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Managing the impact of psychosis: A grounded theory exploration of recovery processes in psychosis
Abstract
There has been little conceptual bridge building between what individuals report as helpful in recovery and how psychological therapy might impact on recovery in psychosis. This study explores the links between therapy and recovery in psychosis.
Grounded theory was chosen as an appropriate methodology to distil an explanatory account across the qualitative data collected.
An initial sample of 19 therapy session tapes and 23 interviews with psychologists and clients engaged in psychological therapy in psychosis was collected and analysed using grounded theory. This data set was extended through the additional sampling and analysis of 31 published personal accounts of the experience of psychosis.
The study reports on specific elements of a larger grounded theory study that particularly relate to recovery processes in psychosis. Specific categories of activity were conceptualised to theorise the key activities involved in managing the impact of psychosis.
Therapy in psychosis appeared to be aimed at enhancing clients' functioning in the social world. In an effort to achieve this, it seemed that clients engaged in an ongoing effort to manage the impact of psychosis on both their subjective experience and on day to day life. The conceptualisation of this effort as an active, ongoing, and individually-directed process was consistent with other examinations of service user accounts.
... In total 20 articles (Balaji et al., 2012; Corin, 1998; Corin & Lauzon, 1994; Davidson et al., 1997; Dilks et al., 2010; Eisenstadt et al., 2012; England Kennedy & Horton, 2011; Forchuk et al., 2003; Jenkins and Carpenter-Song, 2005; Kaewprom et al., 2011; Lam et al., 2011; McCann & Litt, 2004; Ng et al., 2008a Ng et al., , b, 2011 Noiseux & Ricard, 2008; Romano et al., 2010; Saavedra et al., 2012; Tweedell et al., 2004) were identified from 18 data collections within 8 countries. A PRISMA (Moher et al., 2009) flow diagram (Figure 1) provides full details of the selection process. ...
... Four strategies were identified by patients including: (1) The need to accept their illness is real and has occurred. Acceptance has been considered a factor which enabled individuals to change their perspective about the illness (Balaji et al., 2012; Dilks et al., 2010; Kaewprom et al., 2011; Ng et al., 2008b Ng et al., , 2011). (2) Patients required time to navigate, negotiate and understand who they are and how they see themselves, this meant considering time (previous and present experiences and future expectations), and making comparisons with others and learning from reading (Corin & Lauzon, 1994; Dilks et al., 2010; Jenkins & Carpenter-Song, 2005; Kaewprom et al., 2011). ...
... Acceptance has been considered a factor which enabled individuals to change their perspective about the illness (Balaji et al., 2012; Dilks et al., 2010; Kaewprom et al., 2011; Ng et al., 2008b Ng et al., , 2011). (2) Patients required time to navigate, negotiate and understand who they are and how they see themselves, this meant considering time (previous and present experiences and future expectations), and making comparisons with others and learning from reading (Corin & Lauzon, 1994; Dilks et al., 2010; Jenkins & Carpenter-Song, 2005; Kaewprom et al., 2011). It also meant taking on board the effects of medication (Dilks et al., 2010; Jenkins & Carpenter-Song, 2005; Noiseux & Ricard, 2008). ...
Abstract
Background
Research is required to better understand the psychosocial factors that influence the recovery of individuals with schizophrenia .
Objective
To conduct a systematic review and thematic synthesis and identify the factors which influence recovery.
Methods
Major electronic databases were searched from inception until February 2014. Qualitative articles were included that considered the concept of recovery from individuals with schizophrenia, their caregivers or health care professionals. Methodological quality was assessed and studies were thematically synthesised.
Results
Twenty articles involving 585 individuals with schizophrenia, 298 primary care givers or close sources of support and 47 health care professionals were included. The results identified and detailed the psychosocial factors and processes that influenced recovery. The factors which promoted recovery included: (1) adjustment, coping and reappraisal (2) responding to the illness (3) social support, close relationships and belonging. The factors which challenged recovery included: (1) negative interactions and isolation (2) internal barriers (3) uncertainty and hopelessness.
Conclusion
Health care professionals and researchers will benefit from a greater understanding of the psychosocial factors which influence recovery for individuals with schizophrenia. Implications are discussed within the text.
