Description
Book SynopsisStaying Well After Psychosis
Staying Well After Psychosis is extremely readable, based on solid research evidence andpacked full of clinical insights and strategies that will satisfy any clinician seeking innovativeapproaches to the promotion of recovery from psychosis.
Anthony P. Morrison, Professor of Clinical Psychology, University of Manchester, UK
Over the past decade our understanding of the experience of psychosis has changed dramatically. Aspart of this change, a range of psychological models of psychosis and associated interventions havedeveloped.
Staying Well After Psychosis presents an individually based psychological intervention targeting emotional recovery and relapse prevention. This approach considers the cognitive, interpersonal and developmental aspects involved in recovery and vulnerability to the recurrence of psychosis.
Andrew Gumley and Matthias Schwannauer provide a framework for recovery and staying well that
Trade Review
"...extends our understanding of psychosis…extremely helpful for therapists working with psychotic patients who are at risk of relapse." (Behaviour and Cognitive Psychotherapy, May 2007)
Table of Contents
About the Authors ix
Preface xi
Foreword by Max Birchwood xv
Acknowledgements xvii
PART I THEORETICAL OVERVIEW 1
1 Current Perspectives on Relapse, Relapse Detection and Prevention 3
Introduction 3
Psychological Therapies and Relapse Prevention 4
Affect, Meaning and Relapse 18
A Cognitive Behavioural Model of Early Signs and Relapse 23
Antipsychotic Medication and Relapse 27
Implications for Staying Well after Psychosis 32
2 Attachment Theory, Self-regulation and Psychosis 34
Introduction 34
Patterns of Attachment 36
Attachment Theory and Later Psychopathology 38
Stability of Attachment Organisation 42
Attachment Organisation and Psychosis 43
3 Psychological Factors in Vulnerability and Transition to Relapse 47
Introduction 47
The Interpersonal Context 48
The Wider Social Context of Psychosis 54
Significant Life Events 56
Trauma 57
Interpersonal Coping 59
Appraisals of Psychosis and Emotional Distress 62
Conclusions 63
PART II OVERVIEW OF STRUCTURE, STYLE AND ORGANISATION OF THERAPY 65
4 Overview of Principles and Procedures 67
Introduction 67
Primary and Secondary Outcomes 67
Assessment 68
Structure of Therapy 73
Style of Therapy 75
Basic Elements of the Therapeutic Stance 79
General Outline of Therapy Sessions 79
Service Model 84
5 Strategies for Engagement and Formulation 86
Introduction 86
Attachment Organisation, Recovery and Distress 86
Validation 91
The Evolution of Therapeutic Discourse 95
Case Formulation 97
Case Formulation in SWAP 99
Conclusions 102
PART III SPECIFIC COGNITIVE AND INTERPERSONAL STRATEGIES FOR RECOVERY AND RELAPSE PREVENTION AFTER PSYCHOSIS 103
6 Reorganisation of the Self in Recovery: Working with Humiliation, Entrapment and Loss 105
Introduction 105
Life Events and their Dimensions 106
Bowlby on Loss 109
Clinical Interventions and Techniques 111
Conclusions 122
7 Working with Interpersonal Distrust: Developing a Conceptualisation of the Paranoid Mind 124
Introduction 124
Paranoia as an Interpersonal Threat Response 124
The Paranoid Mind is Strategically Deployed 126
Attachment and Paranoia 126
Problems with the Term ‘Paranoia’ 128
Working with the Personal Distress of the Paranoid Mind 129
Awareness of the Paranoid Mind 132
Development of an Accepting Rationale for Paranoia as a Response 133
Benefits and Costs of the Paranoid Mind 135
Development of Alternative Interpersonal Strategies 137
Conclusions 138
8 Working with Traumatic Reactions to Psychotic Experiences 140
Introduction 140
Psychosis as a Traumatic Event 141
Trauma Theory 144
Assimilation and Accommodation 147
Exploring Traumatic Reactions 150
Explaining Traumatic Reactions 152
Exploring Meaning within Traumatic Memories and Imagery 154
Contrasting Experiences of Psychosis and PTSD 158
Conclusions 160
9 Interpersonal Strategies 161
Introduction 161
The Social Environment 161
Interpersonal Environments as a Basis for Psychological Intervention 165
The Role of Interpersonal Anxieties and Social Withdrawal 167
Areas of Interpersonal Difficulties 173
Working with Interpersonal Sensitivity 177
Conclusions 181
10 Working with Underlying Schemata and Core Beliefs 182
Introduction 182
Early Parental Loss and Psychopathology 182
Childhood Abuse and Neglect 183
Psychological Sequelae of Childhood Abuse and Neglect 183
Unresolved Attachment Status 185
Early Childhood Trauma and Psychosis 186
Trauma, Dissociation and Schizotypy 187
Schemata and Internal Working Models 189
Identifying Schemata 192
Schemata and Behaviour Relationships 193
Core Belief Change Strategies in Cognitive Therapy 195
Working with Underdeveloped Strategies 196
Conclusions 201
11 Awareness, Intrusiveness and Fear of Relapse 202
Introduction 202
Phenomenology of Relapse 202
Subjective Experiences and Psychosis 203
Appraisals and Relapse 205
Awareness, Intrusiveness and Fear 206
Cognitive Behavioural Therapy (CBT) and Relapse Prevention 209
Exploring Experiences of Relapse 210
Explaining Beliefs 212
Early Signs Monitoring 213
The Initial Interview for Targeted CBT 214
Testing the Formulation 215
Decatastrophising Relapse 215
Contracting Intervention 216
Subsequent Sessions 216
Introducing Flexibility into Beliefs 218
Transforming Beliefs 219
Testing Transformed Beliefs 221
Conclusions 222
12 Conclusion 224
Introduction 224
Overview of the Treatment Manual 224
Therapist Training 229
Therapeutic Context 229
Appendix I Fear of Recurrence Scale (FoRSe) Questionnaire 231
Appendix II Diagrammatical Formulation of Early Signs 233
Bibliography 235
Index 283
