Clinical perspectives on the relationship between psychosis and dissociation: utility of structural dissociation and implications for practice

Psychosis and dissociation are usually considered independently in their phenomenology, aetiology and treatment within mainstream psychiatry and psychology. Recently, research has suggested a relationship that may be more consistent with historical views of them as related phenomena. Unfortunately, the implications for the practising therapist have often been overlooked and the result is a challenging clinical landscape, with limited guidance. Yet, due to first-hand experiences with clients, therapists are already intervening and arriving at their own understandings. This article presents a qualitative research project that explored such practice-based perspectives. The findings are conceptualised within a model of Structural Dissociation of the Personality, supporting the clinical validity of this model in understanding psychosis and dissociation as related yet distinct constructs, and provide an account of the complex clinical work that follows.