Many people who are diagnosed with psychosis are having difficulties with motivation and connection (commonly referred to as “negative symptoms”) that make them the least likely to engage in psychosocial treatments. These difficulties are unlikely to improve, and may even get worse, after treatment with psychiatric drugs.  Recovery Oriented Cognitive Therapy for Psychosis was developed with the intent of reaching these people. Instead of focusing on symptoms or problems, it works by connecting with the person’s interests and supporting their aspirations, helping them to recover and gain the life they want. 

In a webinar on 6/26/25 (see the recording below), we reviewed the fundamentals of recovery-oriented cognitive therapy, including the basic model and research. We discussed clinical applications, providing a taste for providers interested in trying out the treatment now. We also introduced a new book designed to help individuals with psychosis find ways to recover and live well, along with how providers can use this book in their work with such individuals. The writing process behind the book was also discussed.

About the Presenter:

Aaron P. Brinen, PsyD, is a clinical psychologist in private practice, who employs evidence-based treatments to help people recover from serious mental health conditions. He is also Assistant Professor of Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center in Nashville, Tennessee. Dr. Brinen is a codeveloper of recovery-oriented cognitive therapy (CT-R), and has been active in adapting CT-R for different settings and training therapists from around the world.

About the book, Living Well with Psychosis: Practical Strategies for Improving Your Daily Life

While mental health is thankfully no longer a taboo topic, the experience of psychosis is still highly stigmatized. Leading psychologist Aaron P. Brinen busts myths and helps readers build the lives they want in this empowering book. An expert in recovery from serious mental illness, Dr. Brinen provides step-by-step guidance for becoming a strong self-advocate, navigating treatment options, managing symptoms that cause distress, connecting with others, and pursuing school and work goals. The brief, engaging chapters are warm and compassionate, with downloadable practical tools expressly designed to boost energy and motivation for getting out into the world. Readers can read this book cover to cover or dip into it any time they need extra support to live well and feel good.

To order the book with a 15% discount (good through 10/31/25) go to this link and in the box for “special promotional prices” enter the code “MIA2025” then click “apply.”

By the way, one misconception about “negative symptoms” is that they result from something wrong with the brain, some part of a “mental illness.”  A better understanding is that they result when people get confused and demoralized, due to confusing experiences and the confusing and distressing ways others often react to their experiences, and they are related to negative beliefs that can change with more encouraging experiences.  This webinar and/or this book can help you help others reorient and start having those more encouraging experiences and to reengage with life.

While mental health professionals usually want to help, good intentions are unfortunately not enough to insure that attempts to help will truly be effective, and will avoid harm.

The truth is that mental health issues can be very tricky, and attempts to help often backfire, compounding existing problems. This applies both to attempts by people to help themselves, and to attempts by professionals to help their clients.

But professionals often think too highly of their own expertise, and fail to notice when their well intended interventions are aggravating existing problems. Instead, they assume the difficulties caused by their own mistakes are just part of the client’s “mental disorder” and then often just double down on what isn’t working.

Fortunately, there are communities of people with lived experience of mental health problems who have been observing all this, and who have been developing ideas about how treatment might be provided in ways that reduce harmful interactions and harmful directions.

On Tuesday, 4/15/25, a webinar with Caroline Mazel-Carlton titled “The Hope of Harm Reduction: Exploring New Dialogue Models Developed by Non-Clinical Support Communities” explored this subject.

Event Description:

Frequently, clinical models of mental health support involve telling people their thoughts, feelings, and experiences are “wrong” or “pathological”—and then telling them what to do to “fix” it. Unfortunately, this often creates conditions for iatrogenic harm, extreme power differentials, and coercion.

So what else is out there? Join the conversation about how approaches developed in peer-run communities, mutual aid groups, drug user’s unions, and so on can be applied with integrity in a wide variety of settings (including in our own families).

In this webinar, presenter Caroline Mazel-Carlton from the Wildflower Alliance explores alternative harm reduction dialogue philosophies and how to use them in real-life, whether we are supporting someone who uses drugs, hears voices, is thinking of suicide, etc. We discuss how to avoid common dialogue pitfalls that rupture connections and cause further pain. We also talk about how to build authenticity back into conversations and let go of unhelpful agendas and jargon.

About the Presenter:

Caroline Mazel-Carlton is a psychiatric survivor and former IV drug user who has supported the development of alternative dialogue models that are now taught worldwide. She serves on the Board of Hearing Voices Network-USA and is the Director of Learning Opportunities for the Wildflower Alliance. She has contributed to multiple academic publications on the topic of suicide and one book on her experience skating on a roller derby team as #18 “Mazel Tov Cocktail.”

Check out this video and let me know what you think in the comment section!

