For June 22, 2009 Meeting:

We will continue a discussion about creativity and its role in creating psychosis and possibly in aiding in recovery from psychosis.  One time of day when we are all extremely creative, as well as quite psychotic in a sense, is when we dream.  A good description of some of the links between the dream process and what happens in psychosis is in Schizophrenia: Waking Reality Processed through the Dreaming Brain.

Some people have noted that while psychosis seems like a sort of "waking dream" it often lacks the playful quality of dreams, and people get stuck around certain themes.  Interestingly enough, people who have been traumatized are especially likely to get stuck even in their sleeping dreams, for example in recurrent nightmares.  A method to awaken their mind to alternate possibilities and dream outcomes is described in a New York Times called Rewriting Your Nighmares. A good example of a therapist doing something similar with imagination, only this time with a child's voice, can be found in Silencing unwelcome voices in children.

A more radical method to awaken the imagination is the use of psychedelics.  While not likely to be revived anytime soon, just from a theoretical point of view it is interesting to consider how stories like those described at http://www.hofmann.org/papers/fisher/fisher_4.htm  are even possible.  Check out for example the story about the girl in 24 hour a day restraints due to her extreme self destructive behavior, who was expected to die from her psychosis, who instead saw God and became a bright student.  A pretty amazing account.

One reason that encouraging creativity goes against the grain of most modern treatment is that creativity is generally a fairly disorderly process, and since we see the problem as disorder, we try to impose order as quickly as possible.  The problem though is that this tends to be an order imposed from the outside, so the person ends up feeling that they and their natural way of seeing things is "mentally ill" and must be suppressed by exterior means, such as a lifetime of medications and deference to the opinion of mental health workers.  The approach of "dreaming the dream on" or encouraging the person to continue the creative process till they come to a better outcome, is scary to a system that overly values order.  Some of these issues are discussed in a chapter from the book "Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process" by John Weir Perry.  Available at http://www.efn.org/~ronunger/stuff/Perry%20chapter.pdf  (Note that this book is written from a Jungian, not a cognitive, perspective:  however it might be interesting to discuss how one might apply, or modify and then apply, some of these insights within work that overall follows a cognitive perspective.)

For June 1 Meeting (rescheduled from May 2009):

Our topic will be "Creativity and Psychosis".  This should be an interesting discussion, looking at both the nature of creativity and the nature of psychosis, how the two intersect, and how one might use an understanding of that when helping our clients. One suggested article is Tracking a Finer Madness. Another is Schizotypy and mental health amongst poets, visual artists, and mathematicians. I also pasted in some comments I wrote about the latter article at the bottom of this message.  In these comments I address something that was touched on in our last meeting (how it can be difficult to see creativity as having a role in psychosis, given that people often seem caught in patterns that are the opposite of creativity.  The truth may be that they get into trouble by being "too creative" then overcompensate into being too uncreative, too rigid - so either extreme may be seen, or a mixture of both extremes.

You can also read about how the topic of psychosis and creativity recently hit Newsweek, with an interview of Portland resident Will Hall. If you want to find out more about Will you can read his recovery story or read about a new group he is forming in Portland called Portland Hearing Voices.

For April 2009:

Our topic will be "metacognitive training".  This means training people to change how they go about thinking and making conclusions. One suggested reading is Explaining delusions: a cognitive perspective. This reviews some of the theory of thinking problems that lead to psychotic viewpoints. Also we will be looking at a training program developed in Europe called Metacognitive Training for Patients with Schizophrenia (MCT) that can be used in a group format for clients prone to psychosis. 

For March 2009:

Our topic will be working with families.  While I am told that cognitive therapists working with psychosis usually do a lot of family work, there actually isn't much written on exactly how they go about it.  Here are some suggested readings. Working with families following the diagnosis of an at risk mental state and Windhorse Guide For Families.

For February 2009:

Video documentary "The doctor who hears voices" is about a doctor who hears voices but doesn't want to take meds or quit being a doctor, so she seeks help from Rufus May, a psychologist who himself had decades ago been diagnosed with schizophrenia, and who helps her with an exclusively psychological approach.  I wouldn't recommend everything Rufus does, but it makes for some interesting discussion!

