New Beginnings: Reimagining Psychosis Services & Systems in the US

This workshop will be based on a cognitive behavioral approach to understanding psychosis. The first session will focus on a developmental formulation and how early stressful life events contribute to the development and maintenance of psychotic symptoms. The second session will build on this approach to consider the overlap between the symptoms of PTSD and psychosis, and the extent to which varied psychotic presentations can be understood as complex reactions to trauma. The afternoon sessions will highlight the different possible treatment approaches for working with trauma in psychosis. These will include adapted interventions such as ‘reliving’ and ‘imagery rescripting’ as well as a ‘voice dialogue’ approach to working with voices. The aim of the workshop is to ‘demystify’ these approaches to treatment and to signpost to further available training.

Registration for this event is sold separately and is not included in the main conference registration. 
Conference attendees receive a 20% discount to the training. When you purchase your ticket for the conference a discount code for the pre-conference workshop will appear on the confirmation page. Please save it and Register Online

PLEASE NOTE THE PRE-CONFERENCE WORKSHOP IS NOW SOLD OUT

Conference Reception and Panel Discussion Event - University of Pittsburgh

Join us for an in-person panel discussion featuring emerging and established activist, clinical and policy leaders from across the US. Discussion will focus on priorities, actionable change, and equity in context of race, culture, gender identity, socioeconomic and disability. Refreshments provided.

When: Friday, November 1st, 5:45- 7:30 pm (immediately after the pre-conference workshop)
Where: University of Pittsburgh Cathedral of Learning, Room 2017
Who: This event is open to pre-conference workshop attendees, general conference attendees, and members of the public
Cost: Free

RSVP required: Link here

The medical model of psychosis has dominated treatment and research funding. However, recent years have established the high prevalence of stressful and traumatic life events within people who are diagnosed with a psychotic disorder. Traumatic life events can lead to a range of phenomena, including intrusive memories, dissociation and hearing voices which occur within a wide range of mental health problems. I will draw on psychological models to demonstrate how a range of psychotic presentations can be formulated within a trauma framework, and discuss the subsequent treatment implications. An overview of treatment developments within the U.K, Europe and Australia will be presented.

Over the past decades, participatory methods and lived experience/service user involvement have gained substantial traction in mental health research and policy.  While the United States arguably lags well behind countries such as the UK, Australia, and New Zealand, there has nevertheless been a marked uptick in interest and investment in involvement.    Unfortunately, as a nominal emphasis on involvement grows, so too have tokenism and cooptation, mirroring longer-term trends in peer support.  This panel brings together three international leaders in the lived experience research space – Andrew Grundy (University of Manchester & University College London), Nev Jones (University of Pittsburgh) and Alison Branitsky (University of Manchester)—two of whom are based in the UK, in a panel that will reflect on the deeper, transformative value of lived experience leadership, the harms of cooptation, and the possibilities of work that truly reflects the values, methods and priorities of those historically marginalized in psychosis-relevant knowledge production.

Innovative Approaches in Assessment, Treatment, and Residential Care (3 x 30 minute sessions)  

• The Utility of Psychological Assessment in Detecting Psychosis: A Case Illustration - Connor Adams, PsyD
• EMDR and Psychosis: Nudging the United States Into the Modern Age of Trauma Treatment - Chris Perry, MS, MA, LMFT
• Creating an effective natural team based on the Windhorse approach - Eric Friedland-Kays, MA Victoria Yoshen

The Utility of Psychological Assessment in Detecting Psychosis: A Case Illustration - Connor Adams, PsyD
This presentation with utilize a clinical case to illustrate the utility of psychological assessment when detecting psychosis and creating an individualized treatment plan. The case will feature Mr. G, who was referred for psychological assessment by his therapist to better understand what factors were contributing to Mr. G feeling “stuck” in both life and therapy. Mr. G initially sought therapy due to feeling he was experiencing a “failure to launch” as a young adult. Specifically, he reported starting and stopping graduate school several times, finding it difficult to maintain friendships and romantic relationships, and struggling to engage in daily self-care activities such as personal hygiene and meal prep, despite having previously been successful in all these domains. After approximately one year of therapy both he and his therapist felt their work was not progressing and sought a psychological assessment to gain a deeper understanding of any cognitive difficulties, behavioral patterns, or intrapsychic conflicts that might contribute to his “stuckness.” Mr. G completed a multimethod psychological assessment. Multimethod assessment procedures included a thorough record review, a clinical interview, the Bender-Gestalt, Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF), Rorschach Performance Assessment System (R-PAS), Projective Drawings, Rotter Incomplete Sentences Blank (RISB), Thematic Apperception Test (TAT), Woodcock-Johnson IV Achievement (WJ IV ACH), and Wechsler Adult Intelligence Scale (WAIS-IV). This case presentation will highlight the role of psychological assessment in bringing to light previously unrecognized disordered thinking that notably contributed to Mr. G’s difficulty getting “unstuck” in his life. Moreover, the assessment provided information regarding the conditions under which Mr. G’s thinking was more vulnerable to becoming disorganized, such as during instances of emotional flooding. This presentation will provide an orientation to the utility of psychological assessment, in particular for individuals experiencing psychosis, emphasizing the utility of this intervention in addition to psychotherapy.

EMDR and Psychosis: Nudging the United States Into the Modern Age of Trauma Treatment - Chris Perry, MS, MA, LMFT
The most cursory glance at the literature regarding trauma and psychosis demonstrates a strong correlation between the two. Given this, it would seem axiomatic that a trauma-informed system of care would make evidence-based therapies for posttraumatic sequelae readily available to people who have experienced both trauma and psychosis. In the United States, however, the opposite is true: psychosis is often considered an exclusionary criterion for the exact modalities of trauma treatment that have the strongest evidence base.

This presentation will focus on Eye Movement Desensitization and Reprocessing Therapy (EMDR) as a specific example of an evidence-based treatment for trauma that is systematically denied to people who have had experiences of psychosis and are seeking care in the United States. This reality contrasts sharply with the literature and with clinical practice in other parts of the world. There is a robust literature demonstrating that EMDR is both safe and effective for individuals with past and present experiences of psychosis. A review of this literature identifies clear geographic delineations: of all the available published works on this topic, only a few have been written by authors based in the United States, and none of these are systematic reviews or based on new research. In fact, almost all are cautionary tales about the use of EMDR in the context of psychosis.

This divide in the literature is reflected in clinical training and practice in the United States, which rests on unsubstantiated beliefs about the risk-benefit ratio for this practice and excludes individuals who have experienced psychosis from receiving EMDR treatment. This presentation will present a review of the literature about this practice and a case study of the process of introducing EMDR as a clinical tool in an early psychosis program at UCSF. 

Creating an effective natural team based on the Windhorse approach - Eric Friedland-Kays, MA, Victoria Yoshen
Imagine someone you love needs support because they experience extreme states of mind that make it difficult to cope with their life in an independent, functional way. Their mind makes it difficult to navigate basic tasks, and causes difficulty in relationships with friends, family, and at their job. You find them a well-meaning outpatient therapist who may not have the skill or time to engage with your loved one sufficiently. This situation becomes increasingly isolating and chaotic. What might you do to establish an effective therapeutic environment for your loved one outside of sending them to a hospital or residential program?

Now imagine creating a comprehensive mental health support system in the community for your loved one so that they can continue to engage with their life as it is. This support system consists of providers who establish one-on-one safety with this person, coach them in the real world, and all communicate weekly. This team consists of a therapeutic housemate,a skilled and humble facilitator, therapeutic mentors, and can include a psychiatrist and family members. The team is cohesive and the conflicts that arise within it are held in a therapeutic context. These relationships are consistent and flexible enough so that your loved one has enough support in the world to continue to lead a functional life with a trajectory of healing and growth.

This presentation from Windhorse Integrative Mental Health explores the unique elements of a community-based Windhorse team for individuals in psychiatric distress. For over forty years, our approach has been utilized at sites in North America and Europe with impressive results. This presentation will describe the key elements of a Windhorse team, explore its usefulness, and will cultivate dialogue about its applicability in home and community settings independent of enrolling in a Windhorse program.

Sanctuary in the Forest: An Australian Peer-led Respite for Post-Psychosis Integration Using a Bio-Psycho-Social-Spiritual Approach - Louisa Dent Pearce, MSW (Masters of Social Work)

The Sanctuary in the Forest is an Australian respite model for people who have experienced psychosis, mania or non-ordinary states of consciousness. The service was inspired by the presenter’s own lived experience of psychosis, her early career in peer support, and trauma-informed models of care such as Dr Sandra Bloom’s Sanctuary Model.

