family therapy

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June 30, 2012

Family Therapy Books I Recommend to Individual Therapists

Posted by Nathen under advice, books, family therapy, Fritjof Capra, Gregory Bateson, John Gottman, Ken Wilber, lists, metaframeworks, reading, Susan Johnson, systems theory
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A few weeks ago, one of my posts received a comment that was worth a whole post:

I am also a therapist (though I’m still in training). I’m wondering if you would be willing/able to recommend some family therapy books you’ve found helpful. My program is very focused on the individual and I’m trying to fill in some gaps and find your perspective on therapy to be very resonant with my own.

I’d love to recommend some family therapy books! My program was extremely family-systems focused, which I’ve been grateful for since leaving school. If you want to see an exhaustive reading list (I can’t remember having been assigned a real dud), you can see reverse-order lists of everything I read in my first year here and my second year here.

I’ll try to create a bare-bones list for you here—much more useful for you and a good exercise for me. I should warn you before I begin that I am super nerdy when it comes to family therapy reading and I can imagine many in my cohort rolling their eyes at my “must-read” list. If you are nerdy like me, though, here goes:

Pragmatics of Human Communication: A classic and profound book by Bateson’s MRI team, the first and probably still the best attempt to apply system theory to human relationships.

Susan Johnson’s books The Practice of Emotionally Focused Couple Therapy and Emotionally Focused Couple Therapy for Trauma Survivors. Johnson combines system-thinking, Rogers-style experiential therapy, and attachment theory, creating one of my most-used therapy models.

John Gottman’s books, especially The Marriage Clinic and The Science of Trust. Gottman has taken up the project started with Pragmatics, largely abandoned by family therapy, and is doing it in fine style, with solid science.

Metaframeworks: This book presents my favorite meta-model of family therapy, combining the best parts of the many family therapy models.

A major work by each family therapy model-builder is also important reading: Haley, Madanes, Satir, Whitaker, Minuchin, Bowen, Selvini-Palazolli/Milan group, Weakland/Fisch/MRI group, deShazer/Insoo-Berg, Epson/White, and Hubble/Duncan/Miller. Keep in mind that their books are presentations of informed opinion, not science. Every one of these folks have got some things right and some wrong. They have also advanced the field significantly, and are the largest part the conversation on how to think about families.

Finally, a couple things that I was not assigned in school, but I found extremely helpful in making sense of the flood of information. First, a grounding in systems/complexity theory: Family therapists think of themselves as system-theory experts and throw around a lot of lingo that they may or may not really understand. It’s easy to get confused in this situation. The best introduction to modern system thinking is still Capra’s The Web of Life (though we’re overdue for an update). Also, check out Bateson’s books Steps to an Ecology of Mind and Mind and Nature. Second, familiarity with Wilber’s integral theory really helped me navigate the heated arguments about modernism vs. post-modernism and intervention at the level of individuals vs. family systems vs. larger systems. Check out Integral Psychology or A Theory of Everything.

 

May 5, 2012

A Proposal for a “Most Interesting Questions” List

Posted by Nathen under Couples and Family Therapy, Ethan Mitchell, family therapy, ideas, questions, therapy
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When I find myself in the presence of a new very smart person, my favorite question to ask is,”What is the most interesting question in your field?”* It both makes for great conversation and expands my sense of the envelope of human inquiry.

If you have an idea about the most interesting question in your field, I’d love to hear about it in a comment below. If you are the kind of person who creates and publicizes websites, though, what I’d like even more is for you to create a wiki-style site where folks can go, create a forum for their field or sub-discipline, and propose and vote on most interesting questions. This could generate what I want to look at: a home page that is a self-updating outline of what professionals believe are the most interesting questions in their field. If you want to go whole-hog, you could also let them vote on and link to what they believe are the best pieces of research on their question to date.

