This article comes from WeChat public account: thorn bird habitat (ID: gh_82e4459bdea4) < span class = "text-remarks">, presenter: Jiang Fan, a licensed psychotherapist in New York, USA, finishing the lecture: Di Cuo
First, I want to ask you a question first. From 55 to 2005, the number of psychiatric hospitals in the United States declined. Can anyone speculate why?
“The development of community rehabilitation has been partially transferred to the community and is no longer being treated in the hospital.”
“The development of psychological counseling has solved the mental problems of some people.”
“The development of drugs has made more people not need to be treated in hospitals.”
Everyone gives good expectations. In fact, there are two aspects related to the decline in the number of people in the hospital. One is the increase in homeless groups, and the other is the implementation of the de-institutionalization policy.
In the United States, many patients have little family support. When a person develops a severe mental illness, he or she will be kicked out of the house or left the house by himself. The connection between relatives and friends in the United States is relatively weak, and part of the stress of mental patients comes from family, relatives and friends. However, from my experience, drug treatment can only help patients to reach a stage where they can talk. Most patients’ rehabilitation depends on the community and family. For homeless people, their relationship with severe mental illness is “revolving door” .
This part of patients may fall into a wandering state after being discharged from the hospital, and their condition may worsen during the wandering process.It is worth noting that their discharge does not mean that they have recovered , just as patients with diabetes need long-term medication. From an economic point of view, when a patient belongs to a homeless group, his cost needs to reach $ 63,000, and if he is in a resource that can provide resources to support (Helping to recover) , it only costs $ 16,000. Therefore, the United States introduced a de-institutionalization policy.
Interestingly, we find that there are actually more mentally ill patients in prisons in Los Angeles and New York than in the community, so we can think, is the so-called de-institutionalization really in place? When we don’t provide real resource support to patients, can they achieve balance of body and mind? Is this approach de-organized or re-organized? Does this translate those patients in the institution into patients elsewhere, or does it really cure the patients?
What is the standard for Fuyuan? Some people think that patients’ lives can be taken care of themselves, social recovery and normal work are recovery, but are these criteria to be met in each case? In our definition, Fuyuan has four major life themes: “health, home, purpose, community” . At the beginning I would ask the patient what is your goal? He would say that he is ill and does not need to take medicine. But this goal is not the real goal, because many patients always take medicine, so we will continue to help him find the real goal.
There are many paths to recovery, and we need to discuss with the patient when choosing to find a path that the patient can accept. In the doctor-patient relationship in the West, doctors and patients discuss decisions. In the Eastern discourse system, it may be the family to make decisions.
The path of restoration probably includes autonomous and conscious, different paths (For the therapist, don’t set limits on yourself) , full-person mode (Social, Psychological, Physical) span>, peer support, relationship (Keep good relationship with the rehabilitator, sincere and good relationship will bring positive impact) , culture (There are different small cultures in large cultures, and cultural sensitivity helps to build relationships) , trauma (Not all patients are caused by trauma to cause mental illness, and genes will have a certain effect. For example, if they are also unemployed, people with such a gene combination may be more likely to experience emotional breakdown) Respect and hope.
Regarding how to get along with the recoverers, it should be noted that we cannot evaluate the recoverers with our existing rehabilitation standards , but we should see the changes of the recoverers bit by bit. . Good at observing his behavioral patterns, capturing his positive changes, and drawing the line gently but firmly.
For patients who have relapsed due to not taking medication , we must realize that each relapse will make the recovered person’s spirit and cognition slip further into the abyss. Therefore, what we can do is keep reminding him, such as developing a manual for him to prevent recurrence. The manual can include: What is your early warning? What can you ask for when you feel the possibility of relapse? Help the rehabilitated person to slowly identify the conditions under which they will become better or worse.
When a recoverer tells you about his hallucinations and delusions, don’t lie. For example, if you haven’t experienced this before, you can’t say that I can feel the same with youIn this way, you can put it another way and try to understand his feelings.
Patients with mental illness often put some negative labels on themselves. We will help them explore other labels, such as father and mother, to weaken the patient’s label. At the same time, basic skills training will begin. For example, teach him to listen to others, and split listening to others into eye contact, no interruption, no digression, ability to answer, and repeat each other’s words.
Then we will do some targeted intervention. For example, there is a patient who is often late. The counselor may think that he is more resistant to treatment, but we will understand the reasons behind him. For example, if he finds that he does not set an alarm, I will teach him how to set an alarm.
During the audience questioning stage, some participants working in colleges and universities shared their worries about student work. The teacher found some unusual performances of the students. They may not want to suggest that students go to the hospital for confirmation, but parents are very opposed. .
In response, Jiang Fan responded as follows:
I think the first thing is to determine if this child really has mental illness. In your story, I didn’t hear of a watershed in mental disorders. It may sound like autism, it may be socially impaired, and may express something in a way that ordinary people can’t understand. Generally it is not harmful. This direction is easily implied by the language of others.
From a recovery perspective, what do you think the mother needs most iswhat? Generally we will subconsciously meet the needs of the service object, but what we want to do is not to meet his needs, but to find the reason behind the needs.
Change “why” to “what makes you feel you need it.” When you ask why, he may not be able to respond, you can try to ask a different way to let him think. Overall, this intervention is a very long process.
This article comes from WeChat public account: thorn bird habitat (ID: gh_82e4459bdea4) < span class = "text-remarks">, Speaker: Jiang Fan, Lecture Arrangement: Di Cub