By Lisbeth Sommerbeck, Bornholm Psychiatric Center, Denmark
This article first appeared in the Danish Psychological Association's journal Psykolog Nyt: Sommerbeck, L. (2006). Udenfor Terapeutisk Rækkevidde? Introduktion til Præ-Terapi. Psykolog Nyt, 60(8), 12-20. It has been translated and slightly revised for the WAPCEP website by the author.
Many of the most disturbed clients in the backyards of psychiatry have traditionally been regarded as "beyond psychotherapeutic reach". They are apparently unable to cooperate in an ordinary course of therapy (of any orientation). The reasons for this are most often listed as insufficient interest in, or capacity for, 1) keeping a sustained focus, 2) communicate understandably to the therapist, 3) relate critically to themselves and their situation and 4) receive input from the therapist. The psychiatric diagnosis of these clients can vary, but they are most often diagnosed with some form of psychosis or the other, frequently schizophrenia. Sometimes, however, they suffer instead from severe dementia or mental retardation. Whatever their diagnosis, they seem to have one thing in common: They are experienced as being "out of contact." Rarely do others have any idea of what goes on in them, or the experience is that nothing goes on in them, at all.