1. www.psychosisrecovery.org Engagement and Assessment Kate Hardy, Clin.Psych.D Post Doctoral Fellow Prodromal Assessment, Research and Treatment Team (PART), UCSF Kate.Hardy@ucsf.edu PREP Prevention and Recovery of Early Psychosis

2. www.psychosisrecovery.org Objectives Have explored issues of engagement with this population and suitability for treatment Have an understanding of the techniques used to assess individuals with psychosis and those at risk of developing psychosis Be able to utilize information gained from assessment in the development of problem lists and goal setting

3. www.psychosisrecovery.org Introducing the concept of CBT for psychosis How to introduce concept of CBT to someone with psychosis? Same as would introduce it to someone with any other mental health problem Pacing at speed appropriate to individual Explain link between thoughts, behaviors and feelings Agenda setting Develop problem list SMART goals Contract for number of sessions and review sessions

4. www.psychosisrecovery.org Therapeutic relationship Development of good therapeutic relationship is essential May take longer if someone is paranoid or has had bad experiences of services Therapeutic relationship takes precedence over assessment and intervention Emphasis on warmth, collaboration and mutual respect

5. www.psychosisrecovery.org Therapist Issues Own views of people with psychosis Own views of therapy for psychosis Own views of CT for psychosis

6. www.psychosisrecovery.org Engagement issues Befriending »Focus on neutral non threatening topics »No active formulation or treatment »Non confrontational »Empathic »Supportive »Accepting »Non colluding Assertive engagement techniques

7. www.psychosisrecovery.org Engagement issues continued Non confrontational »Avoid confrontation but avoid collusion also »Show interest in the subject with non judgmental questioning Pacing »May need to be at a slower pace with simple achievable goals set for each session »Use aids to help client to follow session (white board etc) »Be aware of internal distracters that may impact on clients ability to concentrate

8. www.psychosisrecovery.org Engagement issues continued Word perfect accuracy and consistency »Maintain consistency throughout sessions »Open acknowledgement of inconsistencies from therapist »Use of client’s language without collusion Tactical withdrawal »If increase in agitation or distress move from topic to neutral non threatening topics developed through befriending »Agree to disagree on topic

9. www.psychosisrecovery.org Assessment – why? To understand person’s background, present circumstances and concerns Develop a formulation Inform intervention selection Establish baseline against which can measure change

10. www.psychosisrecovery.org Assessing - what? Personal history Route into services Time and onset Symptoms and distress Risk Substance misuse Strengths and hopes for recovery

11. www.psychosisrecovery.org Assessing – how? Terminology »Open ended questions »Careful use of language Interview Corroboration of information Structured assessments »i.e. PANSS, SIPS, SCID Subjective assessment »Scaling questions »Subjective units of distress »Problem list

12. www.psychosisrecovery.org Case examples Justin – referred as being at risk of developing psychosis, on methadone treatment and homeless, paranoid Sarah – history of psychotic episodes, currently stable but limited insight, not want to be seen by psychology but part of treatment plan

13. www.psychosisrecovery.org Role play How might you proceed with the following client? 16 year old male living independently from his parents for the last six weeks. Assessed using the SIPS and identified as being at risk of developing psychosis due to a recent deterioration in functioning plus a first degree relative with schizophrenia. Also, increasingly afraid to leave the house alone. Started about six months ago and now unable to go beyond the end of his street on his own. He does not feel safe when he leaves the house and worries that people he meets may attack him.

14. www.psychosisrecovery.org 22 year old male with a diagnosis of schizophrenia. Recently experienced his first psychotic break. Accessed services after he shot his mother with an air rifle. Experiencing command hallucinations at the time and believed that she was part of an alien conspiracy. Currently stable on medication but still holds delusional beliefs of aliens on earth. Can not explain how these operate now but convinced that they were with him at the time of shooting his mother.