Tag Archives: schizophrenia

Reads recommended by counselors: Psychotic Rage!: A True Story of Mental Illness, Murder and Reconciliation

Review by Judith A. Nelson & Richard E. Watts December 27, 2015

Psychotic Rage!: A True Story of Mental Illness, Murder and Reconciliation is the gut-wrenching, yet fascinating, account of the Malone family and their struggle with severe mental illness. The author, Benny Malone, now retired, was a mental health professional in schools and in the community throughout her career. In this book, she provides readers with a detailed account of living with a mentally ill family member and the journey through the medical, mental health and judicial systems as she and her husband tried desperately to help their son overcome a severe mental illness.

At age 14, Benny’s son, Chris, was diagnosed with bipolar disorder. By the time Chris was 21, his diagnosis had expanded to include schizoaffective disorder. The book details the roller coaster ride of Chris’ 18 hospitalizations due to self-harm or suicidal ideation between the ages of 14 and 24. During this 10-year period, Chris had relationships as a patient with nine different psychiatrists, PsychoticRageworked with two therapists and was prescribed 25 different medications. He was hospitalized for a total of 295 days during these years.

In Benny’s words, “Psychosis became our new family member following the schizoaffective diagnosis, and my son’s health significantly deteriorated despite continual psychiatric treatment.” Despite Benny and her husband’s dedication to their son’s psychiatric treatment, Chris’ health deteriorated until the situation spiraled into an unbelievably tragic event.

In their quiet suburban neighborhood on a warm summer day in 2005, Benny and her husband were chatting at their kitchen table when Chris, now 24, had a major psychotic break, attacking Benny and killing his father. In spite of all the help they had provided Chris and the years of ups and downs with his illness, nothing could have predicted such a tragic outcome.

Benny details the entire account of the murder, including the 911 call, the sirens, the ambulance and the police cars. The scene at the house was chaotic, and even Benny’s visit to the hospital for her injuries is disturbing given the compassionless treatment of the emergency room personnel.

Chris was arrested the same day as the murder. In November 2011, following 6 1/2 years awaiting trial for murder, he was ultimately found not guilty of murder by reason of insanity. Benny recounts this long span of time prior to the trial in which Chris was transferred back and forth four times between a county jail and a state hospital, resulting in his spending a total of 39 months in jail and 38 months in the state hospital. These delays occurred because he was deemed not competent to stand trial for most of this time period.

After years of trying to manage Chris’ severe mental illness, Benny and her family didn’t anticipate the many additional years of burden they would experience struggling to navigate the criminal justice system. Readers are given a vivid sense of how the struggles of families dealing with severe mental illness seem unending.

Benny ends her story by explaining her understanding of her son’s inability to control his illness and her ability to forgive him for his erratic behavior that resulted in her husband’s murder.

This well-written account of living with a family member with a severe mental illness is intended for a variety of audiences. Psychotic Rage provides hope and encouragement to families such as Benny’s. She makes it clear that severe mental illness happens to all kinds of families, even those with a mother who is a mental health professional. Mental illness crosses all economic, social, racial, ethnic and faith lines and often attacks youth first.

The book is also meant for mental health professionals and those in training. It will help them better understand the complexity of severe mental illness and the ramifications for affected family members.

Psychotic Rage is also for policymakers and mental health advocates who need this important information to make informed decisions about the difficult legal aspects of patients and families facing serious mental illness.

To conclude, Psychotic Rage is a must-read for anyone who is interested in a compassionate understanding of the struggles of families who have a member with severe mental illness.

Benny Malone was the recipient of the Professional Writing Award at the most recent Texas Counseling Association Annual Professional Growth Conference.




Have a book that you’d like to recommend to other counselors? Contact us at ct@counseling.org.



Judith A. Nelson is associate professor of counselor education (retired) at Sam Houston State University in Texas and a past president of the Texas Counseling Association. She and Bunny Malone, the author of the book being reviewed, were former colleagues in a suburban Houston school district.

Richard E. Watts is a Sam Houston State University distinguished professor of counseling, the immediate past president of the North American Society for Adlerian Psychology and a fellow of the American Counseling Association.

What counselors need to know about schizophrenia

By Bethany Bray August 22, 2014

The adjective “schizophrenic” needs to be removed from counselors’ vocabulary, says Elizabeth Prosek, a counselor and assistant professor at the University of North Texas (UNT).

Schizophrenia has a great deal of stigma and negative connotations associated with it, and referring to clients in the first person can lessen these, she says.

