Pragmatic Case Studies in Psychotherapy

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December 17, 2014  -- From the Editor 


Pseudohallucinations in an Adolescent: Considerations for Diagnosis and Treatment in the Case of "Kate"   

*** Michael Shapiro, Regina Bussing, & Mathew Nguyen, College of Medicine, University of Florida, Gainsville, FL 


*** Elizabeth Pienkos, Cole Harbour Community Mental Health, Dartmouth, Nova Scotia, Canada

*** Michael Westerman, Department of Psychology, New York University

*** Peter Mertin, Legal Services Commission, Adelaide, Australia      

Response to Commentary

*** Michael Shapiro, Regina Bussing, & Mathew Nguyen, College of Medicine, University of Florida, Gainesville, FL      

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        The first reaction of many psychotherapists to a client who presents with hallucinations is to expect severe psychopathology, particularly psychotic thought disorders such as schizophrenia or organic brain syndrome. Predictably, this is how clinicians initially viewed "Kate," a 16-year-old who was having auditory hallucinations and paranoia. Kate was hospitalized, given a diagnosis of Psychotic Disorder NOS and Anxiety disorder NOS, and started on an anti-psychotic medication. 

        Michael Shapiro, Regina Bussing, and Mathew Nguyen’s case study of Kate presents their expansion of her treatment upon release from the hospital, with formulations and strategies that combine the traditional medical-model interwoven with cognitive-behavioral, psychoanalytic, and adjunctive family systems perspectives.

        In their description of Kate's 29 months of treatment, Kate's hallucinations are framed as less pathological "pseudohallucatinons," and we learn how the authors' different theoretical perspectives interconnect in viewing Kate's and her parents' behaviors, thoughts, feelings, and motives in a complex therapeutic process. The result is considerable therapeutic success, with Kate at termination saying about the hallucinations, "I really can't hear exactly what they are saying, I tune them out," and with Kate having  graduated high school, entered college, and expanded her range of friends. 

        Three Commentaries expand on different ways to look at Kate's case. First, using an approach called "philosophical phenomenology" and starting with a recognition that Kate's thinking is not fragmented and disorganized, Elizabeth Pienkos zeroes in on understanding and interpreting Kates's inner experiences, including the formal features and content of her auditory hallucinations, as a way to understand her needs, drives, and underlying psychopathology.

        Next, Michael Westerman analyzes the nature of the case formulations employed by Shapiro et al. and compares them with an alternative case formulation and treatment plan based on a model Westerman has developed, called "interpersonal defense theory."

        Lastly, Peter Mertin places Kate's case in the context of the empirical literature on pseudohallucinations—looking at the correlates and possible underlying mechanisms associated with auditory hallucinations in populations of nonpsychotic children and adolescents.   

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2. The Client
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Vol 10, No 4 (2014)

Table of Contents

Case Study

Pseudohallucinations in an Adolescent: Considerations for Diagnosis and Treatment in the Case of "Kate" Abstract PDF
Michael A. Shapiro, Regina Bussing, Mathew L. Nguyen 227-259
Using Phenomenology To Understand Hallucinatory Experiences Abstract PDF
Elizabeth S. Pienkos 260-270
The Case of "Kate" and Her Pseudohallucinations from the Perspective of Interpersonal Defense Theory: An Example of Using Case Formulations as the Key Guide for Understanding Patients' Problems and Making Treatment Decisions Abstract PDF
Michael A. Westerman 271-286
What Do We Know About the Correlates and Underlying Causes of Auditory Hallucinations in Nonpsychotic Children and Adolescents, and What Are the Implications for Diagnosis and Treatment? Abstract PDF
Peter Mertin 287-296
A Reconceptualization of Pseudohallucinations in the Case of "Kate" Abstract PDF
Michael A Shapiro, Regina Bussing, Mathew L. Nguyen 297-305

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