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Despite pessimism in the field, persons experiencing psychosis can benefit from psychotherapy and recover. However, there are multiple factors that can interfere with the formation of a positive therapeutic alliance and lead to the premature termination of therapy, which is associated with poorer long-term outcomes. In this article, common therapist, patient, and intersubjective factors are identified that can inhibit personal growth and lead to stalled treatments. After reviewing these various roadblocks, four principles (e.g., an intersubjective orientation to realty, therapeutic openheartedness/vulnerability, "speaking the unspeakable", and recognizing the pain beyond the psychosis) are outlined that can embolden the therapist to take judicious risks while avoiding common pitfalls when working with persons experiencing psychosis. These principles also enable the therapist to maintain an empathic connection to the patient and appreciate the pain beyond the psychotic symptom. The clinical implications and challenges of embodying these principles and implementing these interventions are discussed. [ABSTRACT FROM AUTHOR]

Research demonstrates ongoing health inequities for those from the most marginalized communities. To address these health inequities, medical educators have attempted to incorporate education that targets cultural competence of providers. Over the last decade, increasing evidence has demonstrated limitations to a competency-based approach. In this paper, we outline how utilizing critical reflection strategies in clinical supervision can be a long-term, sustainable approach for addressing health inequities, while improving the existing cultural competency model. We begin by demonstrating how existing ideas of critical reflection can be adopted to enhance learning within supervision by encouraging providers to evaluate and re-evaluate existing beliefs and biases. We then propose how an existing approach to treatment (i.e., Metacognitive Reflection and Insight Therapy) may serve as an example for how to activate critical reflection in supervision using three essential factors. Finally, we propose three clinical implications for providers that may work to dismantle existing healthcare inequities including: an increased comfort in feedback seeking, improved confidence working with diverse populations, and increased insight into how inequities emerge in clinical practice and how best to respond when they do. [ABSTRACT FROM AUTHOR]

Purpose: Psychosis disrupts how persons experience themselves and their lives. Despite knowledge that gender differences have been noted in presentation and course of psychosis symptoms, little is known about differences in how men and women experience these disruptions. Method: The narratives of 26 men and 27 women diagnosed with psychosis, matched on age, education, and race, of the impact of psychosis on one's life, were compared. Using secondary data from semi‐structured interviews, themes were identified using inductive, phenomenological qualitative analyses. Results: Women and men discussed psychosis‐related interruptions to the roles and relationships that shape their identity. Both genders discussed the impact of psychosis on their sense of self, work, and relationships. Nuanced gender differences emerged, informing unique areas of challenge related to (1) parenting and loss of parenting roles, (2) work and loss or changes in work trajectories, (3) isolation and strain on interpersonal relationships, and (4) manifestations of stigma. Conclusions: Psychosis may disrupt distinct aspects of life for men and women. Each gender faces the intersection of socially informed expectations that impact one's experiences of stigma, expectations of others, and manifestations of losses felt in one's role and sense of identity. Findings inform important considerations for therapy and other services. Practitioner points: Gender‐based socialized expectations, losses, and challenges that accompany psychosis are important areas for therapeutic consideration.Current treatments may neglect challenges that are more commonly experienced by women with psychosis. [ABSTRACT FROM AUTHOR]

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Functional deficits are a hallmark of schizophrenia spectrum disorders, but much debate still exists over why and how they originate. One model suggests that disturbances in social functioning are a result of metacognitive deficits or a failure to integrate information to form more complex ideas of themselves and others. It is unclear if this social dysfunction is present across different symptom presentations.We examined the relationship of metacognition, symptoms, and social functioning among a sample of adults with schizophrenia spectrum disorders (N ¼ 334). A latent class analysis produced a four-class model. Groups were classified as follows: diffuse symptoms/moderately impaired social functioning (Class 1), positive and hostility symptoms/mildly impaired social functioning (Class 2), minimal symptoms/good social functioning (Class 3), and negative and cognitive symptoms/severely impaired social functioning (Class 4). Class 3 demonstrated better overall metacognitive capacity than both Classes 1 and 4 but did not differ significantly from Class 2. Classes 2 and 3 both demonstrated better interpersonal functioning than Classes 1 and 4. Together, these findings provide support for models of poor functioning that stem from fragmentation of an individual's experience, leading to diminished abilities to form meaningful connections with others. Additional interpretations, limitations, and research implications are discussed. [ABSTRACT FROM AUTHOR]

Humanistic psychology has made us aware that any understanding of schizophrenia must see persons diagnosed with this condition as whole persons who are making sense of what wellness and recovery mean to them. This has raised questions about what the diagnosis of schizophrenia means and whether the diagnostic label of schizophrenia is helpful when we try to conceptualize the actions and aims of treatment. To examine this issue we propose it is essential to consider what is systematically occuring psychologicaly in recovery when persons experience, interpret and agentically respond to emerging challenges. We then review how the integrated model of metacognition provides a systematic, person-centered, evidence-based approach to understanding psychological processes which impact recovery, and discuss how this guides a form of psychotherapy, metacognitive reflection and insight therapy, which promotes metacognitive abilities and support recovery. We suggest this work indicates that metacognitive capacity is something that can be diagnosed without stigmatizing persons. It can be used to meaningfully inform clinical practice across various theoretical models and offers concrete implications for rehabilitation. [ABSTRACT FROM AUTHOR]