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When the going gets tougher: the importance of long-term supportive psychotherapy in psychosis

Alan Meaden is a consultant clinical psychologist and psychology lead specialising in psychiatric rehabilitation with Birmingham and Solihull Mental Health NHS Trust (Psychology Services, 208 Monyhull Hall Road, Kings Norton, Birmingham B30 3QJ, UK. Email: alan.meaden{at}bsmht.nhs.uk). He is also lead for the trust’s Psychological Interventions Research Programme and project manager for reviewing residential rehabilitation services. Other clinical and research interests include engagement, working with staff groups, and challenging behaviour and risk. Susanna Van Marle retired from her post as part-time consultant psychiatrist in psychotherapy in 2006. She was involved in applying psychotherapeutic thinking to help patients with severe mental health difficulties and the staff involved in their care. Her clinical and research interests include assessment, consultation, long-term supportive psychotherapy and staff support.

There has been considerable progress in recent years in developing psychosocial interventions for people who experience persistent psychotic symptoms. However, it is sometimes difficult to generalise these findings into routine clinical practice. Long-term, psychodynamically informed, supportive psychotherapy is a valuable approach for working with individuals for whom current psychosocial interventions are ineffective or where unhelpful team reactions are obstacles to care. Its principles are used to inform a multiaxial formulation, which is shared with the treatment team and guides treatment, promoting good-quality comprehensive routine care. The benefits of this approach can best be seen at the individual case level using a subsequent multiaxial reformulation.