... There has been recent work emphasizing the therapist's role in assisting a person experiencing psychosis to make sense of this experience in a manner that enhances a sense of agency and self-worth, offers hope for the future, and allows the processing of distress (see Dilks, Tasker, & Wren, 2008;Lysaker & colleagues' work, e.g., Lysaker and Buck, 2006;Lysaker and Daroyanni, 2006;Lysaker, Lancaster, & Lysaker, 2003;Lysaker, Wickett, Campbell, & Buck, 2003). Examinations of personal accounts of psychosis also highlight the importance of making sense of troubling experiences in recovery from psychosis (e.g., Davidson, 2003;Dilks, Tasker, & Wren, 2010;Hirschfeld, Smith, Trower, & Griffin, 2005). Such examinations, as well as individual personal accounts (e.g., de Valda, 2001;Deegan, 1993), make clear that the meanings used to understand psychosis are not neutral. ...
... This position actually seems consistent with both Strauss and Corbin's (1998) and Glaser's (1978) more detailed descriptions of their approaches to grounded theory. This paper specifically reports on a subset of the findings from the grounded theory model of therapy processes in psychosis described more fully in Dilks et al. (2008Dilks et al. ( , 2010. Detailed findings relating to specific therapist activities are described separately here in order to allow a fuller consideration of these activities. ...
... The grounded theory of therapy processes in psychosis is reported in detail in Dilks et al. (2008) and the analysis of the personal accounts data is described in Dilks et al. (2010). The current report focuses on aspects of the analysis relating specifically to therapist activities and describes findings from the analysis of therapy session tapes, interviews with the therapist and client sample, and the additional set of interviews with psychoanalytically aware psychologists. ...
Objectives. This paper reports on a subset of findings from a wider ranging grounded theory analysis of therapy and recovery processes in psychosis. It describes therapist activities involved in maintaining an observational perspective during therapy and the links between these and other therapist activities.
Design. Grounded theory was used to examine the qualitative data collected.
Methods. An initial sample of 19 taped therapy sessions and 23 interviews with psychologists and their clients was collected. This sample was extended through the collection of three further interviews with psychoanalytically aware psychologists. The data were analysed using grounded theory.
Results. A grounded theory model of therapy processes in psychosis was developed that conceptualized therapist actions as providing an observational scaffold to support the client's efforts in moving to new perspectives on their situation. Consistent with the understanding of the core therapy activity as a dialogical process, this set of therapist actions was understood as occurring alongside other therapist activities involved in managing emotion and building a relationship in therapy.
Conclusions. The central activity of therapy in psychosis was understood as a dialogical process continuously negotiated between therapist and client in conversation and was conceptually summarized in the grounded theory as ‘building bridges to observational perspectives’. However, the active and strategic efforts of psychologists to sustain the dialogue implied a particular assumption of responsibility for maintaining this process. In particular, therapists appeared to be ‘working to maintain observational perspectives’, ‘managing emotion’, and ‘doing relationship’ during the therapy conversation as part of the joint effort with clients to build bridges to new observational perspectives on distress and psychosis.
... Other studies have focused on understanding recovery approaches to psychosis (e.g. Dilks et al., 2010) and the therapist's role in psychosis (Dilks et al., 2013). Such investigations arose from the observation that there was a mismatch between what clients and mental health professionals perceived as recovery. ...
... This project aimed to explore clients' experiences of psychological therapy within the PR service through semi-structured interviews and to analyse them using thematic analysis. This project is positioned differently from earlier literature in two ways; (1) in its applied form to evaluate an existing PR service; and (2) in its focus on the experience of psychological therapy for psychosis as opposed to the experience of psychosis itself (McCarthy-Jones et al., 2011), recovery (Dilks et al., 2010) or therapist role (Dilks et al., 2013). ...
We surveyed service users, carers and staff who contribute to involvement in clinical psychology training programmes in the UK about involvement activity and their attitudes towards this. We found generally positive attitudes towards involvement not reflected in activity levels.
... Other studies have focused on understanding recovery approaches to psychosis (e.g. Dilks et al., 2010) and the therapist's role in psychosis (Dilks et al., 2013). Such investigations arose from the observation that there was a mismatch between what clients and mental health professionals perceived as recovery. ...