Australia’s mainstream treatment for psychosis focuses on stabilisation of symptoms while often minimising or denying a person’s personal meaning and spiritual aspects of the experience, hence the healing opportunity may be truncated and the person may be left with unresolved trauma, unanswered questions, unprocessed emotions and internalised stigma.

This respite offers a post-psychosis integrative experience where participants can explore worldviews of psychosis and mania, reflect on personal meaning, share stories in conscious ways, process emotions, learn grounding skills, and reduce internalised stigma.

We use an adapted bio-psycho-social-spiritual framework, along with Intentional Peer Support, the Hearing Voices Approach, Acceptance and Commitment Therapy, somatic therapy, and grief and loss theory. We also use non-psychoactive spiritual and shamanic practices, appropriate to the participants’ worldviews.

We created a healing map called The Connected Self which invites deeper connection to six domains: self/body; nature/earth; family/friends; community/society; ancestors/guides; and God/Universe. The map can be adjusted for different worldviews and language preferences.

Our design logic uses embodied participation within the therapeutic milieu of a rainforest setting, with scaffolding activities such as discussion, teaching, story-telling, ceremony, creative arts and celebration.

Participants and peer facilitators report significant improvements in motivation, insight and confidence in personal choices and values, and a reduction of negative emotions and thoughts related to their experiences of psychosis/mania. This respite may provide a learning template for other such services or research which seeks to bridge the gap between mainstream mental health and broader cultural and spiritual views of non-ordinary states of consciousness.

Psychotherapy training rarely addresses work with individuals diagnosed with psychosis, and often actively discourages trainees from pursuing long-term, relationship-based or in-depth work with people who carry this diagnosis.  This two-session workshop aims to address the questions and concerns of students and early career professionals who are interested in learning more about psychological approaches to psychosis by combining an open forum for discussion with a walk-through of clinical transcripts that can form the basis for commentary that can reveal the richness and efficacy of this often life-giving work.

Incorporating the voices of individuals with lived experience of psychosis into medical education, particularly in psychiatry, has the potential to profoundly enrich the training of future mental health professionals. Individuals with lived experience have important perspectives to share about the nature of psychosis, its treatment, and the mental health system itself. By doing so, trainees and seasoned physicians alike gain invaluable insights into the personal and social dimensions of mental illness, which are often underrepresented in traditional medical training.

Evidence suggests that incorporating lived experiences into education fosters empathy, reduces stigma, and enhances the communication skills of psychiatric trainees. Students report a deeper understanding of the complexities of mental health conditions and a greater appreciation for patient-centered care. Furthermore, this approach encourages future psychiatrists to view patients as partners in the therapeutic process, promoting a more holistic and collaborative approach to mental health care.

This panel, comprised of two clinicians and two people with lived experience of psychosis, will share ways in which those voices have been incorporated into medical education within the Department of Psychiatry and Behavioral Sciences at Emory University. This has occurred in multiple formats including guest lectures, small group discussions, and a Grand Rounds presentation. We will share relevant institutional background leading to the development of these programs, firsthand accounts of the experience of presenting in these settings, and a discussion of ways to expand this work throughout our department.

The presentation also addresses the challenges of integrating these voices into medical education, including potential ethical concerns, the need for appropriate support for participants with lived experience, and institutional resistance to curriculum changes. We discuss strategies to mitigate these challenges, such as providing training for individuals sharing their experiences, ensuring a supportive environment, and demonstrating the value of these programs through research and feedback.

In conclusion, incorporating voices of lived experience in psychiatric education enriches the learning experience, better prepares future psychiatrists for practice, and ultimately contributes to more compassionate and effective mental health care. This presentation calls for a concerted effort to make these programs an integral part of medical education, highlighting their transformative impact on both students and the broader mental health system.

2 x 30 minute Sessions:

1. Highlighting family members’ experience of psychosis-REACH in an early psychosis setting: A qualitative analysis - Melanie Lean, Katie Benitah, MSc, MA
2. Oral Health Recovery: A Peer Specialist-Led Dental Education Program - Adrienne Lapidos, PhD

Highlighting family members’ experience of psychosis-REACH in an early psychosis setting: A qualitative analysis - Melanie Lean, Katie Benitah, MSc, MA
Background: Outcomes in early psychosis are greatly improved by intervening at the earliest possible point using a Coordinated Specialty Care (CSC) model that facilitates comprehensive, multi-disciplinary care for individuals who are exhibiting early signs and symptoms of psychosis. However, there is little guidance on family interventions that best compliments the care the client is receiving, and that meets the unique needs of the family, within CSC. Psychosis REACH (Recovery by Enabling Adult Carers at Home) is a Family Intervention for psychosis (FIp) that delivers psychoeducation, evidence-based Cognitive Behavioral Therapy for psychosis (CBTp)-informed skills and peer support to family caregivers in the community. This study examines family members’ qualitative experiences receiving the pREACH intervention in a CSC setting. Method: 20 Family members, whose loved ones are receiving care in an early psychosis clinic, received training in the pREACH model, attended follow-up monthly coaching calls and peer family ambassador support for 6 months. Ten family members participated in a 45min semi-structured interview to provide feedback on the intervention. A Reflexive Thematic Analysis (RTA) was conducted using NVIVO by three team members not involved in intervention delivery. Results: Three principal themes emerged from the RTA: (1) confidence (i.e., building internal resources), (2) connection (i.e., building external resources), (3) improvements for future cohorts. Discussion: This study is the first qualitative exploration of the integration of pREACH in an early psychosis service. Challenges and opportunities for integration will be discussed and areas for future study presented.

Oral Health Recovery: A Peer Specialist-Led Dental Education Program - Adrienne Lapidos, PhD
Introduction: The link between oral health and mental health is well established, leading advocates to declare that there is “no mental health without oral health” (Kisley, 2016). But people with psychotic disorders are subject to significant oral health disparities, driven by psychological factors; medication side-effects (chiefly xerostomia, or “dry mouth”); and social determinants of health impacting dental care utilization. This presentation will review the bidirectional relationship between mental health and oral health, and describe the results of a pilot study which implemented a Peer Specialist-led oral health education and referral program.

Methods: Community-engaged methods were utilized. Randomized parallel assignment was used to compare two arms: (1) group viewing of an oral health educational video (VC), and (2) a peer-led one-time class providing education and motivation to access dental care (Oral Health Recovery Group, OHRG). In both arms, Peer Specialists followed up with participants to facilitate scheduling dental appointments and reinforce goals. Oral health knowledge, at-home care, motivation, and appointment scheduling were ascertained. Qualitative interviews assessed barriers and facilitators.

Results: Sixty-two people participated. Participants were dentally vulnerable, with 27% reporting they had 9 teeth or less, 55% reporting their teeth caused discomfort in the past 12 months, and 48% reporting xerostomia. Pre/post-intervention survey results did not significantly improve or differ between arms. At follow-up, 25 (68%) in OHRG and 14 (56%) in VC attributed meeting a dental goal to the program. Ten (27%) in OHRG and 9 (36%) in VC attributed making a dentist appointment to the program. Participants were comfortable with Peer Specialists in this role, yet access barriers remained.

Conclusions: Surveys did not significantly improve, suggesting that more intensive interventions are needed. Nevertheless, 19 highly vulnerable people successfully scheduled dentist appointments after only a one-time class and light-touch peer navigation. Oral health integration shows promise, meriting further research.

Madness and the Real: Recentering the Unconscious in the Clinic of Psychosis - Elan Y. Cohen, PhD
This presentation problematizes classical assumptions about the relationship between dreams, madness, the unconscious, and reality. I critique an adaptationist psychoanalytic perspective that interprets psychosis as resulting from a defective ego, failing to regulate an excess of unconscious activity. I argue that the classical interpretation prioritizes ego functioning and emphasizes the subject’s adaptation to a defective social reality. In contrast, this presentation offers a psychoanalytic conceptualization of psychosis that aspires to liberate, approaching psychosis as a resistance to processes that efface subjectivity. As such, I advocate for a combined social and psychoanalytic approach to psychosis that recenters the unconscious, which I define as the psychic apparatus that buffers the subject from unmediated proximity to the Real. The presentation will review Freud’s two principles of mental functioning; Bion’s concepts of psychic metabolism, beta-elements and the alpha-function; and the Lacanian registers of the Real and the Symbolic. In each of these frameworks, psychosis can be understood as stemming from a traumatogenic reality that resists symbolization or alpha-betization. The presentation will highlight the utility of each of these frameworks in clinical practice.