When people have beliefs that no one around them understands or sees as credible, and that lead to trouble in the person’s life, psychiatrists call those beliefs “delusions.” That is a harsh word, and could be seen as excessively polarizing, which is why some prefer instead terms like “troublesome beliefs.” Whatever the word used however, it seems true that many people do start believing things that alienates them from others and disrupts their lives.

To make a finer distinction, important differences can be noted between the troublesome beliefs held by individuals that psychiatrists call “delusions” and the also troublesome beliefs held by groups of people that are referred to by terms such as “conspiracy theories” or simply “strongly held beliefs.” Both kinds of beliefs may seem weird and lacking any credible evidence by those who don’t endorse them, but the key difference is that believers in conspiracy theories are synchronizing their beliefs with other like minded people, their fellow believers, while people who believe in “delusions” are going it alone and not synchronizing with anyone.

Such distinctions are not perfect of course. Sometimes a person may convince just one other person that their “delusion” is true – then psychiatrists call it a  “shared psychotic disorder” or “folie à deux” (French for “madness of two.”) And if a third person starts believing, the term is “folie à troix.” If even more people start believing, then eventually it is no longer seen as a delusion, just a conspiracy theory or whatever. And if just about everyone believes it, we might call it “consensus reality” even though it is pretty clear that not everything that most people believe is really true!

One thing that is clear is that we need better ways of understanding and of talking to people who have beliefs that we think are causing trouble.

If you are interested in learning more about how to have such understanding and such conversations, especially with people who have troublesome beliefs that are individual and unique, I encourage you to view the recording, linked to below, where an expert in therapy for psychosis discusses “Decoding Delusions: Making Sense of Different Types of Troublesome Beliefs.”

In this webinar, which was held on Thursday 2/20/25, Doug Turkington discussed all of the following:

• the variety of different delusions seen in clinical practice including persecutory paranoia, grandiose, Capgras, organic and Cotard’s delusions.
• the typical presentations of delusional systems/memories and substance induced delusions.
• how delusions relate to strongly held beliefs which, despite minimal factual basis, spread widely on social media.
• the variety of approaches for clinicians and also for family members including befriending, collaborative (peripheral) questioning, shared reality testing, asking questions about the pre-psychotic period, and generating a timeline.
• schema vulnerability and goal conflict models

About the Presenter:

Dr. Doug Turkington is a Founding Fellow of the Academy of Cognitive Therapy and a Professor of Psychosocial Psychiatry at Newcastle University. He co-edited the book “Decoding Delusions: A Clinician’s Guide to Working With Delusions and Other Extreme Beliefs” and he has authored over 100 articles and more than half a dozen other books on CBT for psychosis, including notable works such as “Cognitive Therapy of Schizophrenia” and “Back to Life, Back to Normality: Cognitive Therapy, Recovery and Psychosis.” He has also provided guidance to family members interested in drawing from CBT for psychosis to improve relationships with their loved ones who are struggling – some recorded webinars are available here.

By the way, I did previously write a review of the “Decoding Delusions” book that Doug co-edited, you can find that review here.

Biological psychiatry would have us believe that the state of mind called psychosis always results from something gone wrong with the brain, and that a drug intervention is the only way to have a substantial impact on that defect. 

But the reality is much more complex.  Research in past decades has shown that psychosis is often a reaction to adverse life events, to trauma, experiences of oppression, and other stressors.  And if it is a reaction, then the possibility exists that people can learn to react differently, and that this difference in reaction can play a major role in overcoming the problem.

That’s why I was interested when earlier this year I heard that a colleague was co-authoring a workbook designed to help people understand their state of mind in a more psychological way and to take an active role in their recovery.  I was asked to write a foreword for it (which you can read below) and the book is now published:

Here’s my foreword for the book:

Compared to some of the (relatively few) other workbooks or general self-help books devoted to psychosis, this book is notable for drawing on a number of different therapy approaches, including cognitive behavioral therapy for psychosis (CBTp), Acceptance and Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT) and Compassion Focused Therapy (CFT). 

If you like the idea of self-help books though, here’s a few others you might also want to check out:

Think You’re Crazy? Think Again

Relating to Voices using Compassion Focused Therapy: A Self-help Companion

The Dialectical Behavior Therapy Skills Workbook for Psychosis: Manage Your Emotions, Reduce Symptoms, and Get Back to Your Life

Overcoming Paranoid and Suspicious Thoughts, 2nd Edition: A Self-Help Guide Using Cognitive Behavioural Techniques

Overcoming Distressing Voices

Our minds are tricky, and the world is confusing, and it can be difficult trying to figure everything out. Well, we never figure everything out, but with some help, we can often get to a place where it doesn’t seem quite so hard.

Please do comment if you have any thoughts about this post!

