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April4, 2014

Variousresearch studies have found that approaches used to address severepsychosis involves medication as well as psychosocial therapies(PSI).These interventions use approaches such as cognitive behavioraltherapies (CBT), family therapy and educational therapies amongothers. The approaches proposed indicate complex relations betweenenvironment, biological and sociological factors. Critical stress incombination with individual life activities may trigger mental healthrelated problems on people.

Thechoice of psychosocialInterventions for a psychosis patient depends on clinical diagnosis.Common interventions used aims to enhance patient engagement,positive outcomes, family support to patient’s needs, psychologicalmanagement of the mental problem,means of copingand self monitoring.In addition, these interventions are helpful in trainingpatients and the family regarding the problem and its treatment(Gleeson,&amp McGorry, 2004).

Researchstudies indicate that family intervention, Cognitive BehavioralTherapies and medication treatment are critical primary and secondaryinterventions for ameliorating a psychotic patient condition.However, recent researches findings on the effectiveness of CognitiveBehavioral Therapies indicate that it is far from been a conclusiveuniversal remedy for psychosis. There have been calls for PSI useonly during acute settings practitioners perceive PSI as timeconsuming and mechanical, low staffing levels, inflexible shiftsystems, lack of confidence, experience and skill leave practitionersfeeling unable to structure Psychosocial Interventions that meetclinical requirement of psychotic patients and their families (David,et al. 2012).

Cognitiveanalytic therapy

Accordingto Marriott,&amp Kellett (2009) cognitiveanalytic therapy is an interpersonal and integrative approach thatfocuses on self development of the patient. This approach wasestablished after series of studies in UK by Anthony Ryle (David,2009). Initially Cognitive Analytic Therapy was done through simpleprocedural sequences on the patient in order to reinforce theirneurotic coping (Gaudiano, 2005). CAT enhances an individuallyadaptive therapeutic plan, derived from therapist’s expertiseknowledge. This model has a fundamental approach of collaboration andbuilding on shared ‘curiosity’ between the patient and thetherapist. This approach actively involves the patient in thetreatment. The therapist works with the patient in identifying chainof events, emotions, thoughts and seeks to establish the targetproblem and contain it (Brooker, &amp Brabban, 2004).

Inthis therapy approach the patient is assisted in recognizingpatterns, understand origin of the problem and strategies of copingwith the ailment. During Therapy session’s therapist collectsrelevant information during the first session regarding the patientand his experiences. Particular attention is taken to link patternsof patient behaviors when young and the impact of such behaviors inadult life. Therapist then formulates through illustrations unhelpfulprocedures which make the condition prevalent to the patient (David,2009). The aim is to enhance the patient recognize how and when theproblem occurs.

Subsequentsessions help the patient adjust their behaviors to avoid repeat ofthe condition(Marriott,&amp Kellett, 2009).At the end of the therapy session there is an agreed weekly sessionsand planned follow ups that take place to monitor and supportpositive changes on the client. Evidence based studies conductedthrough randomized control trials, (CAT) has been indicated to leadin improving conditions such as Anorexia nervosa, Borderlinepersonality Disorder for the Adolescent and adult patients withpersonality disorders. However, comparative studies reveal that it isleast effective than other forms of psychotherapy (Gaudiano, 2005).

Problemsolving therapy

Thisis a brief structured therapeutic method for helping psychoticpatients understand relations between their problems and symptomslearn how to solve, assess their current problem and have a positiveexperience in solving the problem.This therapy is done through educating patients on essential skillsto deal with problems that arise from psychosis. Patients are takenthrough a step by step approach of solving psychosis complications(Catherine,et al. 2003).This approach teaches patients to apply problem solving skills as anapproach on their mental health condition. The therapy help to orientpatients’ on understanding their situation and that effectiveproblem solving requires time, and systematic efforts (Brooker,&amp Brabban, 2004).

