Agency before action: The application of behavioral activation in psychotherapy with persons with psychosis

Incorporating behavioral activation into psychotherapy with persons with psychosis requires adaptation in its conceptualization and application owing to special deficits in the self-experience. Persons with psychosis often experience a diminished or disorganized sense of self, and have deficits in coherently narrating the experience of the self and in the ability to make sense of how to take action and direct their own lives. Based on a metacognitive model of disability in psychosis, the current paper presents a therapy process of a woman coping with schizophrenia using Metacognitive Reflection and Insight Therapy (Lysaker and Dimaggio, 2014) in the framework of an intersubjective model for psychotherapy with persons with psychosis presented by Hasson-Ohayon, Kravetz, and Lysaker (2016a). The case in point and its following discussion highlight the important significance of metacognitive encouragement as a first step of behavioral activation.