Psychodynamic perspectives on psychosis and psychotherapy I: Theory

Abstract

Psychotherapy with sufferers of psychosis may usefully draw on both cognitive--behavioural and psychodynamic theory. The latter has a long history with fluctuating popularity, whilst cognitive--behavioural approaches are currently attracting the attention of clinicians. Some of the factors which may reduce interest in psychodynamic approaches are reviewed, followed by an overview of core psychodynamic theories of psychosis under the major headings of vulnerability of defence and vulnerability of the ego. A vulnerability-stress formulation of psychodynamic theory is then considered together with implications for intervention.

Psicosis y diferencias sociales: Comparando la prevalencia de las psicosis en dos medios urbanos diferenciados

“…Asimismo, la realidad clínica cotidiana nos muestra la radical importancia que para el futuro de un esquizofrénico joven, posee el que, durante el primer episodio del trastorno, sea tratado de forma "antipsicológica" o bien mediante el tratamiento combinado que hoy se sabe que es imprescindible en estos casos (35,(75)(76)(77)(78)(79)(84)(85)(86)(87). Pero es que en numerosos medios asistenciales no suele utilizarse aún ese tratamiento mixto --o incluso no siempre se incluye en determinados textos de "Terapéutica" (valdría decir entonces, de "terapéutica biologistamente reducida") (66, 67, 69) Desgraciadamente, tanto a nivel popular como a nivel de los grupos de investigación nos vamos acostumbrando a que en la psiquiatría dominante en nuestro medio predomine una fuerte tendencia a sobrevalorar la importancia de los factores de riesgo biológicos.…”

Authors' reply

“…Rather, anxiety and depression -and negative views of self and others -are risk factors for and commonly expressed by patients with delusions. 4 We consider that these research findings render delusions explicable, and may have implications for the way all clinicians engage with people with delusions.…”

“…Our economic evaluation 1 and the preceding report on the main findings from the RIOTT trial 2 should not be considered an attack on the value of oral methadone to the majority who show substantial benefit from this treatment. 3,4 Rather the RIOTT trial needs to be recognised for what it wasan investigation of effectiveness and cost-effectiveness of alternative treatments in a subgroup of the treatment population with severe and chronic addiction who were not responding to oral methadone maintenance treatment. It is also appropriate to inject a note of caution about the potential influence of expectations on trial participants.…”

“…Psychotic defence concepts, wherein the individual denies or distorts reality to defend against trauma, provide one possible lens through which psychotic experiences can be viewed. 4,5 Garety & Freeman's conclusion relating to the infancy of research into the nature of delusion, and its having been overshadowed by focus on the larger concept of schizophrenia, highlights the need for further research. Future research will need to provide some account for the distortion of reality that seems central to the experience of psychosis.…”

Developing services for people with dangerous and severe personality disorders

“…These include those related to organization al dynamics (Handy, 1985;Burke and Litwin, 1989;Garrat, 1990) , psychodynamic theory and re earch (Higgitt and Fonaghy, 1992;Hingley, 1997aHingley, , 1997bFoster and Roberts, 1998 ), and psychosocial rehabilitation (Sh epherd, 1984;Pilling, 1991;Watt a nd Bennett, 1991;Perkins and Repper, 1996;Brooker and Repper, 1998;Lavender and H olloway, 1988). Providing environments likely to enh ance the development of such p ople h as proved both challenging and complex to tho e taff involved in both planning and delivering ervice .…”