In this panel, we will be sharing, discussing, and thematizing preliminary results from an ongoing, grant-funded, qualitative research study which looks at how those experiencing homelessness and housing precarity interact with, negotiate, and navigate mental health services in the City of Pittsburgh.  

From this foundational research, we will tentatively imagine how humanistic, phenomenological, and psychoanalytic perspectives could challenge and transform what is widely accepted as mental health services for those experiencing homelessness in the City of Pittsburgh.

A catered lunch will be provided in the Union Ballroom (main conference space) for all attendees

• Saturday Lunch: Soup, Salad and Sandwich Buffet. Featured soup of the day, garden salad, and assorted deli sandwiches. Brownies, cookies, ice tea, and water.

Recent work within bioethics has engaged with the question of palliative care for mental illness. In particular, recent arguments for palliative psychiatry make the argument that recognition of individuals’ ability to make determinations about care can extend to giving individuals the option to choose palliative care in the face of long-standing, treatment-refractory illness.

While arguments within bioethics have engaged with the question of autonomy here, perspectives from Mad Studies have been noticeably absent in this discourse. This presentation will interrogate the question of autonomy and palliative care from the perspective of Mad Studies, asking how framing and understanding of determinations of futile care, as well as arguments for offering palliative care as a way of respecting agency, change when lived experience perspectives are centered. In so doing, it will argue that these perspectives offer vital, and previously uninterrogated, points of consideration.

From Crack to Psychedelics: Frontiers in Psychosis Work  - 2 x 45 minute sessions

•  Swimming to the Horizon: Crack, Psychosis, and Street-Corner Social Work: Zak Mucha, LCSW
•  The Psychedelic Therapy Train Wreck: Ethical Responses To A Corrupt Industry - Will Hall, MA, DIplPW, Phd Candidate

Swimming to the Horizon: Crack, Psychosis, and Street-Corner Social Work: Zak Mucha, LCSW
Working with a population suffering severe psychotic symptoms, homelessness, and addictions, a non-traditional clinical frame can allow for psychodynamic work. The patient’s relationship to a clinician is more than meds and case management and can be created in a clinical frame not limited to the corners of a physical office. This presentation will consider Bionian and Lacanian structures to examine the possibilities of joining with a patient in their worlds, both internal and external, to understand how psychotic symptoms can hold a narrative of past trauma and possess the hope for an emerging self.

The Psychedelic Therapy Train Wreck: Ethical Responses To A Corrupt Industry - Will Hall, MA, DIplPW, Phd Candidate
Drugs are winning the war on drugs, and it's time to end criminalization of underground psychoactive substances, including psychedelics, less socially accepted than alcohol and nicotine (or psychiatric medications). Harm reduction policies are essential. But proposed medicalization schemes betray the informed consent vital to harm reduction: the new "psychedelic revival" peddles psychedelic exceptionalism hype based in shoddy research, driven by a corrupt decades-old network of new age zealots with a glaring track record of abusing patients under the cover of a code of silence.

"Psychedelic therapy" would put powerful suggestibility, disinhibiting, and vulnerability drugs in the hands of status and money hungry professionals already proven to systematically misuse their power. As the psychiatric system struggles with the decline of the SSRI brand and a lack of products for the PTSD market, are new drugs to play with the solution, or just a repeat of everything wrong with psychiatry? And if commercialization, as tried with cannabis, risks disastrous Brave New World implications in a dystopian capitalist society already desperate to escape and tranquilize, what is the way forward?

Fortunately, new voices are breaking the psychedelic hype bubble: an emerging "critical psychedelic studies" provides a crucial new perspective with wide implications for everyone engaged with the social response to psychosis. In this context, two central myths about psychosis need to be overcome - that anyone with a psychosis diagnosis or history cannot use psychedelics meaningfully in their lives, and that psychosis is just another diagnostic market to benefit from the magic powers of these new wonder drugs. Join us for a sober check-in on how survivors, clinicians, researchers, and policymakers can respond to the new psychedelic revival, and what visions we need for decriminalization of psychedelics from the perspective of innovating our systems and responses to psychosis, not just reinforcing them.

Resources: https://willhall.net/ispspsychedelics2024/

Hearing Voices Implementaiton - 2 x 45 minute sessions

•  Veteran Voices and Visions: Adapting the Hearing Voices Approach to an Urban VA Healthcare System - Ippolytos Kalofonos MD PhD MPH, Erica Hua Fletcher, PhD, Carol Jahchan, PhD, Sahastri Hercules, Cindy Hadge
•  Online Hearing Voices Groups in the NHS: A Feasibility Study - Alison Branitsky, Mres

Veteran Voices and Visions: Adapting the Hearing Voices Approach to an Urban VA Healthcare System - Ippolytos Kalofonos MD PhD MPH, Erica Hua Fletcher, PhD, Carol Jahchan, PhD, Sahastri Hercules, Cindy Hadge, Tim Laprade
The Veteran Voices and Visions (VVV) project is an adaptation of the Hearing Voices approach to the Greater Los Angeles Veterans Affairs Healthcare System that serves 1.4 million Veterans. The VA has officially adopted the recovery model and employs over 1400 peer specialists nationwide. The VVV project uses virtual support groups, co-facilitated by a clinician and a Veteran peer who is an “expert-by-experience,” to normalize experiences such as hearing voices and seeing visions. We are trying to build an evidence-base to get this approach recognized and available for use across the VA. Thus, VVV includes a research component to 1) study the adaptation of a Hearing Voices Facilitator training to the VA and 2) to understand how participating in VVV groups may help Veterans live with their voices and make meaning from their experiences. Our approach has involved multidisciplinary collaborations - including perspectives and contributions from Veterans who hear voices, Veteran peer support specialists, social workers, psychiatrists, psychologists, social researchers, and national Hearing Voices leaders. Group members explore personal understandings and contexts of so-called “unusual” experiences commonly diagnosed as psychosis rather than privileging biomedical framings; we also encourage and support Veterans in engaging with their experiences as potentially meaningful rather than only interpreting them as symptoms of an illness to be eliminated. In VVV groups, Veterans share their stories, coping strategies, and worldviews, and often end up supporting each other in their ongoing life projects.

This panel brings together some of the participants of the project to share our perspectives and experiences, including researchers, clinicians, Veteran participants and facilitators, and trainers. We will explore some of the successes, challenges, lessons learned, possibilities, and contradictions of bringing this community-based, peer-driven approach into a large, bureaucratic health system.

Online Hearing Voices Groups in the NHS: A Feasibility Study - Alison Branitsky, Mres
Over the past 40 years, Hearing Voices Network Peer Support Groups (HVGs) have proliferated across the globe. HVGs are built on the ethos of self-determination and collective liberation, positing that voice hearing is a normal human experience and that individuals who hear voices are best positioned to determine how to understand and respond to their experiences. While HVGs exist widely in the community, they are also being run within statutory services, whose ethos are at times at odds with those of the Hearing Voices Network (HVN). This presentation will explore both preliminary findings and personal experiences of running the first feasibility trial of online HVGs within the UK’s National Health Service (NHS). The presentations will cover how the group was adapted to run in the NHS while maintaining the values of HVN; qualitative and quantitative outcomes of group participation; challenges and opportunities arising from the online medium; the practical and philosophical possibilities and contradictions that arise from implementing survivor-led initiatives into public healthcare systems; and considerations for implementing these groups in a US-context.

Phenomenological psychopathology has traditionally applied the methods and concepts of phenomenology to clarify the experience of those with psychiatric diagnoses, including psychosis. While this has prioritized the lived experience of persons with psychosis and broadened the scope of what psychiatry and other mental health disciplines pay attention to in diagnostic and treatment practices, the focus of phenomenological psychopathology, with some exceptions, primarily been limited to an emphasis on alterations in isolated individuals.

However, there have been some recent trends to expand the discipline to a consideration of systems of care and how they may impact or be involved in the experience of psychosis. Along these lines, one line of work has explored using the tools of phenomenology to explore the meaning-making process in the psychiatric encounter, recognizing the ways certain narratives and explanations may be privileged while others ignored or pathologized. Another set of literature has used phenomenological research methods to explicate encounters with various systems of care and opportunities for enhancing shared decision-making among those with psychosis. A third has pushed for user-led research to further broaden the range of experiences considered in phenomenological approaches to psychosis, while also interrogating the impact of stigma on accessing care. Others have focused on the ways that psychosis is embedded in and takes up particular cultural and political landscapes, and on the impact of contextual factors in experiences of and responses to various interventions.

