Psychodynamic and Cognitive Approaches to Psychosis



by Aaron Beatty

Jeremy Ridenour, PsyD is a Fellow in Psychology at the Austen Riggs Center.“I’ve always been interested in psychosis and how to address it,” states Riggs Fellow Jeremy Ridenour, PsyD, who has been writing and presenting on the topic for several years. His research has led him to the exploration of “ways to bridge the gap between psychodynamic and cognitive therapy in treating psychosis.” 

Individuals experiencing psychosis can often become paranoid, confused and unable to trust what is real. Dr. Ridenour explains, “Often people who experience psychosis – due to the medications they are on and the way they’ve been taught to manage their illness –  shut down their thinking” because experiences of disorganization, paranoia and confusion are so frightening. This, he says, leads to the question: “How can you help people bring their thinking back online; how can you teach people to trust and learn when their minds are working and, when that breaks down, give them strategies they can use to correct themselves?” 

One of the approaches that interests Ridenour stems from work on metacognition and psychosis (Lysaker and Roe, 2016). These researchers prioritize the centrality of agency and self-development driven by the individual in addition to finding ways of helping people exercise their metacognitive faculties (i.e., the ability to synthesize and reflect upon cognitive processes). “Rather than tackling a delusion head on, which does not have a lot of effect, they are trying to teach people how to solve problems,” he says. One such problem is jumping to conclusions, a cognitive error everyone commits. For example, when someone cuts us off while driving, we may develop a quick negative opinion of the driver (What a jerk!) without considering the driver’s motivation - maybe s/he is rushing to the hospital. Ridenour explains how this relates to psychosis: “Someone with a delusion is doing this [jumping to conclusions] all the time, so there is a need to help people recognize when to trust and when not to trust their intuitions, how to use their mind and to begin to understand the difficulties they have in their thinking.” 

Ridenour sees this approach as a place where psychodynamic therapists and researchers “can join cognitive therapists and researchers to help those experiencing with psychosis build up, in psychoanalytic terms, their observing ego so they can begin to more effectively use their mind.” Helping psychotic patients build a framework for their thinking, Ridenour believes, will also help them manage their troubling thoughts and anxieties. 

Ridenour is currently working on a paper that explores the relationship between delusions, imagination and metacognition. 

Reference: Lysaker, P. H., & Roe, D. (2016). Integrative Psychotherapy for Schizophrenia: Its Potential for a Central Role in Recovery Oriented Treatment. Journal of clinical psychology, 72(2), 117-122.

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