Inaddition, they are taught how to utilize rational skills through:problem identification when it occurs, understanding the problem,defining the problem issue, setting objectives to address the issue,devising alternative solutions, choosing and evaluating solutions.Furthermore, patients are assisted in applying the selected solutionsto their condition and assessing efficiency of therapy. Closemonitoring is done on the patient to assess progress and assistanceoffered if initial efforts show limited progress. In the ProblemSolving approach, oral and written presentations are used on patientswith guided practice during therapy session and with homeassignments.

Solution-focused(oriented) therapy (SFT)

SolutionFocused Therapy is a goal-directed and future-focused approachexamining previous solutions to patients’ psychotic conditionsthrough techniques that encourage more of those therapeuticbehaviors. According to research done by Gaudiano, (2005) it has beenfound good for various situations for its efficacy and effectivenessto treat severe mental psychosis illness. A naturalistic researchstudy of formal SFT reveals “good outcome”. Majority ofparticipants reported achieving their goals after a year of therapy.Solution Focused Therapies approach for psychosis applies formaltherapy in day-to-day work for community psychiatric nurses.

Thisapproach to psychosis illness focuses on: building solutions thansolving problems on psychosis patients. Therapy aims to findsolutions in patient’s future than on past or current conditions.In this approach patients are motivated to repeat useful behaviorswhich will influence recovery from the mental health problem.Therapists helps the psychotic patients find solutions to theirpresent undesired behaviors interaction and cognition that arewithin the patients efforts can be co-constructed by therapists andpatient. It is observed that small incremental changes enhance largeincrements in changes for patients’ recovery (David, et al. 2012).

Similarlypatients’ mental health problem remedies are not linkedto observable condition by the patient or therapist. Furthermore,interaction skills needed by the practitioner to their patients increating remedies are different to those required during diagnosisand treating client.SFT approach fits psychiatric recovery andrehabilitation values which incorporate its techniques intoindividual case management to enhance engagement and collaboration.Series of individual case studies found conviction that chronicdelusions decreases in some patients during formal SFT (Brooker, &ampBrabban, 2004).

Incase studies it was revealed that using SFT for a patient with acutepsychosis indicated enhances belief modification. Solution focusedtherapeutic process focuses on how the patient changes rather thanfocusing on diagnosis and treatment. In this approach, the therapistlistens for and absorbs patient’s words and meanings on what theywant and what is important to them (Catherine,et al. 2003).The therapist then asks and continues to listen and absorbs clients’answers. Through this approach of listening, absorbing andconnecting patient responses the therapist and the client canformulate solution based on the shared meaning.

Mostpsychotherapy such SFBT use conversationswhichare focused on patients concerns what and who is important to them,their preferred future and the patients’ expectations among others.Secondly, in the therapeutic process questions about topics ofconversation identified earlier are asked to connect and build onmeanings given by the patient’s. Afterwards, therapist engages inco-construction of altered or new meanings given by the patients(Gleeson, &amp McGorry, 2004).

Lastlypractitioner uses various specific questioning and respondingtechniques that enhances patients to reconstruct their preferredvision of future and by drawing on their past strengths, resourcesand successes. Overall SFBT helps to enhance a collaborative therapywith the patient thereby establishing remedies to patient mentalproblem. In addition SFBT help the patients developing objectivesthat enhance Goals connect emotion, cognition, behavior, andinteraction. Solution Focused Behavioral Therapy is clinically usefulfor therapy programs in adult and adolescent outpatients. SFBT ispart of more comprehensive treatment therapy for patients with severepsychiatric problems. It is useful when addressing primary and lesssevere cases of psychosis (David, et al. 2012).