... This project aimed to explore clients' experiences of psychological therapy within the PR service through semi-structured interviews and to analyse them using thematic analysis. This project is positioned differently from earlier literature in two ways; (1) in its applied form to evaluate an existing PR service; and (2) in its focus on the experience of psychological therapy for psychosis as opposed to the experience of psychosis itself (McCarthy-Jones et al., 2011), recovery (Dilks et al., 2010) or therapist role (Dilks et al., 2013). ...
This article describes a qualitative project in which service users were interviewed about their experience of psychological therapy for psychosis. In the context of local and national pressures and policies, it was hoped this feedback would help improve the service.
... In particular, a number of studies look at the lived experience of involuntary hospitalizations during the acute phase of the disease (Williams, 2008; Wood & Pistrang, 2008). In contrast, a vast amount of literature explores solely the lived experience of the recovery process (Aston & Coffey, 2012; Dilks, Takser, & Wren, 2010; Jensen & Wadkins, 2007; Turton et al., 2011), or the coping mechanisms used to combat mental illness (Green, Hayes, Dickinson, Whittaker, & Gilheany, 2002; Webb, Charbonneau, McCann, & Gayle, 2011; Yangarber-Hicks, 2004 ), whilst others investigate the ambivalent relationship between medication and quality of life (Gale et al., 2012; Piat et al., 2009; Sajatovic & Jenkins, 2007). Furthermore, some other studies describe the relationship between mentally ill people and health care professionals (Borg & Krinstiansen, 2004; Cleary, Hunt, Horsfall, & Deacon, 2012; Gahnström-Strandqvist, Josephsson, & Tham, 2004; McCloughen, Gillies, & O'Brien, 2011; Schroeder, 2012). ...
... Based on this, interventions aiming to social rehabilitation may need to transform their philosophy and adopt a more genuine towards social acceptance character (Drake & Whitley, 2014; Linz & Sturm, 2013; Mizock et al., 2014; Scheyett, DeLuca, & Morgan, 2013). This means that mental health care professionals need to enhance their empathic understanding and subsequently unconditional acceptance of mentally ill individuals, liberated from their preconceptions regarding mental illness (Cleary et al., 2012; Dilks et al., 2010). Indeed, there is evidence which shows that mental health care professionals, in accordance with the wider society, still hold strong stereotypes regarding mental disorders (Ben-Zeev, Young, & Corrigan, 2010; Corrigan, 2000; Schulze & Angermeyer, 2003 ). ...
The diverse experiences of severely mentally ill persons, most of the times, have not been taken into account, or integrated to the treatment procedures. This meta-synthesis aimed to examine what is like to live with severe mental illness narratives by employing a meta-ethnographic synthesis of seventeen published peer reviewed qualitative studies. Third order analysis revealed as core theme “An ongoing struggle for reconciliation with the self and the illness”. Other themes included amongst others: loss of identity, pain of having had one’s life stolen, being an outcast. The identification of the importance of the alterations of self-identity throughout the continuum of the severe mental disorder may be the focus of targeted psychosocial interventions.
... This study draws on and contributes to previous research exploring the experience of self in psychosis and recovery from FEP (Boydell et al., 2010;Dilks, Tasker, & Wren, 2010;Perry et al., 2007). The positive narratives of self-growth found in the strengthening of self group confirm the importance of hope in recovery from FEP (Perry et al., 2007). ...
... The positive narratives of self-growth found in the strengthening of self group confirm the importance of hope in recovery from FEP (Perry et al., 2007). The development of personal coping strategies, the importance of regaining social functioning, and the re-evaluation of values and attitudes were also evident in this group (Dilks et al., 2010). This study has built upon the use of dialogical theory of self in schizophrenia (Lysaker & Lysaker, 2008) in order to understand the experience of both diminishment and restoration of self, following the acute phase of FEP in the first few months of recovery. ...
This study aims to understand the process of change in self and its relationship to recovery in the first three months following first episode psychosis (FEP). As psychosis is understood as a disorder of self, we need theories of self to consider how sense of self is affected and restored. We used semi-structured interviews to explore the experiences of 12 young people who had been diagnosed with FEP. We conducted the interviews at two time points: during the first month following their psychosis and three months later. We employed Interpretive Phenomenological Analysis to explicate interview data and explore the experience of change following FEP. Themes which emerged in the data came under two superordinate themes: loss of self and strengthening of self. Dialogical theory of self was used to interpret the findings and explore the relationship between sense of self and recovery for young people during this critical phase following FEP.
