Researching Psychodynamic Psychotherapy for Psychosis: Are We Ready Yet?

I write this as a person who has experience of that thing we call psychosis, an experience that has run through a range of diagnoses (from schizophrenia to dissociative identity disorder). I was asked to speak about two things for the ISPS UK conference ‘Researching Psychodynamic Psychotherapy for Psychosis’1: (1) Why is it important for people who experience ‘psychosis’ to have access to psychodynamic psychotherapy? (2) What should be researched in this area? These two questions are more complex than they may seem on first reading.

This answer is easy - it's about choice. There are multiple pathways to ‘recovery’ for those in distress. If someone wants to choose the psychodynamic route, we should do all we can to make this available to them. However, I also think that people have the right to choose a whole range of pathways - including cognitive behavioural therapy (CBT), medication, art therapy, spiritual release and tai chi. In a world where our evidence for interventions is flawed, surely we each have the right to choose the range of options we find most helpful to manage our mental wellbeing?

But, do I think that we should encourage people to try psychodynamic psychotherapy as a treatment option? Should the NHS invest more in it? My answer to this is that, in all honesty, I don't know. That is why we need research.

My own feelings about this modality are complex. On the one hand, I recognize the value in an approach that can, when done well, provide people with the precious opportunity to be heard. I welcome therapeutic relationships that help create the space for people to explore and reflect on powerful experiences, finding meaning in what people often dismiss as incoherent or ‘mad’. This appreciation of personal meaning is an oasis in a more positivist culture where we are all too often seduced by the perceived concrete certainty of biology and time-limited