Buying Time - Buying Times for Psychosis

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