Psychological Treatment for Schizophrenia/Psychosis
What is Psychosis/Schizophrenia?
This article is aimed at anyone, whether client, therapist, researcher or carer of someone who has experienced psychosis.
The first thing to say about psychosis is it’s one of the most researched mental health problems and yet researchers continue to disagree about its nature and origins.
Overall, the word psychosis and schizophrenia are used interchangeably to mean similar things. Symptoms can include auditory/visual hallucinations, paranoia and delusions, although the cluster of symptoms can vary greatly from one individual to another.
Medical Model of Psychosis
Some believe that the cause of psychosis lies in obstetric complications whilst others will argue that it is to do with genetic predisposition. Ultimately, the medical model which reduces the psychotic process to biochemical abnormalities in the brain, dominates the mental health system and treatment.
Although psychiatrists and nurses will agree that medication alone is not enough to treat psychosis, many often feel overwhelmed by the demand for quick treatment, which can lead to drug administration as the first point of treatment. Despite some of the benefits, medication can have serious side effects, particularly when used over a long period of time or inappropriately administered.
Recommended Psychological Interventions for Psychosis
Patients and carers sometimes do not even realise that the medical notion of ‘schizophrenia’ is not necessarily one that is shared by other mental health professionals. In fact, the term ‘psychosis’ suggests a different way of conceptualising psychotic symptoms altogether, compared with the traditional medical perspective.
Patients may not even be aware that as well as medication, there are a number of other evidence-based therapeutic interventions which can be effective for the treatment of psychotic symptoms, particularly when combined with carefully monitored dosage of appropriate drugs.
The National Institute for Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy for Psychosis. However, in the NHS, the limited numbers of patients who are referred for CBT are frequently placed on a waiting list.
By the time they see a Psychologist, their symptoms may be worse, there may be a mild decrease in cognitive abilities due to prolonged use of anti-psychotic drugs or patients may simply be more suspicious or withdrawn due to heightened fears and distrust of the mental health system.
Patients who are often detained or restricted by the Mental Health Act are sometimes forcibly administered medical interventions, which unfortunately can lead to secondary trauma in patients who may already have experienced trauma and abuse prior to their admissions to psychiatric care.
These factors of course make the work of a psychologist more challenging, but by no means impossible. It requires a Systemic Approach, namely considering how the system around the patient may be influencing the patient’s experience of distress.
The NICE guidelines also recommend Systemic Family Interventions which are known to reduce relapse rates through improving communication patterns within the family environment. It also recommends Art Therapy for patients who may benefit from processing emotions that they are too unwell to verbalise or tolerate within traditional psychodynamic therapy.
Finally, it also mentions Psychodynamic therapy for treatment resistant psychosis, and for supporting professionals/teams who may be struggling to cope with the demands of working with complex patients.
CBT is certainly recommended as the most effective treatment. However, there are also other options available which need to be highlighted. Clinically, a helpful way of engaging and working with a patient and the systems around them is by adopting an integrative approach, which takes into account psychodynamic, cognitive, behavioural & systemic factors which lead to and contribute to the maintenance of psychotic symptoms.
Promoting Meaningful Recovery
This article is by no means arguing that medication should not be offered. Rather, at the outset, that it should be routine for non-medical interventions to be offered as well, so that patients and their carers can make informed choices.
Clearly there are various treatment choices for patients and relatives. Despite the issues in accessibility, when patients do see a therapist, it can make a huge difference to severity of symptoms, levels of distress and rates of relapse.
Ultimately, it can make a difference to the quality of life for a patient and often their families/carers. It can make a difference to their perceptions of this disorder and enable patients to take more ownership and influence their own recovery.
Psychosis needs to be perceived as emotional distress which gets processed in a way that leads to cognitive distortions and conscious distress for the patient and those around them. Offering medication alone does little to address the roots of that distress, whilst psychological intervention, particularly CBT can increase insight, ability to cope with stressors and reduce the likelihood of chronic debilitating symptoms.
|About The Author
Dr Sidrah Muntaha is a fully qualified and HCPC registered Clinical Psychologist with clinics in South Woodford and Marble Arch, London.
Dr Muntaha offers consultations, assessments, therapy and counselling for a range of mental health issues.
For further information visit her GoToSee profile here
Visit her website www.dynamic-therapy.co.uk