In this panel, we will hear from several panelists on the ways they view the potential for phenomenology to consider experiences of and within healthcare systems, and on the challenges phenomenological psychopathology still faces in its current conceptualizations of psychosis. Commentary and discussion will follow, with an emphasis on linking these initiatives with the history of phenomenological psychopathology and on the relevance of this work for conferences attendees.

We are excited to showcase a diverse array of research and innovative projects in our Poster Sessions, which will be displayed in the Duquesne Ballroom throughout Saturday's conference event. Attendees are encouraged to explore these presentations at their leisure.

To facilitate meaningful discussions and networking opportunities, dedicated poster viewing times will be held during the afternoon breaks from 3:00-3:30 PM and 5:00-5:30 PM. During these times, poster presenters will be available to discuss their work, answer questions, and engage with attendees.

An award will be given to the best poster. A panel of judges, including conference chair Nev Jones, PhD, will select the winner.

Preliminary Poster Presentations (More TBC)

• Exploring the Feasibility and Acceptability of Theater-Improvisation Interventions for Psychosis: Insights from Outpatient Service Users - Selin Yalcinkaya, BA
• Voices of Black Clients and Their Families: Keys to Better Engagement in Psychosis Care  - Yasmine Boumaiz, BS, Beshaun Davis, PhD, Melanie E. Bennett, PhD, Alicia Lucksted, PhD, Nev Jones, PhD, Swati Nayar BS, Arunadevi Saravana, M.Sc, Krissa Rouse, MA, LCPC
• Connection and Shared Meaning in Psychosis: A Qualitative Investigation into the Psychiatrist-Patient Relationship - Melissa Uehling, MA
• Re-stigmatizing Mental Health: Semiotics of oppression in the medical model of schizophrenia -  Alexej Gundy, AB
•  Psychosis: Just a Bump in the Road? - Erin McGrath
• Recommendations for humanizing people in mental health crisis. - Sarah Liberti

Join Kate Hardy, Director of INSPIRE Training, and Aline Rocha, Training Manager, for a discussion about training, workshops, and consultation available through INSPIRE training. Do you have a training idea you would like us to offer? Bring ideas and proposals to this chat as well!

Join Marcus Robinson, Director of Admissions from Windhorse Integrative Mental Health for a conversation about how relational and integrative healing happens in their three therapeutic communities.

While there is new neuroscience research that validates an approach to helping individuals manage extreme states by incorporating awareness of the embodied experience with meditation and mindfulness techniques I would like to propose combining this awareness with a curriculum that also includes engaging in creative flow experiences either in the production of visual art or movement of the body. These approaches have been on the margins of the alternative psychiatry movement for years. Sculpt.Your.Mind™ —future 501(c)(3)—has designed a way to provide alternative therapeutic interventions for those experiencing extreme states and for those wanting to learn their own mind. The value of this approach is coming into the light given neuroscience and interests psychedelics. This needs only one's own mind. The founder of Sculpt.Your.Mind™ -Samantha Dorian- lead an experiential workshop at the annual conference of NSGP at Lesley University. She aims at integrating the embodied experiences of sense perception with the awareness of the here & now, i.e. bridging the meditative technique of concentration with group psychodynamics. There is a third component to this unique curriculum and that is the embodied experience of the visual components with action and production by the participant. Therefore, three aspects of engagement are: group psychodynamic, pro-social priming, meditative concentration on the felt sense of being, and finally the creative production in a state of flow. These organically ignite the prefrontal cortex while engaging the amygdala in a pro-social group experience. Potentially allowing participants to create psychic space and learn their observe their inner landscape rather than be caught by it. This freedom of expression allows for an experience of agency as well as awareness of one’s uniqueness. Stimulating neuropathic reconstructions through imagination & visual representations is nothing new, but this specific curriculum adapts these for extreme states in order to allow the brain to bloom new possibilities for positive sublimation & integration. Neural plasticity ranges from functional to structural and the possibilities for better care for this population are endless with the tools from Sculpt.Your.Mind™

Identifying and Addressing Stigma in Mental Health Care - 2 x 45 minute sessions

• Stigma in professional psychology advice-giving - Philip T. Yanos, PhD, Dan Bernstein MHS, Soo Min Kim, MA
• Destigmatizing Psychiatric Care: Listening to Lived Experience - Dorothy Clare Tessman, MSN, APRN, DNP Pending

Stigma in professional psychology advice-giving - Philip T. Yanos, PhD, Dan Bernstein MHS, Soo Min Kim, MA
Although research generally supports that mental health professionals endorse less stigma toward people diagnosed with mental health conditions than the general public, there is evidence that stigma persists in this group (O'Connor & Yanos, 2024). Further, when expressed by mental health professionals, stigma may be more impactful. Recently, with the growth of online advice-giving platforms (which allow professionals to take on the role of "influencer" [see White and Hanley, 2022]), expressions of stigma by mental health professionals may also be impactful if they are read by members of the general public, who may then feel emboldened to enact stigma (such as social rejection or the expression of demeaning comments) toward people diagnosed with mental illnesses that they encounter in their daily lives. Psychology Today (psychologytoday.com) is a major platform of professional "advice-giving" which at times publishes articles expressing problematic statements which could impact behavior toward people diagnosed with mental health conditions. The purpose of this study is to survey persons who contribute to Psychology Today on their views regarding a number of problematic statements that have been made on the platform. 500 contributors listed on the Psychology Today website will be randomly selected and emailed an invitation with a survey link using publicly available information. The survey includes demographic questions, questions about a series of problematic statements made by Psychology Today contributors, and the Opening Minds stigma scale for health care providers (Modgil et al. 2014). We anticipate that a significant proportion of advice-givers will agree with problematic statements about people with mental health conditions, and that agreement with these statements will be associated with stigma as measured by the Opening Minds scale. Data collection for the project is currently ongoing and we anticipate that it will be complete by July 2024.

Destigmatizing Psychiatric Care: Listening to Lived Experience - Dorothy Clare Tessman, MSN, APRN, DNP Pending
Stigma is a barrier to care for people who hear voices and have disrupted salience regulation, leaving healthcare needs unmet, and healthcare workers reporting helplessness, a factor in burnout. Psychiatric evaluations focus on risk, prompting fearful thoughts for vulnerable patients, instigating stigma, and exacerbating symptoms, a concern for causing more harm than they prevent. Rapport with clinicians reduces repeat admissions and unnecessary emergency visits for mental health. Rapport development with the Maastricht Approach (MAp) is a therapeutic intervention, aiming to improve the quality of healthcare experiences for service users and care teams.

Healthcare workers in psychiatric settings seek less stigmatizing, supportive methods to build therapeutic rapport while also meeting the systemic needs of ensuring safe, effective care. Healthcare reform, widely recognized as a desperate mandate, includes the Quality Improvement aims of reducing burnout by improving care teams’ experiences as well as reducing disparities, and improving the quality and value of care, all of which are factors addressed by this project.

This Quality Improvement project is empowering healthcare workers to use MAp, offering prompts for rapport-building evaluation. Participants completed Continuing Education questionnaires and Adapting Practice forms indicating intent to use MAp in encounters with service users. Aims are to improve healthcare workers’ confidence using open curiosity and compassion to build rapport and therapeutic alliance, reducing stigmatization and harm to service users from assessment processes.

The involuntary hospitalization of people experiencing mental health crises is a widespread practice across the US, as common as imprisonment in state and federal prisons.  In spite of persistent concerns from service users and advocates, the impacts of involuntary treatment have been difficult to characterize, and causal inference limited by structural and ethical barriers.  This panel will lead with important new research led by Dr. Welle utilizing administrative data from Allegheny County, Pennsylvania, and leveraging the quasi-random assignment of evaluating physicians in order to estimate causal effects of involuntary hospitalization on post-discharge death by suicide or overdose, violent crime and employment.   For individuals whom some physicians would hospitalize but others would not, the team has found that hospitalization nearly doubles the probability of being charged with a violent crime or dying by suicide or overdose in the three months after evaluation.  Remaining panelists – Drs. Morgan Shields, Awais Aftab, and Travis Donohoe – will reflect on these provocative findings and share their own adjacent work.  Specifically, Dr. Shields will focus on inpatient psychiatry, including common experiences in inpatient settings, and the potential role of inpatient iatrogenic harm with respect to post-discharge outcomes.  Dr. Awais, a community psychiatrist and philosopher of psychiatry, will discuss ethical and political implications, as well as potential ways forward. Finally, Dr. Donahoe will reflect on methods-related challenges and next steps to advance policy research across the US.  

