Therapeutic reflection – the act of re-stating the client’s ideas using different words – represents an avenue towards mirroring the client’s internal state through therapeutic verbal interaction and the therapeutic stance of the person-centered therapist.

Carl Rogers developed person-centered and humanistic theory and psychotherapy as a way to ameliorate psychological problems. He advocated unconditional positive regard, genuineness and accurate empathy on the part of the therapist as having curative qualities when received by the individual in psychotherapy. He also asserted that therapeutic reflection was psychologically curative.

Humanistic psychotherapy allows the client to lead the verbal interaction, fostering a self-actualizing tendency or a growth potential in the client. The goal of this therapy – as perceived by the client – is the meeting of his real self and his ideal self. Therapy culminates in psychological health when the real self and the ideal self are in synchronicity. While this type of therapy may represent an outstandingly effective paradigm for treatment of psychological problems, and it does, it may be viewed as useless when applied to the schizophrenic.

So, if you are mentally ill, and another person says you are crazy, is it sane to agree with them?

This paradox represents the dilemma for people with schizophrenia, and it is inherent in the contradictory nature of this statement. Whether the psychotic individual agrees or disagrees with the attribution and the label of mental illness, he cannot comprehend himself in a psychologically healthy way. As self-comprehension is an avenue toward healing of psychological problems, a comprehension that may be at the core of any type of psychotherapy, gaining insight into the self may be essential in ameliorating psychological problems.

It might be said that we are sane if the reality of what we are and our own understanding of these are accurately reflected by those in our environment. As indicated, Carl Rogers advocated accurate empathy as having the power of psychological healing. The question that pertains to this is one of whether accurate empathy, enacted by the “other” or the psychotherapist in relation to the “self” of the psychotic individual, as perceived by the “self” of that individual, is even possible.

The problem for the psychotic individual may be, in part, the problem of whether anyone can accurately empathize with her perspective. The thoughts and attributions of the psychotic individual that equate with, essentially, her delusional system, may be completely outside the realm of what the humanistic psychotherapist, or any other kind of psychotherapist, would even consider. This bodes poorly for the possibility of accurate empathy on the part of the psychotherapist, and, even if the psychotherapist is able to accurately mirror the internal state of the psychotic individual, there exists that concern on the therapist’s part that validating the psychotic individual’s perspective may simply affirm the delusional system of that individual, thus rendering such a course anti-therapeutic.

Carl Rogers made the statement: “Only when I accept myself as I am, can I then change.” This idea may be the basis for the effectiveness of accurate empathy and mirroring or reflection of the client’s internal state. In terms of treating the schizophrenic, the issue seems to be one of how to enact accurate empathy toward the psychotic client without affirming her delusional system.

There seems to be an overwhelming stress in the field of mental health to refuse to affirm as credible even the slightest amount of delusional material. It is known that psychotic individuals have over-valued ideas. The act of affirming these ideas as credible is counterintuitive. However, it should be noted that these ideas on the part of the schizophrenic may be over-valued by her simply because therapists refuse to give credence to them. In this sense, over-valued ideas may be a reaction to a lack of affirmation regarding her ideas.

Paranoid schizophrenics, for example, not only have over-valued ideas; they have visceral fear that accompanies their visceral hallucinations and their delusions. The need for the psychotic individual to communicate this fear to her therapist is intense. The psychotherapist’s dismissal of this fear as simply unfounded does not make the delusional individual feel safer, and, in fact, it renders her less safe, even if only due to the fact that she believes she has reason to fear, she is alienated with it, and no one will take her seriously. This amounts to subjective psychological suffering.  

There might exist the possibility for addressing the paranoid psychotic individual’s delusional system by simply by explaining the situation to them. For example, the psychotherapist may say: “I acknowledge that you are afraid of being alone with this fear. Part of your illness resides in the fact that no one will take your concerns as seriously as you take them. If I thought and believed the things that you think and believe, I would be afraid, too. Sometimes talking about one’s fears diminishes them. Can you agree tell me all about your situation? Can we work together to gradually challenge your fears by talking about the information you may be afraid of disclosing, so that we can together prove to you that nothing bad will happen if you do so? I will stay with you through this process. I will listen. And I will comfort you as best I can. I will be able to help you feel safe.”

Self-acceptance may be both a precursor to therapeutic change as well as a result of such change. Perhaps change that is both a cause and a result of self-acceptance that may occur simultaneously. The first step toward dealing effectively with one’s mental illness is admitting that one has a mental illness.

However, if you have a mental illness and someone says that you are crazy, is it sane to agree with them? For the mentally ill person, agreeing with this statement amounts to anarchy on the level of the self. However, by disagreeing with this statement, the mentally ill client may endure a different anarchy that may isolate that individual with his fears, his hallucinations and his delusions.

Humanistic psychotherapy has a potential to be applied effectively to the psychotic individual by an insightful and empathic person-centered therapist who is willing to imagine what her client is dealing with.

Image via Lassedesignen / Shutterstock.