Cognitive Behavioural Therapy for Psychosis - Research Paper Example

Cognitive Behavioural Therapy for Psychosis I. Introduction The recent decades have witnessed a dramatic turnaround in mental health care approaches towards the psychological therapy for severe and enduring mental illness. While, previously, numerous psychiatrists and psychologists alike were distrustful regarding the likelihood of treating psychotic patients aside from drug remedy, the recent years have seen significant advances in the psychological therapy for delusions and other indications formerly believed to be the spasms of a severely disordered brain. The sources of these developments can be drawn from previous experiments; for instance, the Skinnerian psychologists’ simple behaviour modification programmes introduced in the 1960s and the more advanced interventions in behavioural family therapy introduced in the 1970s and the subsequent years (Neenan & Dryden 2004: 36). Nevertheless, the thought that individual therapy could improve the core indications of severe mental illness, rather than just allow the patients to better deal with and handle their illness, is quite a new development. Evidently, cynics remain, particularly in developed countries, wherein the belief that bipolar disorder and schizophrenia are types of severe brain illness that possess no significant psychological factor persists to influence. On the other hand, in UK and for the most part of continental Europe, individual therapies for severe mental illness are progressively viewed as an imperative component of the therapeutic field (Neenan & Dryden 2004). The latest therapies, which are labelled under the generic concept of cognitive behaviour therapy (CBT), have been enhanced partly through empirical experiment, partly through well-informed and logical guesswork regarding the psychological mechanisms that affect symptoms, and partly through the application of therapeutic procedures thought to be successful for mild mental conditions such as depression and anxiety (Basco & Rush 2005). II. Historical Overview on the Development of Cognitive Behaviour Therapy for Psychosis Cognitive therapy was formulated in the 1960s by Aaron T. Beck as a controlled, temporary, difficulty and present-focused psychotherapy for anxiety and depression. It is illustrated by Beck and colleagues as an “active, directive, time-limited, structured approach used to treat a variety of psychiatric disorders (for example, depression, anxiety, phobias, pain problems, etc.)” (Basco & Rush 2005: 61). Beck embarked on his psychiatric profession as a psychotherapist and a psychoanalyst and formulated his theory while making use of dream analysis to confirm the idea that depression was brought about by self-induced aggression emerging from wish fulfilment, particularly the wish of humiliation. While engaged on this task, Beck started to doubt the argument of Freud which claims that certain behaviour has its origins in the unconscious, whereas any irrationalities situated on the conscious level are merely expressions of basic unconscious drives (Basco & Rush 2005). Based on his observation of his patients, Beck assumed that irrationality might be identified in terms of insufficiencies in structuring and understanding reality. Beck, in a work published in 1963, emphasised that the schizophrenic stands out in his inclination to misinterpret the world that is shown to them. While the strength of this argument had been validated by various clinical and empirical researches, it had not commonly been recognised that misinterpretations of reality could as well be an attribute of other severe psychiatric illnesses. On the basis of his clinical experience, he developed the perspective that psychological difficulties were not essentially the outcome of “mysterious, impenetrable forces” (Rosner et al. 2004: 42) but to a certain extent, the outcome of defective learning, coming up with inaccurate assumptions based on incomplete or inaccurate information or input, and a failure to satisfactorily differentiate between false impressions and reality. Cognitive therapy is founded on the hypothetical view that an individual’s emotion and behaviour are primarily influenced by the manner in which they interpret the world to them. Cognitions, such as pictorial episodes in an individual’s stream of consciousness, are founded on outlooks or schemas that are built from experiences. Hence, Beck proposed that psychological mechanism can be mastered through reinforcing differentiations, correcting misinterpretations, and gaining more adaptive approaches. He remarked that since insight, introspection, reality experimentation, and learning are fundamental cognitive mechanisms, this framework towards the treatment of psychosis and other severe mental illness has been referred to as cognitive therapy (Rosner et al. 2004). Nevertheless, it is essential to remember that, while the methods of cognitive therapy is oriented on the misconceptions of a patient, self-defeating attitude and core perspectives, the objective is the alleviation of emotional disorders and other indications of emotional distress. The treatment methods of cognitive therapy are formulated to identify, reality-experiment and remedy misrepresented interpretations and the thoughts behind these cognitions. Mental patients are trained to solve problems and circumstances which the formerly regarded impossible through re-assessing and correcting their mindset. Cognitive therapists guide patients to reflect and respond more practically and adaptively regarding their psychological difficulties and hence alleviate symptomatology (Olevitch 1995). III. Aims and Principles of Cognitive Behaviour Therapy for Psychosis Embedded within the aim and principle of cognitive behaviour therapy are the primary premises or attributes of this therapy, which must allow the practitioner to make best use of their therapy effectiveness and adherence to the framework. Most importantly, cognitive therapy is founded on the cognitive framework of emotional disorders and is hence theory and framework motivated rather than an assembly of strategies. Furthermore, as Judy Beck emphasises, this should be founded on a continuously developing formulation which is consistently improved throughout the therapy as supplementary information are acquired (Ryle & Kerr 