Results of a Transpersonal, Narrative, and Phenomenological Psychotherapy for Psychosis

Abstract

In our academically based, psychiatric outpatient practice, we have encountered those who wish to avoid medications for treatment for psychosis. This study is a qualitative/quantitative study in progress of a patient population diagnosed with psychosis and managed primarily without medication. We reflect upon the transpersonal foundations of an approach in which voices and visions are accepted as real, given full ontological status, and addressed within a dialogical framework. We present interim data on a series of 51 patients over 20 years old who presented with psychosis and who remained with us for at least six months in their effort to reduce or eliminate medication. (An additional 201 patients presented themselves for treatment but did not continue for six months.) The practitioners use questionnaires to quantify symptom level, including the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale, two depression rating scales, the Clinical Global Inventory, and the Revised Behavior and Symptom Identification Scale. In addition, narrative interviews are utilized in a review of symptoms. Of these 51 individuals, 38 managed psychosis without the use of medication (or with very occasional medication as sleeping assist). Another nine managed well on low dose medications. Three individuals required higher levels of medication and one became progressively worse despite all efforts and was eventually involuntarily placed in the State Hospital. The overall cost-benefit is favorable in creating fewer hospitalization, crises, and diminished suicidality. The results do not hint at one algorithmic solution, but suggest the need for individualized approaches that are client-centered and build upon the previous successes of the person, enroll family and friends in a community effort, and collaborate with those communities to apply those approaches desired by the people themselves. We are optimistic that this dialogical approach to psychosis in which lived experience is granted full ontological reality can facilitate recovery of function in the ordinary, consensual world. Each person’s narrative is unique and not necessarily transferable to any other person. How people arrive at successful solutions is varied and makes sense only within their local context and knowledge communities.