Personal Experiences of Psychological Therapy for Psychosis and Related Experiences

Peter Taylor, Olympia Gianfrancesco, Naomi Fisher, Peter Taylor, Olympia Gianfrancesco, Naomi Fisher

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351610544
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

For those struggling with experiences of psychosis, therapy can be beneficial and even life changing. However, there is no single type of therapy, and a great range and diversity of therapeutic approaches have been developed to help different individuals' needs, which makes deciding which approach is most helpful for an individual not a straightforward choice. Personal Experiences of Psychological Therapy for Psychosis and Related Experiences uniquely presents personal accounts of those who have received therapy for psychosis alongside professional clinical commentary on these therapies, giving multiple perspectives on what they involve and how they work.

Presented in a clear and accessible way, each chapter includes accounts of a variety of different therapies, including cognitive behavioural therapy, trauma-focused therapy, open dialogue, and systemic family therapy. The reader is encouraged to explore not only the clinical basis for these therapies but also understand what the treatments mean for the person experiencing them, as well as their challenges and limitations. The book also explores the importance of the individual's relationship with the therapist. As a whole, the perspectives presented here provide unique insight into a range of widely used psychological therapies for psychosis.

With its special combination of personal experiences and concise introductions to different therapies, this book offers a valuable resource for academics and students of psychiatry, clinical psychology, psychotherapy, mental health care and mental health nursing. It will also be essential reading for those considering treatment, their friends and families, as well as mental health professionals, including psychiatrists, clinical psychologists, psychotherapists and nurses.

1
Introduction to the book

Peter Taylor and Olympia Gianfrancesco

Overview

The main goal of this book is to give an overview and introduction to a variety of different psychological or ‘talking therapies’ that are aimed at helping people who are struggling with experiences of psychosis. We do this in two ways: 1) by sharing the first-hand experiences of individuals who have received these therapies; and 2) by sharing therapists’ accounts of the therapies they provide. In this first chapter, we aim to give a general introduction to the book. In particular, we explain some of the terms used in the book, including ‘psychosis’ and ‘psychological therapy’. We also give a rationale for the book and discuss who may benefit from reading it. Lastly, we consider the benefits of looking to first-hand accounts in order to learn more about a therapy, and also some of the challenges in doing this.

What do we mean by psychosis?

The word ‘psychosis’ does not refer to one thing, but in fact covers a broad range of very different experiences. A number of these involve some sense of being out of touch with the world around us. For example, some experiences associated with psychosis include hearing voices that others cannot hear, and having strongly held, unusual beliefs or ideas that appear to be unsupported or excessive (British Psychological Society [BPS], 2014; Freudenreich, 2007). These experiences may be distressing for some people, but not necessarily for everyone. Unfounded or excessive fears that others will hurt you or wish you harm, usually called paranoia, are another common experience of psychosis. Psychosis can also include a loss of motivation (avolition), and social or emotional withdrawal.

Traditionally, these experiences have been linked to particular psychiatric diagnoses, most commonly, schizophrenia. However, in recent years there has been much debate about how valid or helpful these diagnoses are (Bentall, 2017; BPS, 2014). There is now evidence that many experiences of psychosis exist on a continuum (e.g. Shevlin, McElroy, Bentall, Reininghaus, & Murphy, 2016), and that experiences of psychosis are common, to a greater or lesser extent, across the population, including people whom we would normally say are mentally well and people who might traditionally be seen as mentally unwell. In this chapter we refer to psychosis, rather than to a specific diagnosis, for the same reasons. One implication of seeing psychosis in this way is that it suggests that, for many people, psychosis is not a problem. Some people may hear benign or even supportive voices for example, which do not negatively affect their lives or how they feel. However, for other people, psychosis can be very difficult and disruptive. For some, the psychosis itself may not be their main problem, but the way it affects their lives. For example, it may prevent them going outside, meeting people, doing the things they would like to. It is not uncommon for people struggling with their psychosis to feel anxious or depressed at times. As a result, therapies that are designed to help people with psychosis may focus on the experiences of psychosis itself, but may also focus more on related problems, such as low self-esteem or low mood.

It is important to note that there is still much debate around the idea of psychosis, and some people would question the definition we give above. Some would argue against the use of the word ‘psychosis’ at all, due to the psychiatric connotations and the stigma that can become linked to such words. We feel the term ‘psychosis’ is helpful in outlining a set of particular experiences (e.g. hearing voices, paranoia), but would agree that it has its limitations. Here we have given a relatively brief definition of psychosis, and we would suggest that those interested in knowing more about it do further reading on this subject or talk with a health professional about this (for example see BPS, 2014).

What is psychological therapy?