And since I posed the question, I should probably tackle it for my own field… I am a couples and family therapist, and I propose that the most interesting question in my field is, “What are the precise mechanisms of therapeutic change in couple and family systems?” In other words, how does therapy work? We know that it is helpful in most cases, and we have endless models and speculations about how it works, but virtually no evidence about the mechanisms of change. The best research I know about on the topic is the qualitative, two-part, “What Clients of Couple Therapy Model Developers and Their Former Students Say About Change,” by Davis & Piercy. Edging into that territory from another angle is the research summarized in Gottman’s The Science of Trust.

*I stole this question from very-smart-person Ethan Mitchell.

 

April 7, 2012

A Perflouroalkyl Chemical Hypothesis of ADHD

Posted by Nathen under ADHD, Environmental Working Group, family therapy, PFCs, science
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As a family therapist, when I am presented with a child exhibiting symptoms of ADHD, I am trained to look at the child’s environment and history, especially their family relationships. How is it that these behaviors might be a response to the stresses that the child is experiencing? The point is that I do not just assume that the child has been genetically programmed to disrupt their classroom. I came across this study last year, though, that was a good reminder that “environment and history” are bigger than what happens in-between family members.

It found that children with higher levels of polyfluoroalkyl chemicals (PFCs) in their blood were more likely to have been diagnosed with ADHD. PFCs are long-lasting industrial substances that we accidentally eat and breath into our bodies from various coatings, foams, emulsifiers, and cleaning and personal products. Almost all of us have detectable levels of them in our bloodstreams. They are known to be toxic in other animals to the liver, immune and reproductive systems, and fetal development. It is also starting to look like they are neurotoxins as well.

The study was of correlations, so whether the PFCs caused the children to get ADHD diagnoses remains to be seen. ADHD may turn out to be a PFC-toxity-induced syndrome. Or it could be that PFC levels in mothers correlates with that of children, and that it is in-utero PFC levels that are critical. Or perhaps having an ADHD diagnosis causes children to eat and/or breath more coatings, foams, and emulsifiers. Or who knows what else?

Until the scientists know for sure, here are some ways to limit your PFC exposure, from Environmental Working Group:

Forgo the optional stain treatment on new carpets and furniture.
 Find products that haven’t been pre-treated, and if the couch you own is treated, get a cover for it.
Choose clothing that doesn’t carry Teflon® or ScotchgardTM tags.
 This includes fabric labeled stain- or water-repellent. When possible, opt for untreated cotton and wool.
Avoid non-stick pans and kitchen utensils.
 Opt for stainless steel or cast iron instead.
Cut back on greasy packaged and fast foods.
 These foods often come in treated wrappers.
Use real plates instead of paper.

Pop popcorn the old-fashioned way on the stovetop.
 Microwaveable popcorn bags are often coated with PFCs on the inside.
Choose personal care products without “PTFE” or “perfluoro” in the ingredients.
 Use EWG’s Skin Deep at cosmeticsdatabase.com to find safer choices.

 

February 27, 2012

Year 40 Meditation Report

Posted by Nathen under ego-centrism, family therapy, goals/intentions, human development, Ken Wilber, meditation, Not Back to School Camp, S. N. Goenka, science, self-care, Yoga Nidra
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Not Back to School Camp comes right before my birthday, so I often use our closing intention circles to make public goals for my personal new year. In 2010, I announced that I would sit and meditate for 30 minutes each day, every day, all year. I chose this goal for two reasons, one completely practical, and one speculative.

The practical reason was diligent self-care during my last year of grad school. I knew I would be working long hours, and wanted to remain as clear-headed and stress-free as possible, so that I could learn, write, and support my clients at the best of my ability. There is a sizable body of evidence that a regular mindfulness meditation practice could help. I also imagined that succeeding at this goal would help make this kind of self-care a permanent part of my lifestyle.

The more speculative reason came from reading meditation advocates like Ken Wilber, who claim that a mindfulness practice can be an engine of personal development. They conceptualize growing up as a process of continually refining one’s sense of self, becoming less egocentric and more compassionate. While practicing a mindfulness meditation you are learning to make objects of observation out of the contents of your consciousness that you normally inhabit with your identity. The sensations, emotions, and thoughts that you are become objects that you notice, distinct from your self. You can move, for example, from being anger about a certain injustice to having and observing that anger. This increase in perspective should be extremely helpful for family therapists like me–we need to be able to see all sides of the story: How does each person’s perspective on this problem make sense?

