Engaging with psychosis: A psychodynamic developmental approach to social dysfunction and withdrawal in psychosis

Abstract

Engaging and sustaining constructive relationships with people affected by psychosis is a challenge for clinicians, services and carers. Social dysfunction, withdrawal, negativity and hopelessness are inherent and intractable features of psychosis. We propose that the social difficulties experienced by people affected by psychosis can be addressed through the psychodynamic identification of a psychotic part of mind. In this view, people vulnerable to psychosis are affected by problems that originated during their early psychosocial development. This results in an encapsulation of omnipotent processes, which are a normal and necessary part of infant and child development; however, using these omnipotent processes in adulthood compromises social functioning. Drawing on clinical examples from our work in psychosocial recovery services, we demonstrate how the impact of the psychotic part of mind is expressed in ‘negative omnipotence’ and ‘ethical reversals’, and how ‘diplomatic interventions’ can help sustain engagement and improve psychosocial outcomes for people with psychosis