Integrating Loss and Processing Grief in Psychotherapy of Psychosis

Abstract

Objective: While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. Methods: A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Results: Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person’s identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Conclusion: Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Jeremy M. Ridenour

Jeremy M. Ridenour, PsyD, ABPP is a staff psychologist and psychoanalyst at the Austen Riggs Center where he also serves as the Director of Psychological Testing. He obtained his doctorate in clinical psychology from The George Washington University in 2013 and completed a postdoctoral fellowship in psychoanalytic psychotherapy and psychoanalytic studies at the Austen Riggs Center in 2017.

Jay A. Hamm

Jay A. Hamm, PsyD is a clinical psychologist at Sandra Eskenazi Mental Health Center in Indianapolis. He obtained his doctorate in clinical psychology from the University of Indianapolis in 2013.

Courtney N. Wiesepape

Courtney N. Wiesepape, PsyD is a clinical psychologist who works as a clinical research specialist at the Indiana University School of Medicine. She obtained her doctorate in clinical psychology from Indiana State University in 2022.

Paul H. Lysaker

Paul H. Lysaker, PhD is a clinical psychologist at the Richard L Roudebush VA Medical Center and a professor of Clinical Psychology in the Department of Psychiatry at the Indiana University School of Medicine. He also serves as the president of the MERIT Institute. He obtained his doctorate in clinical psychology from Kent State University in 1991.