When someone has delusions of 'self importance'

Freiheit

and is able to acknowledge this, what should one do from a c.b.t. perspective? I'm involved in a support group.

JuliusCaesar

Well, then they are halfway there. But unless you are running a treatment group, there's not a lot you can do. The person really needs to work it out individually with a therapist, or attend a treatment group with a qualified psychologist as facilitor/treater, as a support group is just that - not treatment.

joseywhales

what is wrong with being narcissistic?

Freiheit

I wasn't talking about narcissism, more like believing one is on a divine mission, not exactly like that but of that ilk.

Cinful

CBT cognitive restructuring is typically between client and therapist: One-on-one. A support group can contribute to behavioral activation and enhancing problem-solving skills, but not restructuring where self-delusion interventions occur.

JuliusCaesar

Cinful wrote: »

CBT cognitive restructuring is typically between client and therapist: One-on-one. A support group can contribute to behavioral activation and enhancing problem-solving skills, but not restructuring where self-delusion interventions occur.

>cough< Actually CBT therapists do run treatment groups. Example here. Groups can be a really effective and also cost-effective way of providing treatment.

But this sounds 1. unsuitable for a support group, 2. probably requires individual therapy............given the little information

Cinful

JuliusCaesar wrote: »

>cough<

If your cough persists, please see a Medical Doctor.

JuliusCaesar wrote: »

Actually CBT therapists do run treatment groups.

Certainly they do; GCBT practices have existed for decades.

JuliusCaesar wrote: »

Groups can be a really effective and also cost-effective way of providing treatment.

A review of the ICBT and GCBT literature suggests that GCBT can be cost effective and beneficial, but generally this group protocol does not perform as well as ICBT; i.e., both GCBT and ICBT demonstrate benefits and improvements for individuals of all ages with social phobia, anxiety disorders, bulimia nervosa, obsessive-compulsive disorder, etc., but ICBT generally outperforms GCBT against DSM-IV and similar outcome measures.

JuliusCaesar wrote: »

But this sounds 1. unsuitable for a support group, 2. probably requires individual therapy............given the little information

The cognitive reconstructive phase of CBT therapy for a self-delusional patient should be ICBT (see my earlier post); while at the same time a support group in combination with ICBT may function in a stepped care approach to enhance outcomes; e.g., behavioral activation, (interactive) problem-solving skills, etc.?

To avoid potential comorbidity problems of mixing patients with markedly different mental illnesses with this self-delusional patient (as if this were action research), it is recommend that the CBT support group be more similar than different in its membership. If this suggestion is considered to have merit, it may be a problem to find a sufficient number of patients to comprise a support group? In the Los Angeles greater metropolitan area this would not be a problem, but I cannot speak for Ireland.

Further, to suggest that ICBT be complemented by a support group, is not to suggest simply taking individual therapy protocols and applying them to a group setting. Obviously there are differences in CBT protocols for ICBT and GCBT applications which should be implemented respectively. Furthermore, the extent to which this support group was therapeutic would have to be clarified before appropriate interventions could be suggested?

References:

Beck, J. G., et al. (2009).Group cognitive behavior therapy for chronic posttraumatic stress disorder: An individual randomized pilot study. Behavior Therapy, 40, 82-92.

Huston, K. (2008). Cognitive Behavioral Treatment Approach: Group Therapy vs Individual Therapy. Pacific University, CommonKnowledge http://commons.pacificu.edu/otmh/7

Simos, G., ed. (2002) Cognitive Behaviour Therapy. Hove: Brunner-Routledge.

Solomon, D., et al. (2003) Unipolar Mania Over the Course of a 20-year Followup Study, Am J Psychiatry, 160: 2049-2051.

JuliusCaesar

In the real world, when we are treating people, we have a lot of constraints. Constraints of time and money and availability - but most importantly, most of our clients do not have one psychiatric disorder. People being people do not always fit into diagnostic categories nicely. And besides, many of the problems they suffer from don't even enter the psychiatric lexicon. Low self-esteem, to give an example. Being a psychologist, I don't use psychiatric diagnoses - I use formulations. And it is very rare that two people would have exactly the same formulation. But there might be similar themes, even if the diagnoses are different.

So there has been some demand that research be not just RCTs, but real-world. And so, if you look, you will find research done in naturalistic settings, like out patient departments. And this is often much more useful to the practitioner on the coalface, or careface, as some would have it.

And I won't rant here about the ever-decreasing budgets in the health service - but the clinicians will give their best despite the shortcomings of the system.

hotspur

This is grossly off topic but I've wanted to ask it for a while: Cinful what is it with your idiosyncratic use of questions marks at the end of sentences which aren't questions? It's a consistent feature of your posts.