“I encourage counselors to advocate for what clients with schizophrenia can do rather than [focusing on] the limitations of experiencing psychosis,” says Prosek, who has counseled clients with severe mental health disorders and served on a support team for individuals with schizophrenia living independently. “I once heard someone discuss the ‘aggressive nature’ of those diagnosed with schizophrenia. I could not help but wonder where that perception evolved. In my experience, clients did not demonstrate aggressive behavior or language.”

Counselors, as part of a multidisciplinary treatment team of helping professionals, can play a critical role in the lives of people diagnosed with schizophrenia, say Prosek and Kara Hurt, a puzzlelicensed professional counselor who works with clients with schizophrenia at an inpatient psychiatric hospital.

Prosek and Hurt, who is also a doctoral student at UNT, recently collaborated to write a practice brief on schizophrenia for the American Counseling Association’s Center for Counseling Practice, Policy and Research (see sidebar below).

In the brief, the duo describes schizophrenia as a lifelong illness characterized by negative symptoms, including “delusions, hallucinations (most commonly auditory), disorganized thinking or speech and disorganized or abnormal motor behavior.” The estimated prevalence rate for schizophrenia is 1 percent of the population in Western, developed countries.

For counselors, empathy should play a big part in therapy – from knowing the many side effects of schizophrenia medications to fully understanding what it is like to live with hallucinations and psychosis, say Prosek and Hurt. Special training and workshops can help counselors understand the nuances of the disorder, as can materials from mental health agencies (see “for more information” below).

Prosek once attended a seminar at which participants sat through the experience – virtually – of living with hallucinations, experiencing paranoia and hearing voices intertwined with the dialogue of another person.

Prosek and Hurt led a course this past year in which they showed videos of clients with schizophrenia explaining their own experiences.

“When the students in the class debriefed after the video, many confirmed that hearing firsthand from a client decreased their misperceptions about the disorder,” says Prosek. “Watching a video of a client with schizophrenia who was articulate and successful in a career reduced stigma of the disorder. Also, I noticed that when person-first language is used when discussing clients with schizophrenia [as opposed to using the term “schizophrenic”], negative connotations are immediately lessened.”


What do counselors need to know about schizophrenia?

Elizabeth Prosek: Living with psychosis can be scary and challenging. When working with those diagnosed with schizophrenia, demonstrating empathic concern is essential to build a therapeutic relationship. In my experience, clients appreciated my willingness to embrace their perspective of psychosis. I think all of the clients I worked with experienced their psychosis uniquely, and it was imperative that I understood their lived experience.

Kara Hurt: Schizophrenia affects the client’s support system, not just the client. In my experience, it is just as important to provide counseling and support to family members and loved ones of people diagnosed with schizophrenia as it is to provide support and counseling to clients with schizophrenia. All of us counselors can help provide services in some way that help clients diagnosed with schizophrenia and those that love them.

EP: Counselors may provide family members and friends with psychoeducation on the symptoms and treatment options for schizophrenia. Furthermore, counselors may assist family members and friends to build empathy for the experiences of those diagnosed with schizophrenia. There are support groups for family members through the National Alliance on Mental Illness (NAMI). Find a local NAMI support group through nami.org.

For those clients who do not have a familial support system, encouraging the development of a community support network may be essential for the social and emotional well-being of clients diagnosed with schizophrenia. Regardless of diagnosis, humans in general seek “belongingness” in their community, and those diagnosed with schizophrenia are no different.


What advice would you give about working with clients diagnosed with schizophrenia?

EP: Recognizing strengths can be a great first step to creating an appropriate treatment plan. Several of the clients I counseled had creative interests, such as art and music, and we developed interventions to promote participation in those activities.

Also, I recommend communication with all professionals working with the client. In my experience, collaborating with the client’s psychiatrist and case manager allowed for a holistic approach when addressing current therapeutic needs. Having a multidisciplinary team also allows for clients to more easily transition in and out of inpatient psychiatric hospitalization when necessary. With the appropriate releases of information, all professionals involved can be aware of how the client’s psychosis presented, any medication changes and any changes in treatment recommendations after an inpatient hospitalization stay.

It did not take long after beginning my work with clients diagnosed with schizophrenia for me to recognize the need for socialization. Several of my clients lived in isolation but longed for social relationships. In collaboration with case managers, I organized social outings for clients, which allowed for a more genuine community-living experience. There are several community resources for clients diagnosed with serious mental health disorders, such as supported-work programs. Having knowledge of such programs in the community will serve as great referral sources for clients diagnosed with schizophrenia.


With what other types of issues can clients diagnosed with schizophrenia present?

