Serious and Persistent Mental Illness Concentration
Danielle Knafo, Ph.D., Coordinator of Serious and Persistent Mental Illness Concentration
In this era of psychopharmocology and managed care, we rarely encounter an approach to severe psychopathology involving empathic understanding and intensive psychotherapeutic intervention. We are a unique clinical psychology program that offers specialization training in work with this group. In addition to teaching the genetic and neuropsychological aspects to these conditions, we emphasize the discoveries, since Freud’s time, that have deepened the understanding of the psyche, allowing the attribution of meaning to symptomology, and permitting human encounters that initiate profound change through insight and communication. The program’s appeal and excitement derives from the wondrous inner journeys made possible by only such encounters and the fact that this kind of work takes us to the frontiers of human experience.
The Serious and Persistent Mental Illness concentration (SPMI) at the C.W. Post Campus of Long Island University is one of three concentrations within the Clinical Psychology Doctoral Program that address the needs of underserved, high-risk clinical populations. Serious and persistent mental illnesses have been defined in various ways. Students in the doctoral program who select the SPMI concentration are interested in developing an expertise in understanding and treating severe psychopathology which include thought disorders such as schizophrenia, mood disorders such as bipolar disorder, and severe personality disorders such as borderline and antisocial personality disorders. Also included are addictions and trauma (e.g., abuse, war trauma and terror-related trauma). perversions and eating disorders. Exposure to patients who exhibit these forms of psychopathology is available through a wide array of externship opportunities offered by the program.
Students who select the SPMI concentration will attain the following objectives:
- Gain a thorough understanding of etiology, symptomotology, theories of psychopathology, and varied approaches to the treatment of severe psychopathology.
- Become familiarized with the most up-to-date and cutting edge research in the field, including psychosocial, neuropsychological, and phenomenological.
- Develop a humane, nonjudgmental approach to those who suffer from severe chronic mental illness.
- Be encouraged to engage in research and education that will promote advanced understanding of SPMI populations.
- Facilitate integration of psychological work with that of other disciplines, both in research and practice.
- Prepare students to develop an expertise in the field of severe pathology that can be applied to education, research or practice, in hospitals, courts, clinics, and/or private practice.
The core elective courses within the SPMI concentration are as follows: Theory and Research in Serious and Persistent Mental Illness (PSY 847) and Clinical Applications in Serious and Persistent Mental Illness (PSY 857). The Theory and Research course covers the most up-to-date literature reflecting our contemporary understanding of the nature of serious and persistent mental illness, its genetic, neuropsychological, familial, social, and cultural components, empirical treatment evaluation and outcomes, and public policy initiatives. The Clinical Applications course is a hands-on training for students to become familiar with the phenomenology and treatment approaches relevant to working with those who suffer from severe pathology. Drug approaches will be reviewed and intense focus on the significance of psychotherapeutic methods of treatment will be emphasized. The psychologist's role and contribution within the current mental-health delivery system are discussed.
Monthly concentration meetings invite experts in the field to address additional issues not covered in the courses. SPMI patients are also invited to these meetings to discuss their experiences of living and the treatment they have received. Sample recent topics are: Psychotherapy with Schizophrenia, Harm Reduction Therapy with Addiction, Violence against the Therapist, A Psychoanalyst in Prison, Working with Deeply Distressed Couples, Sexualized Violence against Women and Children, Severe Depression and Creativity, Multicultural Perspectives in Psychopathology and Treatment, Neuropsychology and Psychosis, Bipolar Disorder in Childhood. Student participation in leading these meetings is encouraged. Sensitivity and awareness of cross cultural and gender perspectives to these pathologies is addressed.