Psychosis and the Reproductive Body - 2 x 45 minute sessions

• Reconceiving Peripartum Psychosis: Developmental, psychosocial, and phenomenological perspectives - Elizabeth Pienkos, PsyD, Marie Brown, PhD, Tate Hudson, MA
• Not Just Hot Flashes: Navigating Extreme States in the Menopausal Transition - Leah Harris, MA

Reconceiving Peripartum Psychosis: Developmental, psychosocial, and phenomenological perspectives  - Elizabeth Pienkos, PsyD, Marie Brown, PhD, Tate Hudson, MA

Peripartum psychosis is a largely underresearched condition, and interventions vary widely. In the U.S., it is primarily attributed to biological causes, and treated via medication, often in inpatient psychiatric settings. The narratives of women who face peripartum psychosis, however, reveal the significant role played by communication about idealized states of motherhood, and their conflict with women’s real experiences of motherhood, in the development of distress and ultimately psychiatric symptoms. In this panel, we will highlight these frequently unheard stories of psychosis and motherhood, and the potential for interventions to either enhance or disrupt attempts at integrating a wide range of experiences found in pregnancy and early motherhood. Presentations will offer reflections on: the experience of peripartum psychosis and encounters with medical and psychiatric institutions; phenomenology and its potential to illuminate two recent narratives of peripartum psychosis, Inferno (Cho, 2020) and Setting the wire (Townsend, 2019); multidisciplinary perspectives on peripartum psychosis that help to escape a purely biomedical vision of this condition, drawing specifically on a developmental (i.e., matrescence) and socio-political lens; the possibilities in feminist phenomenology to help unpack the progression of experiences reported by women with peripartum psychosis. From these talks, we hope to offer a range of ways to think about peripartum psychosis that can shape intervention to be more responsive to women’s lived experience.

Not Just Hot Flashes: Navigating Extreme States in the Menopausal Transition - Leah Harris, MA
The menopausal transition can be characterized by a wide range of embodied experiences, including new onset or intensification of voice-hearing and extreme states. Presenter + psychiatric survivor Leah Harris went through extreme states for the first time during this phase of life, and will share insights from documenting and researching this experience over the past five years. For example, there is a documented "second peak" in first onset of extreme states that occurs during the menopausal years of 45-55, as well as higher rates of psychiatric hospitalization and suicide. Yet there is little to nothing in the way of awareness and customized supports for people experiencing psychosis for the first time during midlife. This workshop will highlight holistic, de-pathologized, gender-inclusive, and social justice-based strategies for understanding and raising awareness about this complex, mysterious, and important facet of human experience. 

We are excited to showcase a diverse array of research and innovative projects in our Poster Sessions, which will be displayed in the Duquesne Ballroom throughout Saturday's conference event. Attendees are encouraged to explore these presentations at their leisure.

To facilitate meaningful discussions and networking opportunities, dedicated poster viewing times will be held during the afternoon breaks from 3:00-3:30 PM and 5:00-5:30 PM. During these times, poster presenters will be available to discuss their work, answer questions, and engage with attendees.

An award will be given to the best poster. A panel of judges, including conference chair Nev Jones, PhD, will select the winner.

Preliminary Poster Presentations (More TBC)

• Exploring the Feasibility and Acceptability of Theater-Improvisation Interventions for Psychosis: Insights from Outpatient Service Users - Selin Yalcinkaya, BA
• Voices of Black Clients and Their Families: Keys to Better Engagement in Psychosis Care  - Yasmine Boumaiz, BS, Beshaun Davis, PhD, Melanie E. Bennett, PhD, Alicia Lucksted, PhD, Nev Jones, PhD, Swati Nayar BS, Arunadevi Saravana, M.Sc, Krissa Rouse, MA, LCPC
• Connection and Shared Meaning in Psychosis: A Qualitative Investigation into the Psychiatrist-Patient Relationship - Melissa Uehling, MA
• Re-stigmatizing Mental Health: Semiotics of oppression in the medical model of schizophrenia -  Alexej Gundy, AB
•  Psychosis: Just a Bump in the Road? - Erin McGrath
• Recommendations for humanizing people in mental health crisis. - Sarah Liberti

How do we use our lived experience as therapists in the clinical setting? How much mutuality is “too much”? Are there limits to the use of self-disclosure in the therapeutic dyad?

We are all therapists with various kinds of lived experience who have found our way to professional work as clinicians. To some extent, of course, all therapists have some kind of “lived experience” – which is another way of saying that all therapists use their own life experience in their work, regardless of whether they use explicit forms of self-disclosure in their treatments or not. With this in mind, this panel will ask the question: might explicit forms of self-disclosure regarding a therapist’s lived experience actually benefit the treatment? If so, how?

In this panel discussion, we will discuss our own journeys with respect to becoming clinicians who think deeply about mutuality and self-disclosure in our work – with our patients, clients, as well as our peers. We will explore the limits of self-disclosure and mutuality, depending on the clinical setting and the patient we are working with.

How to Discussion: Lived Experience Writing in Academia - Sirikanya Chiraroekmongkon, MD

Academia is a highly intimidating space, with much of its own technical language and nuances. A person with lived experience (including family members) outside of academia may find this space too foreign or unfamiliar and may struggle with feeling that their writing belong in this space. A person with lived experience (including family members) inside of academia may worry about sharing, with fears of vulnerability and potential repercussion.

This presentation invites all spectrum of feelings and nuances. It aims to walk through the internal and external steps into the undertaking and to create an open and safe environment for a discussion.

Decades after deinstitutionalization, mental health crisis care in the U.S. remains fraught with systemic challenges. Inadequate funding, fragmented services, and policy shortcomings contribute to persistent disparities. Crisis services are critically inadequate and increasingly carceral despite intentions to shift to community-based, person-centered approaches. People experiencing psychosis are more likely to face discrimination and harm within this carceral system. Additionally, underfunded social welfare services and rising living costs make meeting basic needs difficult. Consequently, crisis responses to unmet needs are often pathologized, leading to poverty, unemployment, criminalization, incarceration, housing precarity, and coercive interventions. These issues are exacerbated for historically marginalized populations facing additional discrimination.

Compounding these challenges is the increasing cooptation of peer-based services into the medical system. While peer support can offer holistic and effective care that normalizes experiences of psychosis, its integration into a medical model risks undermining its foundational principles of mutuality and lived experience. This shift can negate the efficacy of peer-based approaches, making it harder to address the root causes of mental health crises compassionately and person-centered.

Despite these systemic barriers, pockets of hope and innovation exist. Community-driven grassroots initiatives and novel research and advocacy efforts are beginning to reshape mental health crisis care. This highlights the potential for transformative change by challenging cultural narratives around psychosis and promoting inclusive approaches to wellbeing.

This roundtable will:
1. Explore how structural influences scaffold our mental health crisis care system and perpetuate adverse mental and social outcomes.
2. Foster substantive conversations about the current state of mental health crisis care.
3. Encourage collaborative efforts to address systemic barriers.

The stigmatization and criminalization of mental health crises often result in punitive rather than compassionate responses. Amplifying diverse lived experiences into leadership roles can help address a critical need to expand non-carceral interventions that prioritize recovery and dignity over punishment.

In September of 2023, James B. (Jim) Gottstein, Esq.; Peter C. Gøtzsche, MD; David Cohen, PhD; Chuck Ruby, PhD; and Faith Myers, published the Report on Mental Health Outcomes (Report).  See, https://psychrights.org/ReportOnImprovingMentalHealthOutcomes.pdf.  The Report documents that the current Mental Health System is reducing recovery rates for people who experience psychosis from a possible 80% to 5% and reducing life spans by 20-25 years.  This is primarily due to the over-reliance on drugs, but also from forcing unwanted psychiatric interventions on people which, incidentally, is a violation of International law.

The Report also documents non-coercive, humane approaches that should be used instead of the drugs and force, such as Open Dialogue, Psychotherapy, Peer-Respites, Soteria-Houses, Drug-Free Hospitals, Housing First, Employment, Warm Lines, Hearing Voices Network, Non-Police Community Response Teams, and emotional CPR (eCPR).

