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Working with the Hard to Reach Downloaded by [New York University] at 03:50 14 August 2016 Innovations in Psychosocial Interventions for Psychosis Despite the steady acceptance of psychological interventions for people with psychosis in routine practice, many patients continue to experience problems in their recovery. The need to develop new approaches, particularly for those who are more difficult to engage and have significant co-morbidities is therefore important. Innovations in Psychosocial Interventions for Psychosis positions psychological formulation as a key organising principle for the delivery of care within multidisciplinary teams. The interventions described all have the common theme of supporting recovery and achieving goals that are of primary importance to the service user which targets interventions on broader obstacles to recovery. Along with their experienced contributors, Alan Meaden and Andrew Fox introduce new developments in psychological interventions for people affected by psychosis who are hard to reach, working in a variety of settings with people at various stages of recovery. The book is divided into three parts. In Part I brief interventions and approaches aimed at promoting engagement are described as interventions in their own right. Part II is focussed on longer term interventions with individuals. Some of these highlight new developments in the evidence base whilst others draw on work applied less frequently to psychosis drawing from the broader psychological therapy practice-based evidence field. In Part III attention is given to innovations in group settings and those aimed at promoting greater multidisciplinary working in settings where a whole team approach is needed. Each chapter describes the theory underpinning a different approach, its development, key strategies, principles and stages, and contains case examples that illustrate the use of the approach in a clinical setting. Innovations in Downloaded by [New York University] at 03:50 14 August 2016 Psychosocial Interventions for Psychosis will be an invaluable resource for professionals working with this client group, including clinical and counselling psychologists, psychiatrists and other allied health professionals. Alan Meaden is a consultant clinical psychologist at the Birmingham and Solihull Mental Health NHS Foundation Trust and is the lead for the trust’s Assertive Outreach and Non-Acute Inpatient Services. Andrew Fox is a senior clinical psychologist at Birmingham and Solihull Mental Health NHS Foundation Trust. This page intentionally left blank Downloaded by [New York University] at 03:50 14 August 2016 Innovations in Psychosocial Interventions for Psychosis Working with the hard to reach Edited by Alan Meaden and Andrew Fox Downloaded by [New York University] at 03:50 14 August 2016 First published 2015 by Routledge 27 Church Road, Hove, East Sussex, BN3 2FA and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2015 Alan Meaden and Andrew Fox The right of the editors to be identified as the author of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Innovations in psychosocial interventions for psychosis : working with the hard to reach / Alan Meaden and Andrew Fox (Eds).—First Edition. pages cm Includes index. 1. Psychoses—Patients—Services for. 2. Psychoses—Patients—Rehabilitation. 3. Psychoses—Alternative treatment. I. Meaden, Alan, 1961– editor. II. Fox, Andrew (Clinical psychologist) editor, RC512.I44 2015 362.2'6—dc23 2014035572 ISBN: 978-0-415-71070-1 (hbk) ISBN: 978-0-415-71073-2 (pbk) Downloaded by [New York University] at 03:50 14 August 2016 ISBN: 978-1-315-72845-2 (ebk) Typeset in Times New Roman by Keystroke, Station Road, Codsall, Wolverhampton I would like to dedicate this book to my wife Ann whose support is always there and to Mark Swain for reminding me that there are no problems, only solutions waiting to be found. Alan Meaden I would like to dedicate this to Amy, for her patience, and to Glynn Farmer for showing me that the owls are never what they seem. Andrew Fox Downloaded by [New York University] at 03:50 14 August 2016 This page intentionally left blank Downloaded by [New York University] at 03:50 14 August 2016 Contents List of figures xi List of tables xiii List of abbreviations xv List of contributors xvii 1 The need for innovation when providing services for the difficult to engage 1 ALAN MEADEN AND ANDREW FOX PART 1 Innovations in engagement and brief therapies 3 2 The Adapted Open Dialogue appoach 5 GERT VAN RENSBURG 3 Using Pre-Therapy in forensic settings 22 RICHARD BARKER Downloaded by [New York University] at 03:50 14 August 2016 4 Adapting Relapse Prevention strategies