CBTp is a specialized form of cognitive behavioral therapy developed specifically for people experiencing psychosis — including hallucinations, delusions, and the disorganized thinking associated with schizophrenia and related conditions. It has a substantial international research base and is recommended by leading clinical guidelines in the US and UK.
Unlike approaches that focus solely on symptom management through medication, CBT-p works collaboratively with the person to understand their experience, reduce distress, and support meaningful recovery. People with longstanding or treatment-resistant symptoms can benefit — the research is clear that psychosis is not a barrier to effective psychological treatment.
I have specialized in CBTp for over three decades and am one of a small number of practitioners in the Bay Area trained to this level of specialization. I work with individuals and, where appropriate, their families.
If you or someone you love is living with psychosis or a schizophrenia spectrum disorder, I am happy to have an initial conversation about whether CBT-p might help.
What is the minimum dose of CBTp that is likely to be effective?
Research on cognitive behavioural therapy for psychosis indicates that a minimum of sixteen sessions produces measurable symptom improvement, with stronger outcomes emerging at twenty to twenty-five sessions. Studies examining dose-response relationships suggest that benefits accelerate beyond the initial threshold, though the relationship between session number and outcome is not simply linear. Importantly, therapeutic alliance—the quality of the working relationship between therapist and client—appears to moderate the benefit of extended treatment; longer therapy is associated with improvement in the context of good alliance but may be less helpful when alliance is compromised. Brief interventions of six to ten sessions show some efficacy but produce more modest gains than standard dosing. These findings suggest individualizing treatment duration based on both symptom response and relational quality rather than adhering to a fixed session protocol.