Training in Recovery-Oriented Therapy for Psychosis

Everyone who encounters the difficult experiences we call psychosis should have access to mental health workers who are able and willing to collaborate with them in learning ways to reduce distress and to forge a path toward recovery. For that to become a reality everywhere, training in skills specific to working with psychosis must become much more available.

My goal is to provide high quality training on this topic, through diverse platforms, at a very affordable price, to individual clinicians, teams, and agencies. I also provide follow up consultation services.

My trainings focus on a cognitive behavioral therapy approach, which I have been using for two decades in my own work as a therapist. I also draw on other compatible approaches, such as methods developed within the Hearing Voices Network, dialogical approaches, some trauma therapies, and Compassion Focused Therapy.

I have been providing training in therapy for psychosis since 2003 in a variety of locations in the US and Canada. I am chair of the education committee for ISPS-US, and president of the Pacific Northwest Branch of ISPS-US. You can read about some of my perspectives on my blog at https://recoveryfrompsychosis.org/

Examples of seminars I have offered include:

• An Overview of CBT for Psychosis: Dialogue and Collaborative Exploration
• Essential Elements of CBT for Psychosis: Engagement Style, Normalizing, & Developing a Formulation
• Paranoia and Troublesome Beliefs: A CBT Approach
• Voices, Visions, and Other Altered Perceptions: Changing Outcomes with CBT
• Trauma, Dissociation, and Psychosis: CBT and Other Approaches to Understanding and Recovery
• Addressing Spiritual and Cultural Issues Within Treatment for Psychosis

Are you looking for training for your team or agency? I can provide training online or travel to provide in person seminars, please contact me to discuss possibilities.

Are you an individual looking for training for yourself? I do offer 3 online courses you can take on your own schedule, information about those is available here. Also, to be notified of when live online seminars will be offered for individual enrollment, please provide me with your email address here.

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Below are descriptions and learning objectives for the seminars I have most commonly offered:

An Overview of CBT for Psychosis: Dialogue and Collaborative Exploration

People undergoing psychosis are typically wandering through bewildering mental territory, and it’s easy for us to get lost when we try relating with their experience. To feel less lost, we might be tempted to hold tight to our own beliefs and professional knowledge, categories, and jargon: but this creates a rigidity that impairs our chances of forming a good connection with the person we want to help.

What might work better?

CBT for psychosis emphasizes the formation of a collaborative relationship, and then taking a fresh look at the evidence together. The CBT practitioner does not impose a point of view, but rather joins with the person in a process of shared discovery of possible ways of making sense, and an exploration of the implications of different perspectives.

At the heart of this process is the creation of dialogue, or bringing different points of view into relationship. This is important because dialogue, both internally and interpersonally, is something that breaks down in psychosis. This breakdown leaves the person either stuck in a fixed point of view or monologue, or overwhelmed by the chaos of competing views that seem beyond relationship. But when we find a way to talk with people in an open-minded way about their most confusing experiences, dialogue can reemerge, and helpful ways of making sense can be developed.

Learning Objectives:

· Identify the creation of dialogue as a “minimal agenda” within CBT for psychosis that can organize sessions even when barriers exist to more organized approaches

· Discuss the relationship between external dialogue, such as between therapist and client, and healthy internal dialogue

· Describe basic CBT for psychosis methods, including normalizing, developing a formulation, changing relationships with voices, flexible approaches to inflexible beliefs, and overcoming negative symptoms by focusing on meaning and connection.

Essential Elements of CBT for Psychosis: Engagement Style, Normalizing, Developing a Formulation

This seminar explores and offers practice in the fundamentals of CBT for psychosis. Questions will be discussed such as, how is it possible to engage collaboratively in exploring experiences with people whose view of reality is radically different from your own? How can providers realistically offer hope to people who may feel their mind is broken?

One CBT method that conveys hope and facilitates engagement is that of normalizing. Framing psychotic experiences as extreme versions of normal reactions “puts them on the map” of healthy human functioning and allows people to consider transitioning to less extreme approaches. Once experiences are understood in a normalized way, it is then possible to follow up by helping people map out or develop formulations about what is happening. These formulations then can be used to develop specific suggestions about what might be done to effect change.

Learning Objectives:

· List four key elements of a collaborative engagement style consistent with CBT for psychosis, and demonstrate this style in practice

· Apply the practice of normalizing while discussing psychotic experiences

· Based on descriptions of psychotic experiences, create CBT formulations which map out what may be happening and what might be changed to “shrink” the problem

Paranoia and Troublesome Beliefs: A CBT Approach

In an increasingly polarized world, more are noticing how difficult it can be to talk to someone whose beliefs are quite different from our own. It can be even more difficult when trust is broken, and paranoia is strong.

In this seminar, the focus will be on establishing helpful conversations with people whose paranoia and extremely different beliefs have led to a diagnosis of psychosis. Rather than a “one size fits all” approach, the emphasis will be on finding a method that works for an individual as that person exists in the current moment. While “reviewing the evidence” and helping the person challenge the belief may sometimes be effective, at other times it may work better to simply accept the belief and to find ways to live successfully while holding it. And at other times, the best approach might be understanding the belief as an indicator of underlying conflicts or vulnerabilities that need to be addressed before the belief can change.