2002). Both the framework and individual interpretations are openly provided to the patient throughout the therapy. Second, cognitive behaviour therapy is instructive and shared or collaborative. This implies that the therapist and the patient agree on aims and goals and afterwards create means in which these can be realised. Initially, the therapist possibly will have to be more instructive in the presentation of knowledge and information and assume on a more authoritative role in the laying out of the sessions plan, yet this should turn out to be a more equally divided assignment throughout therapy (Ryle & Kerr 2002). Group effort or collaboration is particularly essential when working with patients suffering from serious and enduring mental illness. Third, cognitive behaviour therapy intends to be time constricted, and though this is primarily at least ten sessions, the essential attribute is the precise time limitation that is provided to the patient, with evaluations being applied to collaboratively make a decision on the necessity for more intervention (Ryle & Kerr 2002). Within this time-constricted arrangement, precise and practical aims or objectives are collaboratively laid out which are reviewed by both parties to be suitable for the agreed contract. Fourth, cognitive behavioural therapists mainly make use of the Socratic Method or directed discovery. Specifically, apart from giving answers to the questions or difficult unconstructive habitual thoughts of the patients, the therapist give out their own questions that could guide patients in providing their own answers (Moore & Garland 2003). Through applying this therapeutic technique, the patients will gain recognition of the mechanism of therapy, rather than entirely the outcomes, and can, hence, be active contributors in their own recuperation and weakening prevention. The fifth attribute of cognitive behaviour therapy is that a good therapeutic bond is an indispensable prerequisite of advanced cognitive behaviour therapy. A patient should be capable to sense that s/he is able to confide to the therapist. While this possibly will be plain and simple for a number of patients, involving individuals with severe mental illness in a therapeutic relationship could be more difficult and could be an appropriate orientation for initial therapy (Moore & Garland 2003). The demand for a strong therapeutic relationship can be portrayed by the proceeding analogy. If for instance you are trapped, frightened and trembling, halfway up a deep precipice and roosted on a small ridge, a rescuer might have to acquire two elements to help you return to safety: first, the needed skills and devices to help you clamber up, and second, the capability to encourage trust in him in order that you will be capable to make use of these techniques in your climb to safety. Either of these capabilities present in seclusion would not permit patients to generate the needed confidence necessary to upset their present status quo. Lastly, cognitive behavioural therapy is controlled and problem focused. Each session begins with a program that is agreed upon by both the patient and the therapist and points out which difficulties will be addressed at some point in the session and any instructive information that have to be shared and taught. The therapist will guide the patient to determine the hindrances that stop him or her in solving personal problems. These might be skill inadequacies or dysfunctional concepts that hamper the application of formerly gained skills. Together with this, homework is constantly decided at the end of every session and should include an assignment that is pertinent to the current objective and decided on in group effort (Beck et al. 2004). The homework should not merely be applicable to the development and progress of a patient in therapy, but as well allow them to gain awareness of the therapy process and determine potential directions for putting into effect their learned therapeutic strategies. Control and order in therapy sessions is definitely imperative when working with individuals with mental disorder. Even though these fundamental aims and principles are relevant to the practice of cognitive behaviour therapy with every patient, therapy indeed differ significantly according to the presence of different factors. These involve individual problems, his or her objectives, the capability to establish a firm and good therapeutic relationship, encouragement to change and experiences in therapy. The focus in therapy rests on the specific difficulties that the patient expresses. IV. Strengths and Weakness of Cognitive Behaviour Therapy in Treating Psychosis The therapeutic relationship that is present between the therapist and the patient in cognitive behavioural therapy is recognised as a considerable influence on the mechanism of therapy, and the effect of the therapist-patient bond on mechanism and result is one of the earliest premises in psychotherapy literature. A welcoming and healthy therapeutic relationship can have a considerable effect on the treatment mechanism and result, yet a less than adequate therapeutic relationship may have a considerable unconstructive impact (Beck et al. 2004). Therapeutic alliance is a unique element; the existence of a strong therapeutic relationship is important to constructive therapy outcome, though merely in that it improves the influence of the therapeutic alliance. Some psychotherapists assumed that it is the ability of the therapist to be compassionate, emphatic and show absolute positive consideration that is needed for the patient’s recovery; some further argue that provided that the therapist was capable to provide a welcoming human interaction and relationship even the most unmanageable psychotic patients might in due course be reached. Contemporary analysts, though, assumed that the therapist-exclusive prerequisites only presented an incomplete elaboration of the intricate relationship elements that affect therapy mechanism and result (Needleman 1999). A great deal has been written on the issue of therapist aspects or attributes in the therapeutic alliance, underlining both practical skills and interpersonal components. Empathy, truthful warmth and sincerity in the therapist influence both the patient and the therapist’s perspective and behaviour in therapy. Applied cautiously