The relation between psychiatric/psychosocial rehabilitation and psychotherapy: a conceptual analysis

Journal of Psychiatry Reform Vol 9 #11, July 2022

Author Information

Abraham Rudnick, MD, PhD, CPRP, FRCPC

Professor, Departments of Psychiatry and Bioethics and School of Occupational Therapy

Dalhousie University

Email: [email protected]

Abstract

Psychiatric/psychosocial rehabilitation (PSR) and psychotherapy are often used concurrently as part of a person’s mental health care but their relationship to each other has not been systematically addressed. This brief paper comprises a conceptual analysis of the relationship between PSR and psychotherapy. PSR and psychotherapy share a focus on personal skills development and maintenance. Some of this shared focus involves addressing similar if not identical skills, regarding certain social interactions. Some of it involves complementary skills, such as asking for help. Productive combinations of PSR and psychotherapy can be studied theoretically and empirically.

Key words: intrapersonal; interpersonal; psychiatric/psychosocial rehabilitation; psychotherapy; skills

Effective mental health care consists of a variety of interventions which can be classified in diverse ways. Perhaps the most general classification of current effective mental health care distinguishes four main types of interventions, preferably all of them used with a person-centered approach (Akhtar, Forchuk, McKay, Fisman, & Rudnick, 2021; Rudnick & Roe, 2011):

1. Psychotropic medications, such as antidepressant and antipsychotic medications;
2. Neuromodulation, such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS);
3. Psychotherapy, such as cognitive behavioral therapy (CBT) and interpersonal therapy (IPT); and,
4. Psychiatric/psychosocial rehabilitation (PSR), such as cognitive remediation (CR) and supported employment (SE).

Many service users receive more than one of these types of interventions at any given time. Some combinations have been studied, for example psychotropic medications and  psychotherapy interventions (Cuijpers et al., 2014). Other combinations have not been studied much. In particular, the combination of PSR and psychotherapy has not been examined sufficiently. Exceptions include the integration of  CBT with SE (Reme et al., 2015). This kind of combination seems promising theoretically, e.g., both PSR and psychotherapy address intrapersonal and interpersonal skills, often in relation to the same clinical population, although there seems to be some historical misunderstanding that PSR is helpful only for people with severe mental disorders (e.g., psychotic disorders) and that psychotherapy is helpful only for people with milder mental disorders (e.g., anxiety disorders).

This brief paper uses a selective literature review for a conceptual analysis (Yehezkel, 2005) of the relation between PSR and psychotherapy in order to prepare the ground for robust theoretical and rigorous empirical study of the combination of PSR and psychotherapy.

First, definitions of PSR and psychotherapy would be helpful. PSR is the enhancement and maintenance of adaptive skills and supports for people with mental disorders   in order to help them become and stay satisfied and successful in their environments of choice (Rotenberg & Rudnick, 2017). Psychotherapy is the enhancement and maintenance of self-awareness and effective intrapersonal and interpersonal skills in order to reduce or alleviate mental suffering and advance or upkeep independent functioning (American Psychiatric Association, 2019), recognizing that no one is fully independent as everyone is interdependent on each other and on their environment to some extent. Both PSR and psychotherapy address skills of people with mental disorders . It is helpful to explore which skills are addressed in each of them, in order to find important overlaps and other commonalities (and possibly pertinent differences) between PSR and psychotherapy.

PSR addresses skills of practical functioning, including (basic and instrumental) activities of daily living, work, socializing and more (Corrigan, 2016). Psychotherapy addresses skills of emotional, cognitive and behavioral functioning, including emotional regulation, cognitive (re)structuring, behavior management and more (Consoli et al., 2016). Some of these skills clearly overlap, e.g., practical and behavioral functioning can be similar if not identical, such as in the case of social skills for interpersonal effectiveness (in public socializing and in other social interactions such as communicating with close family). More complex commonalities exist, e.g., the skill of asking for help is a practical one but also involves emotional and cognitive acceptance of one’s own vulnerability and need for help. Even in relation to self-awareness, PSR and psychotherapy have some common ground, e.g., PSR readiness involves self-awareness of one’s personal goals and related matters (Cohen et al., 1997).

PSR and psychotherapy share a focus on some personal skills development and maintenance. Some of this involves addressing similar if not identical skills, such as in relation to particular  social interactions, and some of it involves addressing complementary skills, such as in relation to asking for help. Thus, PSR and psychotherapy may be productively combined by synergizing each other, perhaps similar to synergisms within PSR (Rudnick, 2018), or possibly they may be destructively combined by clashing with each other if they are not well coordinated.

A limitation of this conceptual analysis is that psychotherapy is arguably too diverse to generalize about, yet its conclusions may be sound for at least some commonly practiced psychotherapies such as CBT. Based on this analysis, theoretical and empirical studies can be conducted, such as planning, implementing and evaluating combinations of PSR and psychotherapy that address similar if not identical skills as well as complementary skills.

Declaration of interests: The author has no relevant financial or non-financial interests or related conflicts to declare.

Ethics: No ethics review was required for this project.

Funding: No funding was involved with this project.

References

Akhtar, N., Forchuk, C., McKay, K., Fisman, S., Rudnick, A (2021). Handbook of person-centered mental health care. Boston: Hogrefe.

American Psychiatric Association (2019). What is psychotherapy. Washington: American Psychiatric Association (https://www.psychiatry.org/patients-families/psychotherapy).

Cohen, M., Anthony, W.A., Farkas, M. (1997). Assessing and developing readiness for psychiatric rehabilitation. Psychiatric Services 48(5): 644-646.

Consoli, A.J., Beutler, L.E., Bongar, B. (Eds). (2016). Comprehensive textbook of psychotherapy: theory and practice, 2nd ed. Oxford: Oxford University Press.

Corrigan, P.W. (2016). Principles and practice of psychiatric rehabilitation: an empirical approach, 2nd ed. New York, Guilford.

Cuijpers, P., Sijbrandij, M., Koole, S.L., Andersson, G., Beekman, A.J., Reynolds, C.F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry 13(1): 56–67.

Reme, S.E., Grasdal, A.L., Løvvik, C., Lie, S.A., Overland, S. (2015). Work-focused cognitive–behavioural therapy and individual job support to increase work participation in common mental disorders: a randomised controlled multicentre trial. Occupational and Environmental Medicine 72(10):745-752.

Rotenberg, M., Rudnick, A. (2017). Recent developments in person-centered psychiatry: present and future of psychiatric rehabilitation. European Journal for Person Centered Healthcare 5(2):256-262.

Rudnick, A. (2018). Synergism of adaptive skills and supports in psychosocial rehabilitation: a theoretical inquiry. Journal of Psychosocial Rehabilitation and Mental Health 5(1):101-102.

Rudnick, A., Roe, D. (Eds). (2011). Serious mental illness: person-centered approaches. London: Radcliffe.

Yehezkel, G. (2005). A model of conceptual analysis. Metaphilosophy 36(5): 668-687.