Cognative Behavioral Therapy

Inthis approach focus is directed at individualized engagement with thepatient in developing good psychiatric treatment. Therapy process ismore explicit with great personalized attention and less homeworkassessment unlike in other therapy approaches. Patient psychoticcondition is assessed through clinical process and to establishunderstanding of predisposing factors that led to current mentalcondition of patient (Morrison, 2009). During the therapy patientinformation regarding their situation is gathered for formulation toestablish patients’ mental condition and experiences based on theircurrent problems. The information gathered seeks to establish thepredisposing, precipitating, perpetuating and protective factors thatled to patient’s mental condition (Tarkington, 2006). The cognitivebehavioral approach aims at working with patients by listening toclients without prejudgment. During therapy sessions, a change inenvironment is recommended to make patients feel safe, comfortableand free to open up and think differently in regard to theircondition (Harry &amp Vicki 2012).

Duringpatient therapy, two approaches are use in the first case patientsnarratives are elicited by asking questions and in the second phasethe therapist authors new and old narratives to get an inquest in thepatients’ life. Therapist focuses on creating a conversation whereimportant personal aspects are safely expressed, heard and reflectedupon by the patient or group members. Questions are asked to thepatients on forgotten personal aspects of family to openpossibilities for solving the problems with current narratives, thetherapist focuses on listening Listening is healing as well asdiagnostic, as the therapist listens to the patients stories thepractitioner notes exceptions, or unique outcomes, where the problemsmight have occurred.

Therapistsalso encourage clients to mind their narratives from the perspectiveof their lives. This helps the patients learn from occasions when theproblem does not occur and learn from those “exceptions” when theproblem might (Harry &amp Vicki 2012). In this way patients practicetasks that amplify the intensity and frequency of the solutionsequences. This approach is ideally collaborative, enhancesindividual assessment and decision making by the patient on behaviorsthat will reduce symptom and provide potential for success(Rollinson, et al. 2007).

Thisprocess helps the patients in coping, distraction or redirection ofattention without using external aids. In other cases activities orchange in environment may be introduced in between sessions.Behavioral tests are also introduced to assess patient’s attitudesand beliefs (Morrison, et al. 2004). Patients may be required to testtheir ideas with actions but each test is tailed depending on thespecific condition of the patients. These tests should only beintroduced to clients when they are ready and a great deal ofcreativity is required from the therapist. The goal of theseactivities is to enhance development of hope by the client and shiftclients’ focus from Psychosis and makes the patient feel moreempowered by gaining control of distressing feelings (Tarkington, etal. 2006).

Variousstudies show that cognitive behavioral therapy has positive aspectsin therapy of psychosis but when compared to active therapy controlthe significance of cognitive behavioral therapy are limited.According to most studies there is no evidence that CBT preventsrelapse where patients may be re-hospitalized. CBT has been found tobe effective for addressing hallucination during the treatment phasebut not during follow up (Catherine,et al. 2003).However, when integrated with other practices such as family therapyand motivational talk sessions there is a positive aspect inmaintaining gains over time. Other studies have indicated that modestbenefits of CBT facilitate the rate of recovery during acutesituations though no evidence has been adequately established(Morrison, 2009).

However,most studies reveal that clients of CBT reports satisfaction withthis approach. Using Cognitive Behavioral Therapy in psychotherapyfor patients with persistent psychosis problem shows that it canprovide recovery results. According to studies conducted byRollinson, et al. (2007) found that Cognitive Behavioral Therapy aswell as family therapy have low rates of remissions relapses forinpatients. Therefore, generic CBT for psychosis should be applied topatients undergoing distress medication with no responsive signs andits application to patients with acute psychosis needs furtherresearch (Wykes, et al.2008).

Familyintervention therapy

Inthis approach family members engage in therapies that help inimprovement of relational functioning within the family. This isachieved through enhancing patient recovery, strengthening recoveryhope to the patient, facilitating the patient re-establish identitywithin the family and helping the patient find meaning in life.Family therapy Interventions is aimed at reducing expressed emotion.During therapy sessions, family members are taken through sessionsaimed at enhancing their awareness on ways they can help the patientrecover (Frank, 2005).This involves training family members on aspects that can help avoidpatient relapse to psychosis condition. In general family members aretrained on how to love, care and integrate the patient in theircommunal activities that will help distract the patient from theirmental condition. Family members are also trained to identifyvaluable ways of dealing with the patients’ related problems.Family members are helpful in providing early interventions topsychotic patients. Family therapy aimsat easing the burden of psychosis on patients and their familymembers by providing an environment. During therapy members arecautioned against overt criticism, hostility and involvingexcessively the emotions of patients (Frank,2005).

