Intimacy and the sense of self -On sexuality and psychosis NACS 2017 Trondheim 14/10-17

Transcription

1 Intimacy and the sense of self -On sexuality and psychosis NACS 2017 Trondheim 14/10-17 Cecilie Brøvig Almås, Clinical Psychologist FACT- team, Sørlandet Hospital President of ISPS Norway

2 Psychosis Mental breakdown Not able to use our acquired psychological coping strategies Emotional and cognitive chaos Lack of common sense Loose touch with reality

3 Psychosis Thought disturbances Delusions Hallucinations Lack of motivation Emotional change Evolves slowly develops along a continuum Attempt to adapt and make meaning of meaningless experiences

4 Psychosis Stress- vulnerability model Adverse life events What has happened to you?

5 Self- disorder Qualitatively change in subjective experience of one self as a conscious, active and embodied agent in the world Basic disturbance of the self that affects the developmental process of the identity Experience the body as a separate physical object that can be observed from the self. Increased self-monitoring hyper reflexivity

6 Self-disorder Loss of natural flow of thoughts, changing the subjective experience of thought Uncomfortable amongst others social withdrawal Miss out on formal and informal education about sexuality lack of basic knowledge Feeling of transparency - Sensations and tensions are overwhelming Difficulties in differentiating between the self, the body and the environment

7 Intimacy as a threat to the self Intimacy might cause a threat to a persons feeling of being its own person. Threat to eradication of the self Difficult to assume a firm stance about sexual attraction and sexual identity. Difficulties in establishing relationships to others

8 The basis of the self is disturbed Who am I among others? General doubt about identity Influence more complex part of selfhood: Social self Narrative self Lack of cohesive self

9 Regulating closeness and distance Deep longing for intimacy and partnership Overwhelmed by the threat of intimacy Difficulties regulating closeness overwhelmed, anxious and uneasy among other people Feelings of guilt and inadequancy

10 Therapeutic implications Establish a trusting atmosphere and safe environment Permission: open and neutral interest. Direct questioning

11 Adjusting the approach Adjust therapy to metacognitive ability/ability to mentalize Starting work with deeper brain structures, the brainstem moving up the brain structures Sense work: Be aware of their senses Trust their senses Preferences Gradually opening up to the outside world

12 Attachment and cognitive techniques Attachment styles becomes apparent interpretations should be well timed, mindful og the persons ability to differentiate Focus on personal features what makes you a person different from me? Cognitive techniques which demands a greater metacognitive ability Normalizing

13 Sexuality is not addressed by healthcare professionals Lack of education Norwegian study by Schaller and Træen, 2013: Sometimes asks about sexuality Mainly focus on the negative aspects of sexuality Not enough knowledge about the subject to address it properly and feel comfortable to discuss it with clients McCann et al, 2003: Major gap in the psychosexual knowledge by health care professionals

14 Majority of patients emotionally/sexually abused sexuality neglected Lack of privacy in hospitals and supported housing McCann et al, 2010: Dramatic difference in staff and user perception of needs around intimate relationships and having a partner

15 As a healthcare professional we are in a unique position to provide sexual health care needs of clients Express feelings, have their concerns validated and given information necessary to manage their lives Research shows a general willingness, openness and need for people to address sexuality in the therapy room and ward settings

16 PLISSIT We need to give Permission to talk about sexuality in all it forms Health care professionals should have enough education to give some Limited information Maybe even some Specific Suggestions? Knowledge about where to refer if there is a need for Intensive Therapy Open up for intimacy on a different level

17 Thank you for your attention!