Psychosis can seem to involve the loss of access to any kind of spiritual reassurance, while at other times it may appear as a preoccupation with spiritual themes, or taking what seem to be extreme or bizarre spiritual perspectives.  In response professionals frequently ignore the spiritual dimension and frame everything as a struggle with an illness, but that approach can create barriers to forming a common understanding and to accessing and supporting opportunities for development along what might be seen as a spiritual dimension.

What might work better?  How can professionals bring an awareness of this spiritual dimension and a willingness to talk about and work with it into treatment, without making mistakes such as romanticizing psychotic experiences, promoting specific beliefs or dogmas, or causing other kinds of harm?  In the talk below, I explore possible answers to those tricky questions.

Spirituality is a route to recovery frequently cited by service users, yet usually marginalized within treatment.  When professionals are instead willing to engage with people’s deepest concerns in an open minded way, balance may become more possible and new opportunities for recovery may emerge.

If you want to get deeper into this topic, I offer a 6 hour online course on Spiritual Issues within Treatment for Psychosis and Bipolar. You also might want to check out a list of resources for exploring more about that topic, at this link.

Also, note that the talk above was given for the Early Psychosis Virtual Summit put on by the Tennessee Association of Mental Health Organizations (TAMHO). You can access the recordings for other talks given at that event at https://www.youtube.com/playlist?list=PLWThhKstuRWB8po1n74vIad7tXeMxcK2n

Are psychotic experiences something that should simply be suppressed?  These experiences cause so many problems, it may seem that the answer should always be yes!

But there’s a paradox when we try hard to get rid of psychotic experiences.  Our efforts to do so can quickly make the problem worse! 

At its simplest level, we see the basis for this when we try too hard to get rid of a thought.  For example if you focus too much on not thinking about elephants, they will be on your mind all day.  If you focus on not having the thought that you might have germs on your hand, you might spend all day washing your hands to make sure there is no basis for the thought. 

And if you are very sure you shouldn’t be having a thought, it might start to seem that the thought is coming from somewhere else, like a brain implant or a demon or telepathy from someone you don’t like.  Now the battle is really on!  But the prognosis for winning this battle is not good.  Efforts to get rid of what now seem like voices etc. just make them seem more important and more compelling.  Things can rapidly spin out of control, and go to some really dark places, which often just convinces everyone involved that doubling down on attempts at suppression is the way to go!

Fortunately, there is a better way.  Paradoxically, it involves accepting even the “crazy” thoughts or voices that seemed to be causing so much trouble, but in away that avoids making too much of them.

Our brains are weird, our minds are weird, and that’s OK.  We can learn to help people not make too much of the weirdness, and to identify what helps them move on and make a life they value, and to connect with the people and activities they love.

Finding the common humanity within the sometimes freaky experiences that get called psychosis is a key part of the CBT for psychosis approach called “normalizing.”  It can help a lot in getting people to change their relationship with tricky experiences, rather than seeing those experiences as pathology that requires suppression and elimination.

If you would like a better idea of what normalizing is, check out this video:

For those who want to learn more about how CBT and a few other therapy options can be helpful for psychosis, or what gets called that, there is a series of 5 seminars that I am offering over the next few months.  Attending one or more of these seminars could be a very affordable way to grow your competence in a psychological approach for psychosis – and you can save by accessing Early Bird pricing that only lasts through 4/5/24!

Each seminar will be 4 hours long, and will provide time for questions, discussion, and practice. Continuing education credits will be available for most US professionals. Each seminar will be recorded, and those who register will have access to the recording. CE credit however will only be available to those who attend the seminar live (on Zoom, or in person in Eugene OR) for the entire seminar.

The seminars are:

Date: 3/29/24 –  Essential Elements of CBT for Psychosis: Engagement Style, Normalizing, & Developing a Formulation

Date: 5/10/24 – Paranoia and Troublesome Beliefs: A CBT Approach

Date: 6/21/24 – Voices, Visions, and Other Altered Perceptions: Changing Outcomes with CBT

Date: 7/19/24 – Trauma, Dissociation, and Psychosis: CBT and Other Approaches to Understanding and Recovery

Date: 8/16/24 – Addressing Cultural and Spiritual Issues Within Treatment for Psychosis

The most affordable option is to register for all 5 seminars as a bundle (only 59.99 per seminar if you register by 4/5/24) but you can also register for seminars individually.

For more information and to access options for registration, go to this link.

When people report the extreme beliefs that are often labeled “delusions,” it can be difficult to know how to make sense of what is going on and what might be helpful. That’s why I took the time to review a new book on the subject, “Decoding Delusions: A Clinician’s Guide to Working with Delusions and Other Extreme Beliefs,” edited by Kate V. Hardy and Douglas Turkington.

What follows is a draft version of the review, but if you are one of the first 50 people to click on this link, you can see the final version that is now published online in the journal ‘Psychosis.”

