08 September 2026
Bilbao
People living with severe mental health conditions such as psychosis often have difficulty understanding their own mental health. This ability to recognise the condition they have, the need to follow treatment and the social implications of the diagnosis is known as ‘illness awareness’ or clinical insight. The lack or limitation of this awareness is often associated with treatment discontinuation, a higher risk of relapse and recurrent hospital admissions.
In contrast to the traditional medical model, which focuses primarily on diagnosis and medication, the research study “Fostering Insight Among Individuals With Psychosis Through Dialogic Reading”, led by researchers from the University of Deusto’s eDucaR team, takes an innovative and more human-centred approach.
This work is based on a dialogic model that enables participants to express their own voices, reflect on their experiences and construct shared meaning in an environment of deep respect and equality. This approach takes shape through dialogic reading, with Franz Kafka’s The Metamorphosis serving as a catalyst for dialogue. The study demonstrates that this methodology offers a non-stigmatising alternative that helps people with psychosis develop greater insight and understand their experiences from a position of agency and mutual respect.
The study, published in the scientific journal Psychiatric Rehabilitation Journal, has received the American Psychological Association (APA) Editor’s Choice distinction in recognition of its relevance and impact in the field of mental health.
23 patients, 54 sessions
The study involved 23 people (17 men and 6 women) admitted to long-stay psychiatric rehabilitation units at a hospital in northern Spain. All participants had diagnoses within the psychosis spectrum, such as schizophrenia or schizoaffective disorder, and 17 also had dual diagnosis, combining a mental health condition with a long-standing history of addiction, including drug or alcohol dependence or gambling disorder.
Over a five-month period, they were divided into three groups and took part in a weekly session of approximately 45 minutes focused on reading Franz Kafka’s The Metamorphosis. The book was chosen in agreement with the patients themselves because of its rich metaphors relating to transformation, social isolation, changes in body perception and loss of identity.
Reflection on illness and substance use
The study’s findings reveal that this safe space enabled patients to develop greater awareness of their condition. When discussing Kafka’s character, they were able to verbalise for the first time traumatic experiences from their initial psychotic episodes, periods of isolation and emotional distress, reflecting on their ‘medical label’ and their true identity.
Dialogic reading also helped address the social consequences of mental illness. Participants reflected on the stigma they experience in society and expressed deep regret over the pain they had caused their families, while also recognising the importance of accepting help from professionals.
One of the most significant findings of the study was the emergence of thoughts related to addictive behaviours. Several participants identified drug or alcohol use as initially serving as a desperate attempt to cope with loneliness or sadness. Similarly, reflections on gambling addiction showed how guilt and even ‘self-destructive’ thoughts fuelled compulsive behaviour. The group helped to identify triggers and assess social support as a safeguard against relapses.
Key figures in the process
The participants’ feedback on the activity was extremely positive, with some even describing dialogic reading as “therapy for their brains”. They highlighted the calm atmosphere, which allowed them to express themselves without anxiety, as well as the active listening and empathetic identification with other members of the group. They also emphasised regaining a sense of agency, stressing that during these sessions they felt like the ‘protagonists’ of their own recovery process, in contrast to their experiences in other, more conventional therapeutic settings.
In conclusion, the research demonstrates that incorporating a dialogic approach into psychiatric rehabilitation processes provides a non-stigmatising, safe and effective space that restores voice, personal agency and self-awareness to people with severe mental health conditions.
Photograph by cottonbro studio, on Pexels.
