Downloaded by [New York University] at 04:33 12 August 2016 Hallucination-focused Integrative Therapy Hallucination-focused Integrative Treatment (HIT) is a specific treatment for auditory verbal hallucinations which integrates techniques from CBT, systems therapy, psychoeducation, coping training, rehabilitation and medication. It emphasizes active family involvement, crisis intervention when required and spe- cialized motivational strategies. In clinical trials HIT has been proven to have long lasting and wider ranging effects than other therapies, high patient satisfac- tion scores and a low drop-out rate. In Hallucination-focused Integrative Therapy, Jack Jenner presents a full man- ual for using HIT with patients. Divided into five parts, the book offers a clear and straightforward explanation of each aspect of the treatment. Part 1 introduces auditory verbal hallucinations in their social and historical context. Part 2 explains the need for an integrative approach to treating them and sets out the 11-step diagnostic procedure. Part 3 describes the treatment in full, including motivational strategies, the constituent modules and how to integrate them, flexible implemen- tation of a tailor-made procedure and its overall effectiveness. It also demon- strates the use of HIT with specific patient groups, including those suffering from trauma, children and adolescents, those who are suicidal and those with learning difficulties. Part 4 examines other hallucination-focused therapies. Finally, Part 5 covers insight-oriented psychotherapies. The book also includes several appendi- ces of supplementary material which enhance the content. Illustrated throughout with case studies and clinical material, Hallucination- focused Integrative Therapy will be of interest to psychiatrists, psychologists, neurologists, psychiatric nurses and social workers working with patients who Downloaded by [New York University] at 04:33 12 August 2016 experience auditory verbal hallucinations. Jack A. Jenner is a consultant psychiatrist and psychotherapist registered for children and adolescents as well as adults in the Netherlands. He has been present- ing and giving workshops internationally on issues relating to emergency psychia- try, suicidology, psychiatry and hallucinations for over 30 years. He is the director of AUDITO, a centre for diagnosis and treatment of people with auditory verbal hallucinations, and is the creator of HIT. He has formerly been associate profes- sor of community psychiatry at Groningen University and visiting professor at Banaras Hindu University. ‘In this book you will find a novel treatment for persons who suffer from voice- hearing. Over the last 25 years Dr. Jenner has developed and researched a concise goal-directed and evidence-based treatment: HIT! This book is a must read for those interested in treating persons who very often suffer for long periods, despite biological treatments, from voice-hearing. You will find in this book a systematic approach, with many clinical details and which pays special attention to treating specific subgroups of patients, e.g. children. We are very happy that his work on HIT is now also available for a large international audience.’ – Bert L.B. Luteijn MD, Psychiatrist and Chair of the Dutch HIT Implementation Network, the Netherlands ‘A brilliant book that places “hands-on” therapeutic interventions in an innovative theoretical framework. Jenner’s pioneering treatment for auditory verbal halluci- nations is acceptable to patients and relatives. There is a spirit of personal involve- ment and a willingness to go beyond guidelines towards personal needs, written in a coherent style. Exquisite case-vignettes illustrate the “what” and the “how” of his method across a range of contexts and patient needs including suicidality, treatment-resistant schizophrenia, borderline personality disorder, post-traumatic stress disorder, intellectual disability and childhood psychosis. This book will keep us going for years.’ – Jim van Os, Professor of Psychiatry, Maastricht University Medical Centre, the Netherlands ‘In this outstanding resource, Jack Jenner provides an elegant and helpful syn- thesis of the HIT program. Evidence-based strategies to relieve distressing hal- lucinations are presented in depth, always illustrated with key clinical cases. An absolute must-read book for every clinician working with hallucinations.’ – Renaud Jardri, University of Lille, France ‘This book compiles the long experience of one of the leading experts in the thera- peutic approach to hallucinations. Jack Jenner has developed the most complete program currently existing on hallucination-focused integrative therapy, with a wide range of very practical modules of sequenced and combined interventions, which may be adapted to the specific needs, characteristics and circumstances of each patient and his/her hallucinatory experiences. Learning and conducting this hallucination-focused integrative therapy is of great interest for all mental health professionals working in this field.’ – Manuel González de Chávez, Ex-President of the International Society for Psychological and Social Downloaded by [New York University] at 04:33 12 August 2016 Approaches to Psychosis Hallucination-focused Integrative Therapy A specific treatment that hits auditory verbal hallucinations Jack A. Jenner Downloaded by [New York University] at 04:33 12 August 2016 First published 2016 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2016 Jack A. Jenner The right of Jack A. Jenner to be identified as author of this work has been asserted by him 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 Jenner, J. A. (Jacobus Adrianus), 1944- Hallucination-focused integrative therapy : a specific treatment that hits auditory verbal hallucinations / Jack A. Jenner. pages cm Includes bibliographical references and index. 1. Auditory hallucinations—Treatment. I. Title. RC553.A84J46 2016 616.89—dc23 2015020699 ISBN: 978-1-138-93230-2 (hbk) ISBN: 978-1-138-93231-9 (pbk) ISBN: 978-1-315-67935-8 (ebk) Typeset in Times by Swales & Willis Ltd, Exeter, Devon, UK Downloaded by [New York University] at 04:33 12 August 2016 For Marianne my muse, beloved love and companion Downloaded by [New York University] at 04:33 12 August 2016 Downloaded by [New York University] at 04:33 12 August 2016 Contents Foreword xii PART 1 Auditory verbal hallucinations in context 1 1 Introduction 3 Are hallucinations abnormal? 5 The impact of auditory verbal hallucinations 7 Prevalence and incidence rates of auditory verbal hallucinations 8 2 Historical perspectives 10 What does the research tell us? 11 PART 2 The need for hallucination-focused interventions 13 3 Psychosocial interventions 15 Introduction 15 Effectiveness of psychosocial interventions 15 Downloaded by [New York University] at 04:33 12 August 2016 The art of integrating therapeutic interventions 17 4 Hallucination-focused Integrative Treatment 19 The HIT format 24 Adding or integrating interventions and models of care 26 Tailor-made or theory-driven interventions? 28 Intake 28 The two-realities principle 29 Consequences of causal concept ordering 29 viii Contents Tailoring HIT 30 Less is more 31 Motivational strategies 31 Motivating patients who avoid contact 33 Motivational interventions 36 Motivational strategies that are regularly used in HIT 40 Diagnosing auditory verbal hallucinations 53 HIT’s ‘11 step’ diagnostic procedure 54 Step 1: Differential diagnosis 54 Step 2: Determine whether the voices are really heard 57 Step 3: Assess risks 57 Step 4: Search for somatic disorders, as well as possible side-effects of medication 57 Step 5: Assess for psychiatric disorders 57 Step 6: Assess personality traits 58 Step 7: Assess the characteristics of AVHs 58 Step 8: Determine to what extent the voices serve a function for the patient in terms of secondary gain 61 Step 9: Assess whether reactions from relatives selectively reinforce AVHs 61 Step 10: Assess which coping strategies have been tried and their efficacy 62 Step 11: Estimate the levels of reluctance and disability 63 Assessment instruments for AVH-related psychiatric disorders 64 Dissociation Experiences Scale 64 Dissociation Questionnaire 64 Positive and Negative Symptom Scale 64 Schedule for Clinical Assessment in Neuropsychiatry (SCAN) and mini-SCAN 64 WHO Quality of Life Scale brief 65 Downloaded by [New York University] at 04:33 12 August 2016 Illness Effects Questionnaire 65 Groningen Social Disabilities Scale 65 Cases illustrating the HIT diagnostic procedure 65 Medication and compliance 68 Coping training 69 Be aware of pitfalls 71 Coping training monitoring scheme 1 72 Coping training monitoring scheme 2 72 Coping training