Suggested reading Dr. Rufus May: Understanding Psychotic Experience and Working Towards Recovery.

For January 2009:

We will be watching some videos demonstrating cognitive therapy for psychosis, with Turkington and Kingdon being the two therapists who demonstrate their skills.  The excerpts are short, so plenty of discussion will be mixed in.

For December 2008:

We will be discussing the function of metaphor in psychosis and in therapy for psychosis.  Since this topic is not much addressed in most literature on cognitive therapy for psychosis, we will be looking at articles that were written from more of a psychodynamic perspective.  Then, we will discuss how to fit an understanding of our client's metaphors or possible metahphors into a cognitive therapy approach. Please read Psychotherapy with "Schizophrenia": Analysis of Metaphor to Reveal Trauma and Conflict (if time is short, skip to page 11) by Richard Shulman and Trauma and Schizophrenia by Bertram Karon.

For November 2008:

The primary topic will be how to use a method which involves mapping out opposite extremes, as well as an optional "middle way" as a method of both understanding and working with people who have psychotic experience. PowerPoint slides will be presented related to this topic.  There is no assigned reading for this meeting.  One interesting article to look at is: http://www.efn.org/~ronunger/stuff/illusory%20pattern%20perception.doc. 

For October 2008:

The primary topic will be coping methods, and how to sort out the effective ones from the ones that backfire and make things worse. Two chapters related to this topic are available at http://www.efn.org/~ronunger/stuff/coping%20that%20backfires.pdf

Both these chapters are for books written for consumers.  The first chapter is from "Think you're crazy?  Think again" and is titled "Helpful and unhelpful ways of coping."  The other chapter is from "Get out of your mind and into your life" and is titled "Why language leads to suffering." 

For September 2008:

The primary topic will be using acceptance and commitment therapy with psychosis. Acceptance and Commitment therapy has been called a "third wave" form of cognitive and behavioral treatment - most noted for the way it integrates mindfulness, and focuses on accepting symptoms rather than actively attempting to get rid of them.

One easy to read article is available at http://www.efn.org/~ronunger/stuff/Intro%20to%20ACT.pdf
This is an introduction to acceptance and commitment therapy in general. The author summarizes the
therapy with the motto "embrace your demons, and follow your heart."

For August 2008:

The primary topic will be how to talk to clients honestly and in a collaborative fashion about medications. We'll be looking at Chapter 10, "Using Medications" from the book "Think you're crazy? Think again: A resource book for cognitive therapy for psychosis" by Morrison, Renton, French and Bentall.
You can access this chapter at http://www.efn.org/~ronunger/stuff/using%2520medications.pdf

As another resource on this topic, you could read Ron Unger's guide for therapists who want to help clients reduce or get off medications, at http://recoveryfromschizophrenia.org/blog/?page_id=31
This guide contains links to many helpful resources.

For July 2008:

The primary topic will be working with what cognitive therapists call "schema change, which means working to change underlying beliefs and ways of looking at self and the world that make a person vulnerable to psychosis and other psychological problems. This kind of work can be of value to many clients, not just those with psychosis.

We'll be looking at Chapter 10, "Schema change methods" from the book "Cognitive therapy for psychosis: A formulation based approach" You can access this chapter at http://www.efn.org/~ronunger/stuff/schema%20change.pdf

For June 2008:

The primary topic will be working with behavior, especially how to identify and work with what are called "safety behaviors." We will also discuss the use of safety behaviors by the mental health system itself, and the impact that has on treatment effectiveness. We'll be looking at Chapter 9, "Behavioral techniques" from the book "Cognitive therapy for psychosis: A formulation based approach" and also at Chapter 9, "Safety Behaviors" from "Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis." You can access these chapters at http://www.efn.org/~ronunger/stuff/behavioral%20methods.pdf and at http://www.efn.org/~ronunger/stuff/safety%20behaviors.pdf

For May 2008:

We'll be looking at Chapter 9 Behavioral Techniques from the book "Cognitive therapy for psychosis: A formulation based approach" and also at Chapter 9 Safety Behaviors from "Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis." You can access these chapters by clicking on the titles above.