The Report was written specifically for policy makers and potential funders, with hyperlinks to the 12 pages of references. James B. (Jim) Gottstein, Esq., the lead author of the Report, will present its findings and invite discussion, including how to bring the Report's recommendations to fruition.

Dinner
All conference attendees are warmly invited to join us for the conference dinner on Saturday at 6:30 PM in the ballroom. The dinner is by-donation to help us keep the event accessible to everyone. While we encourage a suggested donation of $0-50 per person, we warmly welcome you to join us regardless of your ability to contribute. Your presence is what matters most!

Suggested donation: between $0-50 per person. Your generosity is greatly appreciated!
Please register for the dinner separately at the following link.

Thank you our friends at Duquesne University for the partial sponsorship to allow us to support free and discounted dinner registration for those with low-income or in financial hardship.

Menu

• Chicken Florentine: Oven-roasted breast of chicken stuffed with a blend of spinach, feta, and parmesan cheese with Madeira sauce
• Vegetable Lasagne: Seasonal vegetables with layers of pasta and cheese in a white sauce
• Herb roasted potatoes
• Seasonal roasted vegetable medley
• Garden Salad (with ranch / balsamic dressings)
• Dinner rolls and butter
• Cheesecake with fruit topping
• Coffee, iced tea, and water

Awards
We will also be presenting our 2024 ISPS-US Award recipients who have made outstanding contributions to our mission of promoting psychosocial approaches to psychosis. Join us in celebrating their impactful work.

• Gaetano Benedetti Award - For Life-time Service to ISPS-US and Psychosocial Approaches to Psychosis
• Christian Müller Award - For Dedication to ISPS-US and Psychosocial Approaches to Psychosis
• Bertram Karon Memorial Award
• Best Poster Award

Systemic unethical and illegal practices have played an undeniable role in the development of (my) psychosis. Conventional establishments may reject social and environmental explanations of psychosis because to accept them would implicate their own role in contributive causation while forcing them to acknowledge that they are currently ill-equipped to remediate the problem.  The objective of this presentation is to engage in a social exercise of reality testing by describing my personal journey through academia as an African-American woman challenging existing paradigms in (A) Sociological Theory (B) Physical Theory.  I will describe a sometimes tragic but ultimately resilient story that centers on a repeated peculiar pattern of discrimination including unprecedented violent psychological backlash resulting in a psychotic break.  However, there’s a twist—the psychotic break is not what you think.  By examining scholars with histories of mental health challenges upon facing innovation in academia, this presentation will explore how environmental stressors, pressures, and social traumas can lead to psychosis.  How should we define psychosis?  Why are paradigm shifts and scholarly innovations associated with madness in the academy?  What was the primary factor in my resilience?  These questions will be addressed in this presentation for a discussion on how to reimagine psychosis and why reality testing has the capacity to save America from social crisis.  This presentation is dedicated to the legacy of Sidney Baer.      

From 2002-2020, The Icarus Project developed a network of peer support groups and a creative media outlet that provided a home for folks who experienced mental health struggles and a deep alienation from society. Drawing inspiration from anarchism, anti-psychiatry, permaculture, and other counterculture movements, we aimed to normalize discussions of altered states, intense emotional distress, and suicidality and foster solidarity among people with experiences that were often diagnosed as “serious mental illness” and “psychosis.” At its height, The Icarus Project had thousands of online forum community members, dozens of local peer support/mutual aid groups, and a series of DIY publications that made their way into public mental health systems and became texts for academic analysis. At the same time, we also struggled greatly with interpersonal conflict, leadership burnout and turnover, issues related to identity politics and structural oppression, technological system management, and other challenges common to small social movement organizations.

More than 20 years since its founding, The Icarus Project has left a complicated legacy of ideas and creative visions, influencing individuals and organizations across North America and the world. Former members have gone on to play significant roles in transformative mental health practices, advocating for approaches that prioritize human connection, social justice, and the de-stigmatization of mental health experiences. Others left the organization with the sense that their efforts were underappreciated and lacked recognition in public narratives.

This panel will delve into the origins and impact of The Icarus Project, exploring how its creative grassroots approach has influenced contemporary mental health movements. Attendees will learn about the project's innovative use of language, its critique of the mainstream medical model of “mental illness,” and its commitment to fostering mutual aid communities. Panelists, including co-founders and long-time collaborators, will reflect on the project's successes and challenges, offering insights into how its legacy can inform future efforts in mental health social movements.

Enhancing Early Psychosis Care  - 2 x 45 minute sessions

• Voices of practitioners learning a combined OD and CSC model: Exploring content and research processes - Beth Broussard, MPH, CHES, Emily Griner, MPH, Melissa Uehling, MA, Jen Van Tiem, PhD, Chris Okpor, BS, CPS-P, CTC, CTRS,
• M-PATH: A Statewide Effort To Decrease DUP and Increase Psychosis-Informed Care - Emily Gagen, PhD

Voices of practitioners learning a combined OD and CSC model: Exploring content and research processes - Beth Broussard, MPH, CHES, Chris Okpor, BS, CPS-P, CTC, CTRS, Emily Griner, MPH, Melissa Uehling, MA, Jen Van Tiem, PhD
Two recovery-oriented approaches for early psychosis, Open Dialogue (OD) and Coordinated Specialty Care (CSC), have been developed to address individual needs of young adults. OD is founded on seven principles and fosters dialogue among networks of support (Seikkula and Olson, 2023). CSC provides evidence-based treatment through a multidisciplinary team while emphasizing shared decision making and collaboration (Bello et al., 2017). In Atlanta, Georgia, team members of Project ARROW have incorporated these two models as the foundation of its early intervention program since 2019.

This presentation will introduce OD and CSC to the audience, as well as discuss recent qualitative work with practitioners at Project ARROW. We will discuss experiences of team members learning and implementing the combined OD/CSC model. Lessons learned regarding program implementation and the importance of peer voices will be offered. Additionally, ideas for creating better research practices to promote inclusion of all voices, including peers, will be discussed such as trauma informed interviewing and techniques from the OD framework. The panel will also use the OD framework for presenting; being open to uncertainty and utilizing reflections. Small group discussions will be incorporated, as well as time for larger group discussion and questions.


M-PATH: A Statewide Effort To Decrease DUP and Increase Psychosis-Informed Care - Emily Gagen, PhD
Specialized early psychosis programs aim to decrease the duration of untreated psychosis (DUP) by treating adolescents and young adults soon after the onset of their symptoms. In Massachusetts, several of these programs exist but many families find it difficult to access them, due to lack of awareness, difficulty navigating the mental health care system, and sometimes strict eligibility criteria. Additionally, community providers like outpatient therapists, high school and college counselors, and behavioral health clinicians embedded in pediatric and primary care offices often report a lack of sufficient knowledge and confidence in talking with families about psychosis. The Massachusetts Psychosis Access and Triage Hub (M-PATH) was created to support young people and their families with accessing specialized treatment programs; this includes care coordination, psychoeducation, and family partner and young adult peer mentor services. M-PATH also offers outreach, consultation, and education to community providers in order to help them provide psychosis-informed care. We will discuss the development and launch of this program, its successes and challenges thus far in its first 2 years of existence, and its plans for future growth and expansion.

Supporting Students with Extreme Experiences - Olivia Willis, LCSW
In this presentation, mental health professionals, caregivers, friends, and nonclinical professionals will be given a practical and principled approach to supporting college students, in a college setting, with extreme experiences. It will convey best practices in the form of a framework, the SUCCESS framework, to help health professionals, friends, and caregivers to feel empathetic and skillful in the instances where folks have these extreme experiences. In addition to the SUCCESS framework, presenter will review: challenges that folks with extreme experiences face on college campuses, prevalence information, resources, ethical considerations, and treatment approaches for this population.

Anti-Carceral Crisis Care: Cultivating Agency and Self-Determination for those Experiencing Altered States -Jessie Roth, Noah Gokul, Jazmine Russell
Mental health services for those experiencing psychosis in the United States are largely rooted in coercion and control. Driven by individual provider fear and the system's emphasis on liability, mainstream responses often involve stripping people of their rights and agency. A common example is forced psychiatric commitment, which is expanding rapidly across the country as we speak. Not only are involuntary services an ineffective solution for people experiencing trauma and systemic oppression – research demonstrates that they actively perpetuate cycles of violence. They also disproportionately affect multiply marginalized community members, including the poor and unhoused, BIPOC, and disabled communities.