The only way I can present the results of my year-long experience in a clear-cut fashion is by the numbers, and in that way I failed in my goal. I meditated 30 minutes on 254 out of 365 days in that year. That’s 111 days of not meditating. Most of those days were during the summer that Reanna moved in with me. I found it hard to prioritize alone-time after two years of a long distance relationship.

The other way I failed by the numbers was that I did not sit for 125 of those 254 days. When I said I would sit and meditate every day, I meant it. Pretty soon, though, I had a day when I was so tired that I really, really did not want to sit up. I decided that on the rare days like these, I would lay down and do a relaxation-meditation called yoga nidra that my friend Guyatri Janine had recorded. It turned out that days like that were not rare at all. (When I did sit, by the way,  I sat Vipassana as taught by S. N. Goenka from my birthday in September to the new year (42 days), and then zazen (79 days) as taught by my friend Debra Seido).

The third failure is that I have not continued meditating after my year was over–less than 30 times in the last four months. It’s easy to imagine this says something about the results I experienced from meditating. I apparently did not value what I got from meditating enough to continue prioritizing it when I had my fiance’s attention available, starting last summer, and even less after my official commitment to meditating was up in September.

But what I got from my meditation practice is by far the most difficult thing to be clear about. I can say that without exception I felt better afterwards than I did before I sat down to meditate. Sometimes it also seemed like I was “getting better” at meditating, that I was indeed training my mind at this very difficult task. I can’t say, though, how much it lowered my stress or changed my ego-centrism or compassion levels. I have no control group to compare myself to. I can say that I was fairly stressed out in grad school and that I did a good job with it–the writing, the learning, and serving my clients. I think I can also say that I am more compassionate than I was before that year, but more I’m inclined to credit the connections I made with my clients than my meditation practice.

The problem with evaluating this kind of program is more than just not having a personal control group. It’s also that the program advocated by Wilber and meditation teachers is very long term. “Don’t just sit a year and expect to know what’s going on,” I imagine them saying. “Try 20 years. That’s more like it.”

The skeptic in me replies, “That’s a very convenient way to make testing all this out extremely expensive.” The researcher in me says, “Well, let’s get to it! This could be important. Who’s going to design a huge longitudinal experiment, fund it, and run it? You can still get it done before I die!” The idealist in me says, “20 years, huh? I am strongly considering it.”

 

May 7, 2011

Know Your Logic? Help Me Out!

Posted by Nathen under common factors, family therapy, logic, logical fallacies
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I am writing about a logical fallacy that I have been calling a “pinhole fallacy” and I would like to know what it is actually called.

The general form is this: First, a lot of empirically generated data is summarized into a few ideas, then those few ideas are then used to generate a lot of ideas which are assumed to be empirically generated because of their apparent origin in empirically derived data.

I’ve actually been calling it “family therapy’s Lambert-pinhole common factors fallacy” because I came across it in this form (greatly simplified, of course):  There has been a lot of research into what effective (individual-based) therapeutic modalities have in common. As far as I can tell, this research is pretty good, on the whole, though it has not come close to showing anything like causation, mediation, or mechanisms of change in therapy.  A guy named Lambert wrote a paper about this evidence, summarizing all of the many elements common to therapy modalities into four broad categories: the therapeutic relationship, model-specific factors, hope and expectancy on the part of the client, and extratherapeutic factors. Many writers in family therapy has gone on to take his summary as new data, creating new models of therapy based on the four-common-factor idea, and apparently thinking of this common-factor model as empirically generated and supported.

This process relies on a “hasty generalization” fallacy, and also a “post hoc” fallacy, but it seems to me that it should have its own name. What is it, logicians?

