ISPS-US Virtual Reading & Study Group


The ISPS-US Student & Early Career Committee (Marie C. Hansen, Terri Talley, Halle Thurnauer & Peter Pascatore) is pleased to announce the start of a new initiative– a virtual reading and study group.

Our first reading will be Psychotherapy of Schizophrenia: The Treatment of Choice by Bertram Karon and Gary Vandenbos, a classic text on the psychodynamic treatment of psychosis.

The reading selections will be on a two week cycle, with a week for reading and a week for discussion, using the following dates:

Week 1 (6.19-6.25) Read Chapters 1&2
Week 2 (6.26-7.2) Discussion
Week 3 (7.3-7.9) Read Chapters 3&4
Week 4 ( 7.10-7-16) Discussion
Week 5 (7.17-7.23) Read Chapters 5&6
Week 6 (7.24-7.30) Discussion
Week 7 (7.31-8.6) Read 7&8
Week 8 (8.7-8.13) Discussion
Week 9 (8.14-8.20) Read Chapters 9&10
Week 10 (8.21-8.27) Discussion

The reading group will be conducted through a closed Facebook group. You can access the group here. All ISPS members are welcome to join, with a special invitation to student and early career professionals.

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Video Resources on Psychosis

The following is a list of video resources put together by ISPS-US member Brian Koehler, related to Subjective Experiences, Recovery, Medication, Psychosocial Therapies, etc.
Brian Koehler PhD teaches at New York University & TC, Columbia University.

Subjective Experience & Recovery

Elyn Saks, Debra Lampshire and Paris Williams are all world experts on mental health. They’re using their personal experiences and working in their respective fields to debunk the myths and stigma surrounding schizophrenia. 2016 28 minutes

Continue reading

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“Psychosis: Key Psychoanalytic Concepts” with Danielle Knafo

Danielle Knafo Ph.D. is a leader in the field of psychoanalytic approach to psychosis, so I’m very pleased she was the presenter for the ISPS-US webinar, “Psychosis: Key Psychoanalytic Concepts” that took place on 6/28/17.  See below for the recording.

In this presentation, Dr. Knafo explains key psychoanalytic concepts that help us to understand and treat psychosis or psychotic phenomena. These concepts include: regression, projective identification, psychic retreats, attacks on linking, islands of clarity, and finding meaning in symptoms. She emphasizes the discoveries, since Freud’s time, that have deepened the understanding of the psyche, allowing the attribution of meaning to symptomology, and permitting human encounters that initiate profound change through insight and communication.

Danielle Knafo, Ph.D. is a clinical psychologist, psychoanalyst, and professor in the clinical psychology doctoral program at LIU Post, where she chairs a specialty concentration on Serious Mental Illness. She is also faculty and supervisor at NYU’s Postdoctoral Program in Psychotherapy and Psychoanalysis. She is a popular speaker and a prolific author who has published seven books and dozens of articles on psychoanalysis, creativity, gender, psychosis, trauma, technology and perversion. She maintains a private practice in Manhattan and Great Neck, NY.

Danielle also made a written list of what she believes are good sources from which to learn more about this topic:

Continue reading

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Shamanic Spiritual Emergencies: the dialectic of distress and spirituality – a webinar

What is the relationship between distress and confusion that gets called “psychosis” and the states of consciousness that might be described as shamanic or spiritual?

To explore this, the next ISPS-US webinar will feature from Ingo Lambrecht, who has perspective on this based on both having both experienced shamanic training as well as having extensive experience working in the mental health field as a clinical psychologist specializing in psychosis.

So consider joining in on 4/6/17, 3 PM EDT!  You can register at  There will be time for participants to ask questions.

Here’s more details about this event:

Shamanic Spiritual Emergencies: the dialectic of distress and spirituality, with Dr. Ingo Lambrecht

Throughout shamanic history, extreme states have been configured in relation to states of distress and spirituality. It is however not clear to what extent these states are separated, the same or if integration is at all possible.

