Why Engagement Matters in CBT for Psychosis
Estimated reading time: 4 minutes
By Dr Rachel Manser, Consultant Clinical Psychologist
With editorial support from Maria Brunsden, Marketing Communications Lead, Oxford Cognitive Therapy Centre
When therapy stalls, our attention often turns first to the client.
They may miss appointments, seem uncertain about therapy or feel reluctant to discuss particular experiences. We may find ourselves wondering whether they are motivated, ready or able to engage.
But what if engagement is not something a client simply has or does not have? What if it is something therapists actively help to create?
Rather than asking only why someone is not engaging, we could also ask what we might do differently to make engagement more possible.
That question is at the heart of my upcoming OCTC continuing professional development workshop, “It’s not you, it’s me”: Gaining and Retaining Engagement in CBT for Clients with Psychosis, taking place online on 8 October 2026. The workshop explores barriers to engagement, the offer of CBT for psychosis, the language clinicians use and the beliefs therapists may bring to the work.
Engagement is where effective therapy begins
Engagement is rarely the headline topic in CBT training. Understandably, we tend to focus on formulation, therapeutic techniques and interventions.
Yet even a carefully planned intervention is unlikely to fulfil its potential if the person does not feel understood, involved or able to participate. Effective CBT for psychosis depends on trust, collaboration and a shared process of learning.
For clinicians working in NHS mental health services, this has particular relevance. Services are seeking to improve access to evidence-based psychological therapies while responding to growing demand and increasingly complex clinical needs.
Making a thoughtful, individualised offer of therapy and supporting continued participation are therefore central clinical skills, not optional extras.
Turning the focus towards the therapist
The workshop title is deliberately provocative.
“It’s not you, it’s me” challenges the idea that responsibility for engagement sits solely with the client. It invites us to consider how our language, expectations and assumptions may shape the therapeutic relationship.
This is not about blaming clinicians when therapy does not progress as hoped. Therapists cannot guarantee that every person will engage throughout treatment. We can, however, remain reflective, flexible and equipped to offer the best possible conditions for engagement.
In my experience, meaningful changes can begin with surprisingly small shifts in how we introduce therapy, discuss goals and respond to uncertainty. We can also treat disengagement as useful clinical information, rather than simply as evidence that therapy has failed.
Emerging insights into experiences of exceptionality
I am delighted to be joined by Charis Palmer, a Research Assistant working with Dr Louise Isham at the University of Oxford.
Charis works with people who experience grandiose beliefs and experiences of exceptionality. Clinicians, particularly those working in inpatient and specialist services, may encounter these experiences in practice. However, psychological research and intervention development in this area have received comparatively limited attention.
That gap between clinical experience and available guidance makes this a timely area of research.
Charis explains:
“I hope people will learn to approach individuals with experiences of exceptionality with curiosity, openness and an understanding that these experiences can be highly important and meaningful to them. Working within someone’s belief system, rather than immediately challenging it, can help us engage more effectively with clients.”
For me, Charis’s contribution brings the central message into focus: engagement begins with curiosity, collaboration and a willingness to understand what a person’s experiences mean to them. Her research also reminds us that the way we speak, the assumptions we bring and the choices we make as therapists can all shape whether someone feels able to take part.
By remaining reflective and working within the person’s perspective, we can create the conditions in which engagement and meaningful therapy become more possible.
If you would like to explore these questions with us, join me and Charis for the online OCTC workshop on 8 October 2026: “It’s not you, it’s me”: Gaining and Retaining Engagement in CBT for Clients with Psychosis.
