"New directions for working with people experiencing psychosis:
A focus on principles”
The UK National Institute for Care and Health Excellence (NICE) recommends that all people experiencing psychosis should be offered psychological therapies, e.g. Cognitive Behaviour Therapy (CBT), to target distress associated with symptoms and improve their functioning. However, clinicians working with people experiencing psychosis face multiple challenges. Usually, individuals’ descriptions of their problems don’t match the problem outlined in the referral. Comorbid presentations are the rule rather than the exception, yet evidence-based treatments are designed to be disorder or problem-specific. Existing interventions are designed to be delivered in weekly or biweekly schedules, yet end up being delivered according to variable and unpredictable schedules due to cancelled and missed appointments. Most treatments emphasise using unique strategies and techniques, yet many of these activities reflect common underlying evidence-based principles of effective treatment. It would be extremely useful to have a psychological therapy that is applicable to any problem, ‘a-diagnostically’, using a variable treatment session schedule, and based on robust principles of psychological distress and psychological change. In this keynote, Sara will introduce three principles frequently identified in the literature and integral to providing effective and efficient therapy for psychosis. The principles: control; conflict; and reorganisation will be described and explained using practical illustrations. The importance of control to people’s mental health and general wellbeing is emphasised repeatedly throughout the literature, particularly for people experiencing psychosis. When control is not mentioned explicitly, concepts such as regulation and self-determination point at the same principle. Conflict (incongruence, dissonance, dilemmas, being in two minds) is also commonly discussed and is a general formulation underlying the distress that manifests in various symptom patterns. People become psychologically distressed and develop psychosis when they want to achieve two incompatible goals at the same time. An example of such conflict might be wanting to forget a past traumatic event but also needing to remember it in order to understand how it happened and prevent it from happening again. The third principle, reorganisation, has strong support in the literature, and is the process of change in which new perspectives, insights, and points of view are developed. This keynote explains the way in which these three principles can be integrated to understand psychosis and enhance the effectiveness of therapy by enabling clinicians to work flexibly and responsively. Data from recent studies will also be presented to illustrate the feasibility and acceptability of a principles-based approach to working with people experiencing psychosis.
PROFESSOR SARA TAI
Professor Sara Tai is a Professor of Clinical Psychology at the University of Manchester and Consultant Clinical Psychologist with Greater Manchester Mental Health NHS Foundation Trust. She is a reflexive scientist practitioner, therapist, educator and researcher, who has worked in a range of mental health settings, with people experiencing a broad range of serious and enduring problems affecting their mental health. She has worked with people experiencing psychosis for over 20 years, including early intervention, community, and acute psychiatric in-patient services. Sara is a clinician-researcher who has been developing an a-diagnostic cognitive therapy (the Method of Levels, MOL) since 2005. Her work elucidates how key psychological mechanisms such as control and awareness cross traditional diagnostic boundaries and help unify apparently disparate therapeutic traditions. She is an experienced practitioner, researcher, and trainer of CBT and MOL. Her work not only helps explain the nature and origin of psychological distress but, with colleagues, offers new therapeutic opportunities. She provides supervision and workshops internationally and conducts research, including large clinical trials in the UK, USA, Canada, China, and across Europe. She has published widely in this area, including the book “A principles-based approach to counselling and psychotherapy”.