Virtual Psychotherapy for Psychosis Course and Consultation Group

Thank you for your interest - we will announce the dates of our next cohort when that information is confirmed!

Online Group Consultation - Six 1-hour sessions - Date and time TBD - Limited space available: Maximum 6 learners

PANY invites you to enroll in a seminar demonstrating how to combine CBTp (cognitive behavioral therapy for psychosis) and psychodynamic treatment to aid psychotic patients in their recovery.

The Psychotherapy for Psychosis course will outline Melanie Klein’s conception of the psychology of psychosis and describe CBTp techniques in sufficient detail for psychodynamically-oriented clinicians to employ them in their work. 

Clincians primarily identified with CBT can expect to gain by adding a psychodynamic understanding of psychosis to their work, and psychodynamic clinicians can expect to learn effective CBT-based interventions that can move the psychotherapy process forward.

A follow up online consultation group via videoconference will also be offered as an separate add-on for learners to present clinical material for discussion. 

The didactic course is available for enrollment separately, or in combination with the online videoconference consult group session series.

PANY's Psychotherapy for Psychosis course integrates cognitive-behavioral techniques with psychodynamic treatment (CBTp), illustrating how CBTp can help patients come to doubt the literal truth of delusional ideas, while a psychodynamic approach can help patients explore the figurative symbolic truth of psychotic symptoms. The course will demonstrate how the therapist employs cognitive behavioral techniques which move increasingly toward psychodynamic interpretation as the treatment proceeds. 

• From a psychoanalytic point-of-view, cognitive behavioral therapy for psychosis (CBTp) entails an enhancement of the observing ego that uses secondary process thinking in an effort to reduce psychotic suffering. 
• Noted psychoanalysts such a Silvano Arieti and Frieda Fromm-Reichmann used a combination of psychodynamic, and what would now be called CBTp techniques in their work.  It can be helpful with many psychotic persons to use CBTp techniques early in treatment to help patients understand that their delusional beliefs are literally false.
• Most psychotic persons locate the cause of their suffering not in their own minds, but in the outside world, often in the form of a “persecutory object” (as described by Melanie Klein) that wishes to do them harm, such as the Devil, the FBI, a neighbor, a relative, or a tormenting voice.  As long as patients regards their problems as arising outside the boundary of the self, it is difficult to bring psychotherapeutic techniques to bear on the patient’s suffering.
• When the CBTp work succeeds in raising doubts about whether the problem is in the outside world, as the patient had previously surmised, a psychodynamic approach that can help patients explore the figurative truth of their psychotic symptoms.

This course aims to assist psychotherapists who are working with psychotic persons by presenting a psychological model of psychosis and a psychotherapeutic approach consistent with that model.

• Psychiatrists, psychologists, social workers, and other professionals who encounter psychotic persons in their clinical practice.
• Clinicians who work in a public clinic or hospital setting who find that a majority of patients in their case assignments are psychotic.
• Clinicians in private practice, even those who do not specialize in the treatment of psychotic individuals, whom occasionally encounter a patient who proved to be psychotic or near-psychotic early in treatment, or who developed a psychosis in the course of ongoing psychotherapy. 

Michael Garrett, MD is on the faculty of Psychoanalytic Association of New York, affiliated with NYU School of Medicine in New York City. Dr. Garrett was formerly the Vice Chairman of Psychiatry at SUNY Downstate Medical Center, where he is currently Professor Emeritus of Clinical Psychiatry. He received his medical degree from the Albert Einstein College of Medicine, and completed his residency training in Psychiatry at Bronx Municipal Hospital Center. Most of Dr. Garrett’s professional career has been spent in the public psychiatry sector, first at North Central Bronx Hospital, where he became Associate Director of Psychiatry, and then Medical Director in 1995. In 1997 he became Deputy Director of Psychiatry at Bellevue Hospital, where he was responsible for clinical services. In 2003 he moved to SUNY Downstate as Vice Chairman for Clinical Services. At present his time is evenly divided between patient care, supervision of psychotherapy, teaching, and clinical research. He has for many years had an interest in the difficulties clinicians encounter when trying to develop a relationship with psychotic individuals who have a fundamentally different view of reality than the clinician. He has a particular interest in combined psychodynamic and cognitive behavioral treatments of psychosis. His academic and research interests also include the voice hearing experience and the relationship between psychosis and ordinary mental processes. His publications include:

1. Garrett, M. and Silva, R. (2003) Auditory Hallucinations, Source Monitoring, and a Belief that ‘Voices’ Are Real. Schizophrenia Bulletin, 29(3):445-457
2. Garrett, M, Stone, D. and Turkington,  (2006)  Normalizing Psychotic Symptoms.  Psychology and Psychotherapy: Theory, Research, and Practice. Vol 79, Part 4, 595-610
3. Garrett, M. & Turkington, D. (2011) Cognitive Behavioral Therapy in a Psychoanalytic Frame. Psychosis 3 (1) pgs 2-13
4. Garrett, M. (2016) Psychosis, Trauma, and Ordinary Mental Life. American Journal of Psychotherapy, v70(1),  35-62
5. Garrett, M. (2017) Individual Psychodynamic Psychotherapy and Cognitive Behavioral Therapy for Psychosis In Kaplan and Sadock Comprehensive Textbook of Psychiatry 10th Edition. Chpt 33.16: pg 2866-2886.
6. Garrett, M. (2019) Psychotherapy for Psychosis: Integrating Cognitive Behavioral and Psychodynamic Treatments. Guilford Press/New York.

Duration: 9 hours total

Time Frame: Held on three Saturdays

Location: via Zoom videoconference

CLINICAL CASE 1: The ♀ who feared her cat planned to murder her

• Pathogenesis of Psychosis
  • prodrome
  • delusional mood
  • ideas of reference:  apophany and anastrophe
  • breakdown of ego boundaries
  • diminished sense of self and personal agency
• Object-Relations Theory (Melanie Klein)
  • persecutory objects
  • “voices” as internal psychological objects
  • history of psychotherapy for psychosis

CLINICAL CASE 2: The dog with Xray eyes that could see through clothing

• Combining CBT for psychosis with a psychodynamic perspective
• Symbol formation and concrete metaphor in psychosis
• Psychodynamic interpretation of psychotic symptoms
• Overview of CBT for Psychosis (CBTp)
• Three models
  • Stress vulnerability model of psychosis
  • “Normalizing” psychotic symptoms by relating them to ordinary mental life
  • A-B-C model (an activating event A results in belief B which has an emotional consequence C

CLINICAL CASE 3: The ♀ who almost caused her mother to be lynched by a mob.

• CBT for psychosis techniques
  • Working with voices
  • Agreeing to disagree
  • Peripheral questioning
  • Rating the likelihood of a belief
  • Rating the value of evidence
  • Informational handouts – increasing real world learning
  • Reality-testing experiments
  • Homework assignments
  • Simultaneous CBTp and psychodynamic formulations to guide the psychotherapy

EXTENDED CLINICAL CASE 4: 20 year paranoid psychosis- a ♀ who believed she had a horrible smell.

CLINICAL CASE 5: The ♂ who murdered his parents

CLINICAL CASE 6: The ♀ who heard “voices” who predicted death

Limited space available: Maximum 6 learners

SESSIONS 3-8 (1 hour peer supervision videoconference - Schedule TBA)

• Members of the group alternate presenting clinical material for discussion

Format for Presenting Clinical Material - Psychotherapy for Psychosis Peer Consultation Group

1. A brief (one paragraph) summary in a traditional medical/psychiatric format; e.g., “This is the 3rd psychiatric hospitalization in 2 years  for this 28 y.o. Hispanic man who had his first psychotic episode at age 24 who is non-compliant with his medication  … and so on (pertinent history)…
2. What is the patient’s understanding of his/her situation? What is the patient’s concern?  What is the main source of the patient’s distress, from the patient’s point of view?   e.g., “ I have been the subject of a government experiment for the last 8 years.   They probe my mind and body to test my reactions.”
3. What details can the patient provide about his/her situation? Who is involved, and why?  What are the ‘characters’ in the patient’s story?    When did it all start?  What were the first indications that something was going on?
4. What evidence does the patient offer in support of his/her beliefs? What is the ‘evidentiary chain’? e.g.,  “The “voices” predicted Frank Sinatra’s death and it happened.  They were right.  They can predict the future.”
5. Does the patient report a particular perceptual experience (a body feeling, a sensation, a “voice,” a life event, etc.) that is particularly important in the patient’s evidentiary chain supporting the delusional belief?   “I know from the intense look the preacher gave me that he was hypnotizing me.  I felt a burning sensation in my brain.” 
6. A brief vignette from a session with the patient presented in the form of a transcript of part of a session (1-2 pages), that sketches out what the patient said and what the therapist said in reply, and so on, that illustrates particular clinical issues posed by the patient, or presents an example of a dilemma you face as the therapist working with the patient.

If four or more participants are interested in reserving an hour of small group supervision to discuss one of their patients with Dr. Garrett at length, the fee for each member of a group of a minimum of 4 presenters is $200 ($50/group session/person).  You can reserve a spot in a supervision group at the time you register for the course. Payment for the group will be due once the group is formed and confirmed. If interested in the group, please reserve your spot as early as possible as groups are limited to 6 members. Additional groups potentially may be available depending upon interest and demand.  

Enrollment submissions are currently being accepted.

Seats are limited; early submission is encouraged.

* Consultation group is limited to 6 participants, we encourage you to enroll early. Additional group may be added dependent upon interest. 

• To enroll, download a registration enrollment form and follow instructions on form for submission. Please be sure to also submit your CV.

Click here for enrollment page.

• Course (9 hours): $250

• Course (9 hours) PLUS Online Consultation Group Series (6 sessions): $500

* Learners may enroll in didactic 9 hour course alone.  

* Consult group series enrollment is only available in combination with didactic course, and enrollment is for entirety of 6 group sessions. 

If four or more participants are interested in reserving an hour of small group supervision to discuss one of their patients with Dr. Garrett at length, the fee for each member of a group of a minimum of 4 presenters is $200 ($50/group session/person).  You can reserve a spot in a supervision group at the time you register for the course. Payment for the group will be due once the group is formed and confirmed. If interested in the group, please reserve your spot as early as possible as groups are limited to 6 members. Additional groups potentially may be available depending upon interest and demand.  

• The didactic portion of this course is eligible for 9 continuing education units. 
• Learners must attend all 9 hours to be eligible for credit.

"This course was an excellent review as well as inspired me- to somehow, someway return to direct patient care!"

"Dr. Garrett was a great instructor- I like how he interwove humor and patient vignettes to keep us engaged."

"Dr. Garrett taught in such a way that one knew one was with a great intellect and professional — and who was able to make the material accessible and understandable in an easeful and down to earth way. I particularly liked how he used examples so extensively while integrating theory and application into the vignettes. I won’t forget the principles I learned in the course — the are priceless for those of us who work with any level of psychoses in our patients."