The Application of Maultsby’s Rational Behavior Therapy in Psychosis – A Case Report

AbstractThe purpose of this paper is to present the applicability of Rational Behavior Therapy (RBT) for a patient with psychosis. RBT is a form of cognitive-behavioral therapy developed by an American psychiatrist, Maxie C. Maultsby, Jr. RBT teaches rational self-counseling to achieve emotive and behavioral goals, reduce distress and the symptoms of the disease, improve functioning, improve treatment adherence, and prevent relapse. The challenges in applying cognitive behavior therapy in psychosis are described. We report the case of a 17-year-old patient who had been recently diagnosed with schizophrenia according to ICD-10 criteria, presenting with recurrent psychotic symptoms and suicidal ideation. Over 1.5 years, the patient was treated in an outpatient setting with antipsychotic medications and, intermittently, with RBT-based psychotherapy (by the first author). The therapy process was interrupted periodically due to temporary improvements in the patient’s status, non-adherence, or relapses, including one episode requiring hospitalization. Nevertheless, the treatment eventually resulted in a long-lasting remission. We present examples of the RBT techniques used in this therapeutic process and highlight this treatment modality’s unique features which support patients utilizing rational self-counseling skills to become more independent in coping with their problems. We emphasize that patients with a mental illness like schizophrenia or bipolar disorder also suffer from learned emotional disturbances that are amenable to treatment with cognitive-behavior therapies like RBT. In conclusion, we submit that with its self-counseling properties, RBT offers non-intrusive ways of helping people experiencing psychotic symptoms as part of their diagnosis and in prodromal or non-diagnostic states.