Factors in outcome of cognitive-behavioural therapy for psychosis: users' and clinicians' views

Despite increasing evidence to suggest that cognitive-behavioural therapy (CBT) is helpful for a significant proportion of people with psychosis, only limited information is available regarding factors implicated in outcome. The present study investigated factors differentiating outcomes on the basis of accounts from participants in the therapeutic process.

Four therapists and eight of their clients were interviewed about their experiences of CBT. Clients were defined as having progressed or not progressed during therapy. Interview data were analysed using a qualitative 'grounded theory' methodology.

A number of major categories differentiated the two client groups, including ability to let go of distressing beliefs, logical thought, holding therapy, and presence of a shared goal. Overall, clients who progressed were better able to move into the therapist's frame of reference. Therapists and clients also felt that non-specific benefits accrued from the therapy for both groups.

The results were consistent with previous studies suggesting that ability to disengage from distressing beliefs is important in therapeutic progression. Reasons considered for the inability to progress include emotional investment in psychotic beliefs and cognitive processing. Further research is required to clarify the role of logical thought and therapeutic alliance in progress and in predicting outcome.