Psychology and Psychotherapy-Theory Research and Practice最新文献

Purpose: Cognitive-behavioural therapy for psychosis (CBTp) achieves small to modest effect sizes, which invites the question, 'What clinical modifications might improve outcomes?' This paper proposes an integration of CBTp with a neuropsychoanalytic approach that in clinical practice might extend the gains achieved by CBTp alone.

Methods: The author conducted a focused review of CBTp research bearing on trauma as well as a review of neuropsychoanalytic conceptions of psychological symptoms ('neuropsychoanalytic' meaning principally psychoanalytic ideas about how the brain maintains affective homeostasis) to identify similarities and differences in these approaches relevant to clinical practice.

Results: CBTp-oriented research shows that not only is childhood trauma associated with psychosis, but psychotic symptoms often contain de-contextualized memories of trauma and embody narrative themes that echo the person's trauma history, findings that mark psychosis as a trauma-related disorder in which psychotic symptoms constitute disguised representations of a person's trauma history. This paper expands the definition of trauma to include the symbolic meaning of events and relates psychosis to a neuropsychoanalytic model of the mind in which affect plays a central role, a conceptual lens through which delusions can be seen as meaningful adaptive attempts to maintain affective homeostasis in the aftermath of traumatic experiences. The paper offers an explanation of the developmental origins of the cast of characters and plot lines often encountered in delusional narratives.

Conclusions: There is considerable potential conceptual overlap between CBTp and neuropsychoanalytic approaches to psychosis, which if integrated might lead to better clinical outcomes, in particular in a collaborative development of schema therapy for psychosis.

Objective: Hearing voices is often experienced as being controlling, powerful, threatening or critical. This study aimed to examine the lived experiences of autonomy among people who hear voices.

Design: Employing a qualitative design, this study sought to examine the personal narratives and meaning-making processes of voice hearers and gain deeper insights into the nuanced ways autonomy is experienced, diminished, attempted, re-established and constructed by those who hear voices.

Method: In-depth semi-structured phenomenological interviews with six voice hearers were analysed using interpretative phenomenological analysis to capture the ways participants interpret and respond to their experiences.

Results: Participants' accounts revealed that autonomy was continuously negotiated, requiring reflection, adaptation and self-regulation. Three superordinate themes were identified in the data. First, participants reflected on how hearing voices challenged their sense of self, individuality and the space available for self-authorship. As such, developing a personally meaningful narrative was crucial for re-establishing autonomy. Second, they portrayed a co-existing dynamic where autonomy and power were shared and negotiated with voices. Third, participants described how hearing voices interfered with their perceived competence, and decision-making, introducing limitations to their ability to navigate life on their own terms. Participants' capacity for integration, and perceptions of their ability to influence and cause change, affected the extent to which they felt self-determined.

Conclusions: This study highlights the importance of supporting voice hearers in constructing meaningful, self-oriented narratives to strengthen their sense of autonomy. Future research should explore strategies that empower voice hearers to integrate their experiences constructively, thereby promoting resilience and autonomy.

Background: For voice-hearers from minoritised communities, voices may reflect interpersonal and societal discrimination, including experiences of feeling silenced or 'voiceless'. AVATAR therapy is a relational approach involving facilitated dialogues between a voice-hearer and a digital embodiment of their main distressing voice (the avatar). The aim is for the voice hearer to gain understanding, acceptance and empowerment.

Aims: This paper illustrates an extended form of AVATAR therapy (AV-EXT), which seeks to understand a person's voices within their developmental and relational context.

Methods: We present three therapy narratives in which voices mirrored experiences of discrimination and marginalisation based on aspects of the person's identity. Personalised avatars were used during dialogues to re-enact the lived experience of voice-hearing.

Results: Avatar dialogues offered opportunities to rescript disempowering experiences, target associated meanings and connect individuals with the power of their own identity.

Conclusions: Implications for the continued refinement of AVATAR therapy and other relational approaches are considered. This paper aims to support wider reflection on the impact of discrimination on distressing voices.

Background: Cognitive analytic therapy (CAT) offers a relational framework for understanding psychological difficulties, emphasising how early relational and socio-cultural experiences are internalised and shape the self through a repertoire of reciprocal roles (RRs).

Aims: This qualitative study seeks to explore the relational experiences of LGBTQ+ individuals using CAT theory, focusing on identity development (self-self relationships), self-other relationships, and self-society relationships.

Methods: Interpretative phenomenological analysis (IPA) guided interviews with 11 participants. CAT theory was applied as an additional framework to provide a clinically applicable understanding of these themes.

Results: Six group experiential themes (GETs) were identified: Coming Out: Discovering and Sharing Who I Am; Is it Wrong to be LGBTQ +? Questions and Beliefs about Being 'Normal'; Different Parts of Me; Feeling Safe in Relation to Others; Feeling Unworthy and Unlovable; and Being Authentically Me. Illustrations of themes were created. A CAT map was developed from the themes, outlining RRs, reciprocal role procedures (RRPs), and self-states. The findings highlight the influence of early caregiving relationships, the coming out process, and societal experiences on participants' self-development.

Conclusion: The CAT map captures the distinct RRs and procedures that the LGBTQ+ community may experience, emphasising the critical role of the self-society relationship in identity formation. It underscores the importance of the 'healthy island' concept and illustrates how healing RRPs can promote a more integrated and connected sense of self. This framework may help clinicians support LGBTQ+ individuals facing mental health challenges related to their relational experiences and sense of self.

The Talking With Voices approach, influenced by the work of the survivor-led Hearing Voices Movement, is a non-pathologising way of relating to the experience of voice hearing which emphasises coping enhancement, formulation and direct dialogue as a way to promote control, cooperation and relationship-building while reducing distress. This article presents insights from specialised mental health practice regarding potential facilitators and obstacles to implementing this approach more widely within statutory settings. Consideration is given to transferable skills for practitioners, guiding principles and values, training requirements and the ongoing challenges of bridging the gap between research and practice in clinical services.

Relational approaches to voice hearing (VH), which emphasize changing a person's attitude towards and relationship with their voices, challenge the medical view of VH as a psychotic symptom that can only be managed, typically through medication. In this paper, we review historical perspectives on VH, exploring factors that led VH to be classified as a core symptom of schizophrenia in the late 20th century. Around the same time, an alternative paradigm emerged through the Hearing Voices Movement, which argued that VH was a variation of normal human consciousness that should be accepted and explored without stigma. Dirk Corstens, a psychiatrist working within that perspective, joined forces with Andrew Moskowitz, a clinical psychologist with experience with dissociative disorders, to publish a paper entitled 'Auditory Hallucinations: Psychotic Symptom or Dissociative Experience'? In that seminal paper, Moskowitz and Corstens (2007) argued-after reviewing research on VH in the general population, similarities in VH between clinical and non-clinical populations, and the relationship between dissociation and voice hearing-that VH was better understood as essentially normal and dissociative in nature, rather than pathological and psychotic. They further argued that voice hearers would benefit from dialogical approaches seeking to understand the purpose of their voices and change the voice hearer's relationship to them. Since then, research and clinical trials have strongly supported all the tenets of the 2007 paper, to the point that relational or dialogical approaches to VH are now rapidly becoming an acceptable complement or even alternative to medical treatment for hearing voices.