Moving More Deeply Into Our Client’s Perceptions of His or Her Illness

“Adolescence is a kind of emotional seasickness. Both are funny, but only in retrospect.”

Arthur Koestler

Moving More Deeply Into Our Client’s Perceptions of His or Her Illness

TISA Description of the Problem: I was recently reviewing the tip of the month archive and I came across a tip I felt was particularly good for helping a clinician to understand the person beneath the diagnosis in a sensitive fashion. consequently, I decided it was worth repeating. So here is a throwback Tip of the Month from December 2002. I hope you enjoy it.

When people develop major mental illnesses, such as schizophrenia or bipolar disorder, one of their most difficult tasks is coming to a personal understanding of what having the disease means to them as unique individuals. The following two tips by Asha Mishra, M.D. provide nice avenues for helping the clinician to understand this very individualized perspective including both how the client perceives the etiology of his or her illness as well as what the client views as the possible long-term outcomes.

Tip: I find the following two questions can help both the patient and the interviewer in their explorations of the psychological meaning of the patient’s illness. 1) “Why do you think you got this illness?” and 2) “Where do you see yourself five years from now?”

TISA Follow-up: Excellent questions, such as those suggested by Asha Mishra, often lead to a much deeper understanding of the person who is coping with the disease. The first question can function as a springboard into a wide variety of important topics including difficult psychological and spiritual questions such as, “Did I do something to deserve this affliction?” or “Why would God allow this to happen to me?”

In a similar fashion, the last question may function as a springboard into a more sophisticated understanding of the patient’s perceptions of the quality of his or her future life – a critical piece in understanding of the client’s hopelessness, reasons for living, and self image. All such topics may play significant roles in the patient’s motivation for treatment as well as possible windows into suicidal ideation.

Tip provided by:

Asha Mishra, M.D.
Professor of Psychiatry at MCV/VCU
Richmond, Virginia
Medical Director, Chesterfield CSB