Practitioner psychologists’ experiences of delivering a cognitive behavioural therapy informed crisis intervention for psychosis in inpatient settings: a mixed methods investigation within the CRISIS study

Abstract

Abstract Objectives Cognitive behaviour therapy for psychosis (CBTp) should be delivered in psychiatric inpatient settings, yet little is known about therapists’ perspectives on delivering it. This study examined therapists’ perspectives on delivering a crisis-focused CBTp-informed (cCBTp) intervention. Design The study was part of the CRISIS (CRISis cbtp in Inpatient Settings) study, a feasibility randomised controlled trial of the cCBTp intervention for inpatients experiencing psychosis. A mixed methods approach combined therapy log data and qualitative interviews with therapists after the trial therapy was complete. Methods Seven CRISIS study therapists completed a therapy log, which we analysed descriptively. Semi-structured interviews with six of these therapists explored their experiences with intervention training and delivery, which was analysed using thematic analysis. Results The results from the therapy log demonstrated that therapists’ undertook a comprehensive assessment and prioritised engagement with all participants, and most developed a formulation, which informed change strategy delivery aligned with the patient’s goals. In the qualitative interviews, therapists emphasised the importance of delivering culturally competent flexible, person-centred therapy and supporting patients to work towards goals such as coping with the crisis and discharge planning. They described challenges of delivering therapy in the acute crisis context including interruptions to therapy sessions, patients experiencing acute symptoms, and environment restrictions. Conclusions The study demonstrated the importance of delivering cCBTp collaboratively and supporting patients in understanding and managing their own crisis. It also identified several challenges therapists had delivering the therapy. Further research is needed to explore therapists’ experiences of delivering psychological interventions in this setting. Practitioner Points 1. Therapists must be flexible in their approach and remain adaptable with session timing, location and content to accommodate disruptions in inpatient settings, ensuring continuity of therapy despite high levels of distress and non-attendance. 2. A validating, therapeutic relationship is central to support patients with psychosis in crisis, enabling trust, safety and effective goal-directed work. 3. Therapists and patients collaboratively developing a crisis-focused formulation helps patients make sense of their current crisis, facilitates empowerment and enhances relapse prevention and discharge planning. 4. Therapist should actively explore and integrate patient’s cultural experiences including experiences of racism into therapy to help strengthen engagement and provide a holistic understanding of a patients’ experiences.