Psychotherapy of the affective psychoses

Too few research studies that identify effective therapeutic methods for treatment of psychotic depressions are available. A few studies indicate that cognitive therapy reduces symptoms and may provide prophylaxis in outpatients with moderately severe depressions. Cognitive theory provides a conceptual framework for developing techniques to treat more severely depressed patients. Specific obstacles in the psychotherapy of this group include negatively biased recall of current and past events; difficulties in forming a therapeutic alliance; memory and concentration deficits; hallucinations; delusions; and somatic complaints. This paper presents preliminary attempts to develop and apply cognitive change techniques to some of these difficulties. The role of medication in combination with psychotherapy, the identification of depressions requiring psychotheeapy, and the development of methods specific to psychotherapy with psychotic depressions and promising areas in need of further investigation.