As with psychosis, there is no single thing called ‘psychological therapy’. Instead, a wide range of different types of therapy exist. What many have in common is that they rely on conversation between the therapist and the client as a means of bringing about improvements in the client’s problems (although some approaches such as art therapy are a little different, in that they do not rely on conversation). Some individuals may be sceptical about the idea that simply talking about their problem could bring about any meaningful improvements in the problems they are facing. However, it is common for people to discuss their difficulties with supportive others (e.g. friends, family), and such conversations have the potential to be helpful, changing how a person feels, or how they see their problems. Thus, the idea that conversation alone can be helpful does not seem so far-fetched. Also, for many therapies, the conversations that take place in therapy serve the purpose of trying to bring about a change in a person’s day-to-day life, such as in the way they cope, interact with others, or think about themselves and the world around them. Through such day-to-day changes, improvements in a person’s problems can emerge. Different therapies make use of a variety of different techniques and tools to help achieve improvements for the client.

Psychological therapy in psychosis

Over recent decades we have seen a growing recognition of the value of psychological therapies for people who are struggling with mental health difficulties. Research has steadily grown into understanding how these therapies can and do help many individuals with a wide range of different problems, from depression to anxiety, to problems with using substances or alcohol (e.g. Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012; Linde et al., 2015). The growing recognition of the value of psychological therapy has also extended to psychosis. This has been aided by increasing evidence that psychological mechanisms such as differences in the way individuals perceive others and the world around them, reach conclusions, cope with difficult feelings, or think about their problems, may be important to understanding their experience of psychosis and the associated distress they feel (e.g. Bentall et al., 2014; Dudley, Taylor, Wickham, & Hutton, 2015; Freeman, Garety, Kuipers, Fowler, & Bebbington, 2002). We have started to see evidence that talking therapies do have a role to play in helping people who are struggling with psychosis (BPS, 2014), including specific psychosis-related experiences like hearing voices (e.g. Thomas et al., 2014). One good example of this is that psychological therapies are now recommended as a front-line treatment for people with experiences of psychosis in some national guidelines (e.g. National Institute for Health and Care Excellence, 2014).

This is not to suggest, of course, that there is no longer any controversy around the use of psychological therapy for psychosis. Many people still dispute the value of such therapies, and debate continues (Kinderman, McKenna, & Laws, 2015). Nonetheless, our own perspective is that evidence coming forward from trials and research studies suggests that psychological therapies can help people who are facing problems associated with psychosis. However, debate remains about which therapies are most effective for experiences of psychosis, or which aspects of a particular therapy are most important in helping clients. Different therapies may look similar to the individual receiving them. Alternatively, the same therapy may be practised differently depending on the therapist, and the same therapist may alter their way of working for different clients even whilst using the same therapy model. Moreover, there is evidence that the relationship between client and therapist is particularly important in determining the outcome, irrespective of the type of therapy being used (e.g. Goldsmith, Lewis, Dunn, & Bentall, 2015; Horvath, Del Re, Flückiger, & Symonds, 2011).

The challenge of choice

The growing recognition of the value of talking therapies for mental health problems has led to an explosion in the range of different talking therapies that are available. This has been the case for therapies for psychosis, as with other types of problems. Whilst for some, the possibility of having a choice between different therapies can be empowering, it also has the potential to be bewildering and confusing, especially if we know little about what these therapies involve or how they differ from each other. What is the difference between Cognitive Behavioural Therapy (CBT) and Cognitive Analytic Therapy (CAT)? Which would I prefer? Which of these focuses more on my early experiences? How will they make sense of my problems? It does not help that many therapies have similar sounding names and abbreviations: CAT, CBT, CFT (Compassion Focused Therapy). The decisions we can make about which therapy to go with are of course limited by various factors, not least the services available to us. Mental health services for people with psychosis are usually limited to a small number of different therapeutic approaches. In the UK, for example, available therapies are usually those that currently have the most developed evidence (e.g. CBT, Behavioural Family Therapy) and which are recommended by national bodies (e.g. National Institute for Health and Care Excellence [NICE]). However, even in such contexts, there is still a choice to be made about whether to take up the offer of a particular therapy.

In order to make an informed choice about whether or not to pursue or become involved in a particular therapy for psychosis, we need to know something of what that therapy involves and what it is like. This brings us back to the main aim of this book: to provide an introduction to, and an overview of, a variety of different therapies for psychosis. The accounts of therapists explaining what their work involves are clearly helpful here, but only provide half the story. First-hand accounts from people who have received a particular therapy are also very important. In the current book, we therefore offer a combination of first-hand accounts of different therapies and accounts written by the therapists who deliver these approaches.

Although it has not been possible to cover every therapy in this book, we do cover a number of the dominant and recommended therapies for people with experiences of psychosis within the UK, including CBT and family therapy, as well as more recently developed approaches such as CFT. This book also focuses on therapies aimed at adults, which can differ to recommended therapies for children, and on therapies for individuals or families, rather than groups (although group therapies for psychosis also exist).

