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PsyChris: I'm not your pdoc but most studies show individuals with psychosis should not receive insight oriented psychology.

I'm certain I've linked this one before Chris, but just in case, I'll link it again: 85% Recovery Rate. It's pertinent because both of those clinicians were doing talk therapy with "psychotic" patients.

In case you've not run across them before, here's a few other thoughts in a similar vein -- Dr. Loren Mosher....

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Mosher points out that the kind of therapy dispensed at Soteria House differed profoundly from the work that went on at the famous Chestnut Lodge psychiatric hospital in the '50s and '60s. There psychiatrists had tried to cure patients with traditional Freudian-style psychotherapy. "I'm fond of saying psychosis does not fit the 50-minute hour -- because it goes on 24 hours," Mosher says. "So you ought to conform your treatment to fit the problem." Rather than scheduling specific sessions with their charges, the Soteria staff members made a commitment to be available every moment of the schizophrenic residents' waking hours. Mosher says the overall feeling had much in common with the "moral treatment" asylums that appeared in America in the first half of the 1800s. Small, humane, and pleasant environments, these institutions promoted the concept that many lunatics could recover their sanity if treated with decency, gentility, and respect. As peculiar as that notion might appear today, Whitaker in Mad in America writes that "Moral treatment appeared to produce remarkably good results." He cites records from five moral-treatment asylums showing that between 50 to 91 percent of their patients were able to return to normal lives in their communities. Such outcomes led one asylum superintendent to declare in 1843 that insanity "is more curable than any other disease of equal severity.…"

Source: Still Crazy After All These Years


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and Dr. Bertram Karon...

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PTR: Can you tell us a little bit about your ground-breaking Michigan study which was on the treatment of schizophrenics with psychotherapy versus the usual psychiatric approach?

BK: Yes. This was a study that was done on a NIMH grant using center city Detroit patients. What we did was take clearly schizophrenic patients ... Diagnosis was made by the regular hospital staff and then reviewed by the research staff to ensure they were really schizophrenic. And if anything, they were the very sickest of the schizophrenics.

They were assigned randomly to one of three treatments: psychoanalytic therapy with no medication; psychoanalytic therapy and medication combined or, medication and support as given by a good group of psychiatrists in a good hospital. The evidence that they really were good psychiatrists is the group that did worse in our study -- the medication only group -- did as well as the medication only group in some of the studies ... which claimed to find that therapy didn't help.

The problem is that what they called therapy was done by residents who had no training in psychotherapy, supervised by supervisors who had no training in doing psychotherapy with schizophrenics. In our study, the supervisors had at least ten years experience in doing psychoanalytic therapy with schizophrenics and were considered by their colleagues to be "good therapists". Furthermore, the inexperienced therapists -- because we were interested in whether you could teach this sort of thing -- were psychiatric residents or graduate students in clinical psychology and were given training and supervision, very carefully.

Now here's what we found: the best outcome occurred in those people who got psychoanalytic therapy without medication at all. We used psychological tests, we used a clinical status interview conducted by a very experience psychiatrist who did not know what kind of treatment the patient received. The patients were examined before treatment, after six months, after 12 months and after 20 months of treatment. And then we did a follow up for medication after two years. The best results were obtained with those people who got just psychoanalytic therapy.

The next best results, which were nearly as good, was where medication was used as an adjunct but it was withdrawn as rapidly as the patient could tolerate. The experienced therapist who combined medication with therapy was honest. He told the patients, 'The medication doesn't cure anything. It makes things tolerable so we can talk. But the only thing that will cure you is your understanding.' And he withdrew the medication as quickly as the patients could tolerate and that turned out to be a good way to work.

Therapists who treated their patients with medication as well as psychotherapy but maintained the dosage level of the medication and never withdrew the patients from their medication, this was not nearly as good as just using psychoanalytic therapy or psychoanalytic therapy with medication when the medication was withdrawn as rapidly as the patients could tolerate.

Source: Schizophrenia & Psychotherapy


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Pennkid: My counselor isnt that bad, the problem is that he just kind of thinks he knows a lot more than I do (which he probably does), I went a little far by saying he was rude. The main thing is that I dont feel I need a counselor, I have been to counselors before and it didnt help then either.

Counseling can be a hit and miss proposition at the best of times however for those who have experienced psychosis and would like to pursue a therapeutic relationship, I generally recommend a therapist with a background in either depth psychology (Jungian, not Freudian) or transpersonal psychology.

Naturally, there is a great deal that a person can do on their own as well but a good counselor can help facilitate the healing process.

See also: How To Rebuild Your Life After a Breakdown