Family and Caregiver Schizophrenia Discussion Forum

Therapy or not?

My 22 year old son has Anasognosia . He was seeing a therapist unwillingly .The therapist thinks the sessions are pointless as my son does not think anything is wrong with him .I explained to the therapist that is part of my son’s condition but he still feels he can not help him unless he opens up . My question is , is it pointless ? or do i try and find another therapist that can help my son ?

Hey Linda. Yup, I’d find another therapist. Immediately while you’re still actually able to get your son to see one however unwillingly.
If the therapist doesn’t know the term anosagnosia and isn’t willing to try other approaches and target maybe something other than the illness specifically, I’d venture to say this person hasn’t a clue what they are doing. CBT (cognitive behavior therapy) is a pretty common mode of practice for therapists out there and shouldn’t be difficult to find somebody implementing it. So many things can be addressed besides just the illness directly, such as identifying ones own thought patterns and processing ones own impulses; knowing the difference between thoughts and feelings etc. And considering ‘lack of insight’ seems to be in play, it sounds like the current therapist is doing exactly what Dr. Xavier Amador warns us against and has been proven over and over to be counterproductive: Telling someone who is sick that they are sick and demanding they acknowledge it.
Also, it can be difficult for any and all of us to find a good therapist for ourselves that’s the right fit, somebody that you ‘click’ with and feel comfortable enough to actually open up with. That’s not uncommon. The search continues…

Afterthought: Is he seeing a psychiatrist or just a therapist? Has he seen a psychiatrist that’s willing to work with him?

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I agree with @Wisdom. I wish I had known sooner how to deal with anosognosia and to seek out medical professionals who had real knowledge and successful experience with it. It was better than nothing when my son would see the counselor, but it didn’t solve the real problem in the longer term. My son just kept getting worse. Now I have communication tools learned from NAMI and the book “I Am Not Sick; I Don’t Need Help” plus (after many hospitalizations and other drama) we’ve had the benefit of time in a group home that helped my son become med-compliant and acknowledge his illness! I’m hoping he will be able to “tell his story” someday. He says that he wants to!

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That’s incredibly courageous of your son! I know I for one am always extremely interested in hearing first hand experience from those who live with their MI and success stories are the absolute best!

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You are absolutely right , thank you . It is unreal how so many therapist are clueless how to handle CBT . My son just started to see a new psychiatrist . I will reach out to her and see where we go from here . So frustrating and so mentally draining . 6 different psychiatrist and 6 therapists and still searching …

That would be amazing !

It’s not just therapists who are clueless about anosognosia. Some psychiatrists are clueless also.

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I totally agree !!! you would think its their job .

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Actually I have more hope in the therapists 'getting it ’ for this reason: while psychiatrists may acknowledge anasognosia, their reliance on drug only therapies means they can only achieve theraputic goals through forced or coerced medication which undermines the trust of the patient required for continued cooperation with treatment. Because LEAP is a talk therapy and so many psychiatrists are lousy at the skills required to implement it, responsibility falls to caregivers.

I’m biased, of course, because I only accepted AP medication after a year of psychotherapy, and continued psychotherapy afterwards, but the two disciplines have very different skills and mindsets. I think we’d all prefer that professionals do the heavy-lifting of implementing LEAP, but people with schizophrenia rarely see therapists who have the required skills because of psychiatrists’ biases toward talk therapy. Idealy, a multidisciplinary team approach would be best, but it rarely happens.

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Good points , thank you :pray:

My son has been to countless therapists, and now refuses. There is " nothing wrong with him" why should he go? We are exhausted.

