Psychosis and the dynamics of the psychotherapy process

The role of psychotherapy in the treatment of psychoses remains controversial but there is improving acceptance that an understanding of the dynamics of the psychological processes involved in treatment and in the disorder itself may be important. Psychosis is understood as a detachment of the 'self' from the 'world which results in changed abilities in inter-subjective relating to oneself and others. This understanding has led to guidelines for psychotherapists who engage in treatment of psychoses and these are summarized in this article. As a result of the disturbance in the inter-subjective process, a therapeutic relationship is disrupted and a therapeutic alliance is not assured. Therapists have to pay particular attention to the empathic aspects of the interaction as they attempt to integrate affects to restore meaning to the inner life of the patient. The psychodynamics of this process are described with additional discussion about the role of cognitive interventions and their limitations.