The Sense of Agency and the Search for a Narrative in Acute Psychosis

The search for a narrative in acute psychosis exists but the result of this search can be insufficient because the stories available do not sufficiently capture the pre-narrative quality of personal experience, and hence the sense of agency may be diminished. The context of reflexivity is lost when a subjugating story blocks an individual off from making a choice from among a multiplicity of stories. Psychosis can also be an escape in order to maintain a sense of agency. When the patient has trouble in creating meaning through narrative action, the aim of therapy and treatment is to open a channel through which the pre-narrative quality of life can become narrated, to create a multiplicity of stories, and so offer the possibility of choice in the construction of a narrative identity.     

The Experience of Time in Acute Psychosis and Schizophrenia

From the narrative point of view the plot of a story configures time. In psychosis, when experiences remain unnarrated, experience being-in-time is also missing. Once experiences are given narrative form, they can be left behind as a part of individual's personal history, thus enabling present experiences to be narrated. Unnarrated experiences do not accumulate. Narrative history contains, however, enough redundancy to invite you to restory your past in a new way if you need to. Hence, from the narrative point of view, early, family- and network-centered intervention is of special value in cases of acute psychosis.     

Psychoanalysis and Psychosis: Trends and Developments

This paper presents the basic principles of insight-oriented therapy for schizophrenia, emphasizing the effectiveness of this approach: each treatment effort is a unique adventure, fueled by hopefulness in both participants. Next, it reviews the history of such treatment efforts and current tensions in the field. It presents information on the International Society for the Psychological treatments of the Schizophrenias and other psychoses (I.S.P.S.) and its current mission, to promote quality care for patients suffering from schizophrenia, to promote and facilitate research into this work, and to provide organizational support and ongoing educational programs for clinicians involved in these efforts.     

The Embodied and Contingent Self in Later Life: A Narrative Understanding

This article examines a narrative understanding of identity and discusses its relevance within the sociocultural contingencies of the postmodern age. Providing an historical overview of understandings of the self, Meador traces the lineage of the self from Augustine through contemporary theories of identity. He focuses on the narrative concept of identity, acknowledging the existence of multiple narratives—those that individuals tell about themselves and those told by others. Finally, he explores the transformative potential available within this context for those in their later years.     

Schizophrenia and the experience of intersubjectivity as threat

Many with schizophrenia find social interactions a profound and terrifying threat to their sense of self. To better understand this we draw upon dialogical models of the self that suggest that those with schizophrenia have difficulty sustaining dialogues among diverse aspects of self. Because interpersonal exchanges solicit and evoke movement among diverse aspects of self, many with schizophrenia may consequently find those exchanges overwhelming, resulting in despair, the sensation of fusion with another, and/or self-dissolution. In short, compromised dialogical capacities may be a contributing factor to social dysfunction in schizophrenia.     

Expressed Emotion In The Narrative Context of Family Photographs

This study aims to elucidate cognitive and contextual aspects of the EE (Expressed Emotion) concept. The EE levels of both parents of two first admission psychotic patients were rated from the Five Minute Speech Sample (FMSS), and the emotional responses were further analyzed in narratives of family photographs. The attribution model was found to provide an explanatory framework for understanding relatives' expressed emotions (EE) toward a family member suffering from psychotic disturbances. Four case reports indicated that family photographs induced parents to create narratives in which emotions, attributions, and strategies for coping with stressful aspects of the illness came forward as intertwined phenomena. The method can offer more comprehensive data for intervention strategies aiming to alter the prevailing atmosphere and interaction patterns within the high EE family.     

The self-narrative and acute psychosis

The aim of this study was to apply the narrative approach in analyzing family therapy meetings in cases of acute psychosis. The self-narrative is essential in acute psychosis since it is either collapsed or not coherent enough. The results indicate that it is important to create concrete practices that produce stories concerning the patient in relation to others. The self-narrative must be re-authored by the patient even though it is socially constructed. This is achieved by creating multiple perspectives of self-narratives in so-called therapy meetings with the patient, family members, and staff members representing different professionals.     

