ABSTRACT
In this chapter we provide an overview of the Shared Assessment, Formulation and Education (SAFE) approach to working with problematic behaviours in psychosis. We discuss the importance of adopting an integrative and formulation-based approach, which addresses a range of relevant intrapersonal, interpersonal and environmental factors. We begin by considering the useful aspects of existing approaches to the understanding, management and treatment of individuals with psychosis presenting with problematic behaviours along with their limitations. First, however, it is worth giving brief consideration to the term ‘treatment resistance’. Traditionally, the term has been used to refer to people who do not respond to standard psychiatric care (e.g. medication and nursing). However, standard care now encompasses psychosocial interventions such as cognitive-behaviour therapy (CBT), behavioural family therapy (BFT) and psychoeducation. In this book we suggest that the term may more usefully be applied to those individuals who do not respond to routine best practice, such as that recommended in current guidelines (e.g. DH, 2001; National Institute for Health and Clinical Excellence, 2009).
