The treatment alliance in psychosis

The persistent and safe connection with a person and a team is a key element, in the relationship with a psychotic person.

See Take These Broken Wings -- Recovery from Schizophrenia without Medication, Daniel Mackler, Featuring Joanne Greenberg (bestselling author of "I Never Promised You a Rose Garden"), recovered for over fifty years. Interviews with Peter Breggin, Robert Whitaker, Bertram Karon, and Catherine Penney. 


The treatment alliance with psychotic persons has many common factors which apply to the treatment relationship with any other client: “To the extent that the therapist finds himself experiencing a warm acceptance of each aspect of the client's experience as being a part of that client, he is experiencing unconditional positive regard. It means that there are no conditions of acceptance, no feeling of "I like you only if you are thus and so." It means a "prizing" of the person, as Dewey has used that term. It is at the opposite pole from a selective evaluating attitude-- You are bad in these ways, good in those.'' It involves as much feeling of acceptance for the client's expression of negative, "bad," painful, fearful, defensive, abnormal feelings as for his expression of "good," positive, mature, confident, social feelings, as much acceptance of ways in which he is inconsistent as of ways in which he is consistent. It means a caring for the client, but not in a possessive way or in such a way as simply to satisfy the therapist's own needs. It means a caring for the client as a separate person, with permission to have his own feelings, his own experiences. (From Rogers’ 1957 article “The necessary and sufficient conditions of therapeutic personality change).

What is special for psychosis?

What consumers experience as supporting:

The Recovery Promoting Relationships Scale (RPRS) at the Center for Psychiatric Rehabilitation, 

Therapeutic alliance in early schizophrenia spectrum disorders:

a cross-sectional study Ragnhild Johansen12*, Valentina C Iversen45, Ingrid Melle67 and Knut A Hestad23 

The treatment alliance in casemanagement relationship:

Beyond Psychotherapy± therapeutic relationships in community care by Joel Kanter

Clinical Case Management: Definition, Principles, Components, Joel Kanter 

Evaluation of the two-way communicationchecklist as a clinical intervention, results of a multinational, randomised controlled trial, Jim van Os,Carlo Altamura, Julio Bobes, Jes Gerlach, e.a. see pdf

Training to Enhance Communication with Patients with Psychosis (TEMPO)

The ward atmosphere

Patients’ and Staff’s Perceptions of the Psychiatric Ward Environment, Jan Ivar Rossberg, M.D., Svein Friis, M.D., Ph.D. see full text

Characteristics of a good ward atmosphere, S. Friis, Acta psychiatr. scand 1986 74:469-473, see first page Pdf

Patient satisfaction and treatment, environment: A 20-year follow-up study, from an acute psychiatric ward, J. I. Røssberg, i. Melle, s. Opjordsmoen, s. Friis, Nord j psychiatry vol 60 no 2006 see abstract

A suggested revision of the Ward Atmosphere Scale, Røssberg JI, Friis S. See first page Pdf

Therapeutic Communities for Psychosis: Philosophy, History and Clinical Practice (The International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses) by John Gale (Editor), Alba Realpe (Editor), Enrico Pedriali (Editor) See book

Experiences of Mental Health In-patient Care, Edited by Mark Hardcastle, David Kennard, Sheila Grandison and Leonard Fagin See book on amazon

The psychodynamics of psychiatric institutions, Bob Hinshelwood Jan 2016

Mostly psychiatry focuses exclusively on the symptoms and suffering of people with psychosis. But for a long time it has been known that psychiatry itself, or at least its institutions, show their own symptoms, causing institutionalisation and desocialisation. As a British psychoanalyst, a long time ago, incisively said, Within such [a traditional] setting, health and stability are too often bought at the excessive price of desocialization. read more


Evidence on the importance of the quality of treatment alliance

L. P. Goldsmith, S. W. Lewis, G. Dunn, R. P. Bentall. Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis. Psychological Medicine, 2015; see full text



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ISPS Journal


The ISPS Journal Psychosis accepts personal and institutional subscriptions. All Individual Members of ISPS and members of regional ISPS groups receive quarterly issues of the journal as a membership benefit.

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