In this presentation the aim is to explore the different positions possible when faced with psychotic distress and spirituality. It will draw on the presenter’s experiences during his shamanic training. It will consider some indigenous and current models and interventions of spiritual emergencies.


Dr. Ingo Lambrecht is a consultant clinical psychologist working at Manawanui, M?ori Mental Health Service in Auckland, New Zealand. His special interests include children and adolescents, psychosis and personality issues, as well as trauma and mindfulness. He has also written on the cultural-clinical interface through clinical and psychoanalytic work in different cultural settings, and was privileged to undergo an intense shamanic training as a sangoma, a South African traditional healer. In addition to his recent book, Sangoma Trance States (AM Publishing, 2014), he has contributed articles and chapters on the relationships between culture, psychosis, and spirituality, presenting at national and international conferences on these themes.

ISPS-US online meetings/webinars are free to ISPS members, with a donation of $5-$20 requested from others, though no one turned away for lack of funds. Please do register if you want to attend!

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Slowing Psychiatry: Would That Improve Treatment?

The next ISPS-US online meeting/webinar will be titled “Slow Psychiatry: A Way forward” with Sandra Steingard, M.D. presenting her perspective and then answering questions and participating in discussion. This will occur on Monday May 23 2016, 4:20 PM EDT

In this meeting, Dr. Steingard will discuss the problems that have arisen from an overly medicalized approach to conceptualizing what falls under the label of psychiatric conditions. She will then propose a model in which psychiatry continues to assume an expert role in the use of psychoactive drugs but does so in a drug-centered rather than a disease-centered way. She will explain the distinction between these approaches. She will then discuss need-adapted approaches and will outline how psychiatry, using a drug-centered model, can work with people in distress, their families, and other clinicians in a more humane and democratic way.

There will be time for questions and discussion, including looking at how these ideas might be applied in specific practice situations.

Sandra Steingard, M.D. is Chief Medical Officer, Howard Center, Burlington, Vermont and Clinical Associate Professor of Psychiatry at the University Of Vermont College of Medicine. For over 20 years her clinical practice has primarily included patients diagnosed with schizophrenia and other psychotic illnesses. She was a local principal investigator at a NAVIGATE site for the NIMH sponsored Recovery After an Initial Schizophrenia Episode (RAISE) Early Treatment Program, she studied for two years at the Institute for Dialogic Practice in Northampton, Massachusetts, and she worked for nine months as a consulting psychiatrist to Pathways Soteria Vermont.

She is on the Boards of the Foundation for Excellence in Mental Health Care and Mad In America Continuing Education. She is also on the board of National Alliance of Mentally Ill – Vermont from whom she received an Exemplary Psychiatrist Award in 1996. She was named to Best Doctors in America in 2003. She recently helped to create the Critical Psychiatry Network – North America. She writes a blog called Anatomy of a Psychiatrist on the website “Mad in America Science Psychiatry and Community”,

If you would like to read up on her ideas in advance of the meeting, you can check out Slow Psychiatry: Integrating Need-Adapted Approaches with Drug-Centered Pharmacology or other posts at Mad in America

ISPS-US online meetings are free to ISPS members, with a donation of $5-$20 requested from others, though no one turned away for lack of funds. Please do register if you want to attend!

These meetings are recorded and shared on the ISPS website for later viewing.

To register, go to

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Getting Back to Dialogue – The Core of Healing!

When people are “mad,” they are often insisting that certain things are so, and frequently seem unwilling or incapable of appreciating or learning from other perspectives.  Yet when the supposedly “sane” mental health system approaches those who are mad, it typically does the same thing – it insists that its own view of what’s going on is correct, and seems incapable of appreciating or learning from others, whether they be the patient, the family, former users of services, or anyone who understands madness in a different way.

So what’s going on with that?

One way of understanding it is to reflect on the very human tendency to narrow one’s perspective when feeling threatened.  When people feel threatened, they tend to narrow their focus down to what they believe may avert the threat, and to shut out other perspectives that seem “wrong,” or that could lead to doom.

