This month I interviewed Dr. Sally E. Riggs, clinical psychologist, practitioner of Cognitive Behavioral Therapy for Psychosis (CBTp) and the founder and director of NYC CBTp.
Tell me about yourself
Hi my name is Dr. Sally Riggs, I am a licensed clinical psychologist, trained in the UK, practicing in the US for the last 9 years. I am passionate about helping people with psychosis gain access to effective, evidence based psychotherapy. In 2015 I founded NYC CBTp, a group practice in New York City dedicated solely to CBT for psychosis. We have 3 therapists on staff in two different locations, and also train other mental health professionals in NYC and all over the country in CBT for psychosis. When I’m not working with people with psychosis you will usually find me somewhere in the 5 boroughs training for marathons.
What exactly is Cognitive Behavioral Therapy for Psychosis? How does it work?
The central theory to CBT is that it isn’t the situations or adverse life events that cause difficult emotions, its our appraisals or interpretations of these life events. In the case of CBT for psychosis it means helping someone to understand and make sense of the experiences that they are having and the different meanings they attach to them, ultimately with the goal of lessening distress and helping them achieve their life goals. CBTp takes a normalizing approach to understanding psychosis. Experiences and beliefs commonly regarded as symptoms of psychosis are believed to be often highly understandable reactions to adverse life events rather than indications of the presence of an illness or disease.
When did you first hear about it and how did you learn how to do it?
I think I probably first heard about CBTp when I was an undergraduate. Our undergrad degrees in the UK are specialized so we study 100% psychology from start to finish. Although we don’t learn therapy, there is some opportunity to learn about clinical applications and which evidence-based treatments are available or recommended. I was then trained in CBTp in graduate school. The vast majority of students in graduate school for psychology in the UK learn CBT, including CBT for psychosis, its just part of the curriculum.
What makes the CBT perspective unique? What about this perspective do you find particularly valuable or helpful?
What I love about CBTp is that it offers an ethical, person centered, effective way for people to manage their psychosis and move forward with their life. CBT can be misunderstood in the US to be “skills based” or “challenging people’s thoughts” but actually that isn’t what it is at all. It is highly individualized and collaborative, in that every therapy is uniquely tailored to each different person, solely based on that person’s goals and experiences. There is no “expert therapist” role; the person with psychosis is known to be the expert in their own experiences. Beliefs and appraisals might be explored and evaluated but never challenged or corrected as if wrong. As a therapist it is an enormous privilege to be invited to be part of that process.
What are some books/resources that you particularly like on CBT for Psychosis?
Gosh there are so many and of course my favorites are all by British authors that can be hard to get in the US. Current favorites include Cognitive Therapy for Psychosis: A Formulation Based Approach by Morrison Renton, Dunn, Williams, & Bentall; Person- Based Cognitive Therapy for Distressing Psychosis by Chadwick; CBT for Those at Risk of a First Episode of Psychosis: Evidence-based Psychotherapy for People with an At Risk Mental State by Van der Gaag, Nieman, & Van der Berg.
What advice do you have for people experiencing psychosis? What about their family members and loved ones?
Wow that’s a tough question. Really everyone’s experience is unique and individual so its hard to give general advice. However I would say, not matter what you might be told, hearing voices, seeing visions and other unusual experiences are much more common than people realize and don’t mean that everything in your life now has to be different. Your goals and dreams are still important and achievable and if you don’t find people to support you that tell you that, keep looking until you do! For family members I would say please sign up for our parents newsletter on our website – we give lots of support and advice on how best to support loved ones experiencing psychosis in a way that makes it more likely they can get to where they want to be. Kings College in London also have a great free online course for parents and loved ones that I highly recommend.
What encouraged you to join ISPS-US?
When I finally got my greencard here in the US and was able to start building my own practice it made sense to be in touch with organizations that were also working towards supporting people with psychosis or unusual experiences and had shared and common goals about advancing access to treatments other than medication. A number of colleagues recommended I joined ISPS-US for this reason.
Coming from the UK, what are some differences you have noticed between the UK and the US in terms of approaches to psychosis? Anything we can learn to do differently from our friends across the pond?
When I first moved to the US it was noticeable just how much more prominent the medical model is here. Its not just the dominant model, if you happen to suggest that there’s no such thing as ‘schizophrenia’ or that psychosis is not a ‘disease’ that can be ‘cured’ by medication sometimes people don’t quite compute what you are saying or think you are joking, because such comments are so far outside the so called norm. That isn’t the case in the UK. The majority of psychologists, if not all, embrace the environmental/trauma based explanation of mental health. Psychologists that don’t question the DSM are the minority. It took me a long time to adjust to this cultural difference, and to be honest I haven’t fully adjusted, nor would I want to. I guess the other major difference is that healthcare is for profit in America. That’s definitely something America could learn to do differently, and another thing I will never get used to… although of course that really isn’t specific to psychosis…and sadly changing this issue long term is something that probably needs its own society!
Thank you Dr. Riggs! It was great hearing your perspectives on psychosis and cognitive-behavioral therapy.
Questions or comments for Dr. Riggs? E-mail her at: firstname.lastname@example.org