叙事心理治疗的后现代视角

叙事心理治疗,作为一种本体存在一伦理实践的总体取向,隐含着某些基本的后现代主义视角,尤其是语言观的根本转变。现代主义的观点把语言看作是对现实的表征,而后现代主义关注语言的本体论地位,关注我们如何使用叙事和文本来建构和解构我们的生活世界,强调话语实践的自我反思性。该文探讨了后现代语境中心理治疗的几个关键问题,并讨论了叙事观在心理治疗的临床实践中的应用含义。     

Cognitive-Behavioral Therapy for Individuals Recovering from a First Episode of Psychosis

Schizophrenia is one of the most devastating psychiatric illnesses. There has been a tremendous worldwide research and clinical effort into early intervention for psychosis. However, despite significant improvement in symptoms after a first episode, there is no corresponding quality improvement in function for many individuals. Thus, increased attention has been given to psychological intervention in particular cognitive behavioral therapy (CBT) with the hope of enhancing functional recovery. Outcome trials of CBT for schizophrenia are promising and other work in CBT suggests this may be a viable psychological intervention for this population. This paper will review the need for a CBT approach after a first episode of psychosis and describe a modular CBT approach for this population. This approach addresses adaptation as well as both functional and symptomatic outcome, an approach which parallels the theoretical shift in CBT that occurred in the last decade.     

后现代叙事心理治疗探幽

近15年来国际心理治疗界出现一种由科学隐喻向叙事隐喻转变的潮流。它突出了心理问题的多维性和生活方式的多样性,强调整体联系的视角,与中国文化中的“大人”思想相契合。对叙事心理治疗做探讨,分为三个部分:什么是叙事心理治疗,介绍对叙事心理治疗的整体理解;叙事心理治疗的哲学渊源,介绍叙事心理治疗的理论基础;伦理问题,探讨叙事心理治疗在组织实施过程中权力关系与责任分布。     

纳西族和汉族儿童情绪理解能力的发展

选取3～5岁的纳西族儿童107人,3～5岁的汉族儿童90人,使用情绪理解任务系统地考察了他们情绪理解的发展,同时还测量了两个民族儿童的错误信念理解和语言能力。结果表明,两个民族儿童情绪理解能力具有相似的发展规律,但完成各任务的成绩有显著差异,提示了两个民族儿童情绪理解能力发展的不同步性。研究还发现,心理理论社会知觉成分与认知成分随年龄的增长相互促进和相互制约,并且都与语言能力有关。     

自我的社会建构观与叙事辅导

叙事辅导以自我在话语中形成的社会建构主义观点为理论基础,认为人类依据故事而生活;强势故事和强势话语塑造着人们的生活;生活是不断超越旧我走向新我的非等同圆运动的过程。叙事辅导通过引导当事人解构旧的生活故事,重写新的生活故事而达到对问题的解决。     

Through Solidarity to “Fluidarity”: Understanding Difference and Developing Change Agency Through Narrative Reflection

This paper examines the development of the concept of solidarity as expressing a sense of shared humanity, while detailing critiques of its current use, especially when it implies a privileged center setting the agenda for the sake of marginalized others. My research demonstrates how solidarity can be modified when encountering difference, and how it might be better conceptualized as “fluidarity,” an attitude and practice that embraces the complexity of engaging the other in pluralized and ever‐changing struggles. This engagement with otherness, an explicit part of an undergraduate theological ethics course with an embedded service‐learning component, is pedagogically facilitated by a threefold reflection process required of students: critical reflection on their own narratives, reflection on the narratives encountered in their service‐learning, and reflection on the lives of spiritually grounded agents of social change. Case studies of four undergraduate students demonstrate the ways in which this pedagogical strategy contributes to the development of solidarity and moves students' understanding towards fluidarity. In the end, the students gained a sense of spiritually grounded change agency, combining spiritual development with growth in critical consciousness.     