... Billy seemed to understand this aspect of mindfulness: Developing a sense of agency is discussed in service-user literature as important in contributing to the process of recovery (Davidson, 2003) through empowering the individual to make their own choices and actively pursue the goals and aspirations that are meaningful to them. Without a sense of personal agency a person could feel hopeless and become ''stuck'' in the psychiatric system, feeling unfulfilled and excluded from the social roles they wish to be involved in (Davidson, 2003;Perry et al., 2007;Dilks et al., 2010). ...
... The way in which the group was facilitated, in order to open up space for collaboration, may have been beneficial in this, for example, Byrne et al.'s (2009, p. 213) literature review reported service-user priorities and preferences for ''treatment'', with a clear preference expressed for ''collaborative ''treatment'' approaches that offered opportunities for communication and partnership'' with a significant emphasis on ''greater prominence and value to be given to their own active role.''. Dilks et al. (2010) used grounded theory to explore how individuals managed the subjective experience of psychosis. The concept of ''making sense'' was outlined by participants, defined as ''the process of an individual developing personally acceptable and socially shared explanations of psychosis'' (p. ...
Purpose – There is an increasingly active area of research indicating that interventions incorporating mindfulness can be beneficial for individuals distressed by experiences of psychosis. However, there is little qualitative information regarding clients' experiences of mindfulness groups. This paper aims to fill this gap.
Design/methodology/approach – To explore the subjective experience of mindfulness groups for people experiencing distressing psychosis. Three participants, who had attended a mindfulness for psychosis group, were interviewed and data were analysed using Interpretative Phenomenological Analysis.
Findings – Four main themes were identified: “experiencing distress”, “group as beneficial”, “mindfulness as beneficial”, and “mindfulness groups as part of the process of recovery”.
Originality/value – The mindfulness groups appeared to support participants' journeys of recovery through: promoting choice and control in relating differently to distress; providing space to socially construct shared meanings; and enhancing a sense of agency in “moving on”.
... Deegan, 1993;Frese et al., 2009;Mead & Copeland, 2000;Noiseux & Ricard, 2008;Saks, 2008). Grounded theory studies confirm the perspective of consumers that therapies should address their needs for recovery within the social functioning and personal growth context (Dilks, Tasker, & Wren, 2010). People with serious mental illness consistently affirm that recovery provides opportunities for them to experience the basic human needs of autonomy and self-determination (Piat et al., 2009). ...
... Deegan, , 1996P. Deegan, , 2001Dilks et al., 2010;Jacobson & Greenley, 2001;Lunt, 2000;Mancini et al., 2005;Ralph, Lambert, & Kidder, 2002;Ramon et al., 2007), social workers (Mancini et al., 2005;Mead & Copeland, 2000), and health policy analysts (Alakeson, 2010) refer to recovery as occurring within the realm of the consumer. The consensus of these disciplines is that recovery is more than the remission of symptoms; rather, it encompasses reintegration of illness into the person and attainment of life goals that the individual sets based on his or her reality of existence. ...
This paper examines the concept of recovery in the context of serious mental illness. The analysis uses literature from multiple health care disciplines and different uses of "recovery" in every- day language, technical applications, and popular culture. This iterative process concludes with a definition of recovery from serious mental illness: a nonlinear process of self-organization and adaptation that offsets the personal disintegration of mental illness and enables the individual to reconceive his or her sense of self and well-being on all biopsychosocial levels. The relevance of the concept is reevaluated with this definition for potential usage in the mental health care setting.
... The suggested model depicted the ongoing nature of recovery in voice hearers, and although this model proposes a final phase, this does not denote a cessation of recovery processes. This finding bears resemblance to psychosis literature pointing to continuing management of challenges that arise when in recovery(Dilks et al., 2010; Dixon et al., 2010). ...
Background
Personal recovery literature has been influential in the conceptualisation of emotional distress and service provision. While personal recovery in psychosis has been well-studied, voice hearing literature has not been reviewed to elucidate recovery processes.
