Progressive Approaches to Psychosis, Part 2: What Care Looks Like

In Part 1, I discussed how progressive approaches to psychosis encourage us to rethink the way we understand psychotic experiences, viewing them through a lens of curiosity, cultural humility, and compassion rather than fear and pathology. But what does this actually look like in mental health treatment?

A progressive approach is not a specific intervention or manualized treatment. Rather, it is a way of approaching care that centers the person experiencing psychosis as a whole human being. It asks us to move beyond the question, “How do we eliminate these symptoms?” and toward broader questions:

·      What has this person been through?

·      What meaning do these experiences hold for them?

·      What kind of life do they want to build and can we support them in moving toward that life?

This shift does not mean ignoring distress, minimizing suffering, or rejecting evidence-based treatments. Instead, it means expanding our understanding of what effective care looks like.

What Do People Actually Want From Therapy?

When researchers ask people experiencing psychosis what they value most in treatment, the answers are simple. People want providers who:

·      Validate their experiences

·      Offer hope

·      Collaborate

·      Respect their autonomy

·      Help improve quality of life and reconnect with meaningful activities (Brabban et al., 2016)

Improvements in relationships, work, community participation, identity, and daily functioning often mattered more to participants as symptom reduction. This is an important reminder: people do not seek treatment simply because they have symptoms. They seek treatment because they are human beings trying to navigate difficult experiences while pursuing meaningful lives.

A person experiencing voices may want help reducing distress. They may also want support returning to school, rebuilding relationships, finding housing, reconnecting with spirituality, pursuing creative goals, or feeling more confident in their identity. Effective care makes room for all of these goals.

Engagement Before Intervention

Therapeutic engagement is one of the strongest predictors of successful treatment. Before we can help someone develop new skills, cope with distress, or consider different perspectives, we first have to establish a relationship where they feel safe enough to be honest with us. Previous experiences of harm, invalidation, or mistreatment within the mental health system, as well as experiences suspicious thoughts or voices, can make building this relationship more challenging. Recognizing these barriers with compassion and curiosity is an essential part of creating a foundation for effective care.

Effective providers create calm, welcoming environments, remain curious rather than confrontational, consider cultural context, use language clients identify with, and develop shared treatment goals

This can look different from traditional approaches that prioritize quickly correcting or challenging unusual beliefs. Instead of immediately asking, “Is this belief true?” you may begin with questions like:

·      “What has this experience been like for you?”

·      “When did you first notice this happening?”

·      “What does this experience mean to you?”

·      “What makes it better or worse?”

·      “How does this affect the life you want to live?”

These questions communicate something essential: your experience matters, and I want to understand it.

Validation Does Not Mean Agreement

One common misconception is that validating someone’s experience means agreeing with every interpretation or belief they have. This is not the case. Validation means acknowledging the reality of a person’s emotional experience and the meaning it holds for them.

For example, a provider does not need to confirm that a person’s neighbor is intentionally sending them messages through the television in order to validate how frightening, isolating, or confusing that experience may feel.

A provider might say: “This has been incredibly stressful and has made it difficult to feel safe in your own home. I can understand why you’d feel afraid.”

Validation creates connection. Connection creates the foundation for collaboration. When people feel respected and understood, they are often more willing to explore different ways of relating to their experiences and consider strategies that may reduce distress.

A More Hopeful Future

Progressive approaches to psychosis do not reject evidence-based care; they expand it. Medication, psychotherapy, family support, peer-led groups, housing assistance, employment services, and skills training all have important roles in recovery. Progressive care recognizes that different people need different combinations of support at different points in their lives.

Rather than focusing exclusively on “symptom reduction,” progressive care recognizes that recovery is about helping people build meaningful, connected lives.

Psychosis is not simply a collection of symptoms. It is a human experience that exists within the context of people’s histories, relationships, cultures, communities, and identities. It deserves compassion, cultural humility, hope, and genuine partnership.

As our understanding of psychosis continues to evolve, so too should the ways we provide care. By centering people’s strengths, values, and lived experiences alongside evidence-based treatments, we can help move the field toward a more inclusive and recovery-oriented future.

References:

Brabban, A., Byrne, R., Longden, E., & Morrison, A. P. (2016). The importance of human relationships, ethics and recovery-orientated values in the delivery of CBT for people with psychosis. Psychosis, 9(2), 157–166.