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Relational Psychosis Psychotherapy: A Neuropsychoanalytic Model

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Length: 1 hour

Brian Koehler, PhD

Cichetti (2010), from a developmental psychopathology perspective, emphasized that the abnormalities in the broad domains of genetics, neurobiology, cognition, emotion and interpersonal relationships in severe mental disorders do not exist in isolation. He encouraged researchers to strive to comprehend the interrelationships between the biological, psychological and social in these disorders. I have conceptualized this as a non-reductionistic, translational, more three-dimensional approach which is integrative across the domains of brain, mind/self and culture.  In this paper, I will attempt to demonstrate that looming threats of non-relatedness expressed in annihilation anxieties may be the core situation which helps to explain some of the neuroscience, epidemiological, sociocultural, and clinical findings in many persons diagnosed with a severe mental disorder. Although this model includes both “bottom-up” neurobiological processes, such as the effects of various polymorphisms and neural alterations on psychological and psychosocial functions, and “top-down” processes, such as the effects of the environment on gene expression and neural morphology, it privileges the latter in its hierarchy of etiological factors.  Relational psychosis psychotherapy (RPP), which will be broadly described,  is one form of psychosocial therapy that seeks to address the terrifying threats of unrelatedness, the effects of relational trauma and social isolation. Relational psychosis psychotherapy is built primarily on contributions from such attachment-oriented psychoanalysts such as Christian Muller, Gaetano Benedetti (Benedetti, 1987; Koehler, 2003) and Otto Will (Sacksteder et al., 1987), contemporary relational psychoanalysis, attachment-based cognitive-interpersonal psychotherapies (e. g., Gumley & Schwannauer, 2006), compassion focused therapy (Gumley et al., 2010) as well as the current attempts being made by CBTp clinicians/researchers to link emotions, cognitions, trauma and the social world with the emergence and maintenance of psychotic experiences (Fowler et al., 2006; Bebbington et al., 2008). RPP is an approach that place the capacity for relatedness and containment of the dual terrors of unrelatedness and emotional closeness, i.e., loss of a sense of self, at the center of its  model of care. The relational psychotherapist attempts to not lose sight of the forest for the trees by keeping in close contact with the anxieties and terror of unrelatedness embedded in psychotic symptomatology.


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