Hi,

Patients having psychiatric issues must visit their consultants at least thrice in a month. Regular check-ups and psychotherapy sessions are very helpful.

Regards,

I think there is no real evidence for that and that this was a result of the past idea, that it would be not possible to do psychotherapy with patients with psychosis and therefore there could "only" be "supportive interventions". In the last years more and more concepts of psychotherapy for patients with psychosis emerged and there is growing evidence for the efficacy of psychotherapy for patients with psychosis.

There are also manuals for the psychodynamic treatment of psychotic patients. But i know only one in german (https://www.psychosozial-verlag.de/2739).

The authors are currenlty evaluating their manual in an RCT study (information on this in english: https://www.ipu-berlin.de/en/university/research/project/modified-psychodynamic-psychotherapy-for-patients-with-schizophrenia-mpp-s-study.html).

In this study they treat the patients in weekly sessions.

I am working with psychotic patients as psychotherapist in an acute psychiatric ward and I see the patients twice a week. In outpatient settings I would recommend to see the patients at least one a week.

i am not sure that psychotic patients will benefit from such therapy

@WalidSarhan:

There is growing evidence that psychotic patients do profit from psychotherapy. Just recently this is reflected by german treatment guidelines that recommend psychotherapy in all treatment areas for psychotic patients.

If you do not believe that psychotic patients benefit from psychodynamic treatment you'll have to wait for the results of the posted study, then you'll know

This is the only way I would ever advocate such an approach, which is in partial agreement with some to the comments above:

"Psychodynamically-informed" treatment that takes into account the psychotic patient's fragile ego, compromised defensive structure, and consequent need for many supportive elements to the therapy ( including reality testing, ego-building, titration of intensity with fewer sessions per week, maintenance of positive transference, etc.)

Well I' m interested in psychodinamically informed therapy. Still the question of the sessions it s not so easy. For example I see a lot of chronoc psychotic patient once a month and probably they would nt know what to say once a week BUT sometime they are very careful to keep their montly talking with me, paying a surprising attention to book their session in advance.

Since the 1950s, the usual first-line treatment for persons with psychotic disorders has been neuroleptic medication. The effectiveness of this type of treatment has brought about important improvements in care and management however despite the significant advances made, there is a growing awareness that medication alone is not a sufficient treatment in many cases. A significant proportion of service users (up to 40%) have a poor response to conventional anti psychotic drugs and continue to show moderate to severe psychotic symptoms (both positive and negative).

Psychosis is associated with an increased risk of associated emotional disturbance. This is reflected in the prevalence of co morbid depression and anxiety in this group and the elevated risk of suicide found in people with a diagnosis of schizophrenia (and other psychotic illnesses) in comparison to the general population.

There is also a significant degree of social disability associated with having a psychotic illness that cannot be addressed by use of medication alone. This includes the disability associated with persistent symptoms and associated emotional disturbance, but also reflects problems with social isolation, and difficulties in finding work.

The outcome literature for CBT interventions with psychotic symptoms indicates that there is a growing body of support for a range of related CBT therapy programmes. Specifically, it appears that there is strong support in the form of randomised controlled trials for the use of individual CBT in treating persistent psychotic symptoms such as hallucinations and delusions. (Kuipers et al., 1997; Sensky et al 2000; Chadwick, Sambrooke, Rasch, & Davies, 2000) This form of psychological treatment have been shown to produce significant improvements in psychotic symptomatology and in distress associated with psychotic symptoms.

Families and carers have in many cases an important role in supporting adults with psychosis and schizophrenia. Family interventions are now recognised to play an important part in reducing symptoms and relapse. (Bucci, Berry, Barrowclough, and Haddock. 2016)

I titrate based on degree of risk to self or others. If at low risk and the psychotic sxs are in stable remission, Q monthly. If actively psychotic and responding to command hallucinations, I hospitalize. Upon discharge, I see them BID initially; then weekly and so on.

Rich

It really depends on the severity and quality of the psychosis. I would advocate for threapy once or twice a week, if the client is functioning at a level where they are not inpatient. This work must be more intensive then supportive therapy. I tend to focus on understanding the internal world of the client without judgement- learning from the client about the phenomonolgy of their psychosis as well as how they make sense of their internal and external experiences. Most of the time this work is with the symbolic, both verbal and non-verbal. My goal is almost always to increase the adaptive contact that the client has with the external world, and decrease their avoidance behavior (I know this is a psychoanalytic post so forgive the terminology). I am trained in psychoanyltic theory, but my approach to psychosis tends to feel very trauma based (i.e., increasing feelings of safety, integrating seemingly disparate forms of information, and increasing stress tolerance). If the client hears voices chronically, I am employ internal family systems priniciples.

I absolutely believe that psychosis can be treated with therapy (sometimes verbal, sometimes non-verbal). The therapeutic framework must be flexible enough to change and support a client when the severity of their psychosis changes- in the States, we have a big problem with being able to do this. I find that when the psychosis is due to shcizophrenia, the client can realy benefit from non-judgmental contact with a therapist; a therapist that has the goal of understanding the world that the client lives in. With this understanding, the client can often display a yearning for how to better inhabit the world outside of their own inner experience and this opens them up to other therapeutic techniques. I currently treat clients on an inpatient unit, but I have treated clients with varying levels of psychosis on an outpatient basis as well.

@Thomas Theriault : your answer is very interesting but with psychotic patient not often the more is the better.In other words, if there is some problem in the life of the patient, with a non psychotic patient it s often useful to see him often in order to see the different aspects of the problem. But psychotic patient is different.