For April 2008:

One particular focus will be on the "Talking with Voices" approach, where the therapist attempts to directly communicate with the voice. You can read about this approach at:
http://www.intervoiceonline.org/2006/12/6/talking-with-voices-by-dirk-corstens-and-rufus-may

and another good article at:
http://www.en.transformationalpsychology.com/index.php?cmd=page&id=2676

For December 2007:

Click here for the the attached chapter, which presents a case study as well as some theoretical background related to cognitive subsystems theory.  Discussion about this case should fit in well with any leftover points or questions about  dissociation and psychosis, which was November’s topic.

One possible additional topic for this meeting is how to discuss evidence about a genetic link with our clients:  how can we approach such a discussion so that we are both consistent with the science and are framing things in a way most likely to help support recovery by the client? 

A couple links about genes and schizophrenia:  First, a link to an article that points out weaknesses in studies that are traditionally cited to prove the link between genes and schizophrenia:   http://www.icspp.org/index.php?option=com_content&task=view&id=128&Itemi  
Second, a link to an article that suggests adopted children with some genetic risk may only be truly “at risk” if exposed to certain kinds of environments: 
http://ajp.psychiatryonline.org/cgi/reprint/154/3/355

For November 2007:

Please click here to read the paper on the relationship between dissociation and psychosis. Some other things you may want to look at include:
http://www.rossinst.com/des.htm - on this page you can find, if you skim down to find it, a dissociative experiences scale, that gives you an idea of the kind of experiences that are considered to indicate dissociation. An older article that presents a historical perspective (I've only skimmed this so far) is at:
https://scholarsbank.uoregon.edu/dspace/bitstream/1794/1571/1/Diss_7_4_8_OCR.pdf
For those of you who really want to get into this subject, you might want to read the book Schizophrenia: Innovations in Diagnosis and Treatment by Colin A Ross (2004). Or perhaps you will just get something out of reading the abstract!
http://0-gateway.tx.ovid.com.janus.uoregon.edu:80/gw2/ovidweb.cgi?S=FJI

For September 2007:

The suggested reading is Chapter 10 in the book "Staying Well After Psychosis" (for more information about the book see below).

For August 2007:

The suggested reading is Chapter 9, Interpersonal Strategies, in the book "Staying Well After Psychosis" (for more information about the book see below).

For July 2007:

The suggested reading is Chapter 7 Working with Interpersonal Distrust, and chapter 8, working with traumatic reactions, in the book "Staying Well After Psychosis."

For June 2007:

The suggested reading is Chapter 6, "Reorganization of the self in recovery: working with humiliation, entrapment and loss" in the book "Staying Well After Psychosis."  (You don't need to read the book to attend, but it will help.)  You may also want to read chapter 5, if you have the time.  Staying Well After Psychosis: A Cognitive Interpersonal Approach to Recovery and Relapse Prevention by Andrew Gumley & Matthias Schwannauer. You can find this book pretty cheaply at www.bookfinder.com.

For May 2007:

The suggested reading is Chapter 4, "Overview of principles and procedures" in the book "Staying Well After Psychosis."  (You don't need to read the book to attend, but it will help.)  Note that the first 3 chapters of the book also have a lot to offer, if you have the time.  Staying Well After Psychosis: A Cognitive Interpersonal Approach to Recovery and Relapse Prevention by Andrew Gumley & Matthias Schwannauer. You can find this book pretty cheaply at www.bookfinder.com.

For April 2007

If you have the book, Cognitive Therapy of Schizophrenia, by Kingdon & Turkington, please read chapter 15 before you come.  (Take notes, write down questions you would like to see discussed!)  And please consider bringing some case examples if you have them.

Please read Chapter 5, 6 and 7 in Cognitive Therapy of Schizophrenia (Guides to Individualized Evidence-Based Treatment) by David G. Kingdon and Douglas Turkington (Hardcover - Nov 15, 2004). Please write down some of what you think are the main points regarding these topics, and any experiences or questions of your own which relate to these topics.  This will help insure that we have a great discussion.