Lived experience wisdom can help challenge outdated assumptions about care for those experiencing psychosis and altered states, and has the potential to guide us into a more liberatory future. Unfortunately, this knowledge is often silenced in education, service delivery, and policy contexts. This session will weave together diverse lived experience perspectives on psychosis, such as firsthand experience with altered states, working in the system as a peer specialist, and witnessing psychiatric harm as a family member and trauma survivor. The presentation will be rooted in lineages of activism across movements that have birthed countless anti-carceral approaches to crisis care that cultivate agency and self-determination.

Through a brief presentation and interactive conversation with the audience, presenters will challenge dominant narratives that bolster coercive care approaches (e.g. people experiencing psychosis lack “insight” into their condition, also known as “anosognosia”), explore what becomes possible when crisis is redefined as an opportunity, and introduce a plethora of trauma-informed care approaches that exist within and outside the system. Participants will leave with new skills and strategies for “being with” and caring for those experiencing psychosis in ways that divest from the mental health industrial complex.

Psychoanalytic Legacies and Innovations (In-Person Only)

• Lessons From the Lodge, Riggs, Sheppard Pratt, McLean, and Menninger - James E. Gorney, PhD
• After 40+ Years of Analysis: New Beginnings in Treatment Leading to a Successful Outcome - Martin Cosgro, PhD

Lessons From the Lodge, Riggs, Sheppard Pratt, McLean, and Menninger - James E. Gorney, PhD
Dr. Ann-Louise Silver, psychiatrist, psychoanalyst, a founder of ISPS, and the esteemed and revered past-President of ISPS-US ,long proposed writing a book to be entitled - "Lessons From the Lodge". This would have been a monument to her years of work at Chestnut Lodge treatment center in Rockville, Maryland. Her untimely death a few years ago thwarted the completion of this project. This presentation will memorialize Dr. Silver's intent through an account of long-term psycho-dynamic and psychoanalytic hospital based treatment settings for psychosis, which flourished during the last half of the Twentieth Century.These institutions provided a unique setting for clinical research, milieu treatment, and intensive psychotherapy in regard to extreme states. The unique therapeutic philosophy of patient care developed within these extended stay hospitals will be examined in detail. Numerous clinical examples will be provided to demonstrate the innovative and courageous approaches which arose here in regard to the therapeutic understanding and care of psychosis.

Within the context of currently prevalent managed-care, short-term hospitalization, and over utilization of anti-psychotic medication, it is now particularly important to commemorate lessons learned by the daring clinicians who worked within those noble past institutional settings. Consequently, key insights of Frieda Fromm-Reichmann, Harold Searles, Otto Will, and Ann-Louise Silver in regard to the treatment of psychosis will be explicated here via their own clinical accounts.

This model of humanistic, psycho-dynamic treatment for psychosis, trauma, and other extreme states developed within long-term milieus, provides an alternative, and antidote, to the current, broken mental health system now pervasive within the United States. Treatment wisdom, so painfully gained over so many years, has almost been forgotten. Ann-Louise Silver always encouraged us at ISPS to keep this humane, concerned, benevolent flame alive.

After 40+ Years of Analysis: New Beginnings in Treatment Leading to a Successful Outcome - Martin Cosgro, PhD
Effective psychodynamic/ psychoanalytic psychotherapy for psychosis has been around for a century and is still considered the treatment of choice by some, as the late Bertram Karon suggested. However, at times, this approach has led to limited progress and no resolution of underlying issues. This case presentation will demonstrate how 40+ years of “traditional” psychoanalysis was ineffective, and the modifications in a subsequent 3 year psychoanalytic therapy led to integration and significant improvements in all areas of life. Dealing with underlying trauma, the subsequent emotions and on-going object relations interpretations will be presented as the treatment components that appeared to be missing in the prior treatment and which led to a successful outcome.

A catered lunch will be provided in the Union Ballroom (main conference space) for all attendees

• Sunday Lunch: Fajita Bar - Grilled chicken strips, sautéed onions and peppers, Spanish rice, tortilla chips, flour tortillas, salsa, south cream, lettuce, tomato, shredded cheese, and jalapenos, served with back beans.

Join Al Galves, PhD, member of the ISPS-US Advocacy Committee and president of MindFreedom International for a discussion on advocacy topics. Pick up your lunch and then join us in the ballroom alcove (which will be signposted for this discussion.)

Al will give a brief presentation and facilitate a discussion on the following questions:

• What do we want to do to expand the understanding and use of Psychological and Social Approaches to Psychosis?
• Where are the key strategic places and times in which our intervention can make a difference?
• Who are our allies?
• What are some of the obstacles that need to be overcome?

The shadow of groups and organizations - corruption, ethical misconduct, mistreatment, cooptation - is like a family taboo, growing worse with avoidance and silence. Workplace and community injustice create toxic stress that crushes idealism and inflicts crazymaking dilemmas on staff and activists, leading to group dysfunction, burnout, and failure. Early career activists and staff conform or leave, and innovations implode, while normalized misconduct incentivizes conformity and enables a corrupt status quo. The most vulnerable - BIPOC and LGBTQIA, trauma survivors, economically disadvantaged - are impacted most. What's the way forward?

Standing Together To Respond with Empowerment Against Misconduct (STREAM) is a simple model that breaks the silence in a trauma informed, empowered, and sustainable way. STREAM provides a simple community leadership roadmap for engaging group and organization ethics violations with sustainability and compassion. (This trauma-informed workshop will not name specific instances, but offer follow-up resources.)

In this talk, I’ll discuss some of the challenges faced by the tradition of phenomenological psychopathology and how internationally we may be able to address some of these going forward. In this, I’ll draw on the recent Renewing Phenomenological Psychopathology project and the work of global and lived experience scholars in the field. For the latter part of the presentation, I’ll introduce the concept of Epistemic Injustice and how this relates to phenomenology, and how striving toward epistemic justice may further help us in flattening hierarchies of knowledge and increase democratization in mental health research and practice.

Diagnosis-Related Group 885 (DRG 885) is significant and pivotal in the healthcare system, particularly for classifying inpatient hospital cases involving psychosis. The causation for psychosis can range from being sleep deprived, a mental health misdiagnosis to a physical injury that manifests symptoms related to mental health As a component of the Medicare Severity-Diagnosis Related Group (MS-DRG) system, DRG 885 is extensively relied upon and utilized for billing and reimbursement. This ensures hospitals are compensated. Medicare and Medicaid are major payers for hospital services in the United States of America. As one with lived experience, a psychosis diagnosis is a gateway that leads to inpatient psychiatric care, whether needed or not. DRG 885 remains a leading cause of psychiatric admissions, underscoring its importance in the prospective payment and healthcare reimbursement landscape in psychiatric care. This is problematic, as it can create systemic fraud through the overuse of psychosis, shifting patient-centered care to a medical mode conflated payer-centered model. DRG 885 is an overused classification, reflecting the high prevalence of inpatient admissions for psychosis. It plays a crucial role in clinical reporting and analysis enabling healthcare organizations to monitor the quality of care, manage resource allocation, and improve clinical outcomes. Hospitals track DRG codes to analyze trends and enhance the efficiency of psychiatric services, and used to manipulate the judicial system. Medicare & Medicaid data consistently show DRG 885 among the top four used DRGs. In 2008, DRG 885 was recodified from the longstanding psychosis DRG 430 in use since 1983. Over the past 20-years psychosis remains in the top four for hospitalizations, demonstrating excessive use and the need for system reform. In conclusion, DRG 885 is essential for funding inpatient psychiatric care, whether needed or not. The widespread excessive use of psychosis signifies the substantial need for comprehensive system reform.

Psychotherapy training rarely addresses work with individuals diagnosed with psychosis, and often actively discourages trainees from pursuing long-term, relationship-based or in-depth work with people who carry this diagnosis.  This two-session workshop aims to address the questions and concerns of students and early career professionals who are interested in learning more about psychological approaches to psychosis by combining an open forum for discussion with a walk-through of clinical transcripts that can form the basis for commentary that can reveal the richness and efficacy of this often life-giving work.