That works fine when the threat is relatively straightforward, and a solution can be arrived at which reduces the sense of threat.

But what about when it can’t?

When individuals are facing situations where there seems to be a dire need to solve a problem, yet no solution nor path toward such a solution is apparent, the person naturally enters into a state of conflict.  On the one hand there is above mentioned drive to narrow attention in response to the threat, but on the other hand, there is a drive to expand awareness and experiment with unusual ways of looking at things, so as to possibly find a pathway to a solution that otherwise appears impossible.

It may be that it is the collision between the two tendencies, the narrowing of attention to focus on threat, contrasting and conflicting with the expansion of awareness while seeking to control what otherwise appears uncontrollable, that is responsible for the wild states we call psychosis, or madness.

So we see people who seem creative in some ways, often coming up with very imaginative interpretations of reality, yet who also seem very unimaginative and closed minded when it comes to seeing any down side in their point of view or being able to follow how and why others see things differently, or seeing how to negotiate in a world where others do see things so differently.

Those who are “mad” can then seem difficult to communicate with – their attention seems narrowed and entrenched in their point of view.  We might say they are stuck in “monological thinking” and have difficulty with dialogue, with really appreciating and reflecting on the views of others and learning from them.

Unfortunately, these difficulties can be so intense that those around the “mad” person typically enter into their own kind of threat response, and narrow their own attention, and become stuck in their own “monological thinking” in an attempt to cope.

In the monologue of the traditional mental health system, a “solution” for the problem of madness is outlined.  The mad person is simply experiencing an illness, one that has a name and a clear treatment plan, organized around attempts to suppress that “illness.”

The great thing about having this sense of a “clear path forward” is that it helps professionals and those around the mad person not feel mad themselves.  That is, rather than feel there is a problem that urgently needs solved yet for which there is no identified path forward (the bind that could lead to madness), it is now possible to feel there definitely is a path forward – just narrow down one’s thinking and doing to the medical style approach, and no doubt or further reflection or inner conflict is required!

But now we really have two clashing and very imperfect monologues – that of the “mad “person, and that of the mental health system and those persuaded by it.  And what happens when two fixed views confront each other?  Research shows the tendency is for people who feel confronted to dig in and get more entrenched in their views – and the possibility of dialogue, of reaching across the divide, and of healing, becomes more remote.

But fortunately, there are better approaches!  They are less simple, and involve deliberately accepting uncertainty, and taking some risks, while also attending to safety concerns.  These methods emphasize dialogue, and fight back against that tendency for narrow thinking in response to threat.  Instead they embody a wisdom that recognizes we all best face complex issues when we are willing to be wide and open enough to hear all the voices, and that “sanity” is most likely to emerge through this sort of dialogical process, when it takes place not just within the “mad” person but also within the social network and treatment team.

The Hearing Voices Network makes really important strides in this direction – emphasizing for example changing relationships with voices rather than defining them as illness or suppressing them.  There are now some forms of psychological therapy for “psychosis,” such as the style of CBT for psychosis that I teach (online as well as live) which emphasize relating in a dialogical way.  But it is Open Dialogue, and the dialogical practices it has inspired, which have uniquely framed mental health work as being fundamentally about encouraging dialogue, and which often achieve amazing results just by aiming to support dialogue on all levels.

I’m inspired to write about this now because I’m publicizing an “online meeting” or webinar with Mary Olson, titled “Introduction to Dialogic Practice.”  This could be a great opportunity for some of you to hear “live” from one of the experts in the field about how these practices work, and to get some of your questions answered.

This online meeting happens on Friday 3/25/16, noon EDT.  Here’s more details, and the registration link:

Dialogic Practice emphasizes listening and responding to the whole person in a context – rather than simply treating his or her symptoms. In psychiatric settings, this is accomplished primarily through a treatment meeting, or Open DialogueArising from the influence of the philosophical writings of Mikhail Bakhtin on systemic family therapy, Dialogic Practice can also be effectively applied to more ordinary couple, group, and family therapy, as well as community work in schools.

