Other psychological approaches

(See E Art psychotherapy in Chapter 2, pp. 81-83, and in Chapter 5, pp. 251-5; Music therapy in Chapter 2, pp. 86-91, and in Chapter 5, pp. 261-74; Group therapy and group analysis in Chapter 2, pp. 42-7, and in Chapter 5, pp. 188-94.)

Though not yet subject to satisfactory research, art therapies (art, music, dance, and related therapies) and other group therapies are widely valued by many patients. An increasing number of people with psychosis are turning to peer groups for effective support, especially in finding alternative or additional ways to medication, in understanding and managing voices. The use of a computer avatar to modify unpleasant voices shows great promise in early trials.

Common features

(See E Medical psychotherapy modalities in Chapter 2, pp. 14-20; Research in psychotherapy in Chapter 10, pp. 154-63.)

It is likely that successful psychological therapies have a number of important features in common (erroneously called non-specific factors). Most important of all will be the capacity of the professional to gradually form a solid relationship with the patient and his family. Research has shown that patients repeatedly attempt to talk about the content of their psychotic symptoms, but this is a source of noticeable interactional tension and difficulty for experienced psychiatrists. Other research has long shown how few teams in the UK have organized themselves to provide psychosocial therapies, especially family therapy, in spite of the evidence of effectiveness being available for three decades. Since psychosis, by definition, implies an altered relationship to reality (and the creation of a new reality), it may require particular skills to understand the contextual issues that provoked the psychosis and the reality that the psychosis is disguising.

Recommended reading

Alanen Y (1997). Schizophrenia: Its Origins and Need-Adapted Treatment. Karnac Books: London. Birchwood M and Trower P (2006). The future of cognitive -behavioural therapy for psychosis: not a quasi-neuroleptic. British journal of Psychiatry, 188, 107-8.

Hagen R, Turkington D, Berge T, Grawe RW (eds) (2010). CBT for Psychosis. Routledge; London. National Institute for Health and Care Excellence (2014). Psychosis and Schizophrenia in Adults: Prevention and Management. NICE guidelines CG178. Available at: M https://www. nice.org.uk/guidance/cg178.

Rosenbaum B, Harder S, Knudsen P, et al. (2012). Supportive psychodynamic psychotherapy versus treatment as usual for first episode psychosis: two-year outcome. Psychiatry: Interpersonal and Biological Processes, 75, 331-41.

Seikkulaa J, Alakareb B, and Aaltonena J (2011). The Comprehensive open dialogue approach in Western Lapland. Psychosis, 3,179-204.

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