A Qualitative Exploration of Clients' Perspectives On The Mechanisms of Change in Cognitive-Behavioural Therapy For Psychosis.

Objectives: Little is known about how CBT facilitates change and this study aimed to establish clients’ perspectives of the mechanisms of change in CBT for psychosis. Method: In-depth interviews were conducted with 11 clients. They had received at least 10 sessions of CBT, at a specialist out-patient psychological interventions clinic, for people experiencing psychosis. The interviews were transcribed and analysed using interpretative phenomenological analysis (IPA). Results: Analysis resulted in two master themes: (i) 'The Therapeutic Context for Change’ which incorporated the ‘supportive space’ (where clients’ experiences were listened to, understood and validated by the therapist) and the ‘two-way process’ (which was facilitated by a number of client, therapist and relationship factors). (ii) ‘The Specifics o f Therapy ’ which encapsulated three main tasks in therapy that facilitated change: ‘building an understanding of experiences’, ‘learning new ways of coping’ and ‘belief change processes’. Hypotheses about the possible interactions and interdependent processes between the themes were considered (for example, ‘the therapeutic context for change’ may need to be established before ‘the specifics of therapy’ could then be explored within this context). Conclusions: This study throws light on the complexity of the process of change and suggests that both specific (to the CBT model) and non-specific factors, and their interaction and interdependency, are responsible for facilitating change in CBT for psychosis. The strengths and limitations of this study were examined and the clinical implications for the practice of CBT for psychosis were discussed