CBT for psychosis: a qualitative analysis of clients' experiences.

Abstract

The study explored clients' understanding and experience of cognitive behavioural therapy (CBT) for psychosis. Four inpatients and one outpatient who received CBT for psychosis were interviewed following a semi-structured format, designed for the purpose of the study. The transcribed interviews were analysed using discourse analytic methods and focused in particular on the way clients positioned themselves in relation to their therapists. The consistencies and contradictions within clients' accounts were also examined. The following discourses are described: 'This is truly happening', 'I am ill', 'CBT as an educational process', 'CBT as a respectful relationship between equals', 'CBT as a healing process' and 'CBT participation as compliance with the powerful medical establishment'. Three of the participants switched throughout the interview between insisting that their experiences were true and accepting that they were ill and in need of treatment. With one exception, all highlighted the value of the educational component of therapy. Two participants showed an awareness that their therapist was trying to convince them that their experiences were not true but presented this as educational rather than coercive. Most participants emphasized the value of a trusting and respectful therapeutic relationship. One client presented therapy as unhelpful and described it only in terms of his passive compliance with the powerful medical establishment. The study throws light on the experience of receiving CBT for psychosis and points to some of the therapeutic process variables worthy of consideration in clinical practice and future research.