For the schizoid individual, attempts to communicate and connect, as well as having an identity and a will of one's own, lead to being taken over by others, used and sadistically punished, or to encountering deep indifference. Rather than being subjected to these treatments, the person with schizoid disorder prefers to remain separate and distant from others. In their lives, these individuals aim to feel useful by serving the needs of those around them. These individuals feel like they are called when needed and then forgotten, like a genie in a bottle. For this reason, schizoid individuals believe that constantly connecting with others will lead to a person becoming a puppet, a servant or a slave. It is important for these patients to be diagnosed correctly in therapy. Because schizoid individuals have a desire to maintain distance between themselves and others in their inner world, this situation may be seen as a narcissistic defense by the clinician, their inability to establish relationships may be evaluated as autistic, and their adaptation may be evaluated as a borderline patient. In therapy, if the therapist cannot make sense of the schizoid patient's sitting and distant approach, this may cause the schizoid client to experience engulfment, occupation and control in his/her self-expression and relationship style. This situation, on the contrary to the beginning of the therapy, causes the therapy to become difficult and not to progress, and even causes the patient to drop out of the therapy. Interpreting schizoid dilemmas (dillemma) immediately after the therapeutic alliance is formed will help therapy begin and continue steadily. Late and inadequate interpretations may complicate the patient's treatment process. The therapist's involvement in the master-slave object relationship that occurs in therapy with schizoid clients is another issue that causes difficulties in therapy. The situation in which the schizoid client is a slave may continue throughout the session. In this case, the therapist may interpret the patient's adaptation as healing. The lack of a trusting relationship between the therapist and the schizoid client during therapy is another issue that prevents the progress of therapy and the healthy continuation of the process. If the schizoid client cannot trust his therapist and cannot create a safe space in therapy, it may be difficult for him to open himself up in therapy and establish a healthy relationship by experiencing a secure attachment. it will fire. In therapy with a schizoid patient, it is important for the therapy process and recovery that the therapist creates space for the schizoid patient. It may take time for the schizoid client to express himself/herself clearly and fluently in therapy, emotionally, intellectually and behaviorally. In these cases, if the therapist does not create space for the schizoid client in therapy, the patient exiles himself (breaks away from the relationship) and prevents the therapy from taking place. All of these are difficulties experienced in the therapy of the schizoid patient, which prevents the progress of the therapy process.
Keywords: Therapy, Difficulties in Treatment, Schizoid Personality Disorder
Difficulties In The Treatment Of Schizoid Personality Disorder
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Abstract
In the eyes of a schizoid individual, attentives of both communicating and having personal agency leads to being Possed, used, sadistically punished and deeply ignored. Rather than being a subject of these treatments, one with Schizoid disorder chooses to stay away from others. These individuals aim to feel useful in their daily lives by satisfying others' needs. They feel like they are summoned when needed, and forgotten afterwards like a genie in a lamp. Hence, Schizoid individuals believe that constant communication with others would make one a puppet, servant or a slave. It is significant to diagnose these patients accurately. This is because Schizoid individuals have the wish to keep the distance between themselves and others in their inner worlds; This situation might be interpreted as a narcissistic defense by the clinician, the inability to establish a relationship might resemble autistic attributes and the orientation might resemble a borderline patient's. If the therapist fails to make sense of the client's distant seating and approach; the client may experience the relationship style as repressing, invading and controlling in his / her self expression. Instead of starting the therapy, this situation leads the client to have a hard time in progressing in the therapy, and even drop out. Interpreting Schizoid dilemmas right after forming the therapeutic alliance will help the therapy to start and progress consistently. Late and inadequate interpretations may complicate the patient's treatment process. The involution of the therapist to the master-slave-object relationship formed by the Schizoid client is another issue which leads to complications i n therapy. This state of client as slave may continue during the whole session. In this situation, the therapist may interpret the patient's orientation as progression. The absence of a trust relationship between the therapist and Schizoid client in the course of therapy is another issue that hinders a healthy treatment process. It would be difficult for the Schizoid client to open up in therapy and experience a securely attached, healthy relationship if he/she does not trust the therapist and build a safe haven.
It is important that the therapist creates some free space for the Schizoid patient for the sake of the treatment process and recovery. It can take time for the Schizoid client to express himself / herself emotionally, intellectually and behaviorally, in a clear and fluent manner.In this case, the patient exiles himself / herself and spoil the therapy if the therapist does not give some free space to him/her. All the aforementioned are challenges in Schizoid patients' therapy, which hinder the progress of the treatment process.