 

November 19, 2010

Some Views on the Nature of Reality

Posted by Nathen under epistemology, family therapy, lists, metaframeworks, philosophy
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In the field of family therapy, most theorists these days are postmodern and take care to spell out their epistemological lens–how and why they think they know what they know. They know that their theories are colored by their beliefs, so they want their readers to know what biases were involved in creating their theory.

I’m on page 33 of a very promising family-therapy-theory book called Metaframeworks: Transcending the Models of Family Therapy. The authors describe four views of reality, how they relate to each other, and which one they choose. The four are:

Objectivism: The often unconscious belief that there is an objective reality and that we have direct access to it. This view is also called “naive realism.”

Constructivism: This camp generally believe that a reality exists out there independent of us, but that we can’t know what it is like because our access to it is completely mediated and limited by our senses and cognitive processes. This is also called “pessimistic realism.”

Perspectivism: There is a reality out there and we have only mediated, distorted access to it, but it is possible to map it to greater and greater degrees of accuracy. That is, some maps are better than others. This is the authors’ camp.

Radical Constructivism: As far as we know, “reality” exists only in the mind. We are not qualified to make any statements about what actually exists or goes on “out there.”

 

July 3, 2010

Idiographic Vs Nomothetic Family Therapy

Posted by Nathen under arguments, cultural imperialism, emotionally focused therapy, epistemology, ethics, etiology, family therapy, family therapy terms, intergenerational family therapy, Ken Wilber, language-systems therapy, modernism, narrative therapy, oppresssion, postmodernism, solution focused therapy, strategic family therapy, structural family therapy, therapy models
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I’m taking a couples assessment class this summer, and right now I’m reading about a tension between family therapy models that Sciarra and Simon (in Handbook of Multicultural Assessment) call either idiographic or nomothetic.

Nomothetic models say that families have problems because they get out of whack in ways that families do. That is, each nomothetic model has its own list of ways that families can get out of whack and a therapist using that model is to keep a sharp lookout for those things. Structural therapists look for dysfunctional boundaries, for example. Strategic therapists look for incongruous hierarchies. Bowenians look for emotional reactivity. Emotionally-focused therapists look for maladaptive attachment styles. Each nomothetic model says that the therapist needs to assess for these underlying problems, treat them, and therapy should be successful.

Idiographic models call nomothetic models “cultural imperialism.” That means nomothetic therapists are just teaching (or tricking) their clients into thinking, feeling, and acting like them. Nomothetic therapists are forcing their culture on their clients. Calling someone a cultural imperialist is about as close to an accusation of pure evil as a post-modernist will make. Further, idiographic models say that culture (any culture) is oppressive of individuals, and that this oppression is the only reason families seek therapy. The ideographic therapist’s job (Sciarra & Simon list language-systems, solution-focused, and narrative therapies as idiographic) is to have a conversation with families about the ways they are being oppressed by their culture.

There are a couple of funny things going on here, but to understand it, first you need to know that nomothetic models are mostly “old-school” models that emerged in the 1950s and 60s, while ideographic models are newer, postmodern, all the rage, and emerged as a consequence of this nomothetic/ideographic conversation. In the 1980s, postmodern family therapists started saying that family therapy was arrogant and hierarchical and created the idiographic schools.

The first funny thing is that the old-school, nomothetic family therapy models emerged in much the same way, as a reaction to the arrogant and hierarchical field of psychiatry. The founders of family therapy said to psychiatry, “Human problems exist in the context of families. Your pathologizing medical model is not appropriate here.” Now the ideographic models are saying to the nomothetic founders, “Human problems exist in the context of cultures. Your pathologizing medical model is not appropriate here.”

Who is right? Well, that depends on your epistemology. So far, the nomothetic models have more experimental evidence to support them, and they are undeniably effective. To be fair, they have had more time to collect evidence, so in time things may go either way. And to be extra-fair, real post-modern idiographs can reject experimental evidence on philosophical grounds; experiments are so modern, so medical-model. What value system produced your research questions, anyway? That’s funny thing number two.

