Originally, when I applied CT to psychosis, I was interesting in alleviating the psychotic symptoms. I therefore utilized the Socratic method of questioning the beliefs regarding the psychotic phenomena such as voices. For example, I would inquire as to what characteristics the voices had and I would discover say, that the voices were powerful. I then examined this belief and subjected it to behavioral experiments.
Gradually when I moved more to the current methods, I followed the following thesis:
- Utilize the symptoms simply to find out what needs or drives were being expressed through the symptoms. For example, the belief about powerlessness might reflect a generalized sense of powerlessness about the voices.
- Translating this into real life. I tried to elucidate when the individual would feel powerless in a reality situation such as in dealing with other people.
- I tried then to reverse the powerlessness as I would with a non-psychotic individual. Namely, facilitate the opportunities to engage in activities that would demonstrate that the individual had some power.
It still remains to be demonstrated that the current approach is superior to the conventional approach. It would probably take a clinical trial to compare the impact of CBTp as compared with CT-R. Of course, the outcome measures might favor CT-R since they are based on the idea of Recovery, having a better quality of life, becoming involved in the community, having friends, getting involved in productive work, etc.
For the present however, it does seem that trying to strengthen the individuals’ sense of power not only makes them feel stronger but also reduces the power of the voices.
Please let me know your reactions to the above.