for use with difficult to engage populations 38 MORNA GILLESPIE 5 Brief interventions and single sessions as stages in a change process for people with psychosis 55 DEBORAH ALLEN viii Contents PART II Innovations in interventions for individuals 71 6 Cognitive Behavioural Therapy for emotional dysfunction following psychosis: The role of emotional (dys)regulation 73 MARK BERNARD, CHRIS JACKSON AND MAX BIRCHWOOD 7 Compassion Focused Therapy for people experiencing psychosis 91 SOPHIE L MAYHEW 8 An existential approach to therapy: Core values and therapeutic principles 111 CATHERINE AMPHLETT 9 Enhancing social participation and recovery through a cognitive-developmental approach 129 ANDREW FOX AND CHRIS HARROP 10 Telling stories and re-authoring lives: A narrative approach to individuals with psychosis 147 HELEN HEWSON PART III Innovations in group and whole team interventions 165 11 Group Rational Emotive Behaviour Therapy for paranoia 167 RICHARD BENNETT AND LOUISE PEARSON Downloaded by [New York University] at 03:50 14 August 2016 12 Team-Based Cognitive Therapy for distress and problematic behaviour associated with positive symptoms 184 ALAN MEADEN, ANDREW FOX AND DAVID HACKER 13 Long-Term Supportive Psychotherapy as a team-based therapy 200 ALAN MEADEN AND HELEN HEWSON 14 Team-Based Cognitive Therapy for problematic behaviour associated with negative symptoms 219 ANDREW FOX AND ALAN MEADEN Contents ix 15 Concluding remarks 234 ANDREW FOX AND ALAN MEADEN Index 237 Downloaded by [New York University] at 03:50 14 August 2016 This page intentionally left blank Downloaded by [New York University] at 03:50 14 August 2016 Figures 3.1 Grey-zone functioning 25 4.1 Completing early signs with the person 45 4.2 Early signs action plan 51 5.1 A 5Ps shared formulation of Paul 63 5.2 The ‘problem’ representation for Paul, with explorations of solutions and blocks to solutions 65 6.1 Formulation of emotional dysfunction following psychosis 85 7.1 Old brain–new brain 96 7.2 Three Circles Model of affect regulation 96 7.3 Compassion circle 99 7.4 Maggie’s formulation 103 7.5 Maggie’s reformulation 107 9.1 Formulation of Harold’s self-construction difficulties 142 11.1 The ABC model of psychological distress 168 11.2 An ABC form illustrated with Mavis’s example 172 11.3 John’s ABC 180 Downloaded by [New York University] at 03:50 14 August 2016 12.1 ABC mismatch 185 12.2 Shared formulation aims 188 12.3 CARM formulation of Matthew’s aggression towards staff 197 14.1 CARM formulation of Amanda’s specific behavioural deficit 230 This page intentionally left blank Downloaded by [New York University] at 03:50 14 August 2016 Tables 6.1 Measures of emotional regulation 79 9.1 Summary of useful resources 132 12.1 TBCT A to H relevance to clients and teams 186 12.2 Client and team parallel processes 187 13.1 Multi-axial formulation framework for Liam 213 14.1 Staff attributions pre- and post-formulation 231 Downloaded by [New York University] at 03:50 14 August 2016 This page intentionally left blank Downloaded by [New York University] at 03:50 14 August 2016 List of abbreviations AOT Assertive Outreach Team CARM Cognitive Approach to Risk Management CBT Cognitive Behavioural Therapy CTO Compulsory Treatment Order EWS-P Early Warning Signs of Psychosis EWS-R Early Warning Signs of Risk HDU High Dependency Unit MDT Multidisciplinary Team PLF Personal Level Shared Formulation PICU Psychiatric Intensive Care Unit REBT Rational Emotive Behaviour Therapy SAFE Shared Assessment, Formulation and Education Downloaded by [New York University] at 03:50 14 August 2016 This page intentionally left blank Downloaded by [New York University] at 03:50 14 August 2016 Contributors Deborah Allen, Clinical Psychologist, Derbyshire Healthcare NHS Foundation Trust. Deborah Allen is a clinical psychologist working within a RAID model liaison team in Derbyshire. Her work includes supporting people who are admitted to hospital for physical health problems and who may experience an onset of mental health difficulties or have pre-existing mental health problems. Her work also includes supporting people who attend at the emergency department having undertaken an act of deliberate self-harm. Catherine Amphlett, Principal Clinical Psychologist, Birmingham and Solihull Mental Health NHS Foundation Trust. Catherine Amphlett is a clinical psychologist for the recovery and rehabilitation inpatient services at Birmingham and Solihull Mental Health NHS Foundation Trust. She also trained as an existential psychotherapist at the New School of Psychotherapy and Counselling and uses an existential approach as a basis for therapeutic integration in her clinical work.
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