According to the DSM-5, symptoms of psychosis may include delusions, hallucinations, disorganized speech, markedly illogical thinking, or behavior that is grossly disorganized or catatonic, as well as diminished emotional expression and avolition (American Psychiatric Association, 2013).
A recent study by researchers at The University of Manchester and the University of Liverpool showed that the patient-therapist relationship was the most important issue—more important even than which therapy was used—in predicting therapeutic outcomes in psychosis patients.
The therapeutic relationship has repeatedly shown to be a determining factor in positive outcomes in psychosis treatment. But how specifically do clinicians ensure that this alliance is the best it can be?
When working with people with psychosis, a compassionate approach is critical, given the high rates of trauma history and the trauma that can be experienced as a result of psychosis symptoms. In some cases, the treatment of psychosis itself can even be traumatizing (for example, being brought into treatment involuntarily by the police).
When it comes to treatment for psychosis, CBT and acceptance- and mindfulness-based approaches have, at times, been assumed to be incongruent with respect to the goals of “control” and “change.” However, in their integration these approaches can complement one another by emphasizing the understanding, exploration, observation, and acceptance of thoughts and feelings rather than the “stopping” and “controlling” of unwanted thoughts and feelings.
Psychotherapeutic modalities such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have proven to be effective for a range of psychiatric and psychosocial difficulties including depression, anxiety disorders, substance abuse, eating disorders, and personality disorders. But when it comes to treating psychosis, CBT and other forms of psychotherapy have historically received less attention, owing to the traditional reliance on pharmacological strategies for treating psychotic disorders.