Case of the Week - N° 14: Working with self-disturbance in a patient diagnosed with schizophrenia

Submitted by Joke on Jan 18, 2018 in Case of the Week

Case of the Week - N° 14:   Working with self-disturbance in a patient diagnosed with schizophrenia

In our case of the week, the case of Adam is told. Adam is a 22-year old man who presented himself with the following symptoms: panic attacks related to concerns about his physical health, several physical complaints, cognitive problems such as difficulties of choosing between two options, a feeling of heightened meaning of the things surrounding him, a pattern of social withdrawal, feelings of depersonalization and catatonia. He was diagnosed with the DSM-diagnosis schizophrenia, catatonic type.

The author describes how merely focusing on CBT-approaches in the treatment of the positive symptoms of schizophrenia (with a focus on rehabilitation and acute recovery of schizophrenic episodes) might enclose a danger as they might exacerbate meta-cognition processes and intensify interpersonal engagement, both of which are already pathological in people with schizophrenia.

Inherently embedded in the onset of schizophrenia is a state of hyper-reflexivity on for instance bodily symptoms combined with feelings of being controlled by close others. Both refer to an ontological anxiety for being objectified. Based on the existential-phenomenological model of psychotic vulnerability of Laing, the therapist aims to focus on Adam’s feelings of subjectivity. Rather than seeing the interpersonal difficulties with his partner Fiona as side-effects, the therapist really feeds into Adam’s experiences of self-(other)-disturbance. This helps Adam to justify the therapeutic work he is doing.

The case shows how more behavioral techniques (such as helping Adam to express his discomfort with certain aspects of the relationship with Fiona) can be embedded within a phenomenological approach of schizophrenia. It also shows how the phenomenological approach might entail a danger as well, for instance when there is an increased focus on “first person” (“how do you feel…”) or “second-person” (“how would you think Fiona would feel…”) subjective positions. The therapist demonstrates how switching to third person-positions (“people in these situations…”) might be helpful then.

The case is interesting for those who work with people with schizophrenia or those who are interested in the existential-phenomenological therapeutic approach.


Here you can find the link to the case in our Archive (registration is required):

To find our previous cases of the week, go to  


Warm greetings,  

The SCA team  

schizophrenia , existential, phenomenological, CBT, self-disturbance,