You may have noticed that people diagnosed with psychosis are often encouraged to think of themselves as passive victims of their disorder. Psychosis is commonly framed as an illness that just comes into people’s lives, through no fault of their own. Framing it this way is often understood as the benevolent thing to do: “we don’t want anyone blaming themselves for what has gone wrong!”
But there’s a downside to this. When people see no role for themselves in what has been going wrong, they are also likely to see no possible role for themselves in getting things back on track. Instead, they naturally feel helpless, and despair can set in.
But what’s the alternative? Encouraging people to blame themselves for their mental confusion and psychosis seems unlikely to produce great outcomes!
Fortunately, some psychological approaches to psychosis, including cognitive behavioral therapy (CBT), have been developing a “middle of the road” alternative to either of the above. In this approach, emphasis is put on the way that both the world, and our brains (which we did not design) are quite tricky, and it is very easy to go down an unhelpful path. So there is no need to “blame” anyone for having gotten lost and confused; however, it is still possible, especially with help, to develop an understanding of what may have gone wrong and to take steps to correct mistakes.
This puts the person diagnosed with psychosis back into an active role, framing them as capable of making changes in thinking and behavior that can reduce or perhaps even eliminate any “psychotic disorder.”
This way of framing things, and of working with people, will be at the heart of each seminar in my upcoming series on CBT for psychosis.
This series starts on May 13th: information on the entire series, including details about how to register for the all of the seminars together at a discounted bundled rate, is available at this link.
Note that each seminar will be recorded and the recordings of the seminar will be made available to those who registered for 4 weeks following the seminar. But attending the seminars live will be required in order to receive CE credit.
When efforts to help backfire…..
One additional reason people with psychosis can feel helpless to do anything about their problems is because their efforts to make things better often inadvertently make the problem worse! This can also discourage professionals who don’t yet understand what is going on.
For example, efforts to “fight back” against voices often result in the voices being louder and more aggressive, and to the voice hearer feeling less in control. But giving up, and just becoming a helpless victim of the voices, or even a servant of the voices, doesn’t work very well either!
The CBT approach is to study what is going on with problems, map it out collaboratively, and then experiment with finding ways to truly make things better. It is often possible to identify how natural reactions to events have lead people into destructive “vicious circles,” but then also to identify alternative responses that can turn things around, leading to “virtuous circles” and possible recovery.
This approach does not require a professional who presents as fully comprehending “reality”: instead, it requires some humility, and a recognition that the world and our minds are too tricky and complex for anyone to claim certainty about what is happening. The CBT approach involves collaborative exploration of an uncertain world, aimed at discovering together some constructive path that can work for a particular individual.
So it is tricky, but there is reason for hope! I look forward to a time when everyone struggling with psychosis will have the chance to work with professionals who appreciate both the trickiness of the issues and the potential for people to make sense and to recover.