CBT for psychosis in a psychoanalytic frame

Abstract

Some clinicians regard psychodynamic psychotherapy (PP) and cognitive behavioral therapy of psychosis (CBTp) as treatments with little in common. An integrated model is presented in which PP and CBTp fit together, with each modality playing an essential role in different ways at different points over the course of treatment. This model is developed by examining a core symptom in psychosis. Psychotic individuals seemingly perceive events in the outside world which are actually reflections of internal mental processes. Instead of experiencing thoughts or feelings, a person “sees” or “hears” things which appear to be occurring outside the self, a “thing presentation” of mental life. Before the unconscious meaning of psychotic symptoms can be psychodynamically interpreted to a person, “thing presentations” of mental life must first be returned within the boundary of the self. CBTp provides the technical means to do this. Once CBTp has helped re‐establish connections between psychotic experience and internal emotional life, a psychodynamic perspective becomes increasingly important. In this model treatment begins with CBTp practiced in a psychodynamic frame, followed by a second phase of treatment in which PP bears empathic witness to a person’s mental life, nourishing self experience.

Keywords:

• psychosis
• schizophrenia
• psychotherapy
• psychoanalysis
• delusion
• hallucination