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 backgroundInequity and lack of resources for people who experience chronic psychosisThe focus on medication rather than other forms of treatment for psychosisBIPOC 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 disordersCultural considerations when determining what is psychosis or other types of experiencesThe lack of inclusion of psychosis in the researchPsychosis is not “other” but is actually a spectrum of behaviors and are very commonThe symptoms of psychosis are not constant, they fluctuate for every individualThe importance of following the model and voices of the disability justice movementIncluding education on the treatment for psychosis, rather than allowing therapists to opt outFolks with psychosis are often not included in the research, which needs to changeWhat to do when psychosis comes into the treatment picture for our clients
We need more training on psychosis to feel confidentNormalizing the experience of psychosisHelping to make peace with psychotic symptoms (i.e., making friends with the voices) to decrease distressLooking at treatments beyond medicationHow to identify psychosis and assess for impact and impairmentThe myth that all elements of psychosis are distressing and badWhy 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 psychosisUsing DBT skills for emotion regulation concerns that frequently come up in psychosisPsychosis and PTSD oftentimes occur together and aren’t always diagnosedTrauma can influence the onset of psychosis AND psychosis can be traumaticMaggie’s pilot program with DBT for psychosisThe concrete and straight forward nature of DBT skills make them very accessibleUnderstanding psychosis differently, including the cultural differences of what is “normal”
How to identify what is “real” and what is psychosisHow 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 safeTake the lead of your client and trust that they know themselves bestThe tension between taking the lead of the client and mandates and requirements as a therapistThe Dialectical Behavior Therapy Skills Workbook for Psychosis by Maggie Mullen, LCSW
Maggie wrote a book to democratize DBT skillsUsing DBT, but making the skills more concrete and accessible