This conversation, or dialogue, is not “about” the person, but is instead a way of “being with” the person and living through the situation together. Referred to as “Withness Practices” by Tom Anderson, M.D., this process mitigates the sense of isolation and distance that a crisis can produce and gives the person at the center of the dialogue greater voice and agency. Ultimately, this allows them to participate more meaningfully in both the conversation and the resulting decisions about their own lives.

After eliciting the person’s point of view at the meeting outset, there is typically a back-and-forth exchange between this person and the therapists both to develop a more lucid way of expressing the situation and to create a shared language.  The voice of each participant is then woven into this conversation to create a new fabric of meaning and engagement to which everyone contributes.

In this online meeting, Mary Olson will help us understand more about what Dialogic Practice is and isn’t, what it requires, and what it looks like in action.  (Those interested in learning Dialogic Practice in some depth might consider attending the Introductory Intensive in Dialogic Practice which happens May 25-29 in NYC.)

Mary Olson, PhD is an internationally-recognized leader in the development of Dialogic Practice.  She is the founder of the Institute for Dialogic Practice in Haydenville, MA and is a faculty member of both UMass Medical School and the Smith College School for Social Work.  She has written numerous articles and book chapters on Dialogic Practice, including “The Key Elements of Dialogic Practice in Open Dialogue” (2014, with Jaakko Seikkula & Doug Ziedonis), and maintains a private practice in Western Massachusetts.

ISPS-US online meetings are free to ISPS members, with a donation of $5-$20 requested from others, though no one turned away for lack of funds. Please do register if you want to attend!

These meetings are recorded and shared on the ISPS website for later viewing.

Use this link to register:  I hope to see some of you there!

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“Schizophrenia Breakthrough” – Or a Case of Ignoring the Most Important Evidence?

Last week, the headlines were blaring: Schizophrenia breakthrough as genetic study reveals link to brain changes!  We heard that our best hope for treating “schizophrenia” is to understand it at a genetic level, and that this new breakthrough was now getting us really started on that mission, as it showed how a genetic variation could lead to the more intense pruning of brain connections which is often seen in those diagnosed with schizophrenia.  We were told that this study was very important.  “For the first time, the origin of schizophrenia is no longer a complete black box” was one quote.  And the acting director of the National Institute of Mental Health (NIMH) described the study as  “a crucial turning point in the fight against mental illness”.

But is all this hype justified?

A “back story” to this article is that the NIMH has a long history of bias toward biological approaches to understanding mental and emotional difficulties, with an accompanying tendency to ignore even the most obvious evidence that these difficulties often relate to problems in living experienced by people.  For example, even though numerous studies confirm that adverse childhood experiences make a later diagnosis of schizophrenia much more likely (more so than do any particular genes), the NIMH, on a website about the possible causes of schizophrenia, claims it’s “unknown” what kind of psychosocial factors might contribute to putting people at risk.

But it really isn’t a mystery.  To people like NYU professor Brian Koehler who have been following both the biological and the psycho-social research for decades, it’s clear that the real story is that the biological differences we often see in people diagnosed with disorders like “schizophrenia” are often the result of stressful life events, not something that requires specific genes (even though it may be true that some genetic variations increase vulnerability to some limited degree.)

Below (with his permission) I am quoting a recent email from Brian Koehler, where he shared some of what we would be hearing from the media if the medio were being given the whole story.  (His writing will make more sense to you if you understand that microglia are the type of brain cells active in the synaptic pruning that was being discussed, though only in reference to possible genetic causes, in the articles about the recent “breakthrough”…..)

