IJSP Number 4, 2022

72 Working With Odd Realities in Supervision: The Psychotic Patient POPESCU Oana-Maria 1 1 The Association of Integrative Research, Counselling and Psychotherapy Emails: dr.oana.maria.popescu@gmail.com Abstract Working with the psychotic patient is one of the most difficult tasks in psychotherapy, especially for beginner therapists. The paper presents some of the major difficulties in the psychotherapy of schizophrenia, structured according to the integrative-strategic approach, together with potential interventions in supervision. Key words: psychosis, schizophrenia, clinical supervision. 1. Background Symptoms in schizophrenia include a large array of cognitive, behavioural and emotional dysfunctions, most individuals diagnosed with schizophrenia having delusions and hallucinations [1]. Also, emotional symptoms are common in schizophrenia and can be simultaneous with active-phase symptomatology [2] Depersonalisation, derealisation and somatic symptoms may reach delusional proportions, anxiety and phobias are quite frequent and approximately 5 to 6% of schizophrenics commit suicide [3] From a cognitive standpoint, seven distinct domains are malfunctioning in schizophrenia patients: cognitive processing speed, attention or vigilance, work memory and long-term memory, verbal and visual learning, judgement, problem solving abilities and social cognition [3]. Many patients with schizophrenia lose their capacity to think logically regarding own thoughts and feelings, as well as the thoughts and feelings of other people. The individual may have difficulties in recognizing and naming own emotions, in forming ideas about the intentions of others, in seeing the subjectivity of own conclusions and in making the difference between hopes, memories and plans [4]. The ability to think about emotions and thoughts is a meta-cognitive capacity. When this meta-cognitive capacity is impaired, the individual has a decreased ability to think about own person and others and may find difficult to connect present events to those in the past or future, this meta-cognitive deficit also explaining the diminished sense of self or own identity [5] At an emotional level, schizophrenia is apparently characterized by “flattened affect ”, although emotions (and especially the negative ones) are more intensely felt by the schizophrenic in comparison to most people, and the onset of schizophrenia is often preceded by overwhelming feelings of fear, anger or joy. The exacerbation of psychotic symptoms is accompanied by a critical rise of emotional tensions, and there is often an extreme existential anguish in schizophrenia, hidden under the lack of emotional expression [6]. Psychosis can therefore be an attempt to establish a