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Psychotherapy in Psychosis

In this post, I would like to highlight an open-access article that highlights that value of psychotherapy in the treatment of psychosis. It offers valuable insights into the aspects of psychotherapy that people with psychosis found most useful in their paths from acutely symptomatic to fully recovered.

The article is free for download at the online journal Frontiers in Psychology. It was written by Jone Bjornestad and colleagues and draws from their experience at the Network for Clinical Research in Psychosis program at Stavanger University in Norway.

Readers of the article will gain deeper understanding of what it can feel like to have psychosis, and knowledge that forming trusting, empathic and helpful alliances is both possible and valuable to people undergoing an episode of psychosis.

The importance of connection, support and hope in the early stages of psychosis

“Being psychotic was, for most participants, incompatible with regarding oneself as a full citizen.” 

The experience of psychosis is unlike anything that most of us can imagine. It can be strange, frightening, sometimes exhilarating, and often disorienting. Even though about one in ten people report having had a psychotic experience (Scott et al., 2018), it’s a topic almost never talked about. Most people end up feeling alienated.

The article describes how early reduction of frightening positive symptoms is a crucial early step to alleviate pain, and to help affected people obtain a feeling of mastery.

It’s imperative that therapy give rise to feelings of safety and hope. These were viewed by participants as crucial for future treatment adherence.
Further, participants said that it was crucial that their therapists had a warm and respectful style – and that their therapist had specific suggestions and advice how to handle specific issues.

Putting psychosis in brackets and cultivating all that is healthy

Along with building deep rapport and fostering senses of safety and hope, participants appreciated how their therapists would put aside illness symptoms in favor of a focus on building on client strengths. Nurturing client strengths to help overcome what illness may temporarily impair is a tried and true method in psychotherapy, and one that was appreciated by the participants.

The importance of setting full recovery as the treatment goal

As they began to improve, clients valued an approach that focused on progressing to re-connecting with their communities and life goals.

“Everything should be focused on functioning in society, not functioning well in the psychiatric ward” said one service user.

All I had to offer was myself

The authors point out that this approach (focusing on mutual respect, personal closeness, and therapeutic support) differs from the nowadays common primary focus on risk, symptoms, and disease.

I had the great privilege during my residency training to have been mentored by many psychiatrists who began their careers in the pre-pharmacology era.
One such mentor emphasized that the most useful approach was to connect with people on an emotional level. “All I had to offer was myself,” he told me of his approach to people with psychotic illness in those days.

Though clinicians now have many more tools to assist the recovery of our patients, we should always remember that heart of psychiatric care is the caring. One of the most important things we can do as clinicians is to offer our most authentic selves as we foster hope, and aim to help our patients return to full recovery.