Emergence of psychotic content in psychotherapy: An exploratory qualitative analysis of content, process, and therapist variables in a single case study

Objective: Emerging integrative metacognitive therapies for schizophrenia seek to promote subjective aspects of recovery. Beyond symptom remission, they are concerned with shared meaning-making and intersubjective processes. It is unclear, however, how such therapies should understand and respond to...

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Bibliographic Details
Published in:Psychotherapy research 2018-03, Vol.28 (2), p.264-280
Main Authors: Leonhardt, Bethany L., Kukla, Marina, Belanger, Elizabeth, Chaudoin-Patzoldt, Kelly A., Buck, Kelly D., Minor, Kyle S., Vohs, Jenifer L., Hamm, Jay A., Lysaker, Paul H.
Format: Article
Language:English
Subjects:
Content analysis
Humans
insight
Intersubjectivity
Male
Meaning
Metacognition
Middle Aged
Psychosis
Psychotherapy
Psychotherapy - methods
qualitative methods
Qualitative Research
Recovery
Remission (Medicine)
Schizophrenia
Schizophrenia - therapy
Single case studies
Therapeutic alliances
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Summary:Objective: Emerging integrative metacognitive therapies for schizophrenia seek to promote subjective aspects of recovery. Beyond symptom remission, they are concerned with shared meaning-making and intersubjective processes. It is unclear, however, how such therapies should understand and respond to psychotic content that threatens meaning-making in therapeutic contexts. Accordingly, we sought to understand what factors precede and potentially trigger psychotic content within psychotherapy and what aids in resolution and return to meaning-making. Method: Forty-eight transcripts from a single psychotherapy case were analyzed with thematic analysis. Passages of delusional or disorganized content were identified and themes present prior to the emergence and resolution of such material were identified and coded. Results: Themes that preceded the emergence of psychotic content varied across early, middle, and late phases of therapy. Material related to the patient's experience of inadequacy and potential vulnerability, therapist setting boundaries within the therapeutic relationship and making challenges appeared to trigger psychotic content, especially early in treatment. Conclusions: Psychotic content may emerge in session following identifiable antecedents which change over phases of therapy. Attending to psychotic content by assuming a non-hierarchical stance and not dismissing psychotic content may aid in maintaining intersubjectivity and support patient's movements toward recovery in integrative metacognitive therapies.
ISSN:1050-3307
1468-4381
DOI:10.1080/10503307.2016.1219421