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Cognitive Behavioral Therapy for Psychosis Practiced Within a Psychoanalytic Frame: Theory, Practice, and Case Examples

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Length: 38 minutes

Michael Garrett, MD

In the last 20 years a new cognitive behavioral therapy for psychosis has been developed in Great Britain.  How does this model overlap with a psychoanalytic perspective, and how is it different?  How can a CBT perspective be combined with psychoanalytic insights into psychosis to frame more effective treatment?  In the presenter’s view, the traditional psychodynamic approach focuses too much attention too soon on unconscious mental processes, while focusing too little attention on the conscious experience of the psychosis.   More specifically, the traditional interpretive approach does not provide the clinician effective tools to examine the central role of perception, memories of perceptions, and logical inference about these perceptions in the pathogenesis of psychosis.  The psychotic individual believes the problem lies outside his mind in the outside world.  Neighbors are planting listening devices, ‘voices’ are speaking to the patient, and so on, all events occurring outside the self.  The presenter advocates a two phase treatment approach which combines CBT and psychoanalytic perspectives.  In phase one, the clinician uses a CBT approach to engage the patient and ‘normalize’ psychotic symptoms, gently challenging the patient’s belief that distressing events are originating outside the self.  In phase two, once distressing psychotic symptoms have been re-located within the boundary of the self, symptoms become more amenable to psychodynamic interpretation.  This treatment approach will be illustrated with three case examples: a woman who heard ‘voices’ predicting deaths, a man who believed he was hypnotized by Evangelicals, and a woman with distressing delusional memories.



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