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March 2, 2007
Here's what Kevin Benbow emailed to us about his experience supervising a clinician with her first schizophrenia patient: As a clinical supervisor for a small, rural mental health clinic in Arizona I get the opportunity to supervise and train behavioral health technicians.  Such individuals have a wide range of experience and education levels and are allowed to practice under Arizona State law if they receive supervision from a licensed Behavioral Health Professional. One of these clinicians has been particularly receptive to the cognitive model and has been helping many of her clients identify their automatic thoughts and subsequently test them.  Recently she assessed a client who was subsequently diagnosed with schizophrenia.  She had only weeks before experienced her first psychotic episode. Naturally, she was hesitant to provide therapy for such a person and seemed relieved when this client instead opted to receive treatment from a more experienced therapist who lived closer to her home. After 2 months of seeing the other therapist the client contacted my supervisee because things were not going well.  Both therapists met with the client.  According to my supervisee, the other therapist made several statements to the effect that "this client is not ready for therapy" etc.  Naturally, the client felt both stigmatized and hopeless as a result. I discussed the issue with my supervisee, who, with fear and trepidation, as well as the client's grateful consent, decided to begin therapy with her.  In only a few short sessions, the client had uncovered dysfunctional thinking related to how her illness had stigmatized her and made her feel useless.  She wonders if she will ever return to her premorbid level of functioning.  CT is being used to address and evaluate her beliefs in this regard. My supervisee was naturally happy to see how CT can be applied to such a serious condition.  Soon after she accepted another individual with schizophrenia on her caseload.  This person has been suffering with the illness for quite some time, continually experiences auditory and visual hallucinations.  My counsel was for the trainee to treat the hallucinations as automatic thoughts and help the client determine if there might be some detectable meaning behind them.   For confidentiality reasons, I won't go into the nature of what was uncovered, but taking this approach with the client visibly lessened the client's level of distress, helped him understand the nature of his experience, and at least in the session made some of the more prominent hallucinations disappear. Naturally, my trainee was excited and emboldened to continue working with this very misunderstood population.  Readers will be interested to know that the course of treatment comes from Kingdon and Turkington's "Cognitive Therapy of Schizophrenia (Guides to Individualized Evidence Based Treatment)."  This protocol seems to be a highly useful adjunct to family support and pharmacotherapy for management of this devastating disease. Kevin L. Benbow, MA, LAC Yuma