Dancing with the Demons – Making sense of schizophrenia

ABSTRACT

This paper explores the empathic nuances of the therapeutic process with a person experiencing ongoing psychosis associated with a diagnosis of schizophrenia, and with a history of severe relational trauma. Incorporating the self psychological principles of working with the therapist’s and client’s forward edge, utilizing experience-near empathic attunement, and the somatic psychotherapy essential for kinaesthetic conversation were essential elements for the ongoing integration of the client’s self. This work demonstrates the development of a nuanced understanding of pathological accommodation with its internal self-organizing dynamics as well as offering examples of forward edge movement. Interweaving vignettes from a two-year period with the subjective and intersubjective somatically animated experiencing of the therapist, the puzzle of how to work with all parts of the client unfolds gently and carefully. This paper outlines how connections were made between the two participants, in a clinical sense and within the client, creating a sense-making structure within the nuclear self experience of the client. Real life clinical experiences of what somatic psychotherapy, undertaken within a relational, intersubjective psychodynamic process, looks and feels like are in short supply. The presentation of this case hopes to remedy that by demonstrating the body mind integration required to work this way.

KEYWORDS:

• Experience near attunement
• forward edge
• pathological accommodation
• psychosis
• self psychology

Acknowledgments

With grateful acknowledgement of editing input and this quotation, suggested by Sandra Kay Lauffenburger.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Karen Stewart

Karen Stewart is a white woman born in the 1970s in Australia, currently living and working on Ngunnawal and Ngambri land in Australia. Karen was raised by a military father and a health professional mother, living in many different places during her upbringing. Karen has her own private practice and works primarily in a psychodynamic psychotherapeutic way. Karen’s professional background includes working with people of all abilities who have experienced trauma and mental ill health, with offenders in the justice system, people in crisis due to family violence or sudden death, people with disordered eating and as a couples and relationship therapist. Her work is infused with a somatic orientation and informed by self psychology and affect theory.