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THE ANNE SIPPI CLINIC TREATMENT PROGRAM
The Anne Sippi Clinic for the treatment of the long term mentally ill holds out hope for those patients that have seen treatment failure after failure. Our principles of treatment are basic. We believe that all
people afflicted with severe mental illnesses want to change, but don't know how. We must help them find direction. It is our responsibility to help them change.
We think that given an optimistic atmosphere, which respects our patients integrity and their needs for an independent life style, that they can be encouraged to "make it in the real world".
Treatment with this population is typically restrictive not allowing them the opportunity to actively participate in decision making that involves their survival needs. We think they should be able to
participate in treatment negotiations. The hypothesis is simple. These are human beings that may be more dysfunctional than they need to be. We hold that this is a result of the world around them that sees them
as strange and unable to cope. This attitude becomes a self fulfilling prophecy. We believe they can do much to help themselves if we have an understanding of them as unique individuals with the need to succeed
given the opportunity and the guidance they require.
Our program provides a variety of treatment methods that lead to healthy relationships, a sense of dignity, and productive living. Our treatment program is specifically designed to provide immediate quality
of life improvements for its residents. Today, the best research points out the importance of utilizing a variety of treatment methods, which operate in a contiguous manner, to affect the best treatment and
outcome.
It is important to state that we are treating the individual, not the diagnosis. We must consider each person and their individual differences and design a program that fits their specific needs. We want to
help them improve the quality of their lives, which of course, also means keeping them out of psychiatric hospitals.
As we outline the treatment modalities we use, it should be understood that these methods are not implemented without some understanding of the client's tolerance to the stress factors involved with
activating and stimulating therapeutic activities. Bearing this in mind may require a period of treatment preparation.
The following is a list of what we offer each resident:
1. Our approach emphasizes Psycho-Social treatment.
2. Daily psychotherapy,
reaching toward and developing with the patient achievable treatment goals. We are not looking for insight as much as we are trying to motivate the patient to work in collaboration with the therapist, to act differently, and behave in more socially acceptable ways. We remind you that our patients are not early onset cases.
Group therapies follow a whole range of approaches to sharpen social skills and direct patients in their rehabilitation efforts. Throughout the years, traditional treatment has focused on pathology and
forgotten the healthy parts that exist in all human beings. Our concentration is on patient strengths rather than weaknesses. It is our opinion that these efforts reduce pathology and reinforce strengths.
Psychotherapy, both individual and group is designed to re-motivate the patient and make her aware of the realities of their existence and their impact on the world around them. Psychotherapy is also
designed to help them increase their interpersonal skills. Frequency is based on the patients specific needs and treatment plan.
3. Our efforts at re-socialization and rehabilitation are individually designed to help patients improve their self image, and help them acquire independent living
skills. Those patients who progress significantly enough to live in structured/supervised apartments in the community are offered space in our clinic apartments. They are then assisted in maintaining the level
of control necessary to remain in this more independent setting and are retrained in independent living skills.
4. Daily physical activities are designed to help the patients coordinate their minds and bodies and relieve some of their anxieties and the depression which is
characteristic of their condition.
5. Activity Programs. Many mentally ill patients tend to withdraw and isolate themselves from individuals and groups. The milieu at the clinic offers activity
programs that help the patient become increasingly comfortable in relationships with peers at the facility and in other social situations. We provide group and individual activities to effect better
communication skills to make the patient more aware of themselves and the impact of their presence on people around them. Interpersonal skills is an area of concentration. Pathological fears persuade patients to
withdraw and that when their fears diminish they are able to relate. However, in many cases they form only the most superficial relationships which is no indicator of change. We go beyond the superficial and
help patients regain social confidence by retraining them in more substantive individual and group interactions, providing growth in communication skills. Which includes when indicated, training and treatment in
family therapy settings.
Our program of Psycho-Social Treatment has as its target treatment population the highest utilizers of psychiatric services. The long term or so called, chronic psychiatric patients represent the greatest
challenge to psychiatry and the field of mental health. These are patients who have resided and or vegetated in public psychiatric hospitals for long periods of time.
Well replicated international studies have shown that half or more of persons diagnosed as having schizophrenia experience social and symptomatic recovery twenty to thirty years after their florid illness
began. (Ciompi 1980; Huber, Gross, Schuttler and Gross, 1980: Harding, Brooks, Ashikago and Strauss 19878; Liberman 1988) "the question is no longer whether or not schizophrenia and related mental disorders
are treatable but, what can be done to accelerate functional recoveries in such individuals". ( from Robert P. Liberman in his Effective Psychiatric Rehabilitation).
The key to any lasting change is the development of a durable treatment alliance. Without this relationship, change and rehabilitation will never be implemented. Our initial concentration is on this
relationship and all staff members bend their efforts in this direction. The emphases on a sustaining relationship creates a collaborative set and reduces the resistance to participation in a program that is
developed over time to meet each individual's specific needs. All staff including the patient take part in decision making and carving out this well designed program.
In designing a program, we have to develop goals that are achievable and which help our patients understand that their program is designed to help them gain a measure of freedom outside of a hospital and in
independent living.
