Psychotherapy and Recovery from Schizophrenia: A Model of Treatment as Informed by a Dialogical Model of the Self Experience in Psychosis

Abstract

Since the term schizophrenia was coined, the disorder has been linked to experiences of self-diminishment. This link calls for theoretical work that helps us understand experiences of diminishment wherein persons find themselves less than they once were but nevertheless able to recognize and describe their diminishment. In response this paper describes how dialogical psychology may help us both understand this feature of schizophrenia and inform the practice of psychotherapy. In particular, we suggest that some alterations in sense of self in schizophrenia may proceed from a range of losses in a person’s ability to sustain intrapersonal and interpersonal dialogues. Moreover, we suggest that these losses lead to at least three different forms of disturbed self experience: barren, monological and cacophonous selves. We then explore the unique challenges each poses to psychotherapy and suggest that attention to dialogical deficits may enrich self-experience if it attends to aspects of self-experience that emerge within session.