January 10, 2022

How to Understand and Treat Psychosis

40 minutes

How to Understand and Treat Psychosis: An interview with Maggie Mullen, LCSW

Curt and Katie interview Maggie Mullen, LCSW, a national trainer on culturally responsive, evidence-based care for psychotic spectrum disorders. We talk with Maggie about their anti-racist and disability justice framework of psychosis, understanding psychosis on a spectrum, what to do when psychosis enters the treatment picture, assessment of psychosis, and treatment using Dialectical Behavior Therapy (DBT). We also talk about how society defines “normal” and pathology, exploring cultural differences in these definitions.

Interview with Maggie Mullen, LCSW

In this podcast episode we talk about looking at psychosis differently

Maggie Mullen’s anti-racist and disability justice framework of psychosis

Maggie came from a community organizing background

Inequity and lack of resources for people who experience chronic psychosis

The focus on medication rather than other forms of treatment for psychosis

BIPOC individuals being shot by police when psychosis shows up in a public space

“Psychotic spectrum” versus the segregation of psychosis as “other”

“We are often the least prepared to deal with our most acute clients”

The continued segregation of psychotic disorders

Cultural considerations when determining what is psychosis or other types of experiences

The lack of inclusion of psychosis in the research

Psychosis is not “other” but is actually a spectrum of behaviors and are very common

The symptoms of psychosis are not constant, they fluctuate for every individual

The importance of following the model and voices of the disability justice movement

Including education on the treatment for psychosis, rather than allowing therapists to opt out

Folks with psychosis are often not included in the research, which needs to change

What to do when psychosis comes into the treatment picture for our clients

We need more training on psychosis to feel confident

Normalizing the experience of psychosis

Helping to make peace with psychotic symptoms (i.e., making friends with the voices) to decrease distress

Looking at treatments beyond medication

How to identify psychosis and assess for impact and impairment

The myth that all elements of psychosis are distressing and bad

Why Maggie Mullen is using Dialectical Behavior Therapy (DBT) to treat psychosis

“People with psychosis deal with emotion dysregulation, actually more so than the average person…that's where we know DBT is really effective”

We frequently underestimate the ability to help folks with psychosis

Using DBT skills for emotion regulation concerns that frequently come up in psychosis

Psychosis and PTSD oftentimes occur together and aren’t always diagnosed

Trauma can influence the onset of psychosis AND psychosis can be traumatic

Maggie’s pilot program with DBT for psychosis

The concrete and straight forward nature of DBT skills make them very accessible

Understanding psychosis differently, including the cultural differences of what is “normal”

How to identify what is “real” and what is psychosis

How do you define what is normal for someone?

What do we decide what we pathologize?

Breaking up the binary of normal or not normal – reframing as “experience”

The importance of understanding what is negatively impacting the client and how to keep clients safe

Take the lead of your client and trust that they know themselves best

The tension between taking the lead of the client and mandates and requirements as a therapist

The Dialectical Behavior Therapy Skills Workbook for Psychosis by Maggie Mullen, LCSW

Maggie wrote a book to democratize DBT skills

Using DBT, but making the skills more concrete and accessible

...more

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By Curt Widhalm, LMFT and Katie Vernoy, LMFT

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