Funny thing number three is that, as Ken Wilber says, everyone may be right. Perhaps problems happen at every level of complexity, from our bodies to our minds to our families to our larger social systems, and nomothetic models just specialize in the family level, while idiographic models specialize in cultures. It’s a neat idea, possibly too neat, and difficult to tease out. I’ve written a little about it here.

The fourth funny thing is that the idiographic models, while broadening the scope of consideration in some ways, put the focus back on the individual in therapy. They say that culture is intrinsically dehumanizing, and that dehumanization is what an idiographic therapist talks about, but the other parties in the process are not part of the conversation. If I’m a narrative therapist and you send your depressed son to me, we will talk a lot about that depression. We will externalize it, maybe give it a name like “Mr. Funky,” talk about how Mr. Funky speaks with the voice of oppressive culture, talk about times when your son was able to overcome Mr. Funky’s influence and work on ways of increasing that ability. In the end, if I’m a good therapist, we have probably helped your son, but we’ve also focused on how your son thinks, feels, and behaves, where a nomothetic therapist would have been focusing on the whole family–how do they interact? Do the parents get along? How might this symptom of depression make sense in your son’s immediate system of relationships? Who all has a stake in this behavior and can we get them in the room too? And so on. There is a way that by ostensibly moving the location of pathology out of the family to the larger culture, ideographic models have brought the clinical focus back to individuals, which may seem like regression to the founders of family therapy.

 

June 22, 2010

Virginia Satir’s Criteria for Terminating Treatment

Posted by Nathen under communication, family therapy, treatment plans, Virginia Satir
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Virginia Satir lays out three sets of criteria for terminating treatment with a couple–criteria which, when met show that therapy has been successful. This is my favorite set, from p. 228 of Conjoint Family Therapy. The individuals in the couple can:

—Be direct, using the first person “I” and following with statements or questions which:

Criticize

Evaluate

Acknowledge an observation

Find fault

Report annoyance

Identify being puzzled

—Be delineated, by using language which clearly shows “I am me” and “You are you.” “I am separate and apart from you and I acknowledge my own attributes as belonging to me. You are you, separate and apart from me, and I acknowledge your attributes as belonging to you.”

—Be clear, by using questions and statements which reflect directness and the capacity to get knowledge of someone else’s statements, direction, or intentions, in order to accomplish an outcome.

I find these criteria charming, but I don’t think I will be able to use them overtly, for a couple reasons. First, insurance companies want a DSM diagnosis and a clear resolution of the Mental Disorders indicated. Satir did not speak their language. She didn’t like to label people.

Second, supervisors tend to want behavioral definitions of specific problems, so our treatment plans can say things like “The couple reports arguments have decreased from 4 times a week to 2 times a week, and that the intensity of those arguments have decreased from 7 to 4 on a 10 point scale.” This can be more collaborative and transparent with clients. It can appear to make things measured and therefore authoritative and amenable to research. I will have to write my treatment plans like that during school and probably any time I’m working for someone else. I’ll get good at it. Maybe I’ll come to like it.

 

June 12, 2010

Congruent & Incongruent Communication, Paradox & Double Bind

Posted by Nathen under behavior, children, communication, congruent communication, cybernetics, double bind, experiential family therapy, family therapy, going meta, incongruent communication, lists, love, mental disorders, paradox, parenting, Paul Watzlawick, psychology, relationships, talking, therapy, transparency, Virginia Satir
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Family therapy got started when the grandparents of the field, interested in cybernetics–the science of self-regulating systems–started studying communication in families. Some of the more interesting ideas they came up with were the three progressively more problematic kinds of contradiction. This is a summary of Virginia Satir’s version of those contradictions, from Conjoint Family Therapy:

Simple contradiction: This is when a person says two things that contradict each other straightforwardly, as when someone might say, “I love you but I don’t love you.” This kind of contradiction consists of assertions that are incompatible, but at least out in the open, in an easily decodable way. That means that the receiver of the message can easily comment on the contradiction, saying “I don’t understand what you mean. You didn’t make sense to me just then.”