Personality Disorders
Personality; It is defined as persistent characteristics in the way of perception, establishing relationships, thinking and perceiving about the environment and oneself. In other words, it is the sum of a person's internal and external behavior to adapt to life.
Early childhood experiences, social and cultural factors have an important place in the development of personality. Childhood experiences prepare the ground for disordered behavior. Rewarding action, blocking creativity, and encouraging non-compliance have an important place in the formation of personality disorder (Yüksel, 2006, p.351).
General Personality Disorder; It is defined in the DSM-V as;
An ongoing pattern of internal experience and behavior that deviates significantly from the expectations of the culture in which the person lives. This pattern manifests itself in two (or more) areas of the following:
Cognition (ways of perceiving and interpreting oneself, other people, and events).
Affectiveness (range, intensity, variability, and appropriateness of emotional responses).
Interpersonal functioning.
Impulse control.
Ongoing, flexible This pattern of lack of clique covers a wide range of personal and social situations.
This ongoing pattern may lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
This pattern is persistent and long-lasting, with onset extending at least into adolescence or early adulthood.
Ongoing This pattern cannot be better explained as a manifestation of another mental disorder or as a consequence of another mental disorder.
This ongoing pattern is associated with the use of a substance (e.g., a substance of abuse , a drug) or another health condition (e.g. head injury) (DSM-V (2014) fifth edition).
DSM-V Examines Personality Disorders by Dividing them into Three Clusters:
Cluster A
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Doubtful (Paronoid) Personality Disorder
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Schizo-like (Schizoid) Personality Disorder
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Schizotype (Schizotypal) Personality Disorder. (Individuals with these personality disorders are seen as strange and eccentric.)
Cluster B
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Isolated (Antisocial) Personality Disorder
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Borderline Personality Disorder
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Histrionic Personality Disorder
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Narcissistic Personality Disorder (Here people are seen as dramatic and labile).
Cluster C
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Avoidant Personality Disorder
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Dependent Personality Disorder
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Obsessive-Compulsive Personality Disorder
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Other personality disorders (Personality Change Due to Another Health Condition) Here the cases are fearful, inhibited and anxious. (DSM-V (2014) fifth edition).
Historical Process in Defining Schizoid Personality Disorder
The basic question is, will we define Schizoid Personality disorder separately from other personality disorders? This disorder is anxiety disorder, social phobia, avoidant personality, accommodating borderline or a narcissist who avoids contact?
When we look at the historical process, descriptive psychiatry (DSM-V) and dynamic psychiatry (classical psychoanalysis object relations) defined schizoid personality disorder. Bluer and Kfestchmer (1925) examined this structure throughout history. The concept of schizoid was defined by Kfestchmer (1925) as meaning 'strange, cold and devoid of emotion'. Another name that stands out in the historical process is contemporary object relations theorist Melanie Klein. Especially dealing with the early spiritual structure; While Melanie Klein defines this structure; He emphasized the division mechanism. It has been hypothesized that the structure that separates the mother's mind into feeding breast and non-feeding breast (good breast and bad breast) in the world of the 0-3 year old baby, combines good and bad after the age of 3 (integrates on one person). However, we see that this splitting mechanism is used as defense in the Schizoid personality structure (Klein, 2012, p.80).
Fairbain was among the important names in defining Schizoid pathology. Fairbain talks about three personality structures: neurotic, psychotic and schizoid. She focuses on the concept of distance in the relationship and the need for self-preservation. Schizoid patients acquire a belief that they cannot love their mothers as they are, due to their mothers being overly caring or not caring at all in the first years of life (Masterson, 2005, p.21).
Guntrip lists 9 characteristic features of the schizoid patient, schizoid dilemma and He emphasized the ways of coping with these, the schizoid compromise, and finally the importance of fantasy as a regressive defense (Masterson,2005, p.25).
Definition of Schizoid Personality Disorder
Schizoid personality disorder is defined as individuals who are introverted, keep their distance in social relations, are silent, and isolated in groups. In DSM-III and DSM IV, it is evaluated as weakness in social relations, It is distinguished from avoidant personality disorder in DSM-IV. Currently, it is evaluated as follows in DSM-V:
