title: Emergence of psychotic content in psychotherapy: An exploratory qualitative analysis of content, process, and therapist variables in a single case study.
abstract: Emerging integrative metacognitive therapies for schizophrenia seek to promote subjective aspects of recovery. Beyond symptom remission, they are concerned with shared meaning-making and intersubjective processes. It is unclear, however, how such therapies should understand and respond to psychotic content that threatens meaning-making in therapeutic contexts. Accordingly, we sought to understand what factors precede and potentially trigger psychotic content within psychotherapy and what aids in resolution and return to meaning-making.
  
  
  
  Forty-eight transcripts from a single psychotherapy case were analyzed with thematic analysis. Passages of delusional or disorganized content were identified and themes present prior to the emergence and resolution of such material were identified and coded.
  
  
  
  Themes that preceded the emergence of psychotic content varied across early, middle, and late phases of therapy. Material related to the patient's experience of inadequacy and potential vulnerability, therapist setting boundaries within the therapeutic relationship and making challenges appeared to trigger psychotic content, especially early in treatment.
  
  
  
  Psychotic content may emerge in session following identifiable antecedents which change over phases of therapy. Attending to psychotic content by assuming a non-hierarchical stance and not dismissing psychotic content may aid in maintaining intersubjectivity and support patient's movements toward recovery in integrative metacognitive therapies.
authors.affiliation: a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.|b Indiana University Psychotic Disorders Program , Indianapolis , IN , USA.|c Midtown Community Mental Health Center , Eskenazi Health , Indianapolis , IN , USA.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Leonhardt
authors.affiliation: d Roudebush VA Medical Center , Indianapolis , IN , USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Kukla
authors.affiliation: e School of Psychological Sciences, University of Indianapolis , Indianapolis , IN , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Belanger
authors.affiliation: e School of Psychological Sciences, University of Indianapolis , Indianapolis , IN , USA.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Chaudoin-Patzoldt
authors.affiliation: d Roudebush VA Medical Center , Indianapolis , IN , USA.
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Buck
authors.affiliation: a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.|b Indiana University Psychotic Disorders Program , Indianapolis , IN , USA.
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Minor
authors.affiliation: a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.|b Indiana University Psychotic Disorders Program , Indianapolis , IN , USA.|c Midtown Community Mental Health Center , Eskenazi Health , Indianapolis , IN , USA.
authors.forename: Jenifer L
authors.initials: JL
authors.lastname: Vohs
authors.affiliation: c Midtown Community Mental Health Center , Eskenazi Health , Indianapolis , IN , USA.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Hamm
authors.affiliation: a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.|d Roudebush VA Medical Center , Indianapolis , IN , USA.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lysaker
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D036301:Qualitative Research; D012559:Schizophrenia / Q000628:therapy*
keywords: insight; psychotherapy; qualitative methods; recovery; schizophrenia