Therapy for Psychosis and Mental Health Crises

When reality becomes difficult to hold onto

A mental health crisis can unsettle a person’s sense of safety, meaning, identity, and functioning. Voices, unusual perceptual experiences, threatening beliefs, paranoia, confusion, or a profound change in the way the world is experienced can be frightening and isolating. The people closest to the person may also be unsure how to speak about what is happening without arguing, dismissing it, or becoming alarmed.

Some people seek therapy after a psychotic episode or hospitalization. Others come following an experience that developed during meditation, spiritual practice, a ceremony, or the use of psychoactive substances, and are unsure whether to understand it as a spiritual crisis, psychosis, or a combination of the two. It is not necessary to settle that question.

Making sense of the experience

In therapy, we will take what you experienced seriously, try to understand the meaning it has for you, and explore together how it affects emotion, the body, relationships, and your actions.

We can maintain a curious stance even when there is no certainty about the explanation or origin of the experience. In the midst of confusion and uncertainty, it is still possible to agree on goals that may help: sleeping better, increasing a sense of safety, reducing the power of voices, reconnecting with other people, leaving the house, or restoring a sense of influence and movement in life.

Understanding the experience in context

Mental health crises and psychotic experiences do not occur in a vacuum. We will try to understand what was happening in the period before the crisis: stress, isolation, loss, trauma, sleep deprivation, changes in relationships, substance use, intensive practice, or an accumulation of several factors.

Attending to context does not exclude biological factors or the possibility of psychiatric treatment. It can, however, make the experience more understandable and less alien.

Therapy may include developing a shared formulation: which situations intensify paranoia or voices, how worry and arousal affect interpretation, which safety behaviours or forms of avoidance provide temporary relief while narrowing life, and what strengthens moments of stability, connection, and choice.

Spiritual crisis, substance use, or psychosis?

Experiences of elevation, revelation, a sense of mission, loss of the boundaries of self, or a profound shift in the perception of reality may carry spiritual meaning and value. They may also be accompanied by fear, sleep difficulties, confusion, impaired functioning, or risk. Deep meaning does not negate the difficulty, and difficulty does not necessarily negate the meaning.

When an experience includes positive or meaningful aspects, these can be given space. Alongside this, practical interventions may be used to restore a sense of safety, improve functioning, reduce risk, and consider how the experience can be integrated into life with greater stability.

What does therapy involve?

The work draws on CBT for psychosis (CBTp), recovery-oriented practice, ACT for psychosis, CT-R, and principles from the Feeling Safe programme. Depending on what is needed, I also integrate trauma-focused interventions, approaches learned through work in residential alternatives to hospitalization and in harm-reduction safe spaces supporting people through crises related to substance use, and an understanding developed through many years of spiritual practice.

At times we may focus on practical areas such as sleep hygiene, regulation, daily structure, connection with supportive people, a clear-eyed examination of patterns of substance use, and understanding the situations that intensify the difficulty.

Therapy may include work with worry, voices, threatening or unusual beliefs, jumping to conclusions, safety behaviours, and avoidance. We may develop gradual and careful experiments that make it possible to gather new information, examine beliefs, and try different ways of responding.

Alongside work with distress, we will identify aspirations, interests, relationships, and roles that remain important to you and look for practical steps toward them. Strengthening connection, agency, and meaningful activity can restore a sense of direction and capacity, even when difficult experiences remain present.

When is another setting or urgent help needed?

The therapy I offer is not an emergency service and cannot provide continuous supervision. If there is immediate danger to yourself or others, prolonged lack of sleep accompanied by deterioration, acute confusion, an inability to meet basic needs, or a need for supervision, contact emergency services or an available treatment setting in your area.