Advanced Psychopathology

Monday, March 27, 2006


Interpersonal/relational take on paranoia

The commonalities of interpersonal and relational theorists point toward a therapeutic approach that seems useful for paranoid clients.

First, the interpersonal/relational belief in relationships as the central aspect of subjective experience dovetails well with the paranoid’s defensive structure – the paranoid individual desperately needs other people, if only to serve as targets for projection. The interpersonal/relational therapist and the paranoid patient already share the belief that one’s experience is a product of one’s relationships to others. It is the therapist’s job to get the paranoid client to see that this relatedness is a good thing; to move the client towards understanding which relationships are salient (as opposed to imagined, as in the case of conspiracies), benign, and even benevolent. This movement is effected via the therapeutic relationship and unusual, sensitive interventions -- McWilliams, for example, suggests humor.

Second, the interpersonal/relational technique of staying in the “here and now” and experiencing the therapeutic moment with the paranoid client is more likely to disarm the client’s defenses than interpretations, which the paranoid individual is likely to find threatening. In addition, by removing the therapist from the role of expert interpreter, this therapeutic stance may diminish the analyst/analysand power differential, which in turn may engender in the client a feeling of trust and even closeness. According to Sullivan, it is such experiences of warmth, trust, and intimacy that are frequently lacking in paranoid clients’ histories. (Presumably, interpersonal/relational therapy is meant as a corrective emotional experience to the emotionally arid upbringing common to paranoid clients; I don’t think Sullivan says this directly, however.) Privileging the interpersonal/transferential content of the client’s associations over their manifest content also gives the therapist a meaningful focal point – rather than having to parse the client’s latest elaborate plot, the therapist may look instead to the emotional content in the room as the patient spells out his theories.

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