In the late 1970s & early 1980s, as a result of some biochemical research I was conducting and my work in psychotherapy with people on an inpatient unit of a NYC hospital, I became very interested in the pervasive effects of chronic and significant anxiety on our brain and body. I partly made it my life’s work to study and demonstrate that the neuroscience of what we call “schizophrenia” (a highly problematic term) is in actuality, and often in many persons, the neuroscience of severe, chronic stress/anxiety/fear. I am grateful for the opportunity to be educated on the neuroscience of psychosis and stress at such places as the Nathan Klein Institute of Psychiatric Research (NKI), which is managed by the NYS Office of Mental Health and maintains a strong academic collaboration with New York University.

I quickly observed in the persons I was working with on inpatient and outpatient settings, that the content of what we call “delusions” and voices, are re-traumatizing to the person experiencing them. Not only may they be attempts at “cure” or “restitution” (as Freud thought), but they may create significant distress for many persons experiencing them, especially if they feel not in control of aversive threats, accusations, danger situations such as social exclusion, etc. Psychological and social traumas, I quickly learned in the 1970s and 1980s, were prevalent in the histories of many of the persons I was working with. Surviving survival of various social and psychological traumas also played a role in the neurobiological and immunological changes we were observing (even in persons who had not yet started taking antipsychotics, which we now know can cause neural atrophy, mostly subtle, but atrophy nevertheless). In the 1990s, I learned of transgenerational transmission of traumas (specifically, the transmission through epigenetic channels of inducible defences against threats to survival) first in plants, then insects and then in mammals. Since 1990 I have checked on every single finding in the neuroscience of “schizophrenia” and have cross-checked with the emerging literature (thanks to sMRIs, fMRIs, PET, etc.) on the neuroscience of chronic stress. To this day, I still have not found one single specific neuroscience finding in “schizophrenia.” The findings are mostly non-specific (I am leaving the door open, in the name of science, for specific findings). When one is emotionally and intellectually invested in a particular belief, it is important to look even more intensively at the evidence that disconfirms one’s belief and to strive for intellectual and emotional honesty. I admire the current Dalai Lama for when he was asked if science definitely disproved reincarnation, what would he believe? He said, he would give up his belief in reincarnation!

The latest findings in the neuroscience of psychosis have included the role of microglia and neuroinflammatory processes. (e.g., “Microglial activation and the onset of psychosis” by Tyrone Cannon, published in the American Journal of Psychiatry, January 2016). Microglial cells, are glial cells (which are at least as plentiful as neurons in the brain, of which there are close to 100 billion with trillions of connections with other neurons-the connectome) are innate immune cells of the brain. They have a role in the regulation of the extracellular milieu and they participate in neuronal regeneration. They respond quickly to injury and produce a wide variety of pro-inflammatory molecules, neurotrophic factors, and neurotransmitters. Microglial cells can be activated by several factors including systemic infection, physical trauma, oxygen and energy depletion, and some neurodegenerative disorders.

Stress definitely activates the microglia-and this has been known for quite some time. I am no longer surprised when persons researching “schizophrenia” present their findings without checking the research on such important factors as social adversities and chronic stress. I strongly believe that in many, if not most, persons with a diagnosis of “schizophrenia” the neuroscience findings could never fully be understood without reference to the whole person living in a particular sociocultural context, both of which are impacted by social adversities across the generations (e.g., the individual and social traumas of one’s parents, grandparents, social group, etc.). Not so easy to study with only neuroimaging, genome wide association scans, microarrays, etc!!

I have included only a few recent research studies documenting the effects of stress on microglia from such journals as Molecular Psychiatry, Stress, etc.

Brian Koehler PhD
Stress 2015 Jan;18(1):96-106. doi: 10.3109/10253890.2014.995085. Epub 2015 Jan 8.
Microglia activation regulates GluR1 phosphorylation in chronic unpredictable stress-induced cognitive dysfunction.
Liu M1, Li J, Dai P, Zhao F, Zheng G, Jing J, Wang J, Luo W, Chen J.

