I have been working with a client ( this client is a composite) for a period of time and she has been receiving “ treatment as usual” from a variety of teams in her NHS journey. Currently the “patient” is with the Early Intervention in Psychosis Service and has additionally experience periods of hospitalisation. Interestingly the client enjoyed her period in hospital and recovery it removed her from the home and the family situation which was for her increasingly stressful. It also removed her from her responsibilities as a mother, partner and friend and from an environment which she had been finding increasingly difficult to function in.

She is an interesting and thoughtful individual who for a long while, since childhood in fact, has been seeking an alternative path. This path has been a hard one for her involving a childhood where her needs were for a greater part unmet. Physically her basic needs in the Maslow hierarchy were acknowledged and catered for, she was fed, clothed, housed and schooled but she always felt emotionally neglected. She describes having friends at school but she has not maintained contact and that pattern of lack of contact has continued throughout her life. The separation of her parents appears to have had more of an impact than she initially acknowledged and she gradually lost contact with her father. Her childhood was not untypical of many children within the U.K. in that there was no obvious deprivation or physical or sexual abuse, yet she describes a palpable disconnect from early on. The client had had no contact with services until her early 40’s when she describes what happened as a “ mental breakdown”.

Prior to the “ mental breakdown” the client experienced a period of increased isolation and inward reflection leading to more spiritual approaches to her health and training in various alternative therapies with a desire to heal herself and others. The client was referred to EIS under diagnostic uncertainty and refused medication as she has very strong views on the subject of medication and the drug companies. On admission to a unit she found herself running a healing group for her fellow patients and enjoyed this period which she found rewarding. Her experience of “psychosis” she regards as a spiritual awakening and feels that the conversations she has with professionals disregard the importance of this. In particular she has found the conversations with psychiatrists difficult she has been consistent in her refusal to be medicated and she feels unheard and patronised because of this. Interestingly we talked about the concepts of Open Dialogue about which she had read but she had been unfortunate not to have been included in the pilot in Kent. Open Dialogue is she feels what she needed and she read Russell Razzaque’s “Breaking down is Waking Up” which she related to in its entirety.

About Author: I am Jane Hetherington Principal Psychotherapist and Operational Lead with Early Intervention Services in Kent. I trained as an integrative psychotherapist and have worked in substance misuse, primary care and psychosis services. I have completed the Open Dialogue training and will be involved in the new Open Dialogue Service, in addition I am on the APOD UK Board and completing the International Train the Trainer Open Dialogue course in Helsinki.