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I agree !! Exhausting . One day at a time , their mood changes all the time . The question is if they don’t have insight does the therapy help ? . I believe it helps if one wants to get help … I don’t know anymore , this is so draining ! His last therapist said to me “what’s the point ?” I actually wanted to reply the point is that you are not doing a good job and that you should know about anasognosia ! But I thought forget it as I have no time to teach the therapist what we all live and learn on this site and in reality . I’m trying to find another one now , someone that can relate to him . That’s if he still agrees to go . Hang in there :pray:

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It’s seems like I may be in a minority on this one, but I agree with the therapist. A long ago I asked a very good therapist if it was worthwhile for my son who is sz bp who was not on treatment to start seeing her. She was honest and told to me that nothing could be accomplished if he was not on treatment, that it would be a waste of time and money. Remember that this is a brain disorder… The psyquiatrist said the same. The advice was to start on treatment then start with therapy. I know we may see value on going to the therapist as a way to keep them engaged with the mental health system. As long as that is the goal OK but expectations about results should be kept low.

I do understand what you are saying but If a good , caring therapist is educated well about Schizophrenia and has good communications with his patients then i believe it may help the patient release things and in some cases may have insight too . The problem is that it is so hard to find a good therapist and psychiatrist . I believe most of the caregivers on this site are much more educated than most therapists . Sometime i am so amazed how clueless they are . If i was a therapist dealing with MI i would want to educate myself from A-Z

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**i agree that although meds alone will not address the issues without meds there is no point in therapy. At least with my son when he is not on meds he is not intellectual available or able to engage.

Someone not med compliant i completely agree too but someone who is med complaint like my son and has no insight i believe with the right therapist (if that even exists ) may help .

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My son suffers from anosognosia and is unmedicated for his schizophrenia. He hadn’t been able to grocery shop for himself for several years. He said it was too stressful with all the people (voices) yelling at him in the store. He later became paranoid that I was poisoning him through the groceries I picked up for him. He chose to see a cognitive behavior therapist to help him figure out how to shop for himself. Being able to handle shopping for himself opened up other possibilities in his life using the techniques he learned from the therapist.

Dr Amador teaches us to listen for something our family member wants and to use that to motivate them. To get him diagnosed in the first place, I used LEAP communications to get him to talk to me. He had gotten where he didn’t trust me at all. When he eventually mentioned he would like to go to Colorado for a trip (yes for the obvious reasons) I offered him a trip to Colorado if he would see a psychiatrist for one year for his anxiety - his self diagnosis. He was supposed to take meds for the year, while he was prescribed many meds, he only took the anti-anxiety.

I think therapy is very useful when they want to go see someone for help and the person helps them in the area they want help.

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Whether therapy is helpful depends on the motivation of the individual, the type of therapy and the skill of the therapist. Anosognosia in many ways gives a cop-out to psychologists and psychiatrists alike for their lack of listening and empathy skills. If the therapist throws up her hands and says I can’t do anything with him unless he takes medication, and then the psychiatrist throws up his hands and says I can’t do anything with him unless he takes his medication, the problem ends up in the caregivers or social workers or worse the law enforcement system’s lap. It’s Officer Krupke from West Side Story all over again. LEAP is a method to break that cycle; doctors who say therapy is pointless should be handed Dr. Amador’s book and told “physician heal thyself”, before you try healing others.

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Hi Hope , That was very interesting, you seem like an amazing mother and you handle your son so well with LEAP .non med compliant and wanting to see a therapist is unreal . Well done ! You are so right when you say to work on what they really want . My son does not want to lose his Drivers license , (his car is his life ) and in order to keep it he needs to comply with a psychiatrist and that’s the reason he is med compliant . (This is all my doing lol ) but he does not have insight and does not think he needs Meds or to see a therapist. I am still practicing the LEAP method with him :wink: I have been feeling poorly for the last week and my son worries about me a lot so yesterday Was a great day , my son decided to go to the grocery store , buy healthy food and cooked in his apartment . He make food for me and asked me when I got back from the doctors to come and pick it up . I was amazed how well he cooked and even more amazed that his kitchen was not a crazy mess ! I was so happy :grinning:. I love days like those and it keeps me in peace but every day is different depending on his moods . Last week I was worried sick all the time , he slept so much and turned his days in to nights and didn’t get back to my calls . One day at a time is best for me .

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I totally agree with you and funny you said that about the book as my first and exact thought was to hand him a copy of Amador’s book After he said to me , what’s the point !