Chronic stress is considered to be a major risk factor in the development of psychopathological syndromes in humans. Cognitive impairments and long-term potentiation (LTP) impairments are increasingly recognized as major components of depression, anxiety disorders and other stress-related chronic psychological illnesses. It seems timely to systematically study the potentially underlying neurobiological mechanisms of altered cognitive and synaptic plasticity in the course of chronic stress. In the present study, a rat model of chronic unpredictable stress (CUS) induced a cognitive impairment in spatial memory in the Morris water maze (MWM) test and a hippocampal LTP impairment. CUS also induced hippocampal microglial activation and attenuated phosphorylation of glutamate receptor 1 (GluR1 or GluA1). Moreover, chronic treatment with the selective microglial activation blocker, minocycline (120?mg/kg per day), beginning 3?d before CUS treatment and continuing through the behavioral testing period, prevented the CUS-induced impairments of spatial memory and LTP induction. Additional studies showed that minocycline-induced inhibition of microglia activation was associated with increased phosphorylation of GluR1. These results suggest that hippocampal microglial activation modulates the level of GluR1 phosphorylation and might play a causal role in CUS-induced cognitive and LTP disturbances.

CNS Neurol Disord Drug Targets. 2015;14(3):304-8.
Commentary: the effects of psychological stress on microglial cells in the brain.
Yuan TF1, Hou G, Zhao Y, Arias-Carrión O.

Psychological stress leads to activation and proliferation of microglial cells in different brain regions. These effects are mediated by inflammatory cytokines, as well as stress hormones including glucocorticoids and norepinephrine. Eliminating microglia from the nervous system or blocking their activation prevented the stress-induced impairments on brain cognitive functions. We conclude that microglial cells are important meditators underlying anti-depression therapies.

Molecular Psychiatry 2014 Jun;19(6):699-709. doi: 10.1038/mp.2013.155. Epub 2013 Dec 17.
Dynamic microglial alterations underlie stress-induced depressive-like behavior and suppressed neurogenesis.
Kreisel T1, Frank MG2, Licht T3, Reshef R1, Ben-Menachem-Zidon O1, Baratta MV2, Maier SF2, Yirmiya R1.

The limited success in understanding the pathophysiology of major depression may result from excessive focus on the dysfunctioning of neurons, as compared with other types of brain cells. Therefore, we examined the role of dynamic alterations in microglia activation status in the development of chronic unpredictable stress (CUS)-induced depressive-like condition in rodents. We report that following an initial period (2-3 days) of stress-induced microglial proliferation and activation, some microglia underwent apoptosis, leading to reductions in their numbers within the hippocampus, but not in other brain regions, following 5 weeks of CUS exposure. At that time, microglia displayed reduced expression of activation markers as well as dystrophic morphology. Blockade of the initial stress-induced microglial activation by minocycline or by transgenic interleukin-1 receptor antagonist overexpression rescued the subsequent microglial apoptosis and decline, as well as the CUS-induced depressive-like behavior and suppressed neurogenesis. Similarly, the antidepressant drug imipramine blocked the initial stress-induced microglial activation as well as the CUS-induced microglial decline and depressive-like behavior. Treatment of CUS-exposed mice with either endotoxin, macrophage colony-stimulating factor or granulocyte-macrophage colony-stimulating factor, all of which stimulated hippocampal microglial proliferation, partially or completely reversed the depressive-like behavior and dramatically increased hippocampal neurogenesis, whereas treatment with imipramine or minocycline had minimal or no anti-depressive effects, respectively, in these mice. These findings provide direct causal evidence that disturbances in microglial functioning has an etiological role in chronic stress-induced depression, suggesting that microglia stimulators could serve as fast-acting anti-depressants in some forms of depressive and stress-related conditions.

Curr Immunol Rev. 2010 Aug 1; 6(3): 195–204.
Responses of glial cells to stress and glucocorticoids
Jauregui-Huerta,1 Y. Ruvalcaba-Delgadillo,2 R. Gonzalez-Castañeda,1 J. Garcia-Estrada,1,3 O. Gonzalez-Perez,1and S. Luquin1

Microglial cells are the innate immune cells of the brain. Like astrocytes, they have a role in the regulation of the extracellular milieu and they participate in neuronal regeneration [4]. Like other immune cells, they respond quickly to injury and produce a wide variety of pro-inflammatory molecules, neurotrophic factors, and neurotransmitters [59]. Microglial cells can be activated by several factors including systemic infection, physical trauma, oxygen and energy depletion, and some neurodegenerative disorders [60].

