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The Integration of Ego Psychological and Cognitive Behavioral Interventions for First Episode Psychosis : Strengthening the Self and Treating the Symptoms

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The Integration of Ego Psychological and Cognitive Behavioral Interventions for First Episode Psychosis : Strengthening the Self and Treating the Symptoms Smith ScholarWorks Theses, Dissertations, and Projects 2011 The integration of ego psychological and cognitive behavioral interventions for first episode psychosis : strengthening the self and treating the symptoms Megan Mary Czaja Smith College Follow this and additional works at: https://scholarworks.smith.edu/theses Part of the Social and Behavioral Sciences Commons Recommended Citation Czaja, Megan Mary, "The integration of ego psychological and cognitive behavioral interventions for first episode psychosis : strengthening the self and treating the symptoms" (2011). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/1061 This Masters Thesis has been accepted for inclusion in Theses, Dissertations, and Projects by an authorized administrator of Smith ScholarWorks. For more information, please contact [email protected]. Megan Czaja The Integration of Ego Psychological and Cognitive Behavioral Interventions for First Episode Psychosis: Strengthening the Self and Treating the Symptoms ABSTRACT This theoretical study is an exploration of the use of ego psychological and cognitive behavioral interventions as an integrative treatment for the beginning phase of schizophrenia known as first episode psychosis. Schizophrenia develops as first episode psychosis in young adults who are navigating complex developmental tasks. Current research on schizophrenia treatment indicates that appropriate and prompt care following first episode psychosis improves prognosis and allows individuals to regain and maintain developmentally appropriate levels of functioning. This study was undertaken in an effort to identify the holistic treatment needs of young adults experiencing first episode psychosis. The clinical phenomenon of schizophrenia and first episode psychosis was described. Then schizophrenia was conceptualized from an ego psychological and cognitive behavioral orientation. Treatment methods associated with each methodology were detailed and each theory was applied to first episode psychosis. The two theoretical orientations, ego psychology and cognitive behavioral treatment, were applied to a first episode psychosis case. A discussion follows which highlights the importance of utilizing interventions from both modalities to ensure treatment needs are met for first episode psychosis clients. THE INTEGRATION OF EGO PSYCHOLOGICAL AND COGNITIVE BEHAVIORAL INTERVENTIONS FOR FIRST EPISODE PSYCHOSIS: STRENGTHENING THE SELF AND TREATING THE SYMPTOMS A project based upon an independent investigation, submitted in partial fulfillment of the requirements for the degree of Master of Social Work. Megan Czaja Smith College School for Social Work Northampton, Massachusetts 01063 2011 ACKNOWLEDGMENTS This thesis could not have been accomplished without the assistance of many people whose contributions are gratefully acknowledged. I wish to thank both research advisors who guided me through this process, Joyce Everett for her patience, understanding and acceptance of my choices and Jean LaTrez for motivating me, following my pace and providing me with unwavering encouragement. Thanks to the staff at the Family Resource Center, you inspired me to take risks, taught me the importance of the relationship and allowed me to follow my bliss. This research would not have happened without your support and motivation. Thank you also to Jason, for your consistent support, patience and partnership along this journey. Thank you for never doubting me. You and me together, we can do anything! And gratitude towards the first episode psychosis clients, thank you for allowing me the honor of bearing witness to your tears, smiles and stories of healing and hope in the face of a storm. You can tolerate the intolerable and enjoy the whimsy of life. i TABLE OF CONTENTS ACKNOWLEDGMENTS .................................................................................. i TABLE OF CONTENTS .................................................................................... ii LIST OF TABLES .............................................................................................. iii LIST OF FIGURES ............................................................................................ iv CHAPTERS I. INTRODUCTION ...................................................................................... 1 II. THE PHENOMENON ............................................................................. 11 III. THEORY ONE ........................................................................................... 32 IV. THEORY TWO .......................................................................................... 59 V. DISCUSSION AND CONCLUSIONS ..................................................... 76 REFERENCES ................................................................................................... 98 ii LIST OF TABLES Table ................................................................................................................ Page 1. CBT interventions for Specific Symptoms of Schizophrenia ................... 73 iii LIST OF FIGURES Figure Page 1. Cognitive Model Individual with Auditory Hallucinations ...................... 61 iv CHAPTER ONE INTRODUCTION Imagine being 19 years old, after a whirlwind senior year of high school, involving arguments with parents, tearful goodbyes to peers and the last days of a summer job. You are moved into your dorm room, it is your first time away from home. You have packed your books, IPOD, that old teddy bear, and the good and bad memories you have encountered throughout your life. You are struggling to connect with any new friends. Suddenly, you are a different person and don’t really feel comfortable leaving your room. At the same time it seems as though you are experiencing a lot of coincidences; it seems as though people are following you and a sense of doom creeps over your mind. Who you once were seems to have disappeared overnight; in fact you are not even sure you exist anymore. You begin to panic and wonder if you do not exist then, how are you supposed to be like the other 19 year olds? You should be discovering life goals and growing up. Instead there are beings that are sending you messages on how to find a way to an alternate dimension in which they say you belong. You cannot go to class anymore, it is not safe and the beings may not be able to find you there. You do not want to miss the messages; the beings tell you the only way to the other dimension is to drink a bottle of cleaning fluid. There is a knock on the dorm room door; your parents are there, along with the police and an ambulance. You are taken to a hospital, you scream, you cry you are told to take pills. You take them and go numb and the beings settle down a bit. The doctors tell you that you will 1 now be seeing a therapist; you must move back home and you have to keep taking the pills. The therapist tells you that you have schizophrenia, and she wants to help you recover. You are not you anymore and you do not know who you will become. You wonder: “Do I need to recover? Do I want to recover? Is it possible to recover?” The above describes the process of a young adult developing first episode psychosis (FEP), or in other words, the first psychotic break and initial diagnosis of schizophrenia. It is a time of fear, disappointment, trepidation and loss. The safety the FEP client once felt is gone, along with a sense of self. However, with appropriate treatment that acknowledges specific needs of young adults, an FEP client’s chance of recovery from schizophrenia will improve and the young person will be able to re-engage with life. This study examines the treatment needs of a unique population, young adults with FEP, from a cognitive behavioral and ego psychological perspective, with an aim at developing a holistic treatment modality to help FEP clients process the experience of mental illness and learn to live despite the diagnosis. FEP requires special clinical attention as the needs of young adults experiencing their first psychotic break are different than the needs of individuals who deal with chronic schizophrenia (Cullberg, 2006). In the 1990’s, treatment programs emerged that focused on early intervention for FEP (Compton & Broussard, 2009). It is believed that young adults approximately 18 to 26 in age benefit from specialized phase specific treatment that is designed to help young adults achieve developmental milestones as they transition to adulthood and adapt to a diagnosis of schizophrenia. Phase specific treatment programs offer a range of services including pharmacotherapy, individual psychological and family interventions, case management, group therapy and vocational rehabilitation (Addington & Addington, 2008). 2 Australia and the United Kingdom require the availability of programs especially designed for FEP clients (Sin, Moone & Wellman, 2005). Other countries are expanding specialized treatment as well. However, the United States does not have many programs for FEP due to the current managed care system. Many of the services offered through specialized programs; such as long term case management, and family, individual and group therapy are not paid for by insurance companies (Kuller, Ott, Goisman, Wainwright, & Rabin, (2010). Furthermore, most people cannot afford the out of pocket costs of such services Therefore, young adults who have experienced a first psychotic episode do not receive the necessary level of care that would promote high levels of recovery. The focus
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