Why Is Psychotherapy More Successful With Some People Experiencing Psychosis Than With Others? Clinical Perspectives

Psychotherapists may share our work more easily when we believe our psychotherapy with a person experiencing psychosis has been helpful to them. It is may be more difficult to describe treatments in which 1) the therapist was... [ view full abstract ]

Psychotherapists may share our work more easily when we believe our psychotherapy with a person experiencing psychosis has been helpful to them. It is may be more difficult to describe treatments in which 1) the therapist was unable to engage the patient; 2) insurmountable obstacles to progress emerged during the treatment; or, 3) positive but quite limited outcomes were achieved. The workshop will provide a forum for clinicians to share experiences to foster a better understanding of frequent problems encountered in psychotherapy for psychosis. The presenter will spend 15 minutes discussing each of the above outcomes, offering clinical examples, followed by 45 minutes of open discussion in which attendees can comment from their clinical experiences and present cases of their own if they like. With respect to engagement, the presenter will explore a variety of meanings and beliefs that psychotic persons may have that make it impossible for them to engage in psychotherapy, including an inability to invest an interpersonal relationship with hope, a terror of being influenced or having one’s mind changed, in whole or in part, as a result of the psychotherapy, and a conviction that the therapist does not regard their concerns as “real,” but rather, as “imagined.” With respect to insurmountable obstacles, the presenter will describe situations in which the entirety of the treatment is absorbed by the psychosis, and will discuss the difficulty patients may have in letting go of ways of living that have absorbed them for many years. With respect to limited outcomes, the presenter will offer ideas about why certain patients progress so far and no farther, or why some patients may plateau in treatment but, after a period of time, return to revitalized work. The presenter will conclude with comments about counter-transference.