Refreshments will be provided in the Union Ballroom

Crisis Response: From Critique to Action - Brian Nuckols and panelists TBD

The presentation develops a critical theory of psychiatric crisis response, addressing three fundamental levels: theoretical foundations, methodological choices for intervention, and measurement, evaluation, and outcome research. This critical theory establishes a comprehensive framework to critically examine current practices in crisis response and proposes an interdisciplinary and community-based approach to theory, intervention, and measurement. At the theoretical level, the presentation integrates critical perspectives from psychology, sociology, anthropology, theology, medicine, public health, and urban design, exploring the historical and socio-political contexts that shape current psychiatric crisis response systems. Methodologically, it advocates for approaches that have been ignored or erased by hegemonic psychiatric models, emphasizing creativity and experimental forms of narrative research to capture diverse experiences and perspectives on emotional crisis. For measurement and evaluation, the presentation proposes new metrics and evaluation criteria that reflect the complexity and holistic nature of psychiatric crises. A mixed-methods research approach combining quantitative and qualitative methods is suggested to provide a comprehensive evaluation, focusing on outcomes that are meaningful to service users and their communities. From this critical perspective the, the presentation proposes a swarm of movement-building interventions. The swarm, while ultimately uncontainable to any one objective, will stimulate itself through organizing an interdisciplinary consortium comprising service users, peers, and professionals from diverse fields such as art, psychotherapy, theology, medicine, sociology, anthropology, public health, and urban design. The consortium will collaboratively design, implement, and evaluate alternative community responses to emotional crises.

 

Family Narratives and Systemic Insights - 2 x 45-minute sessions

• Remembering Rachel a sisters perspective - Deborah Kasdan
• Straight From The Cuckoo's Nest: A Patient's & A Caregiver's Perspective - Perri Bach, BS, Ethan Back, AS

Remembering Rachel a sisters perspective - Deborah Kasdan
A personal account of the impact of the impact of failed psychiatric treatment on my sister Rachel, myself and our entire family of six, as recounted in my book, "Roll Back the World: a sister's memoir."

Rachel was healthy and vibrant during her gap year working on a kibbutz in Israel but when she returned to the U.S. her behavior was erratic and disorganized. She was unable to care for herself and our parents were unable to care for her. In 1965 at 23 years of age, Rachel was institutionalized with a diagnosis of schizophrenia; I was just starting college and was unable to process what was happening to her. My brother started college the next year. We had no family meetings or therapy to help and support us. Our parents wanted to keep Rachel safe, but we wanted her to be free. Our parents filed a Federal law suit to keep her in the hospital because she was assaulted and raped in boarding houses where she was discharged. Her siblings' attempt to free her from the hospital backfired and Rachel ended up on her own two thousand miles from home. She lived on the streets and in three state hospitals for years until a social worker was stunned by the quality of her poetry and got her into an outpatient program. Eventually, the staff found an ideal home for her and she found acceptance and respect in a synagogue. I explore my own feelings of shame and guilt, my inability to help her as I wished to, or share these feelings --until finally, in publishing the memoir about us, I brought them to light. This personal history suggests the need to include adult siblings in decision-making and help families deal with the host of conflicts that arise around hospitalization and treatment of a loved one.


Straight From The Cuckoo's Nest: A Patient's & A Caregiver's Perspective - Perri Bach, BS, Ethan Back, AS
Ethan has endured five psychotic breaks from 2012 to 2020, each profoundly shaped by The Truman Show Delusion. In his talk, he will delve into the factors that contributed to these episodes and this unique delusion. Drawing from a clip of The Truman Show, he’ll connect its themes to his lived experiences.
Ethan will also share a personal excerpt from the forward of his memoir, followed by a gripping passage that captures the intensity of a psychotic episode.
He’ll close on a hopeful note before introducing his mother, who was his caregiver during these difficult years. She will share her journey of caregiving through his struggles and reflect on the broader state of mental illness care in the U.S.

Integrating Psychoanalytic Theory - 2 x 45 minute sessions

• Archetypes of Home and Homelessness: Social Displacement,  Alteric Spaces, and the Trauma of the Unhoused - Claude Barbre, MDiv, PhD, LP
• Alfred Adler's Understanding of Extreme States - Thomas Federn, MDiv, MS

Archetypes of Home and Homelessness: Social Displacement,  Alteric Spaces, and the Trauma of the Unhoused - Claude Barbre, MDiv, PhD, LP
Archetypes are often defined as universal, inherited ideas, patterns of thought, or images that are present in the collective unconscious of all human beings—literal, symbolic, and psychic. In essence, archetypes are the deepest paradigms of psychic functions, reflecting the perspective we have of ourselves and the world. As James Hillman notes, “all ways of speaking of archetypes are translations from one metaphor to another… and these perspectives offer the advantage of organizing into clusters of constellations a host of metaphors and events from different areas of life” (Hillman, 1989). In this presentation we will explore the archetypes of home and homelessness, and the social complexes that occur in response to these collective primordial images. The archetype of home as a container, or a place to which one can belong, also suggests a “narrative reality” (Hill, 2010) that describes how we attach to a place, a person, an object, a nation, a group, a culture or an ideal” (Bright, 2014). As Bright notes, “home is a word weighted with affect and associated with rootedness, attachment, belonging, shelter, refuge, comfort, and identity” (Bright, 2014). Conversely, a severed connection to home creates emotional and psychological implications. Homelessness symbolizes a state of disconnection, both externally and internally. As Lee says, “Homelessness ranges from temporarily unsheltered individuals between jobs or homes to chronically unhoused individuals who spend years without stable housing” (Lee, 2023) Hence, traumatic and psychological distress (e.g. Enreiss, or “tears in the psyche”) accompany conditions of homelessness, as found in the etymological meaning of the word “uncanny” that literally means “homelessness at home.” In this presentation we will explore the psychological and spiritual implications of home and homelessness, particularly the archetypal images of the Outcast, Stranger, and Scapegoat that reflect the power of personified images of alteric spaces and homelessness.

Alfred Adler's Understanding of Extreme States - Thomas Federn, MDiv, MS
Alfred Adler (1870 to1937) was one of the first four individuals to meet regularly with Sigmund Freud to discuss Freud’s ideas. These meetings began in 1902. Eventually, in 1911, because he disagreed with too many of them for comfort, he and some likeminded fellow members left what by then had become the Vienna Psychoanalytic Society and founded what became known as the second of the three psychological schools of Vienna, the Society for Individual Psychology. Like those of Freud, Adler’s ideas ended up being disseminated throughout the entire world.

Adler believed that all the emotional difficulties of a person stemmed from feelings of inferiority acquired during early childhood. In order to compensate for these at times devastating negative feelings, a person engaged in what Adler called “masculine protest,“ a socioeconomic term which refers to the unfortunately still very prevalent inferior position of women in society. Adler believed that the goal of all psychotherapy was to help the individual overcome their need to be superior to others and to replace this need with a sense of community that involved a feeling of self-worth grounded in belonging to one’s own family and community. In order to achieve this end psychotherapy needed the help of both of these to motivate the person to abandon their “masculine protest” against their feelings of inferiority. Last but certainly not least, Adler believed that the individual was not just an aggregate of individual mental and emotional actions but a unified whole. Hence the name of the school of individual psychology.

My presentation will be comprised of three parts. First a brief one, placing Adler in his historical context. Then a longer summary of his basic ideas and finally then an even longer description of how to apply these ideas when one assists persons experiencing extreme states.

The integration of lived experience within mental health systems has gained recognition as a crucial element in enhancing service delivery and outcomes. This panel will explore the multifaceted dimensions of meaningful involvement of individuals with lived experience (peers) in mental health systems, emphasizing the co-production of services, training, and research. Drawing from qualitative research and panel members' expertise we will examine best practices and barriers to effective involvement. Central to our analysis is the concept of "meaningful involvement," which transcends tokenistic inclusion, advocating for active and sustained participation that influences decision-making processes.

We investigate various models of engagement, including peer support roles, advisory boards, and co-researcher positions, highlighting successful implementations across different mental health settings. We seek to discuss how meaningful involvement contributes to a more empathetic and person-centered approach in mental health services, fostering trust and improving all elements of services. Key factors for success include robust training programs for peers, institutional commitment to culture change, and the creation of supportive infrastructures that value lived experience as essential expertise. However, myriad challenges persist, such as stigma, power imbalances, and the sustainability of peer roles within traditional hierarchies. We provide recommendations to address these challenges thorough different lenses, with a panel with four lived experience experts and one clinical expert. The panel seeks to underscore the necessity of embracing lived experience as a cornerstone in the evolution of mental health systems.

By systematically incorporating the voices of those who have navigated mental health challenges, we can co-create more responsive, effective, and humane systems of care. The perspectives gleaned from this panel aim to inform practitioners, policymakers, researchers, and individuals with lived experience in committed to fostering inclusive and transformative mental health services.