Familytherapy looks at ways of reorganizing the family system influence onthe interactions of family members and focusing on belief systemthrough narrative therapy where unhelpful beliefs and behavioralpatterns are addressed. Ideally family sessions are arranged whereinteractions are enhanced through conversations between thetherapist, family members and the patient. Family therapy is moreinterested in solving problems than trying to identify causes.Families are assisted in finding behaviors or causes which can betterimprove the patient condition. As such family therapist focuses onindividuals in the system and the relationships that constitute them.In this way they analyze the conflicts or aspects at play and proceedto addressing the sources of conflict with more abstract approach bypointing out interactions within the family. Family therapy has beenproved to be effective for treating psychotic related ailments aftercognitive behavioral therapy(Clarke, et al. 2012).

Besttherapy Approach for psychosis patients

Manyresearch studies have found that cognitive behavioral therapies aremore effective in integrating patients in the recovery process thanother therapies (Tarkington, et al. 2006). This is because theapproach is multifaceted addresses maladaptive behaviors, emotionsand cognitive process (Harry &amp Vicki 2012). In a broader sense,this therapeutic approach enhances and covers greater aspect ofpatient recovery. Unlike the other therapeutic approach that focuseson single aspects, CBT covers behavior actions and the cognitiveaspects of the patient in a systematic procedure (Morrison, et al.2004).

Unlikethe Solution based approach, cognitive analytic approach and thefamily therapy, CBT goes beyond empathetic and rational dimensions tofocus on particular patients behaviors that predispose them topsychosis ailments (Frank, 2005).As such it is more involving (action oriented) where the patienttakes the central role in the therapeutic process. In addition, CBTis effective in a variety of psychosis related problems which can notbe effectively addressed by the rest therapies (David, et al. 2012).Many evidence based research have been conducted and significantfindings indicate that in most cases it ameliorates patients’psychotic problems. By enhancing patients change their maladaptivethinking, it helps to challenge individuals thinking and the way theybehave which eliminates chances of relapse because it is individuallyelicited (Morrison, 2009).

Overallunlike other therapeutic methods, it enhances individual selfassessment, skills acquisition, consolidation and application.Furthermore, unlike the rest of therapies which are more narrativebased and temporally, CBT is a clinical practice, research informed,have clear operationalization of problem, measure changes and is goaloriented. CBT has also been computerized unlike the rest of thetherapies. Computerized therapies have been designed to treatdepressions and anxiety disorders (Rollinson, et al. 2007).

However,other therapeutic processes such as family therapy are effective inproving post psychosis treatments. Family therapy is more significantespecially to outpatients in early stages. Relations, interactionsand encouragement within the family helps the patients to relax,distract from stressing conditions and general feeling of belongingwhich many psychosis patient suffer. Nonetheless, no psychotherapy isabsolute effective without a combination of other therapies.Cognitive Behavioral Therapy combined with other therapies such asfamily therapy, cognitive analytic, solution based therapy can giveeffective results (Wykes, et el. 2008).


Itis evident that many approaches have been designed to addresspsychosis ailments. Each of these therapies have some significantaspect far from the other but more research studies need to conductedto ascertain the efficacy of these therapies and ways of improvingtheir efficiency. However, studies conducted on psychosocialtherapies show positive models of addressing mental related problems.According to many evidence based studies Cognitive Behavioral therapyis more effective in addressing psychosis ailments (Gleeson, &ampMcGorry, 2004).


Cognitivebehavior therapy, psychosocial interventions, family health therapy,

Mentalhealth,Integration,Psychological treatment, Psychosis, Psychotherapy


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