Paradoxical (or incongruent) communication: A paradox is a special kind of contradiction, where the incompatible statements exist on different “logical levels.” That is, one of the statements is part of the context of the other statement. These are significantly more difficult to decode and comment on. The two logical levels in human communication are usually verbal and non-verbal behavior, where the non-verbal behavior is the context for the verbal. For example (from p.83) “A says, ‘I hate you,’ and smiles.” If A had said “I hate you” with an angry look on their face, that would be congruent, but what does “I hate you” mean in the context of a smile? This is more confusing than the simple contradiction, both because it is more difficult to track the two levels of communication simultaneously, and because we have unspoken social norms against commenting about how someone is speaking. Consequently, it takes more awareness and bravery to question the speaker’s intent when they present you with this kind of contradictory communication. (Satir calls paradoxical communication “incongruent communication.”) Being able to metacommunicate, or comment on the communication going on, is the major tool of the psychotherapist. We don’t usually know it, but this skill is the main thing we go to therapists for.

The double bind: The double bind is a special kind of paradoxical communication that was first laid out in Watzlawick and colleagues’ Pragmatics of Human Communication. A double bind is a paradox with two additional rules, giving four total requirements:

1) A verbal statement

2) A contradictory non-verbal context

3) A rule that you are not allowed to metacommunicate

4) A rule that you are not allowed to leave the field

This happens to people all the time. Children, especially, mercilessly, unconsciously, are put in this position a lot because they are not in a position to leave their parents “field.” They are completely subject to their parents on every level.

Here’s an example: A parent, obviously stressed out, tense, and in pain for whatever reason, says to their child, “I love you.” This puts the child into a double bind, because the statement is contradicted by the “I don’t love you” expressed by the parents’ body language and facial expression. That’s 1) and 2). Third is that the child can’t comment on the contradiction because they don’t have the tools, and even if they did, and said something like, “Mom, I hear you saying that you love me but it doesn’t really seem like you love me right now. It seems like you’re having other feelings,” the child would almost certainly be punished in some way for being insubordinate, for questioning the parent’s love, for questioning the parent’s word, for making the parent feel uncomfortable. Fourth is that the child is not allowed to leave the field. That is, even if they had the communication tools, the awareness, and the bravery, they have no where else to go if they are rejected by the parent. Their lives are dependent on the love and support of the parent. They are stuck in the field. To cope, they “learn” one or both of the following:

I am not lovable. My parent knows this, and I have figured it out, but at least they are pretending that they love me, which keeps me alive, so I’ll go along with the pretense that they love me.

I may be lovable, but love feels awful. Still, it’s the best thing available.

Then the child grows up and, having their own children, perpetuate the process, being a pretending-to-be-lovable parent with awful-feeling love to give to the next generation. Not only that, but they develop adaptations to this way of living that look like DSM-diagnosable Mental Disorder conditions.

Metacommunication and congruent communication: Notice that metacommunication is the key out of all of these situations. In the case of a true double bind, you might need the help of someone else’s (a therapist’s or friend’s) metacommunication, but metacommunication is still the key. Someone needs to stand up and say, “I’m confused! Can we slow down here and talk about what we’re talking about? What can you say to me right now that your body language and facial expression will agree with?”

 

May 31, 2010

Diagnostic Criteria for Schizophrenia

Posted by Nathen under diagnosis, diagnostic criteria, disease, documentaries, drugs, DSM-IV-TR, etiology, family therapy, lists, mental disorders, mental illness, psychology, psychopathology, psychosis, psychotropic medication, schizophrenia, tests, therapy, World Health Organization
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Schizophrenia is a fascinating set of phenomena, the study of which has launched a thousand ships including, arguably, my field, family therapy; many of the original family therapists left psychiatry to study schizophrenia (or, as the DSM would have me write it, Schizophrenia–capitalizing words gives them more authority, don’t you think?) as an interactive process. That is, if all behaviors make sense in their context, what context might make schizophrenic behavior necessary?

