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This article originally appeared in the South London Press on 17/10/16.
Lambeth and Southwark Mind have teamed up with local news teams South London Press and London Weekly News to launch the Change Is Possible mental health campaign.
In the latest in a series of exclusive interviews for our appeal, reporter Jack Dixon meets psychoanalyst Dorothée Bonnigal-Katz, who has aspirations to launch a pioneering new therapy service for south Londoners in crisis.
Hallucinations, illusions, hearing voices. For most people these things are the stuff of fantasy. But for those living with psychotic conditions, such symptoms can become a part of everyday life.
In these complex cases, the same standard treatments won’t necessarily work for everyone – and mental health practitioners face a constant challenge to find the right form of therapy for each individual.
Communication is key, says Dorothée Bonnigal-Katz, whose pioneering approach to psychosis therapy could soon start to change lives in south London.
“We work with people on the basis of their experience, not their symptoms or behaviour,” she says.
“We focus on what they tell us and take it on board critically and non-judgementally.”
For the last four years, Dorothée has been leading an important psychosis therapy project in north London through Islington Mind.
It aims to promote and develop long-term, individualistic forms of treatment for people with psychotic diagnoses.
Dorothée, 47, and a team of 15 other trained experts, work mainly with paranoid schizophrenics and people who have bipolar disorder.
Crucially, they offer open-ended, talk-based therapies that are carefully designed so as to avoid the pitfalls of labelling and rejection.
Having seen impressive results in Islington, Dorothée is now working with Lambeth and Southwark Mind to explore options for a similar service in south London.
“I think it’s something that would be great because the needs in this area are very high but the provision for this profile of client is quite limited. Psychotherapy is not really something that’s on offer.
“All the people in mental health services in south London that I’ve spoken to are quite open to the idea of our interventions because they find themselves with people who need more than what they are getting at the moment.”
Currently, says Dorothée, there is too strong a focus on medication, and individuals who experience hallucinations and other psychotic symptoms can only expect up to 12 weeks of cognitive behavioural therapy from statutory service providers.
Her approach is to be less restrictive, offering an open-ended number of sessions to help clients feel more comfortable in a therapeutic setting.
“People should have access to therapy for long periods of time because, especially with psychosis, things are very slow and you need a permanence or steadiness in the work that you offer for people to be able to benefit.
“Time-limited work can be helpful in some ways – but it’s just not enough.”
Dorothée says the approach is directly tackling the stigmatisation of mental health issues by not treating the client as a patient who must be cured, but as a unique individual with a whole new perspective on the world.
“We don’t have the sense that, for example, a delusion is a delusion so you shouldn’t talk about it because it’s not reality. On the contrary, we really engage with the client’s view of the world.
“This might not be what people refer to as a ‘normal’ take on things. But actually, if you spend enough time talking to people and listening to them, you find that what is labelled as ‘madness’ or ‘illness’ is in fact a response to an environment and an attempt to make sense of it, which is pretty rational. It is their way of coping with experiences that can be very overwhelming.”
She says the client is the one who is “in the know” and must “guide” the therapist.
“It can be very helpful because people then feel that instead of being judged, rejected, pathologised, labelled and overmedicated, there is some validity that is given to their experience by someone who listens, believes and understands – or attempts to understand.”
Dorothée is originally from Paris and trained as an English teacher before moving to the UK 10 years ago to further her work in the mental health field.
A regular contributor and translator for academic journals, she has written several authoritative books on the subject of psychoanalysis.
She runs a private practice in Leamington Spa, Warwickshire, but commutes regularly to London to work on the psychosis therapy project.
Accessing funding to continue the project is a constant challenge, despite its successful results over the last four years.
It has grown, she says, from a session-based service to a flourishing community of users who support each other during their treatment.
“People will come for their session but there is also a time to drop in, so people can come earlier or leave later. They can hang out together and share food – it goes beyond the actual session.
“That element has been very important, I think, in making the project successful.”
A similar psychosis therapy service in south London will require financial support for Lambeth and Southwark Mind. But Dorothée is optimistic looking ahead.
“It’s worked out really well in terms of clinical results. We now have about 16 therapists working in Islington on a regular basis with a caseload of about 30 people. But it’s growing, so it’s really been a very successful project from a therapeutic perspective.
“I really believe in the benefits of talk therapy for people with this profile. I think it would be highly beneficial in south London.
“Of course, we will need to secure some funding so that we can make things happen but in terms of the discussions we have had so far I am actually quite encouraged and things are looking promising.”