Psychological stress and glucocorticoids have long been shown to suppress immune responses [61]. Thus, GCs could be expected to exert immunosuppressive actions on brain resident microglia. Consistent with this immunosuppressive hypothesis, in vitro studies have shown that treatment of microglia with GCs decreases the ability of these cells to proliferate [62], to produce proinflammatory cytokines [63, 64], and to produce toxic radicals [65]. These anti-inflammatory actions were confirmed in a spinal cord injury model treated with methylprednisolone [66]. However, recent in vivo studies suggested that stress and GCs can enhance immune function within the brain [67]. Restraint stress combined with water immersion, for example, induces massive microglial activation in the rodent brain [68]. In addition, brief tail-shock [68], immobilization [69], and social isolation stress [70] increase the expression of interleukin-1?(IL-1?) in the rat brain [71]. Moreover, four sessions of restraint stress were capable of increasing the proliferation of microglia, apparently due to corticosterone-induced, NMDA receptor activation [72]. This proinflammatory evidence has lead to the suggestion that stress-induced microglial activation may be involved in the progression of neurodegenerative disorders [73].

In conclusion, maybe the real “breakthrough” we should be working for, would be to get the NIMH and eventually the media to become interested in a “person in context” view of mental distress and mental disorders, so that biological facts will not be taken out of context, and we can orient our institutions both toward doing more prevention of distress and disorder in the first place, and more appropriate interventions once problems have occurred!

For another, more detailed look at this same subject, I recommend the article by ISPS member Noel Hunter,

Breaking News! The “Cause” of “Schizophrenia” Finally “Discovered”!(?)

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Supporting People in Getting Active in Their Own Recovery

Often, especially with big mental health problems like those we call “psychosis,” almost all the discussion and attention tends to revolve around what the rest of us should do to help the person, and not what the person could do to help himself or herself.

And often the “help” that is offered makes people less inclined to do things to help themselves than they would otherwise be.  People are encouraged to give up trusting themselves and instead to think of themselves as “mentally ill,” and they are encouraged to take drugs which have a general effect of making people more passive or “tranquilized.”

Of course, it can seem like a good thing to have people lose trust in their “crazy” ideas or perceptions, and to have people be passive rather than engaged in activity we see as “psychotic.”  But to really recover, people need to find ways to trust themselves again and to become active toward their own values.  So we need something different from standard kinds of “help” if we are going to really help people move into “agency,” or really taking responsibility for their own recovery.

In their presentation for the next ISPS-US online meeting/webinar, which will happen at noon EDT  on Friday 9/25/15, Lewis Mehl-Madrona MD and Barbara Mainguy MA will share their views on this topic.

In their own words, they plan to “explore the interface and the movement between at least two different worlds in which people diagnosed with psychosis interact. First and dominant is the biomedical world in which the solution to virtually all of life’s woes is to take a pill and not to make personal, relational, or lifestyle changes. Important to recognize, we believe, is that these beliefs are as prominent for medical illnesses as they are for the so-called psychiatric illnesses. Then comes the Recovery Community in which people work from passivity (the biomedical model) toward agency in which they can actively contribute and create their recovery.

“We want to suggest that most psychiatrists are so saturated in the passivity model that they do not recognize when patients present from the agency model. We suggest that the two models are more widespread than mental health and represent fundamental differences in approaching health and disease. We review some of our results in working within both worlds. Specifically, the people with whom we work within a Recovery model improve and those within the passive, biomedical model, do not.”

Lewis and Barbara will be discussing what they have found may assist people in making this shift from passivity toward agency, especially telling stories of characters with agency to indirectly implant ideas of the possibility of agency. With patience, and with the practice of “radical acceptance,” they have found that this can be very effective!