One other resource of note on alternative ways of understanding and working with “delusions” is this video presentation by Rufus May – a psychologist who was once hospitalized due to his own extremely paranoid beliefs!

I often hear from family & friends of people with psychosis that they want to be helpful but don’t know how. So I put together a list of resources that might provide some guidance.

One simple overview of how family and friends can help was put together by Mind in the UK.

There are some free videos for family members teaching perspectives and skills drawn from CBT for psychosis – these go into a lot of detail, and the instructor is very knowledgeable.

There’s also a free online training course for family members based on CBT for psychosis offered by SPIRIT Labs in WA. They also offer a list of possibly helpful resources.

There’s a short guide for family members in communicating with someone with psychosis

There’s a weekly online meeting for family and friends of people who hear voices And Understanding Voices has a page of helpful ideas for friends and family. Or here’s a webinar where experts in the hearing voices movement discuss the role of family and friends:

Family support groups organized by NAMI may be helpful and are available in many locations across the US.

Or parents who are skeptical of conventional drug-based treatments for children struggling with mental health issues and who are looking for alternatives may be more interested in Mad in America’s online parent support groups. And they have this list of additional groups.

Survivors And Families Empowered (SAFE) is a coalition of psychiatric survivors, families, and mental health professionals who believe in the power of hope and the resilience of the human spirit. Their experiences have taught them that deconstructing the fears and myths about mental illness will reduce the over reliance on restrictive interventions which interfere with recovery.

There’s an online course called “Demystifying Psychosis for Family Members” that might be of interest.

EASA, the Early Assessment and Support Alliance, has a list of resources for families, allies, and young adults

Some of these resources, in particular NAMI, may be at times overly invested in describing psychosis as definitely an “illness” rather than as a possibly understandable reaction to difficult or confusing life experiences. But there’s a lot that can be helpful in these resources, despite their imperfections.

Sometimes the emphasis on “blaming the illness” comes out of a reluctance to say anything that might lead family or friends to blame themselves in any way for how their loved one became lost and confused. This has led leading organizations to promote statements like “Psychosis is nobody’s fault. People do not cause it.” Unfortunately, as I have written about before, this leads to a denial of how trauma and in particular interpersonal trauma is often a big cause of psychosis, and also to ignoring how other kinds of stressful and confusing life events can play a role.

My perspective is that rather than teach family members to “blame the illness” as a way of avoiding getting caught up in self blame, we can instead guide them in finding a middle way. That is, we can acknowledge that life is tricky and confusing, our brains are tricky and confusing, and because of this we family members may not always have been helpful to those we love and care about, and sometimes we may have been clearly unhelpful or hurtful in ways that may have contributed to the psychosis. But this does not have to mean getting caught up in blaming ourselves; we can instead shift our focus to learning what we can do now to be part of the solution. In other words, we can model accepting ourselves as imperfect and sometimes confused and confusing people who nevertheless can love and value both ourselves and others in the present- the same sorts of skills that will be so useful to our loved ones in their own journey toward recovery.

Back in 2015 Paris Williams wrote a 3 part series on Madness and the Family, see Part 1, Part 2, and Part 3 that explores some of the complexities around psychosis and families.  Or you might also appreciate hearing a 45 minute talk he gave on the same subject

While it’s still common for people to be told that psychosis is a brain disorder that was not caused by anything anyone did to them, there is now an extensive body of research that indicates that traumatic experience can be a cause of psychosis, and the link between having multiple types of trauma and later psychosis is close to the strength of the link between smoking and lung cancer.

But what is the nature of the connection between trauma and psychosis? One factor that seems to play a role is that of dissociation, which is something we all do at times but which is often very strongly triggered by trauma.

To help professionals understand and work with this issue, I offered a free one hour webinar “Trauma, Dissociative Splits, and Psychosis: Approaches to Healing” on Friday April 21st – the recording is now available, see below. (This event was hosted by APA Division 18 Community and State Hospitals Section.)

Here’s the description for it:

“Dissociation is a factor that can mediate the relationship between adverse life experiences and psychosis. This webinar explores how methods drawn from diverse sources like evidence-based practice (CBT) and peer support/lived experience (Hearing Voices Movement) can help people regain perspective and personal power. Discussion regarding the utilization of effective psychosocial interventions and supports to promote healing and quality of life will be conducted.”

Learning Objectives:

• Explain how dissociation as a trauma response can create risk for psychosis.
• Identify and describe at least 2 therapeutic interventions for dissociation that also reduce distress related to psychotic symptoms.
• Describe at least 2 individual factors to consider when selecting and adapting treatment for trauma and psychosis.

There are also recordings of a couple of earlier webinars that you can view:

Trauma and Psychosis: Exploring the Intersection

Moving from Trauma and Psychosis to a Recovery Story