MEDICATION
The use of medication is part of the overall treatment approach at the Anne Sippi Clinic. However important as it may be, we are aware of its limitations with the long term schizophrenic patient. Medication
is prescribed and used judiciously. We believe that in small doses it can contribute to the well being of our patients. We have seen some patients benefit therapeutically when there is a good alliance with the
prescribing physician and the psychotherapist. When this collaboration is established with the treatment specialists, the patient is more responsive and willing to participate in the program that she creates
with the treatment team. Realistic and achievable goals are established and the patient and therapists have direction and a sense of educated purpose in their efforts. We are sensitive to the importance of
reducing medication so that the patient and the therapist know that their efforts are responsible for making corrective changes in the patient's life, not just the symptomatic changes that medication brings
about.
Not all of our patients are medicated, since we do not see medication as the primary treatment need. We do in fact work with patients who we do not think will benefit from medication, with good results.
It is important to realize what 10 (ten) or more years of schizophrenia can do to the individual afflicted with that condition. Recovery should be understood to be represented by that individual who no
longer requires active treatment and can regain his/her place in the community with a sense of dignity and self respect. Beyond that, one needs to assess with the patient their stress tolerance. We should not
underestimate the individual's capacity for productive involvement, however, we should not overestimate it, but achieving a sense of independence from treatment forms that appear endless is in fact a goal we
seek out with each of our patients.
Psychotherapy
Psychotherapy with a schizophrenic population must address emotional conflicts as well as social issues in order to be effective. We utilize active psychotherapeutic efforts designed to make rapid contact
with our schizophrenic patients.
In the beginning stages of therapy the main emphasis is on establishing a workable relationship. The therapist must use his/her self as a tool to break into the patients delusional structure. This is
accomplished by first listening to the patient. While content is important, the therapist should also be looking at the patients process, mannerisms and emotional structure. It is important to see how the
patient relates to others. While delusional material is somewhat organized on the surface, its content may defy logic, so our design is to overcome this active defense mechanism Rapid psychotherapy methods make
it possible for a clearer picture of the patient to emerge. When the whole person is considered, it becomes easier for the therapist to begin relating in a meaningful way. The therapist gains access to the
patient, and the patient is more prepared for treatment.
If the patient is paranoid and has delusions of persecution, the therapist can become a strong symbol against these mysterious forces. The main therapeutic thrust often actively engages the patient on her
level and help to initially reduce fears. As the patient begins to trust the therapist, the patient begins to be open to changing behaviors and thought patterns. It is the therapist's job not to allow the
therapy to lose it's direction in the exploration of past issues, rather these new behaviors need to be explored and integrated.
This is accomplished by speaking the patients language, Louis Hill, the noted American psychiatrist called this language "schizophreneeze". Here the therapist regards the patients delusions as
real to the patient, and begins to join with the patient in fighting the common "enemy", in other words, fighting the patients illness and relating to the healthy person within the schizophrenia.
For example a patient with great fear states: "The aliens are replacing my body parts with wires and gears and they are trying to take me over so that they can stop women from being with me".
Joining with the patient in her delusional world the therapist follows with "Well we won't let that happen, and I know how to beat them. I want you to take a shower, because you know aliens can't
handle soap. After that, I want you to play pool, eat dinner with a female patient then play more pool. The aliens will stay away".
This patient was a disheveled, isolated angry man. By joining with the patient the therapist was in a position to encourage the patient to change his behavior. Changing made him more presentable, he thought
the soap would repel aliens. Playing pool stopped the isolation and focused him on something other than delusions. After settling his thinking he was able to eat with a female patient with some comfort. This new
behavior was now being reinforced with an increase in comfort around others. It was the therapist that began this process by allowing the patient to feel very comfortable in his presence. By speaking the
language of the patient, the therapist was in a position to direct the patient to behave in a sociable self reinforcing way, and establish a therapeutic alliance.
Aggressive, anti-social manipulative patients can be effectively treated if the therapist is willing to become involved in the patient's world.
It is assumed that this patient's psychosis is expressed in an anti-social fashion in order to give the patients a perceived measure of control over their world.
If control is an issue, it will be the therapist's task to wean the patient from past patterns of behavior. Manipulations can be addressed by demanding that the patient state her wants and desires directly.
If they are within reason the therapist can help the patient to attain these ends. If they are unreasonable the therapist can help the patient find a more reasonable goal. As therapy progresses the therapist
must help the patient attain a more mature outlook regarding their desires.
Aggression can be dealt with in a variety of ways, in some cases it may be helpful to verbally meet the aggression head on. Many patients who are aggressive are actually frightened. If the therapist
presents a strong front, the patient may feel comforted, that she is in the presence of someone willing to be in control. It is always advisable to have the support of assistants when attempting this treatment
strategy in case the patients loses control. It is also very important to effect closure when the aggression is resolved, by focusing on positive attributes of the patient.
In some instances aggression can be dealt with by joining with the patient against her imaginary foes.
In another example a patient began screaming in the hallway "I'm going to tear this place apart because the computer is saying that I'm going to die".
Therapist, responding powerfully with the following intervention: "You don't have to do that. Let me call the source and make the computer stop". The therapist then engaged the patient in
conversation that gradually became superficial, other patients were encouraged to socialize with the patient. As the patient was responding to auditory hallucinations, a diversion was needed to interrupt the
flow of stimuli. It was imperative to keep the person focused on neutral material when she was out of control. As she focuses on non-stressful issues her hallucinations subside.
Successful psycho therapy with a schizophrenic population is characterized by active involvement in the patients reality and a refocusing of positive attributes into realistic social situations.
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