KH: One of the presenting issues that I had not expected when I started working with clients diagnosed with schizophrenia was substance abuse. One client in particular stands out in my mind because of the extent of his illicit drug use, which worsened his paranoia and other delusions. When working with clients with schizophrenia, you may need to reconsider your assumptions to appreciate that these clients have many of the same kinds of problems as other clients.

EP: I agree. Substance misuse was prevalent among the clients diagnosed with schizophrenia that I worked with as well. I also observed many secondary diagnoses, including anxiety and depression. I connect the anxiety and depressive symptoms back to the potential isolation clients experienced. Furthermore, it seems to me hearing voices and feeling out of touch from reality would lead to feelings of anxiety. Helping my clients accurately explain symptoms to their psychiatrists allowed for more precise medication prescriptions.


What are some common misperceptions about schizophrenia?

EP: One of the common misperceptions I hear frequently when describing a client with schizophrenia is the term “medication noncompliance.” I advocate for this phrase to be removed from counselor language. From my observations, when clients did not take medications regularly or as prescribed, it was not with intentional noncompliance, but rather there was confusion when medication regimens became complex or changed with frequency. Moreover, several antipsychotic medications have uncomfortable side effects. On a bad day, when a client is not feeling well, he or she might not feel inclined to perpetuate the experience by taking medications that may worsen physical symptoms. In counseling sessions, taking time to hear clients’ concerns or complaints about side effects may help clients feel validated in their experience.


What challenges do counselors face in this area?

EP: I think there may be a perception that clients with schizophrenia only need a case manager and psychiatrist. From my perspective, counselors can play a vital role in the treatment team. Never underestimate the power of a space in which a client’s experience is heard and valued.

KH: I think it is absolutely critical to have good supervision when working with a client diagnosed with schizophrenia. I have felt frustrated with my perceptions of clients’ lack of progress or insight, but with supportive supervision, I have been able to be more flexible with my therapeutic expectations and shift my perspective to be a better counselor for my clients. I cannot underestimate the value of good supervision. It can help you gain awareness of potential burnout and the need for regular self-care.

EP: Supervision is helpful. I often felt frustrated with the mental health care system and how clients with schizophrenia became victims of gaps in continuity of care. I agree with Kara that there is a greater potential for burnout when working with clients in and out of crisis.

Another challenge for counselors might be understanding the differences in antipsychotic medications most commonly prescribed for clients with schizophrenia. Actually, Kara introduced me to an app (named Epocrates) that provides names, descriptions and side effects for medications. I remember when I first started working with this population, I had a hard time differentiating the medications the clients were prescribed. There are several research studies published outlining effectiveness and common side effects of antipsychotic medications which may be helpful to read.

Going back to one of Kara’s original statements about the importance of family supports, it may be challenging to help family understand the experience of schizophrenia. Counselors can serve as a good source of information to help educate and support family members. Consequently, family members can better support the client diagnosed with schizophrenia.




For more information




ACA Center for Counseling Practice, Policy and Research practice briefs

Prosek and Hurt’s information sheet on schizophrenia is one of 30 practice briefs available to American Counseling Association members through the Center for Counseling Practice, Policy and Research.

The briefs, which range from working with victims of domestic violence to animal-assisted therapy to posttraumatic stress disorder, are written by ACA members who are experts on that particular topic. New practice briefs are being added regularly.

The practice briefs are designed to be practical, evidence-based resources for ACA members, says Victoria Kress, executive editor of the ACA center’s practice briefs project and a professor at Youngstown State University in Ohio.

Counselors can use the practice briefs as a refresher on topics they may not encounter very often, such as schizophrenia, or as a jumping-off point for further research. Each brief contains links to in-depth sources and data on a topic, as well as therapy models and other tools.

Kress says each practice brief is written and edited to be practical and succinct, with focused bursts of information on topics that counselors in all works settings may encounter, from divorce and autism to perfectionism and suicide prevention.

The plan is to post 15 to 20 new briefs each year, Kress says, including on each of the new disorders added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Kress began soliciting practice briefs from ACA members, then editing and posting the briefs on the ACA website, close to two years ago. The idea grew out of ACA past president Bradley Erford’s focus on counselor use of evidence-based practices, Kress says.

“Counselors don’t always have access to, or the time to read, journal articles,” she says. “We wanted to provide an outlet for ACA members to sit down and get a quick overview. … It was really born out of this idea that counselors should be using evidence-based practices. We know that counselors are busy and have competing demands. … The ultimate idea is that it will improve their practice. It’s better for their clients and the profession.”






Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


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