Cognitive-behaviour therapy for psychosis : individual accounts of the therapeutic process in successful and less successful outcomes

Despite a historical pessimism about the possibility of helping people with schizophrenia using psychological therapies, a great deal of progress has been made recently using cognitive-behavioural therapy (CBT) approaches. These treatments have been developed from changing understandings of schizophrenia, and focus on reducing the distress of psychotic symptoms through coping strategies and altering distressing beliefs. There is increasing evidence that suggests CBT may be helpful for a significant portion of people with psychosis. Limited information on the factors implicated in differing outcomes is available. The present study investigated factors differentiating individuals with good and poor outcomes on the basis of accounts of CBT for psychosis from eight therapist/client dyads. Four therapists and eight of their clients (two associated with each therapist) were interviewed about their experiences of CBT. Topics covered included, effect of the therapy, elements felt to be helpful and the therapeutic relationship. Interview data was analysed using a qualitative, "grounded theory", methodology. The analysis produced a number of major categories which differentiated clients who progressed and did not progress in CBT. These included ability to let go of distressing beliefs, logical thought, holding therapy, and presence of a shared goal. Overall, clients who progressed were better able to understand, hold and engage with ideas put forward by the therapist. Additionally, clients' views of CBT were positive and therapists and clients felt that non-specific benefits accrued from the therapy even when CBT specific progress did not occur. The results were consistent with previous studies suggesting that ability to consider disengaging from distressing beliefs are important in therapeutic progression. However further research is required to clarify the role of logical thought, holding therapy and therapeutic alliance in progress and in predicting outcome. Reasons considered for the inability to progress include, emotional investment in psychotic beliefs and information processing factors