Individuals who experience psychosis remain underrepresented in trauma-focused research and practice. However, strong links between trauma and psychosis have led to the development of effective trauma-focused therapies (TFTs) for reducing associated distress. Psychological processes similar to those associated with post-traumatic stress are present in individuals with psychosis, such as experiential avoidance and dissociation, yet research jointly exploring dissociation and avoidance as trauma-related processes in psychosis remains limited.

Ten participants who had experienced TFT for psychosis participated in narrative interviews, which were subjected to narrative analysis. Depictions of dissociation and avoidance in the narratives were explored, and whether and how these processes were addressed in TFT.

The narratives depicted psychosis as a response to traumatic events, particularly interpersonal trauma, both in childhood and later life. Although the term ‘dissociation’ was not always recognised by participants, many described experiences that could be interpreted in this way. Avoidance was more readily understood by participants. Both dissociation and avoidance were depicted in the narratives as ways of managing trauma-related distress, whilst also being acknowledged as contributing to maintaining difficulties. The therapeutic relationship and support in managing emotions were identified as helpful in overcoming distress.

Findings highlighted the need for assessment of dissociation and avoidance in psychosis using everyday language, and for enough time in therapy to build a trusting relationship to support this.