Psychosis, explained.
Understanding, support & safer practice.

What is psychosis?

Psychosis describes experiences in which a person finds it difficult to distinguish what is happening around them from what their mind is telling them. They might hear voices that other people do not hear, hold beliefs that seem out of keeping with the available evidence, or find their thoughts unusually difficult to organise.

These experiences can feel completely real. They may be confusing or distressing, although not everybody experiences them in the same way. An episode of psychosis is a description of what somebody is experiencing; it is not, by itself, a diagnosis of schizophrenia.

It's also worth remembering that people can hear voices or have unusual experiences for a range of reasons. One experience alone doesn't tell us what is happening or what support someone might need. That is why an appropriate assessment matters.

Why might psychosis happen?

There is no single explanation that fits everybody. Psychotic symptoms can be associated with several mental health conditions, but they may also occur in connection with substances, medicines or physical health problems.

Mental health conditions

Psychosis may occur in schizophrenia, during some episodes of bipolar disorder, or in severe depression with psychotic features. Having psychotic symptoms does not automatically mean that someone has any one of these conditions.

Other possible contributors

Sleep deprivation, significant stress or traumatic experiences may be relevant in some cases. Alcohol or drug use, withdrawal from some substances, certain medicines and some neurological or other physical illnesses can also be involved. Occasionally, a medical problem such as an infection or head injury needs urgent attention.

How is psychosis assessed and treated?

If somebody may be experiencing psychosis, a GP should be contacted promptly. The GP can assess immediate needs, consider possible physical or substance-related causes and refer the person for specialist mental health assessment. In England, an Early Intervention in Psychosis (EIP) service may be involved, particularly for a first episode.

According to NHS and NICE guidance, treatment often includes a combination of the following, tailored to the person and their circumstances:

• Specialist assessment and coordinated care to understand symptoms, safety, physical health and personal goals.
• Antipsychotic medication when clinically appropriate, with ongoing review of benefits and side effects.
• Specialist cognitive behavioural therapy for psychosis (CBTp), which can help a person explore their experiences and find ways to reduce distress.
• Family interventions, where appropriate and agreed, so relatives and carers can better understand the situation and support recovery.
• Social and practical support relating to work, study, housing, relationships and everyday life.

These decisions belong within a shared care plan involving the person and the qualified healthcare professionals supporting them. Prescribed medication should never be stopped or changed without advice from the responsible clinician.

How can you support somebody who may be experiencing psychosis?

If somebody you care about seems frightened or is describing an experience that you do not share, you may not know what to say. You do not need to pretend you agree with a belief, but you also do not need to argue about it.

1. Listen calmly and without ridicule. You could say, “That sounds frightening. I can see it's affecting you.”
2. Focus on how they feel. Acknowledge their distress without confirming an unusual belief as fact.
3. Encourage professional assessment. Offer practical help with contacting a GP or existing mental health team.
4. Look after immediate safety. If someone seems at risk or unable to remain safe, use urgent or emergency services rather than trying to manage alone.
5. Remember your own wellbeing. Families and carers may also need information, support and time to recover from a difficult situation.

What does this mean for us as therapists?

In my work as a psychotherapist, clinical hypnotherapist and lecturer, I often return to one principle: our first responsibility is to act in the client's best interests, even when that means recognising that we are not the right person to provide the treatment they need.

If somebody appears to be experiencing psychotic symptoms during an initial consultation or session, I believe it is important to respond calmly, prioritise their safety and arrange prompt medical or specialist assessment. This is not a situation in which to proceed with hypnosis or attempt to resolve the symptoms through a relaxation exercise.

Assessment, consent and supervision

Asking about current symptoms, relevant history, medication and existing professional support is part of considering suitability for therapy. But a previous mental health diagnosis does not, on its own, mean that every person must automatically be rejected or that a therapist should contact their GP without discussion.

Where liaison would be appropriate, I would normally explain the reason, seek the person's consent and discuss how information will be shared. Professional consultation or supervision can support sound decision-making while respecting confidentiality. If there is a serious and immediate safety concern, the applicable safeguarding and information-sharing duties must guide our response.

For fellow practitioners and students, the distinction between supporting someone compassionately and claiming to treat a serious mental health condition is fundamental. Those interested in broader professional development can explore our hypnotherapy diploma and training information.

Can Solution Focused Hypnotherapy treat psychosis?

It should not be presented as a treatment for psychosis. NICE recommends specialist assessment and evidence-based care, including medication, CBT for psychosis and family interventions where appropriate. Hypnotherapy is not listed as an established treatment for psychosis in this guidance.

The NHS also warns that hypnotherapy may not be safe for people with schizophrenia or a history of psychosis. For that reason, I would not use hypnosis as an intervention for psychotic symptoms or assume that relaxation-oriented techniques are appropriate without specialist clinical assessment and appropriate advice.

This is different from the broader question of how a person with a mental health history might receive psychological support for another difficulty. Suitability, the type of treatment, professional competence and coordination with the person's existing care team all matter. A qualified specialist is best placed to advise on psychosis-related treatment.

Reducing everyday stress can be valuable to general wellbeing, but it would be inaccurate to claim that Solution Focused Hypnotherapy makes antipsychotic medication more effective, prevents episodes of psychosis or can replace specialist care. Those claims are not established by the evidence reviewed for this article.

When and where to get help

Psychosis deserves prompt attention, even when the person is otherwise managing some aspects of daily life.

For people outside England, use the appropriate NHS service or local emergency pathway for your nation. This blog is not a crisis service and does not replace an individual assessment.

Related information from Best Mind Therapy

These pages provide general information about other aspects of mental wellbeing and professional training. They are not alternatives to specialist treatment for psychosis.

Education only. This article is not a diagnosis, clinical assessment or emergency service. Best Mind Therapy does not advertise hypnotherapy as a treatment for psychosis. Individual treatment decisions should be made with qualified healthcare professionals.