clinician might observe psychotic symptoms such as delusions or hallucinations if the client is in the middle of an episode. It is also normal to notice positive or negative symptoms of schizophrenia. Owen (2016) states that it is normal to recognize psychosis and speech impairments (Owen, 2016).
There are different aspects of delusions that the clinician should look out for. The APA (2013) says that the most common form of delusions is persecutory delusions (APA, 2013). Other common types of delusions are grandiose delusions (ex when a client believes they is married to Bill Gates) or erotomanic delusions (ex. Thinks Jessica Simpson is in love with them). The most common types of hallucinations associated with schizophrenia is auditory hallucinations (APA, 2013). Auditory hallucinations can be described as when the clients hear voices. When clients go into a psychotic episode, they might go into a catatonic state. When this occurs, they might react inappropriately or fail to respond at all.
The Impact of Diagnostic Labels
The diagnostic label can be devastating to the client and their family members. Dickerson, Sommerville, Origoni, Ringel, & Parente (2002) says that a stigma can lead to this population experiencing discrimination (Dickerson, Sommerville, Origoni, Ringel, & Parente, 2002). This label might make the client feel like an outcast in social settings, and make it hard for them to find or maintain steady employment. There also could be a feeling of shame in the family, especially if there is a history of mental illness.
It is acceptable to assign a diagnostic label when insurance companies provide compensation for services. They usually require written documentation of a diagnosis and time frame for sessions that is needed. On the other hand, we must do what is in the client’s best interest. It would be more ethical to avoid diagnosing the client if they are emotionally in a place where they might not be able to cope with the diagnosis. Therapeutically, it could damage the relationship if diagnosing can strengthen the therapeutic alliance if the client trusts the counselor. The learner would want to help the client work through their experience of being diagnosed and what it means to them. At Track 1 residency, a theme that stayed with the learner was focusing on the process over content. The focus should not be that this client is schizophrenia and is permanently impaired because that falsely labels them without looking at the entire identity. The focus should be on processing the client’s experience and helping them cope with the diagnosis.
In this paper, the learner had the opportunity to practice selecting a clinical diagnosis. She had the opportunity to discuss different theoretical models and their perspective on schizophrenia. Towards the end of the paper, she described different symptoms of schizophrenia and it helped her develop more awareness about this disorder.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.) Retrieved from: Capella
Dickerson, F., & Sommerville, J., & Origoni, A., & Ringel, N., & Parente, F. (2002). Experiences of stigma among outpatients with schizophrenia. Schizophrenia Bulletin. Retrieved from: Capella
Gottlieb, J., & Mueser, K., & Glynn, S. (2012). Family therapy for Schizophrenia. Retrieved from: Capella
N.A. (2010). History of schizophrenia. Retrieved from: Schizophrenia.com
Nowak, T, & Sabariego, C., & Switaj, P., & Anczewska, M. (2016). Disability and recovery in schizophrenia: A systematic review of cognitive behavioral therapy interventions. BMC Psychiatry. Retrieved from: Capella
Owen, M., & Sawa, A., & Mortensen, P. (2016). Schizophrenia. Retrieved from: Capella
Park, C., & KiPark, S. (2012). Molecular links between mitochondrial dysfunctions and schizophrenia. Retrieved from: Capella
Smerud, P., & Rosenfarb, I. (2008). The therapeutic alliance and family psychoeducation in the treatment of schizophrenia: An exploratory prospective change process study. Journal of Consulting and Clinical Psychology. Retrieved from: Capella.