Beyond medication: Therapeutic engagement and the recovery from psychosis

Abstract

Beyond medication brings together psychotherapists and recovered patients from the United States to explore what helps recovery from psychosis. The book comes from a broadly psychodynamic perspective, and is not anti-medication, but makes it clear that to achieve effective and sustained recovery, clinicians and services need to go "beyond medication". A uniting feature of the chapters is a wish to understand the complexity of the human experiences that lead a person to develop psychosis, and emerging from this perspective comes a recognition that the single most important factor in a successful recovery from psychosis is a deep and meaningful therapeutic engagement.The structure of the book reflects its clinical grounding, with three main parts titled: "Engaging the patient", "The elements of change" and "Listening to the patient: Stories of what really works". The first part starts with David Garfield and Daniel Dorman presenting three case reports demonstrating clearly the importance of the therapeutic relationship in helping patients rediscover a sense of themselves following a psychotic breakdown. In the following chapter, Elizabeth Faulconer and Ann-Louise Silver present three more case reports illustrating how a flexible approach is essential in working successfully with people with psychosis. Garry Prouty in an inspiring chapter describes his Pre-Therapy Method for engaging with chronically regressed patients, and his detailed transcripts from sessions form a practical master class in approaching engagement with difficult to reach patients. Warren Schwartz and Frank Summers provide an immensely helpful chapter stressing the therapeutic importance of forming a deep emotional engagement with the patient; demonstrating that the most transforming therapeutic encounters occur when a patient can truly feel their therapist taking-in their deepest emotions, including negative ones.A highlight of the second part of the book is a chapter by Brian Koehler, in which he offers an in-depth account of his successful therapy with a very disturbed man with psychosis and uses his work to illustrate key theories by psychoanalysts such as Benedetti, Searles, Bion and Rosenfeld. Another high point is Daniel Mackler's description of his personal experience of sustaining his work as a psychotherapist despite the pressure from his employing organization only to value medication and throughput. Julie Kipp also provides a well-written and clear account of the benefits of milieu therapy for people with psychotic difficulties. Frank Summers and Patricia Gibbs both present chapters based around case reports that are beautifully written and psychoanalytically very helpful; however, I think these chapters could have had more impact on everyday psychiatric practice if the patients chosen were more typical of