Beyond Medication: Therapeutic Engagement and the Recovery from Psychosis, 1st Edition (Hardback) book cover

Beyond Medication

Therapeutic Engagement and the Recovery from Psychosis, 1st Edition

Edited by David Garfield, Daniel Mackler


216 pages

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Beyond Medication focuses on the creation and evolution of the therapeutic relationship as the agent of change in the recovery from psychosis.

Organized from the clinician’s point of view, this practical guidebook moves directly into the heart of the therapeutic process with a sequence of chapters that outline the progressive steps of engagement necessary to recovery. Both the editors and contributors challenge the established medical model by placing the therapeutic relationship at the centre of the treatment process, thus supplanting medication as the single most important element in recovery.

Divided into three parts, topics of focus include:

  • Strengthening the patient
  • The mechanism of therapeutic change
  • Sustaining the therapeutic approach.

This book will be essential reading for all mental health professionals working with psychosis including psychoanalysts, psychiatrists, psychologists and social workers.


"This superbly executed work is as courageous as it is timely. At last psychoanalytically informed psychotherapy is being recommended and justified for the treatment of psychotic patients - over and above - and often instead of - psychopharmacology! This work is recommended for all mental health workers but particularly for psychiatric residents and psychologists in training." - James Grotstein M.D. Clinical Professor of Psychiatry at the David Geffen School of Medicine, UCLA and Training and Supervising Analyst at the Psychoanalytic Center of California and The New Center for Psychoanalysis, Los Angeles, USA

"This book will surely be an interesting read for experienced clinicians to better understand the therapeutic effect of psychodynamic psychotherapy in some disturbed patients." – Dr Sherry Kit Wa Chan, Psychological Medicine, 40, 2010

Table of Contents

Karon, Silver, Foreword. Part I: Engaging the Patient. Garfield, Dorman, Strengthening the Patient. Faulconer, Silver, The Initial Engagement in the Psychotherapy of Psychosis, With and Without an Asylum. Prouty, Making Contact with the Chronically Regressed Patient. Schwartz, Summers, The Role of the Therapeutic Alliance in the Treatment of Seriously Disturbed Individuals. Part II: The Elements of Change. Summers, Sustaining Relationships: Cure, Care, and Recovery. Kipp, Sustaining Relationships in Milieu Treatment: A Corollary to Summers. Koehler, The Process of Therapeutic Change: Trauma, Dissociation, and Therapeutic Symbiosis. Gibbs, Technical Challenges in the Psychoanalytic Treatment of Psychotic Depression. Mackler, Practicing the "Impossible Profession" in Impossible Places. Part III: Listening to the Patient: Stories of What Really Works. Penney, Leaving Schizophrenia: The Returning Home of the Awakened Mind. Greenberg, Life in the Mines: A Retrospective on my Therapy. Foltz, The Experience of Being Medicated in Schizophrenia: A Subjective Inquiry and Implications for Psychotherapy. Part IV: Concluding Chapter. Steinman, Sustaining the Therapeutic Approach: Therapists May Need Help Too!

About the Editors

David Garfield is Professor, Associate Chair and Director of Residency Training in the Department of Psychiatry and Behavioral Sciences at Rosalind Franklin University of Medicine and Science, Chicago Medical School. He is also faculty at the Institute for Psychoanalysis, Chicago.

Daniel Mackler is a psychotherapist in private practice and a filmmaker, New York City.

About the Series

The International Society for Psychological and Social Approaches to Psychosis Book Series

ISPS (The International Society for Psychological and Social Approaches to Psychosis) has a history stretching back more than five decades, during which it has witnessed the relentless pursuit of biological explanations for psychosis. This tide has been turning in recent years and there is growing international interest in a range of psychological, social and cultural factors that have considerable explanatory traction and distinct therapeutic possibilities. Governments, professional groups, people with personal experience of psychosis and family members are increasingly exploring interventions that involve more talking and listening. Many now regard practitioners skilled in psychological therapies as an essential component of the care of people with psychosis.

A global society active in at least twenty countries, ISPS is composed of a diverse range of individuals, networks and institutional members. Key to its ethos is that individuals with personal experience of psychosis, and their families and friends, are fully involved alongside practitioners and researchers, and that all benefit from this collaboration.

ISPS’s core aim is to promote psychological and social approaches to understanding and treating psychosis. Recognising the humanitarian and therapeutic potential of these perspectives, ISPS embraces a wide spectrum of therapeutic approaches from psychodynamic, systemic, cognitive, and arts therapies, to need-adapted and dialogical approaches, family and group therapies and residential therapeutic communities. A further ambition is to draw together diverse viewpoints on psychosis and to foster discussion and debate across the biomedical and social sciences, including establishing meaningful dialogue with practitioners and researchers who are more familiar with biological-based approaches. Such discussion is now increasingly supported by empirical evidence of the interaction of genes and biology with the emotional and social environment especially in the fields of trauma, attachment, social relationships and therapy.

Ways in which ISPS pursues its aims include international and national conferences, real and virtual networks, and publication of the journal Psychosis. The book series is intended to complement these activities by providing a resource for those wanting to consider aspects of psychosis in detail. It now also includes a monograph strand primarily targeted at academics. Central to both strands is the combination of rigorous, in-depth intellectual content and accessibility to a wide range of readers. We aim for the series to be a resource for mental health professionals of all disciplines, for those developing and implementing policy, for academics in the social and clinical sciences, and for people whose interest in psychosis stems from personal or family experience. We hope that the book series will help challenge excessively biological ways of conceptualising and treating psychosis through the dissemination of existing knowledge and ideas and by fostering new interdisciplinary dialogues and perspectives.

For more information about ISPS, email or visit our website,  

For more information about the journal Psychosis visit

Learn more…

Subject Categories

BISAC Subject Codes/Headings:
PSYCHOLOGY / Clinical Psychology