Narrative Representation and Phenomenological Knowledge

The purpose of this paper is to demonstrate that narrative representations can provide knowledge in virtue of their narrativity, regardless of their truth value. I set out the question in section 1, distinguishing narrative cognitivism from aesthetic cognitivism and narrative representations from non-narrative representations. Sections 2 and 3 argue that exemplary narratives can provide lucid phenomenological knowledge, which appears to meet both the epistemic and narrativity criteria for the narrative cognitivist thesis. In section 4, I turn to non-narrative representation, focusing on lyric poetry as presenting a disjunctive objection: either lucid phenomenological knowledge can be reduced to identification and fails to meet the epistemic criterion, or lucid phenomenological knowledge is provided in virtue of aesthetic properties and fails to meet the narrativity criterion. I address both of these problems in sections 5 and 6, and I close with a tentative suggestion as to how my argument for narrative cognitivism could be employed as an argument for aesthetic cognitivism.     

Narrative closure

In this article, “Narrative Closure,” a theory of the nature of narrative closure is developed. Narrative closure is identified as the phenomenological feeling of finality that is generated when all the questions saliently posed by the narrative are answered. The article also includes a discussion of the intelligibility of attributing questions to narratives as well as a discussion of the mechanisms that achieve this. The article concludes by addressing certain recent criticisms of the view of narrative expounded by this article.     

Acceptance and Commitment Therapy for Posttraumatic Stress Disorder in Early Psychosis: A Case Series

Persons with psychosis often report high levels of posttraumatic stress disorder (PTSD) symptoms, which render them more vulnerable to relapse, symptom exacerbation, and reduced well-being. However, less is known about how to adequately accommodate the needs of persons recovering from a first episode of psychosis, presenting with PTSD. Further, the existing evidence-based interventions for PTSD seem less equipped to deal with serious mental disorder and comorbid conditions. This study aimed to assess the efficacy, acceptability, and safety of Acceptance and Commitment Therapy (ACT) for persons suffering from PTSD with comorbid trauma and psychosis. Three consecutively referred participants meeting ICD-10 criteria for PTSD and a first-episode nonaffective psychotic disorder were treated in an outpatient service within a case-series analysis. A manual-guided ACT intervention of 12 sessions showed clinically relevant improvement on self-report measures of PTSD symptoms and emotional distress. These initial findings are promising and appear to justify a more controlled evaluation of this brief intervention.     

Emotional Abuse and Psychosis: A Recent Review of the Literature

This article evaluates the published empirical findings on childhood emotional abuse and its proposed relationship with psychotic symptoms. Research and governmental policy indicates that emotional abuse is present in all forms of abuse and neglect, suggesting it is the form of abuse most frequently linked to mental health problems. Literature searches were conducted in 3 peer-reviewed electronic databases and relevant papers were reviewed. Results suggest childhood emotional abuse is statistically related to psychosis in adulthood. This adds tentative support to the hypothesis that emotional abuse is related to psychotic experiences; in particular to hallucinations and persecutory delusions. A number of studies also provide tentative support to the dose–response effect proposed between cumulative trauma and a greater risk of positive psychotic symptoms.     

Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

Narrative Discourse and Theory of Mind Development

The authors examined experimentally whether exposure to social discourse about concepts related to mental states could promote changes in children's theory of mind understanding. In 2 studies, 3- to 4-year-old children were assigned to either a training or a no training control condition. All children were administered several theory of mind measures at pretest and 2 posttests. Training was not effective in improving performance in Study 1 (n = 37); but in Study 2 (n = 54), modifications of the training procedure led to significant improvements on measures of false belief and deception from pretest to 1st posttest. The findings support the influence of social discourse on children's theory of mind development.