2021 Annual Scientific Meeting Pre-Conference Seminar (ONLY): Working with Paranoia: Helping Patients with Paranoid Dynamics, Including Paranoid Psychoses

Helping Patients with Paranoid Dynamics, Including Paranoid Psychoses

The term “paranoia,” whose roots suggest “a mind outside itself,” refers to states in which a person finds it hard to distinguish what is inside from what is outside the self. Although DSM criteria for diagnosing paranoia involve externally observable traits such as suspiciousness, this seminar construes paranoia as an intrapsychic process marked by disavowal and projection, often related to inadequate psychological separation from caregivers to whom the paranoid person was anxiously attached. Although most visible in patients with psychosis, paranoid states of mind are common in others. Dr. McWilliams will review theory and research on paranoia and will make related recommendations for therapists working with paranoid patients. Dr. Garrett will review clinical and empirical work on psychotherapy with patients experiencing paranoid psychoses, emphasizing the integration of CBT techniques with psychodynamic understanding. This pre-conference seminar is designed for social workers, psychologists, mental health professionals, and psychiatrists. All levels of training are welcome. 

This presentation on paranoia will include:

1.     An overview of paranoid dynamics and their different expressions;

2.     Information on the pathogenesis of both psychotic and nonpsychotic paranoia;

3.     Attention to the overall clinical stance that is most helpful to paranoid patients;

4.     Integration of object-relations theory with cognitive-behavioral techniques; and

5.     A video of a woman treated by Dr. Garrett who recovered from a schizophrenic disorder.

Learning Objectives: Participants at this workshop will be able to:

1.     Identify not simply the more familiar persecutory paranoid dynamics (projection and denial of anger), but those involving projection and disavowal of other feelings (e.g., erotomania, paranoid jealousy, megalomania, paranoid hatred).

2.     Summarize the suspected etiologies of paranoid dynamics.

3.     Describe how Kleinian object-relations theory accounts for the psychological origins of “persecutors” in both psychosis and ordinary mental life.

4.     Assume a therapeutic stance that allows paranoid patients to elaborate their experience and reduce the shame that underlies paranoid adaptations (e.g., unwavering respect, honesty, clarity about boundaries, acknowledgement of the grain of truth in projections).

5.     Develop skills in psychotherapeutic approaches to the treatment of patients with diagnosable psychotic disorders, based on research conducted from both CBT and psychodynamic perspectives.