There was an almost violent backlash against this line of thinking, as it seemed to (and did, in many cases) blame mothers for their schizophrenic children–as in the unfortunate phrase “schizophrenogenic mother.” The conventional wisdom about schizophrenia these days reads like a pharmaceutical company press release, something like, “Schizophrenia is a biological disease of the brain which is at present incurable, but there are drugs which can help manage the symptoms, and if taken regularly can provide a decent quality of life.”

So schizophrenia is assumed to be a biological disease of the brain though it, like every other Mental Disorder, has no laboratory test that can detect its presence. The best we can do is a set of behavioral diagnostic criteria which, frankly, are a bit of a mess. You may notice as you read that different flavors of schizophrenia may have nothing or little in common with each other. Are they really the same “disease”? We don’t know.

We do have good evidence that you can inherit, in some fashion, a tendency for one of these constellations of behaviors. There is good evidence that environmental factors are also important, though they are not a big part of the mainstream discussion. We also have evidence that therapy helps in a lot of cases. There is some (hotly contested, I’m sure) evidence from the World Health Organization that unmedicated schizophrenics can eventually recover while those on medication do not. Here is a trailer for a moving documentary about two recovered women and the public perception of schizophrenia, called Take These Broken Wings. Also, consider checking out the documentary A Brilliant Madness, about John Nash, in which puts the lie to A Brilliant Mind, which showed Nash recovering with the help of psychopharmaceuticals.

The DSM says that schizophrenia may be overdiagnosed (or at least is diagnosed more often) in African- and Asian-American men, that it affects men differently than women (men tend towards the negative symptoms were women tend towards delusions and hallucinations), and that incidence rates are something like .5-1.5% of adults.

Here are a few terms that you’ll need to know to get through the criteria:

affective flattening: does not show emotion. Also, “affect” means “emotion” to scientists and people who like to talk like scientists.

alogia: lack of speech.

avolition: lack of motivation.

prodromal: symptoms coming early on in the course of a disease.

echolalia: repetition of others’ speech sounds.

echopraxia: repetition of others’ movements

And here are the diagnostic criteria, word-for-word, from the DSM-IV-TR, pp. 312-319:

Diagnostic criteria for Schizophrenia

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

(1) delusions

(2) hallucinations

(3) disorganized speech (e.g. frequent derailment or incoherence)

(4) grossly disorganized or catatonic behavior

(5) negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significatn portion of the time since th onset of the distrubance, one or more major areas of functioning such as work, interpersonal relations, or self-care are mardekly below the level achieved prior to the onset (or when the onset is in childhood or adolewscence, faliure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuou signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. Doring these prodromal or residual periods, the signs of the ditrubance may be manifested by only negative symptoms or two or more symptoms listen in Criterion A pressent in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Classification of longitudinal course (can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms):

Episodic With Interepisode Residual Symptoms (episodes are difined by the reemergence of prominent psychotic symptoms); also specify if: With Prominent Negative Symptoms

Episodic With No Interepisode Residual Symptoms

Continuous (prominent psychotic symptoms are present throughout the period of observation); also specify if: With Prominent Negative Symptoms

Single Episode In Partial Remission; also specify if: With Prominent Negative Symptoms

Single Episode In Full Remission

Other or Unspecified Pattern

Diagnostic criteria for 295.30 Paranoid Type

A type of Schizophrenia in which the following criteria are met:

A. Preoccupation with one or more delusions or frequent auditory hallucinations.

B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.

Diagnostic criteria for 295.10 Disorganized Type

A type of Schizophrenia in which the following criteria are met:

A. All of the following are prominent:

(1) disorganized speech

(2) disorganized behavior

(3) flat or inappropriate affect

B. The criteria are not met for Catatonic Type.

Diagnostic criteria for 295.20 Catatonic Type

A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:

(1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor

(2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli

(3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism

(4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumptions of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing

(5) echolalia or echopraxia

Diagnostic criteria for 295.90 Undifferentiated Type

A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

Diagnostic criteria for 295.60 Residual Type

A type of Schizophrenia in which the following criteria are met:

A. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.

B. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

 

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