Brief cognitive analytic therapy for post‐acute manic psychosis on a psychiatric intensive care unit

Abstract

A study of the efficacy of brief cognitive analytic therapy (CAT) with a series of patients (n = 4) with treatment-resistant manic psychosis on a psychiatric intensive care unit (PICU) was carried out. In one patient such an intervention proved redundant given an improved medication regime and subsequent willingness to comply with treatment. In a second, it proved impossible, in this context at least, due to fixed grandiose and paranoid delusions. In two others, however, this approach, particularly the technique of joint 'reformulation', appeared to be remarkably containing and effective with rapid subsidence of disturbed and non-compliant behaviour. Much of the 'psychotic' psychopathology of these patients became comprehensible within this model in terms of secondary, 'self-state' or narcissistic damage and enactment of maladaptive 'procedures' and 'reciprocal roles'. Additionally, discussion of these procedures and the reciprocal roles elicited from and enacted by staff produced a marked change in attitude and behaviour by them. In one of these patients, improvement was such that transfer to an open ward was possible within a week and discharge soon after. Subsequent treatment was markedly more collaborative and enabling of good social function. It appears that CAT and its collaborative use of the 'tools' of reformulation could play an important role in the treatment of psychotic disorders in this and possibly other settings.

Exploring narratives of psychological input in the acute inpatient setting

“…Individual psychological interventions in the acute inpatient mental health setting typically draw on theoretical models developed in community-based settings (Kerr, 2001). Given the unique aspects of the inpatient setting, interventions are often adapted to meet the needs of the environment (Heriot-Maitland, Vidal, Ball, & Irons, 2014).…”

Clinical and Service Implications of a Cognitive Analytic Therapy Model of Psychosis

“…Thus, a further important outcome of this therapy was the reduction of stress reported by the staff team. In the case reported above and in others reported elsewhere a further important outcome has been reduction in number of relapses and hospital admissions in the period (1 year) of follow‐up with reduction in accompanying economic costs and also in reported stress and distress to family, friends and other carers [6,9].…”

The States Description Procedure: the use of guided self-reflection in the case formulation of patients with Borderline Personality Disorder

“…This allows care planning and case management to be matched with the patient's specific problems and individual dysfunctional role procedures (see e.g. Dunn and Parry, 1997;Pollock, 1997;Kerr, 1999Kerr, , 2001. By alerting staff to the individual patient's range of alternating states and hence to the specific pressures and demands to be expected, collusive, anti-therapeutic responses can be more easily avoided or corrected and treatment can be accurately focused.…”