and thoroughly, they will strengthen the practical skills used. Bordin (1974) illustrated the operational relationship between the patient and the therapist as a “pantheoretic construct that substitutes the idea (that the relationship is therapeutic in itself) for the belief that working alliance makes it possible for the patient to accept and follow the treatment faithfully” (cited in Needleman 1999: 68). Even though the relationship can be illustrated and evaluated in numerous ways, it simply shows the individual attributes of the therapist and the patient, and the alliance established between them. The therapist is not capable to directly change patient factors but can have an influence, in some way, on the manner s/he involves the patient and provide input to the relationship with respect to compassionate, asserting, mutual and interactive approach that integrates the successful application of tested interventions. On the other hand, an inadequately understood medical framework of psychosis, with a limited focus on the biological causes of psychosis could weaken a more broad-minded or scientific perspective to psychosis. Psychotherapists still possess significant amounts of power, influence and position within the field of mental health care and services, and an unresponsive, or even unsympathetic, outlook to the possible helpful input of psychologically focused models from a psychotherapist can bring about real difficulties for other specialists supporting such models (Scott et al. 1991). Given that a team member supporting such a model belongs from a profession with a past high respect to medicine, this can look like a genuinely major problem. Apparently, such problems can as well originate from team members with varying expertise. It could be that the team has an influential leader who does not have a psychiatric background, and aggression or apathy from this individual or any powerful member in the team can be problematic. Evidence from empirical literature and research into the delivery of family intervention in regular services seems to indicate that if people have obtained education in psychosocial interventions in seclusion from the team, then regular implementation of such models is difficult to put into effect. This is particularly true if the members obtaining such education are of a quite junior status or ranking within their own specialist team (Scott et al. 1991). One possible solution is to attempt to produce a mutual understanding of the individual problem and condition. Since this precisely integrates physiological or biological knowledge and the social context, it can be beneficial in presenting a concept that everybody in the team can easily recognise and sense that they have a cherished role with respect to. It is as well, perhaps, more foretelling with respect to medical interventions than a medical analysis would be. For instance, it is commonly believed that antipsychotic treatments remedy delusions and brain disorder, which are mental and behavioural awareness, rather than the disorder of schizophrenia, and depression reduction therapy remedy stabilises mood swings (Taylor 2004). One means to address this is to concentrate on the demands that are to be dealt with by services, and to repeat that the services we deliver are there to fulfil the paramount interests of our patients, in contrast to our own specialised interests. V. Conclusions Cognitive behavioural therapy mechanisms that have been devised particularly to cater to the needs of psychotic patients are supportive of the findings from current psychological researches of symptoms. Definitely, a number of methods have been openly influenced by the outcomes of psychological researches, even though others have been advanced empirically or practically by innovative therapists. Though, this observation does not mean that the symptom framework is perfect. There are still limitations that should be noted by therapists or clinicians. Providing cognitive therapy regularly to individuals suffering from severe and chronic mental illness or psychosis seems to be more complicated than it possibly have to be; once adequately educated and trained in cognitive behavioural therapy, the therapist has to make sure that s/he has legitimate access to ongoing care and assist other mental health team to make proper application of their newly acquired skills. This is occasionally challenging since mental health teams are comprised of individuals with varying points of view on the treatment of psychosis. Although the therapist providing cognitive behavioural therapies to individuals with psychosis has a high-quality evidence base in which to rationalise their framework, the traditions of several mental health services is not constantly scientific or evidence based. Partnerships possibly will have to be established with therapists, patients and caregivers so as to situate evidence based mental treatments in their appropriate places, in harmony with organisational duties such as medical supervision. The dimension of this medical and organisational schema is such that an even-handed hierarchy of seniority or change supervision awareness may be beneficial in put it into practice. References Basco, M. R. & Rush, A.J. (2005), Cognitive-Behavioural Therapy for Bipolar Disorder, New York: Guilford Press. Beck, A. T. et al. (2004), Cognitive Therapy of Personality Disorders, New York: Guilford Press. Moore, R. G. & Garland, A.(2003), Cognitive Therapy for Chronic and Persistent Depression, Chichester, England: John Wiley & Sons. Needleman, L. D. (1999), Cognitive Case Conceptualization: A Guidebook for Practitioners, Mahwah, NJ: Lawrence Erlbaum Associates . Neenan, M. & Dryden, W. (2004), Cognitive Therapy: 100 Key Points, New York: Brunner-Routledge. Olevitch, B. A. (1995), Using Cognitive Approaches with the Serious Mentally Ill: Dialogue across the Barrier, Westport, CT: Praeger. Rosner, R. I. et al. (2004), Cognitive Therapy and Dreams, New York: Springer. Ryle, A. & Kerr, I.B. (2002), Introducting Cognitive Analytic Therapy: Principles and Practice, New York: John Wiley & Sons. Scott, J. et al. (1991), Cognitive Therapy in Clinical Practice: An Illustrative Casebook, London: Routledge. Taylor, S. (2004), Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive-Behavioural Perspectives, New York : Springer. Read More