The Persecuting God and the Crucified Self: The Case of Olav and the Transformation of His Pathological Self-Image
Keywords:God representation, affect organization, existential-affective-dynamic-treatment model (VITA), treatment-resistant depression, shame, guilt, self representation, self-image
AbstractThis case study describes the treatment of "Olav," a divorced lawyer in his mid-30's, who, at the time of treatment, had been continuously hospitalized in closed, short-term psychiatric wards for more than seven years with severe treatment-resistant depression, transient psychotic episodes, self-destructive behavior, and suicide attempts. He was about to be admitted to a long-term ward for chronic schizophrenics. A great deal of his psychopathology revolved around his feeling tortured from condemning inner voices of what he called "the Committee" that he believed were the sacred voices of God. The present case study describes Olav's treatment in our institution's "VITA" unit, a 12-week, group-based, residential day-treatment program that explicitly focuses on existential and religious issues. The VITA program includes diary-writing, affect consciousness, and regular group sessions consisting of such activities as mindfulness training; art therapy focusing on drawing or painting internal representations of self, father, mother and God; multiple group experiences; and reflection on existential issues. A standard assessment battery documents Olav's dramatic improvement over the course of treatment and at one-year follow-up.
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