The clinical training within the SPMI concentration consists of completing two externships in the third and fourth years that expose students to patients suffering from thought disorders, mood disorders, and severe personality disorders. Students conduct individual and group psychotherapy and social-skills groups with patients on hospital inpatient psychiatric units, day-treatment programs and partial hospitalization programs, and specialty outpatient clinics. Students’ treatment is supervised by experienced on-site clinical supervisors who offer their mentorship and expertise with these kinds of severe psychopathology. Typical externship placements include the North Shore Veterans Administration Hospital, North Shore Hospital and Long Island Jewish Medical Center, Downstate Medical Center, and the HOPE Program in Brooklyn. The experiences acquired from these settings thoroughly prepare students for clinical psychology internship opportunities by the fifth year, when students take full-time positions at internship sites to further develop their clinical skills in specialty areas. SPMI students (as well as students from the other two concentrations) have an excellent track record of acceptance to selective internship programs, in part because of the superb training provided through their externship placements. The clinical psychology internship experience in turn prepares students for their first applications for landing a job in the real world, ideally working with patients diagnosed with serious and persistent mental illness.
In spite of powerful managed-care forces, the realities of the current job market, and the success of cognitive behaviorists in demonstrating treatment efficacy for a wide range of illness, the SPMI concentration would like to continue to foster opportunities for students to learn and to master psychodynamic approaches to serious and persistent mental illness. Students from most other clinical psychology programs never receive the opportunity to learn or practice this method of working with patients, emphasizing the patient's relationship to the therapist and the personal meaning of the patient's symptoms not only for the patient but also for the therapeutic relationship. Many people in the field and out consider these patients untreateable, but for those of us willing to rise to the challenge and do this amazing work, we will find that not only is the growth of the patient fostered but our own is as well.
This course will address current neuroscience and psychosocial research in severe mental illness, particularly in the schizophrenias and bipolar disorders. A serious problem in the field has been our reliance on biogenetic reductionistic models to the exclusion of psychological and sociological factors. A comprehensive, translational-integrative, approach to severe mental illness will be the subject of this course, using the 'trilingual' approach of brain, mind and culture. This will involve the careful and in-depth study of, but not be limited to, the following subjects: epidemiological research; phenomenology, neurophenomenology and subjective first-person accounts of these disorders; the role of genetics and the emergent field of epigenetics; biological research on the transgenerational transmission of trauma; neuroplasticity, neurobiology and 'relational' neurobiology; neurodevelopmental models; neuroimaging research, including sMRI, fMRI, PET, SPECT, and newer imaging techniques such a diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) of white matter tracts; neuroimaging research on specific psychotic symptoms such as delusions and hallucinations; the role of mirror neuron systems in symptomatology; developmental psychobiology, particularly focusing on the effects of separations and traumatic disruptions of attachments; the role of the limbic-hypothalamic-pituitary-adrenal axis (LHPA) in schizophrenia, bipolar disorder and major depression; psychophysiological and neurocognitive research; the significant role of psychological and social traumas, chronic and profound stress/fear/anxiety, as well as social isolation and social defeat on CNS structure and function; sociocultural factors (e.g., social fragmentation, urban living, migration, racism, high expressed emotion, poverty, social isolation, etc.) identified in research to be instrumental in the initiation, course and outcome of these disorders; cognitive-behavioral and psychodynamic/psychoanalytic models of symptom formation; recovery research, including all of the major international studies demonstrating that persons with severe mental illness can recover.
The aim of this course is to familiarize students with psychotherapeutic understanding and techniques for the treatment of serious and persistent mental illness. The course is divided into two sections in addition to an introduction that explores the controversial, and sometimes misleading, terminology of sanity and madness. The first part of the course addresses key concepts -- e.g., projective identification, attacks on linking, psychic retreats and autism, and regression – in the treatment of primitive or regressed states of mind, regardless of diagnostic category. Section one of the course also carefully examines the importance of appreciation and use of countertransference in these treatments. Part two of the course addresses psychotherapy techniques that are designed to treat specific diagnostic categories – including: narcissistic, schizoid, and borderline personality disorders, psychosis, trauma and addiction, severe depression, and perversions. Part two also includes discussions of specific issues and techniques related to inpatient work and the use of medication. Considerable clinical case material will supplement basic readings.