Guest blogger, and UKCP-accredited psychotherapist Jude Perry, presents a thought-provoking article about psychosis and an idea that is referred to as ‘pre-therapy’.

Radical Acceptance: Re-thinking approaches to Psychosis

My grandad was a generous, loving and talented man. When we used to go visit my grandparents when we were little, he would be so excited that he would get my grandma to collect bags of £1 coins in the weeks running up to our visit. This was so that when we were colouring in, and were able to stay within the lines, we would receive £1. I wonder how you view my grandad after reading this story?

What if I told you that my grandad also lived with paranoid schizophrenia?

Do you view my grandad any differently now that you know this?


How often are those who experience psychotic processes, like my grandad, described or defined by this label? How often have we read about the ‘psychotic killer’, the ‘psycho’, or how dangerous and violent people with paranoid schizophrenia are? Despite the fact that those who experience psychotic processes are at least 14 times more likely to be the victim of a violent crime than arrested for one. (Brekke, Prindle, Bae & Long, 2001).

Psychotic Processes

But what is psychosis? Psychotic processes can include a range of different experiences and for my MSc research in this area, I defined psychotic processes as “clients who experience psychotic processes may hear voices, experience hallucinations, delusions, paranoia, or exhibit behaviour and thinking deemed culturally unusual or disturbed.” (Perry, 2018).

Carl Rogers is the founder of Person-Centred therapy and described six necessary and sufficient conditions for therapy (Rogers, 1957). The first of these conditions is psychological contact between the therapist and client, described by Rogers as “two people are to some degree in contact, that each makes some perceived difference in the experiential field of the other.” (Rogers, 1957, p.96). But what if a client is out of psychological contact, for example if they are experiencing psychotic processes? This is where Pre-Therapy comes in.


Pre-Therapy is a person-centred way of working with clients where there is little or no psychological contact between client and therapist. The creator of Pre-Therapy, Garry Prouty, said “My deepest hope is that Pre-Therapy opens up a new way of understanding psychosis…This approach is offered to suffering people to bring them help.” (Prouty, 2002, p.55-56).

Pre-Therapy aims to help clients restore three types of contact; their contact with self, others, and the world (Prouty, 2002; Peters, 1999). Pre-Therapy has five different types of ‘contact reflections’ (Prouty, 1976) to help establish contact between therapist and client:

  1. Situational
  2. Facial
  3. Body
  4. Word-for-word
  5. Reiterative

It can sound either very mechanical or very simple, but it is actually a delicate art. These different contact reflections allow the opportunity for relatedness as well as supporting a possible move from a pre-expressive to a more expressive state where psychotherapy could begin.


My love for my grandad and heartbreak over the stigma he experienced drove me to become a psychotherapist and to find a way to work with and support those so often labelled as “beyond psychotherapeutic reach” (Sommerbeck, 2017, p.416). What a joy it was to discover Pre-Therapy – a therapeutic method that not only reached out to those who experience psychotic processes but also in a manner that was a philosophical fit.

As part of my MSc in Person-Centred & Experiential Psychotherapy, I conducted a piece of research titled ‘Radical Acceptance: How do Person-Centred and Experiential Pre-Therapy practitioners experience offering unconditional positive regard to clients experiencing psychotic processes?’

I chose to focus on unconditional positive regard (UPR) as this is the fourth of Rogers’ necessary and sufficient conditions, described as the therapist “experiencing a warm acceptance of each aspect of the client’s experience being a part of the client” (Rogers, 1957, p.97). It is often viewed as the person-centred therapist holding a non-judgemental attitude towards their client and this felt important to explore in my research due to the stigma often associated with psychosis.

I was fortunate enough to interview five members of the Pre-Therapy International Network ( and hear their experiences of working with this client group. This formed the basis of my research findings and led me to create a description of the lived experience of Pre-Therapy practitioners offering UPR to clients experiencing psychotic processes. The full research is available on the Pre-Therapy International Network website, or by contacting me directly, and a section of the final description is below:

Lived Experience

“Offering UPR to clients experiencing psychotic processes is a complex and profoundly felt experience. It is more than words: it draws from your soul. It is beautiful, rewarding, enriching, and an exchange of worlds. It is about humanity at its deepest level and a philosophical stance rather than a ‘doing’ thing or tool to ‘use’ with clients; it is an active being.

UPR has a particular importance and de-toxifying power when working with clients experiencing psychotic processes. It is a radical acceptance of those so often rejected by society, that looks beyond the symptoms and normalises experiences that clients are often told are invalid or ‘mad’.

Offering UPR to these clients is profoundly moving, the essence of being, and fundamental to being human.” (Perry, 2018).

Next Steps

My findings are not alone. A recent study by Xhrouet, Gillain and Zech (2019) explored Rogers necessary and sufficient conditions in relation to clients experiencing psychotic processes, and similarly found that Roger’s conditions are all the more fundamental to this client group. If we continue to research the therapeutic impact of Rogers conditions with clients experiencing psychotic processes, we may find that rather than these clients being ‘beyond reach’, Rogers conditions could actually be a crucial and empathic way to connect and reach out.


My grandad’s house was the only one on the street where people would not visit or knock on the door because ‘that’s where the crazy man lives’. If just one person had knocked on the door, had reached out, had offered support, their lives could have been transformed.

I firmly believe that we all have the potential to change and grow if offered the right conditions. I have seen in my personal and professional life the transformative power of offering and receiving unconditional positive regard. What if we were to change how we viewed psychotic processes: what if we dared to step away from the label of being ‘beyond reach’ and offered a hand and hope to those so often rejected by society?

My hope is that we can start a conversation about Pre-Therapy in the UK and re-evaluate the way clients who experience psychotic processes are currently treated, both therapeutically and societally. As one of my research participants said in my Pre-Therapy research: “that’s a bit radical isn’t it?”

Get Involved

If you would like to find out more about Pre-Therapy, join the free Pre-Therapy discussion group or enquire about Pre-Therapy workshops, please visit or contact Jude on

The next annual Pre-Therapy International Network Meeting is being held online on Saturday 21 November 2020 from 2-8pm (UK time) and is open to all. If you would like to attend, you can register here:

Jude Perry is a Person-Centred & Experiential psychotherapist based in Nottingham; she also delivers talks and workshops and is a member of the Pre-Therapy International Network.

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