ISPS online meetings are free to ISPS members, with a donation of $5-$20 requested from others, though no one turned away for lack of funds.  Please do register, by going to if you want to attend!

(Some of you may also want to read a recent article by Lewis Mehl-Madrona, Working to Recover, or Adjusting to Illness?)


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Online Course, “CBT for Psychosis” Is Now Available

Udemy cbt imageCognitive Behavioral Therapy (CBT) for psychosis is an evidence-based method to reduce distress and disability related to psychotic experiences, and to support a possible full recovery. Psychotic experiences are conceptualized as being understandable in relationship to an individual’s life story, and capable of being altered when people experiment with different ways of thinking and behaving. Learn how to collaborate with people having these experiences, “exploring the evidence” rather than imposing beliefs, and developing coping options so people are not forced to rely entirely on the often limited effectiveness of medication to address problems.

This new online course starts by examining the nature of psychosis and CBT, providing a foundation for understanding how CBT can be helpful. Then the basic style of CBT for psychosis is introduced, followed by an introduction to two of the most important techniques. Finally, applications of CBT are explored for some of the main problem areas, such as hearing distressing voices, paranoia, delusional beliefs, disorganization, and negative symptoms.

Included in the course are video lectures, slides with some diagrams, video demonstrations of CBT for psychosis being practiced, and links to additional resources for further study. Periodically, there will be live question/answer sessions, and recordings of past question/answer sessions will also be available.

CBT for psychosis uses a minimal amount of jargon, and the concepts and practices tend to be easily understandable.

In this introductory seminar on CBT for psychosis, you can learn to:

  • Collaborate with people in exploring difficult experiences, helping people develop their own perspective and their own solutions rather than telling people what to think
  • Reduce fear of psychotic experiences, and build hope for coping and for recovery. using the CBT approach called “normalizing”
  • Help people develop a coherent story or individualized formulation of what led to psychotic difficulties, which then guides efforts toward recovery
  • Become familiar with a broad range of psychological strategies which have been found helpful for experiences such as paranoia, hearing voices or other “hallucinatory” experiences, delusional or disorganized thinking, and “negative symptoms.”

5 CE credits are available for social workers, psychologists and nurses in the US.

Cost:  The regular cost for this seminar is $90, however, it’s being offered here for the discounted price of only $50.  Also, if you register here, 1/2 of your registration fee will go directly to ISPS-US (the rest will go to me, Ron Unger, since I am the author and producer of the course.)

To register, or for more information including a free preview of the section on “normalizing,” go to this link.

You might also be interested in a related online course, Working with Trauma, Dissociation, and Psychosis:  CBT and other Approaches to Understanding and Recovery.  This is also available for $50, with 6 CE credits.

(Also, you might want to be aware of other online courses that are now appearing through Mad in America.)

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“Self Psychology and Psychosis: The Development of the Self During Intensive Psychotherapy…’

There are many pathways to recovery, but one thing people have often been told does not work for “psychosis” and “schizophrenia” is intensive psychotherapy.

But many of those who research the effectiveness of such therapy, and those who practice it, would beg to differ.  (You can also hear the voices of two recipients of such therapy who speak out in Daniel Mackler’s film which you can watch on youtube, “Take These Broken Wings.”)

Self Psychology is one Self Psychologyapproach to intensive psychotherapy.   On Friday June 5, 2015, at 6:30 PM Eastern Time, there will be an opportunity to hear directly from, and interact with, Ira Steinman and David Garfield, who will be speaking about this approach during an online meeting/webinar.

Ira and David will be discussing their new book, “Self Psychology and Psychosis:  The Development of the Self During Intensive Psychotherapy of Schizophrenia and other Psychoses.”

This meeting is sponsored by ISPS-US, which does request a small donation for the meeting from non-members, but does not turn away anyone who can’t afford to or doesn’t want to pay.

Read on for more information about the book, and how to register for the meeting:

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