ABSTRACT

This book has been written in order to provide clinicians with a description of the approach that we take to the understanding of psychosis, and to illustrate how this understanding can determine which interventions will be helpful in reducing the distress of a person with psychotic experiences. It offers an approach that is based on Aaron T.Beck’s cognitive therapy for emotional disorders, and assumes that the differences between people with psychosis and people with emotional disorders are largely about the kinds of interpretations they make for events. It is an approach that suggests that the experiences of people with psychosis are understandable, and that the distress they experience as a result is associated with the culturally unacceptable interpretations that they make about events, and is often maintained by counterproductive responses. We also recognise that psychotic experiences are often functional for a person, particularly when they develop; their present difficulties are frequently a result of using old survival strategies that have not changed to reflect the person’s new environment. While it is likely that there are multiple pathways to psychosis, it would seem that changing the way people think and behave is a useful way of alleviating distress and improving quality of life. This book is designed to allow readers to gain a psychological perspective on psychosis, and a detailed understanding of the cognitive, behavioural, emotional, physiological and environmental factors that contribute to the development and maintenance of distressing psychotic experiences. It will also provide readers with knowledge regarding the process of cognitive therapy for psychosis, and equip readers with a variety of cognitive and behavioural methods for helping people with psychosis to change. It emphasises Beck’s principles for cognitive therapy, particularly the collaborative nature of the endeavour and the need to be scientific in our efforts. It also examines specific issues in the implementation of cognitive therapy for psychosis, which our experiences of providing supervision and workshops suggest many clinicians struggle with. These include how best to utilise homework with people who experience psychosis, how to maximise chances of successfully delivering a psychological service within the wider mental healthcare setting, how to integrate with other services and how to deliver cognitive therapy when there are significant environmental factors that contribute to people’s problems.