• Deborah Mitchison, Simon Jakes, Siobhan Kelly, and John Rhodes.
• Birunji Youth Mental Health Unit, Campbelltown Hospital, Sydney, Australia.
• Clin Psychol Psychother. 2015 Jan 1; 22 (1): 22-31.

ObjectivesPsychotic clients may be difficult to engage in psychological therapy, and many potential participants decline to participate in controlled trials of cognitive behavioural therapy. The aim of this study was to investigate psychotic patients' perspectives regarding therapy.DesignThe design was qualitative and used thematic analysis to investigate emerging themes. Methods A total of 46 inpatients with psychosis were interviewed about their views on therapy. Interview summaries were submitted to thematic analysis.ResultsA total of 41% of participants were rated as interested, 36% were rated as not interested and 23% appeared ambivalent, or their interest in therapy was unable to be assessed. Themes related to interest in therapy included the desire to build skills, to address (usually non-psychotic) symptoms and for a therapeutic relationship. Themes related to not wanting therapy included a denial of psychological problems, distrust in the healthcare system and psychologists and low perceived efficacy in therapy.ConclusionsA large minority of psychotic patients may be interested in therapy, although mostly not to address psychotic symptoms. Future research on pre-treatment approaches to disconfirm negative perceptions and increase interest in therapy is warranted.Key Practitioner MessageThe reasons why some patients with psychosis are not interested in receiving psychological therapy may relate to past negative experiences with psychologists, negative perceptions of psychologists as a group and low perceived efficacy of therapy. These barriers may be addressed through interactions with psychotic patients during an admission to a hospital that disconfirms these perceptions and provides a positive alternative experience with a psychologist. Patients who are hospitalized with psychosis may be interested in receiving psychological therapy; however, the reason for this likely will not be to address psychotic symptoms. Rather, the therapist should be willing to work with the patient on a range of other presenting problems. If a patient has a lack of insight into their psychotic symptoms, this does not always negate them from perceiving other psychological problems for which they may desire support in addressing. Thus, therapists should be encouraged to approach all psychotic patients on a ward, even when there is an apparent lack of awareness of their psychotic symptoms. The themes related to patients' perspectives were generated from psychologists' summaries of interviews with patients and not directly from verbatim transcripts. Although this meant that the reasons given for participants being interested or not interested in therapy were interpreted by the psychologist, efforts were made to relate the exact reasons provided by the participants. Eighteen (29%) of the potential participants were not interviewed, usually as a result of their being discharged or transferred prior to arrangement of an interview. This meant we were unable to capture the views of these patients. Discharge prior to being seen by a psychologist is a barrier to engaging a patient in therapy and preventing them falling through the gaps of service provision.Copyright © 2013 John Wiley & Sons, Ltd.

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