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Background: Life narratives are an underutilized mechanism to understand experiences of people diagnosed with serious mental illnesses (SMI). Understanding one's life can help form a narrative identity (i.e. one's integrated, internalized life story), which helps individuals make sense of their lives, sense of self, and relationships with other people. This increased awareness can thus enable effective self-management and living a meaningful life. The purpose of this exploratory study was to examine life narrative interviews completed with individuals with SMI. By doing so, we aimed to elucidate important aspects of life narratives and inform narrative identity. Method: Participants completed a semi-structured interview in which interviewers asked participants to narrate the story of their lives. Interviews of 11 participants were transcribed and analyzed by three independent coders using thematic analysis. Results: Five themes emerged: (1) Isolation; (2) Adverse Social Interactions; (3) Adverse Life Events; (4) Formative Socialization; and (5) Growth Narratives. Discussion: Findings from this exploratory study add context and depth to established psychological concepts important in understanding the lives of persons with SMI, including adversity, trauma, and resilience. Further, we hope this study informs psychological treatments, for example with further understanding resilience and recovery. [ABSTRACT FROM AUTHOR]

Psychotherapy for individuals with psychosis is an effective treatment that promotes recovery in various ways. While there is strong quantitative evidence across modalities, less is known from the patient's perspective. There are many varied forms of psychotherapy, and gaining the patient's perspective can improve understanding of salient elements of psychotherapy and increase engagement, ultimately improving recovery rates. The purpose of this review is to identify and integrate data from published studies of patient perspectives of psychotherapy for psychosis to understand essential elements across approaches, differences between approaches, and how psychotherapy impacts recovery. We aimed to understand further: what are the perceptions about individual psychotherapy from the perspective of individuals with psychosis? The current study was a systematic review using PRISMA guidelines of studies that included qualitative interviews with persons with experiences of psychosis who participated in psychotherapy. All three authors participated in the literature search using Pubmed, APA PsycInfo, and Psychiatry Online. We identified N = 33 studies. Studies included cognitive therapies, acceptance and mindfulness approaches, trauma therapies, metacognitive therapy, and music therapy. All studies reported participants' perceived benefit with the therapeutic relationship as especially salient. Participants described diverse aspects of objective (e.g., symptoms, functioning) and subjective (e.g., self-experience or quality of life) recovery improvements, with perceived mechanisms of change, and with music therapy having some unique benefits. Participants also reported challenges and suggestions for improvement. Study findings highlight the salient aspects of psychotherapy identified by patients that may help therapists to individualize and improve approaches to psychotherapy when working with individuals experiencing psychosis. Overall, findings support the potential for integrative psychotherapy approaches for maximal treatment personalization. [ABSTRACT FROM AUTHOR]

The term schizotypy refers to the latent personality organization that is thought to underpin the liability to develop schizophrenia and associated disorders. Metacognition, or the ability to understand and form increasingly complex and integrated ideas of oneself, others, and one's community, has been proposed to be an important transdiagnostic construct across schizophrenia spectrum disorders and a range of both clinical and non-clinical manifestations of schizotypy. In this paper, we review evidence that deficits in metacognition are present in individuals with relatively high levels of schizotypy and that these deficits are related to symptomology, function, and quality of life. We address the idea that decrements in metacognition may also contribute to the progression from schizotypy to more severe manifestations, while the amelioration of these deficits may enhance aspects of recovery, including the ability to form an integrated sense of self, others, and the wider world. We also review the following two recovery-oriented psychotherapies that target metacognition to promote recovery in individuals with clinical manifestations of schizotypy: Evolutionary Systems Therapy for Schizotypy (ESTS) and Metacognitive Reflection and Insight Therapy (MERIT). [ABSTRACT FROM AUTHOR]

Hope is known to be a crucial factor that can facilitate recovery from psychosis. In contrast, hopelessness has been associated with a variety of poor outcomes for people with psychosis, such as low self-esteem, depression, and suicide. While hope is central to recovery, the concept of hope can be challenging to identify and define. Furthermore, little is known about how psychotherapists can help people with psychosis reawaken a sense of hope that enables them to recover and lead meaningful lives with a severe mental illness. In this paper, the concept of hope is explored based on a selective review of the psychological and philosophical literature and through engagement with first-person accounts of psychosis. Following the review, key principles and interventions are described, including the importance of reckoning with therapist's hope, processing hopelessness, facilitating a sense of belonging, fostering agency, and making meaning of the psychosis and promoting spirituality, that can rekindle a sense of hope. These principles and interventions are transtheoretical and can be applied to a variety of psychotherapeutic orientations. Finally, future directions are considered and possible factors that might enable the formation of hope for people living with psychosis are explored. [ABSTRACT FROM AUTHOR]

Objective: While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. Methods: A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Results: Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person's identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Conclusion: Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope. [ABSTRACT FROM AUTHOR]

The experience of psychosis involves changes in an individual's sense of self and their understanding of others and the world around them. Studying life narratives and narrative identity offers one way to better understand these changes. Narratives of persons with psychosis display alterations in their themes, structures, and processes. These narratives often portray the person as possessing relatively little sense of agency, without meaningful connections to others, and often describe events in a negative emotional tone. The structure of these narratives often lacks temporal cohesion, unfolding in a disjointed manner. The overall structure and content of narratives further appear to struggle to respond to experience, suggesting that individuals with psychosis may have difficulty incorporating new information into their narrative, leading to a lack of narrative evolution. This body of research illustrates how psychosis reflects the interruption of an unfolding life in which sense of self is compromised and cannot be understood as a collection of symptoms and skill deficits. There is a need for treatment to address disruptions in personal narratives among persons with psychosis to promote a sense of purpose, possibility and meaning. As our understanding of psychosis continues to evolve and we emphasize first-person life stories, the authors believe that stigma in providers will decrease and the importance of subjective recovery will be further revealed. [ABSTRACT FROM AUTHOR]