Learning Objectives:

· Describe the possible functions of paranoia in the formation of troublesome beliefs or delusions

· Identify 4 different but complementary approaches to reducing disturbances due to troublesome beliefs

· Demonstrate how to collaboratively explore evidence for and against an apparently delusional belief

Voices, Visions, and Other Altered Perceptions: Changing Outcomes with CBT

We depend on our senses for accurate information about the world, but for many people, a significant portion of what they experience as sensory information has no apparent basis in our shared world. This may appear to be a definite problem, yet, research in the last quarter century shows that only some of the people who hear voices and see visions have significant problems from these experiences; others seem to get on with their lives successfully.

What makes the difference? One huge factor is how people interpret and relate to these experiences. This training will explore CBT methods of shifting from often unproductive or even counterproductive attempts to eliminate “hallucinations,” to constructive ways of coping. With this change in relationship, experiences like voices may fade, become less troublesome, or even shift into something the person experiences as an overall positive in their lives.

A special area of focus will be the problem of compliance with command voices. Patterns of compliance with command voices dramatically increase the risk of self harm and other destructive behavior; we will review and practice CBT approaches which have been shown to be effective in significantly reducing such compliance.

Learning Objectives:

· Use an acceptance and commitment therapy approach to help people change relationships with voices, visions, and other “hallucinations.”

· Identify relationships between problems with voices and with difficult emotions, allowing attention to shift to facing core issues and schemas

· Utilize a proven CBT strategy to help people reduce even partial or imagined compliance with command voices

Trauma, Dissociation, and Psychosis: CBT and Other Approaches to Understanding and Recovery

A large number of studies now provide strong evidence that psychosis is often an understandable reaction to trauma, abuse, and other difficult life experiences. This training will introduce you to a science based yet humanistic conceptualization of extreme human experiences that can be related to trauma, and will demonstrate how to help people change their relationship with these experiences, for example, by collaborating with them in building coherent and compassionate self narratives that can set the stage for a strong recovery.

Dissociation can be a normal response to traumatic stress and can, in its more extreme forms and when misinterpreted, easily lead to psychosis. Drawing on this understanding, the possibility of addressing dissociation and misinterpretations of dissociation using methods drawn from diverse sources such as CBT, the Hearing Voices Movement, mindfulness, and psychodynamic approaches will be presented. These approaches can help people to regain perspective and personal power and create an opportunity to resolve internal conflicts rather than remaining stuck in endless efforts to suppress whatever is disturbing them.

Learning Objectives:

· Identify possible interrelationships between trauma, dissociation, and psychosis, including ways that psychosis itself, and reactions to psychosis by others, can be traumatizing

· Describe a possible causal route from trauma to psychotic experiences, and describe the role of dissociation within that process

· Plan to integrate CBT for psychosis with various trauma therapies to effectively treat clients who have experienced both trauma and psychosis

· Demonstrate a collaborate approach to helping clients develop coherent and compassionate stories of trauma and recovery which provide an alternative to both fragmented “psychotic” stories, and to helplessness-inducing “mental illness” stories.

Addressing Spiritual and Cultural Issues Within Treatment for Psychosis

There is not just one way of making sense of reality; instead, each culture or even each subculture goes about it differently. Further, many or even most people affirm beliefs in various “spiritual” aspects of reality that transcend everyday experiences. But this leads to the question: how are we to distinguish healthy diversity in culture and spirituality, from that which is pathological or “psychotic?”

One approach to this question is to assert that if a way of making sense is common in a culture, then it is sane and acceptable, while if it is unique, then it is pathological. While this approach makes room for diversity that is well established in large social groups, it continues to risk pathologizing possibly healthy innovations made by individuals.

This training will explore how CBT for psychosis can be practiced in a flexible way to adopt to cultural and spiritual differences, allowing for collaborative and respectful explorations of both the possible value as well as dangers of various ways of approaching reality. Based on such explorations, people can discover their own paths to a healthy integration and a path forward in their lives.

Learning Objectives:

• Demonstrate the ability to adopt CBT for psychosis approaches to meet the needs of individuals from varying cultural groups
• Explain the role of cultural humility, and an awareness of the uncertainty of one’s own knowledge, in respectful and effective therapy for psychosis
• Utilize cultural competence in addressing spiritual issues within a recovery oriented approach to psychosis while working with individuals from a variety of traditions and subcultures

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So, if you are looking for training for your team or your agency, I can provide training online or travel to provide in person seminars, please contact me to discuss possibilities.

And if you are an individual looking for training for yourself, I do offer 3 online courses you can take on your own schedule, information about those is available here. Also, to be notified of when live online seminars will be offered for individual enrollment, please provide me with your email address here.

Or, if you want to check out some trainings offered by others, I’ve put together this list of possible leads on that!