EP85 Workshop 15 - Co-Therapy of Ambulatory Psychotogenic Family - Carl A. Whitaker, MD

Description:

Edited video of thirty-five hours of family therapy conducted along with co-therapist, David Keith. Psychotic episode occurred in the father and three sibs but not in the mother.

Educational Objectives:

1. To know the use of co-therapy and when to employ it
2. To list the characteristics of a psychotogenic family
3. To show how consultation in the therapy interview aids the therapists and the patients
4. To describe how co-therapy resembles the two parent family 

*Sessions may be edited for content and to preserve confidentiality*

Outline

Evolution of Psychotherapy and Co-Therapy

Introduction

• Carl Whitaker introduces psychotherapy's evolution and a workshop based on an 8-year family therapy case.
• Introduces co-therapist David Keith and editor Jim Ingersoll.
• David Keith humorously discusses the challenges of co-therapy, including maintaining individuality.

Family Dynamics & Carl's Role

• Discussion on a family therapy session resembling a wrestling match.
• Focus on a father’s actions that led to his son’s broken arm.
• Misunderstandings about the session's focus are clarified.

Psychotherapy & Medication

• Carl Whitaker contrasts psychotherapy and medication—medication is seen as "magic," while therapy is not.
• Discussion on schizophrenia: families enforce abnormal "normality."
• Exploration of delusions in schizophrenia vs. everyday fantasies.

Delusions & Family Influence

• Carl shares personal delusions (e.g., fear of city slickers, belief in another Depression).
• Comparison of delusions to religious beliefs.
• Influence of childhood hypnosis from his mother.
• Recommends Soul Murder by Schatzman, discussing family impact on mental health.

Therapist’s Personal Experiences

• Challenges of being a therapist and its personal impact.
• Skepticism about single parents raising children.
• Importance of embracing "craziness" at the right time.
• Discussion on self-esteem and confidence in relationships.

Family Role Models & Integrity

• Social awkwardness and its effects on relationships.
• Discussion on a father’s role as a financial provider.
• Contrast between open parents and families that avoid discussions.
• Impact of family dynamics on individual behavior.

Creativity & Craziness

• Link between creativity and "craziness."
• Stories of stress-induced breakdowns and recovery.
• Role of external factors in masking internal struggles.
• Importance of controlling and utilizing "craziness" creatively.

Therapeutic Techniques & Inferences

• Using therapeutic language to guide patient understanding.
• Example of how an inference about panic led to a breakthrough.
• Importance of adding to, rather than taking away from, patient experiences.
• Story of using sleep as a therapeutic tool.

Family Therapy & Group Dynamics

• Group therapy’s role in understanding psychotherapy.
• Matching "craziness" creatively in therapy.
• Story of a shared dream experience in therapy.
• Being authentic as a therapist fosters deeper connections.

Break & Continuation

• Plan for a break before resuming discussions.
• Importance of play therapy for understanding children’s emotions.

Challenges & Benefits of Co-Therapy

Co-Therapy Dynamics

• Carl emphasizes allowing families to lead therapy sessions.
• The role of co-therapists in balancing gender dynamics and therapeutic approaches.
• Concerns about female therapists self-destructing in therapy settings.
• Gender differences in therapy experiences and perspectives.

Challenges in Co-Therapy

• Families sometimes complain about therapist gender.
• Success depends more on therapist compatibility than gender.
• The importance of having a co-therapist in crisis situations.

James Free’s Co-Therapy Model

• Discussion on Free’s male-female co-therapy model vs. Whitaker’s approach.
• Learning psychotherapy through couples' co-therapy sessions.
• Benefits of group therapy with multiple perspectives.

Bringing in a Co-Therapist

• Comparing co-therapists to consultants in single-parent families.
• Fresh perspectives help move families forward.
• Example of differing therapist perceptions of a family’s dynamics.

Rules & Techniques in Co-Therapy

• Mandatory presence of both partners in couple therapy.
• Prohibiting discussions about therapy outside sessions.
• Importance of concrete symbolic experiences in therapy.

Intimacy & Co-Therapy

• The role of mutual respect and philosophical alignment in co-therapy.
• Challenges of working with therapists from differing backgrounds.

Personal Experiences & Challenges

• Stories of working with suicidal and autistic patients.
• Importance of persistence despite therapeutic challenges.

Technical Aspects of Co-Therapy

• Use of videotaping in therapy sessions.
• Importance of transparency with families about recordings.
• Benefits of multiple camera angles in university settings.

Dealing with Family Dynamics

• Strategies for managing family conflicts in sessions.
• Knowing when to intervene or let tensions resolve naturally.

Integrating Different Therapy Models

• Importance of blending different therapeutic approaches.
• Naming one’s therapy model to distinguish it from others.

The Power of Co-Therapy & Team Dynamics

Maintaining Individuality in Co-Therapy

• Challenges of expressing joint therapeutic actions.
• Concept of the "psychogenic family" fostering schizophrenia.
• Case study of a diagnosed schizophrenic son and family therapy approach.

Therapeutic Approach to Schizophrenia

• Using ambiguous language to challenge family realities.
• Invading and distorting family perceptions to create change.

Process Over Progress in Therapy

• Focus on the therapeutic journey rather than specific outcomes.
• Case study of a symbolic breakthrough in schizophrenia therapy.

Co-Therapy as a Support System

• Reducing fear of failure through co-therapy.
• The co-therapy team becomes a "new entity" guiding the family.
• Advantages: shared responsibility and avoiding personal burnout.

Enjoyment in Therapy

• Therapists should enjoy their work; otherwise, reconsider their career.
• Goal: help families deepen relationships with themselves.

Integrity & Schizophrenia

• Schizophrenia as a disorder of "abnormal integrity."
• Case study of a patient refusing unethical work as an example of integrity.
• Therapists must differentiate between their own and the patient’s "craziness."

Maintaining Integrity in Therapy

• Supporting patients' autonomy and moral choices.
• Challenges of sustaining therapeutic progress outside of therapy.

Videotape Presentation Preparation

• Emphasis on the visual component in understanding therapy.
• Encouraging audience engagement through questions.
• Introduction of editor Jim Ingersoll for additional insights.