The power of the first-hand account

Learning about others’ experiences of a particularly therapy is a helpful way of gathering information about that approach and deciding whether that is the therapy for us. In other, perhaps more mundane aspects of life, it is common to check others’ experiences before we make decisions, such as booking a holiday or picking a restaurant. The choice of whether to take part in therapy, or of which therapy to undertake, is clearly a bigger decision, and so knowing what others went through when they received these therapies can be helpful. First-hand accounts are informative because they can go beyond just giving us an idea of what tasks and discussions a particular therapy may involve, and can describe how it may feel to experience that therapy. Such accounts are valuable not just in identifying some potential strengths and benefits of a particular therapy, but also in noting some possible challenges and difficulties.

Despite the value of considering others’ experiences when making up our minds about therapy, there also needs to be some caution here. Everybody’s experience of therapy will be different, even if they receive the same type of therapy. A huge array of factors will play a role in an individual’s experience of therapy, some relating to themselves (e.g. their expectations and goals for therapy, their own understanding of their difficulties), and some relating to external factors (e.g. the qualities and preferences of the therapist, the nature of the service). A particular therapeutic approach, like CBT, does prescribe a certain set of methods and techniques. However, the way one therapist applies this approach may differ from that of another therapist. As a result, first-hand accounts of therapy provide a useful guide or outline of what a therapy might be like, but we can never assume that our own therapy journey will feel quite the same. This caution can also be extended to the accounts written by the therapists themselves, of course, because as noted above, one therapist’s way of working may differ to another’s.

It is also important to note that one person’s account of their therapy does not necessarily constitute evidence that a particular therapy does or does not work. There is ongoing research with the goal of determining which therapies are helpful, in what way and to whom. One of the challenges facing the researcher is that if any single individual gets better after receiving therapy, it is hard to know why. Perhaps the therapy helped them, but perhaps they would have got better anyway, or perhaps it was just the act of talking to someone about it, and so nothing special about that particular therapy that helped. It could even be that something small, like the act of regularly travelling to see the therapist, was enough to bring about some improvement. Researchers draw upon various methods and approaches, and look at the experiences of large numbers of people, to establish whether it is the therapy that helps, as opposed to some other unknown factor. Considering this, we can see that an individual first-hand account where someone found a therapy helpful does not necessarily provide good evidence that therapy will work for most people. For this reason, we would suggest that, in considering therapy, it is important to also consider the evidence that currently exists for that therapy. Within this book, the chapters written by therapists provide a brief overview of the research behind each approach.

About this book

We hope this book will be helpful for a number of different people. We particularly hope it will assist those who have been offered therapy, or are seeking a referral for therapy to help with difficulties related to psychosis, and the friends and family of people in these situations. We also hope this book will be of value to therapists and other clinicians (and those training in these professions), either as a resource to provide to clients, or to support their own learning and development as practitioners. Indeed, our own opinion is that there is much to be learned from first-hand accounts for the therapists themselves in terms of how they introduce and conduct therapy. Many of the therapies covered in this book, whilst used in the UK, are also used internationally (e.g. CAT, CBT, family therapy, open dialogue), and so we believe this book will be relevant to many readers from around the globe.

The book has been structured so that each chapter concerns a different therapeutic approach. Within each chapter there is a section giving a first-hand account of the therapy, and a section giving an introduction to that therapy from the perspective of the therapist. In putting this volume together, we are particularly indebted to those who have shared their experiences, progress, and achievements, as well as their difficulties. The chapters have demonstrated to us both the potential for therapy to change the lives of those who are faced with the challenges that psychosis can bring.

References

Bentall, R. P. (2017). Six myths about schizophrenia: A paradigm well beyond its use-by date? In J. Poland & S. Tekin (Eds.), Extraordinary science and psychiatry: Responses to the crisis in mental health research (pp. 221–248). Cambridge, MA: MIT Press.

Bentall, R. P., de Sousa, P., Varese, F., Wickham, S., Sitko, K., Haarmans, M., & Read, J. (2014). From adversity to psychosis: Pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology, 49, 1011–1022. doi:10.1007/s00127-014-0914-0

British Psychological Society. (2014). Understanding psychosis and schizophrenia. Leicester: British Psychological Society. Retrieved from www.bps.org.uk/system/files/Public%20files/aa%20Standard%20Docs/understanding_psychosis.pdf

Dudley, R., Taylor, P. J., Wickham, S., & Hutton, P. (2015). Psychosis, delusions and the “Jumping to conclusions” reasoning bias: A systematic review and meta-analysis. Schizophrenia Bulletin, 42, 652–665. doi:10.1093/schbul/sbv150

Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41, 331–347. doi:10.1348/014466502760387461

Freudenreich, O. (2007). Psychotic disorders: A practical guide (pp. 2–13). Philadelphia, PA: Lippincott Williams & Wilkins.

Goldsmith, L. P., Lewis, S. W., Dunn, G., & Bentall, R. P. (2015). Psychological tre...