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I have worked with clients experiencing psychosis for almost twenty years in both private practice,and while managing programs focused on clinical care. I also have experience supervising the training for interns entering the field and learning how to work with clients managing psychosis.

Psychosis is a broad term describing different states wherein a person disconnects, to varying degrees, with reality. It covers a range of disorders including schizophrenia, schizoaffective disorder and certain manic or depressive behaviors. Psychotic episodes can be brief, or recurrent, or a psychotic state can be ongoing. Psychosis may be manifested by shifts in mood, disorganized or paranoid thoughts and speech, voice-hearing, or catatonic states. Symptoms of psychosis most often begin to appear in the late teens and early twenties. Psychotic episodes can be exacerbated by periods of intense stress or substance abuse. Seeking support and treatment early generally results in more positive outcomes.

Not every symptom associated with psychosis means that a person has schizophrenia or schizoaffective disorders. The same behaviors may be the result of dissociation, substance abuse, or medical conditions including type 1 diabetes. In treating these symptoms, it’s critical for the clinician to correctly understand and recognize the symptoms in context since an incorrect diagnosis can negatively impact treatment and overall success for the client.

Untreated psychosis can be a very frightening thing for both the individual experiencing the symptoms and for their friends, families and coworkers. The resulting behaviors can be difficult to understand and easy to misinterpret. When changes are sudden and severe, it’s common for others to worry that behaviors will escalate into dangerous situations. While persons experiencing psychosis may be suffering internally because of the constant pressure of voice-hearing or confused states, aggression and violence are not typically associated with psychosis or psychotic states. But unpredictable behaviors, coupled with inaccurate and negative depictions of psychosis in the media, can make a difficult situation harder to manage for all concerned.

With proper treatment and support, most individuals are able to mitigate the effects of these symptoms. Learning to manage stress, anxiety, PTSD, and understanding that all symptoms of psychosis are meaningful forms of expression can help individuals reduce those symptoms and engage more fully in creating the life they wish to have.

Catherine Keech, LMFT

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