Method
Five databases were systematically searched to identify relevant qualitative recovery literature. 12 eligible studies were included in this review and an appraisal tool was applied to assess quality. Thematic synthesis was used to examine results.
Results
Three superordinate themes were found relating to ‘Recovery Phases’, ‘Recovery Facilitators’ and ‘Barriers to Recovery’. Papers included descriptions of finding voices distressing initially yet moving toward integrating and accepting voices. Searching for meaning versus seeking distance from voices were pivotal processes to recovery pathways. Enabling and disrupting recovery experiences are discussed within a proposed model.
Conclusions
Recovery in voice hearing is an individual and potentially ongoing process. Future research should seek to examine recovery factors in voice hearing longitudinally and add further evidence to the supportive role services can play in recovery and voice hearing.
... In this study, the mentor is expected to have a network and be able to become a liaison between the needs of recovery survivors and other appropriate parties. A study revealed the perspective of schizophrenia survivors that therapy must meet their needs for recovery in social functioning and personal growth contexts (Dilks, Tasker, & Wren, 2010). This opinion is in accordance with the principle of holistic recovery, that is, apart from physical and psychological conditions. ...
The personal recovery paradigm in schizophrenia patients require a change of service. One of the changes that can be made to support the schizophrenia recovery process is a change in the concept of the relationship between patients and nurses. Nurse mentorship for schizophrenia patients is a new terminology of innovation in a supportive relationship between health workers and patients. At present, it is not known how the structure, process, and outcome of mentorship to schizophrenia survivors. This study aimed to explain how the structure, process, and outcome of mentoring nurses to schizophrenia survivors. This research is qualitative research using the case study method involving three cases of mentorship conducted in Banyumas Regional Hospital. A total of nine participants were involved in this study which consisted of three nurses as mentors, three schizophrenia survivors, and three caregivers. Data were collected by semi-structured interview techniques, observation, and document review. After in-depth analysis seven research themes were found. Participants' perception about the structure of mentorship include the theme mentorship requires a variety of abilities of nurses and conditions of survivors who can participate in mentorship. While the mentorship process includes the theme requires patience in mentorship, giving guidance for the recovery of survivors, and facing the recurrence of survivors due to treatment factors. Participants revealed the outcome of mentorship in the theme mentors feel inner satisfaction, and survivors feel more enthusiastic about life. The results of this study provide the view that mentorship has the potential to be developed into quality nursing interventions to support the recovery process of schizophrenia survivors.
... Pinfold, 2000, στοιχεία που συνδέονται άρρηκτα με την ενδυνάμωση (Nelson et al., 2001). Αντίστοιχα, οι στρατηγικές που υιοθετούν τα άτομα, προκειμένου να επιτύχουν την ανάρρωση, περιλαμβάνουν τον προσωπικό αγώνα και ενεργοποίηση, την κινητοποίηση διαπροσωπικών υποστηρικτικών σχέσεων και την επαφή με επαγγελματίες και υπηρεσίες ψυχικής υγείας (Dilks et al., 2010. Nixon et al., 2010ab. ...
Η Μονογραφία αυτή συνεισφέρει στη βιβλιογραφία για την ανάπτυξη ενός κοινοτικά και κοινωνικά προσανατολισμένου συστήματος ψυχικής υγείας. Οι δεκαετίες της ψυχιατρικής μεταρρύθμισης στην Ελλάδα συνέβαλαν ουσιαστικά στην προαγωγή και την προστασία των ανθρωπίνων δικαιωμάτων των ατόμων με ψυχικές διαταραχές, και στην ποιότητα ζωής τους. Τα τελευταία χρόνια, το κοινοτικό μοντέλο φροντίδας ενισχύεται από νέες προσεγγίσεις, όπως το μοντέλο της ανάρρωσης που δίνει έμφαση στην ενδυνάμωση των ατόμων με ακραίες ψυχικές εμπειρίες αναγνωρίζοντας τις προσωπικές τους εμπειρίες ως πηγή γνώσης και νοηματοδότησης. Η Μονογραφία υπηρετεί τις σύγχρονες αυτές προσεγγίσεις, κομίζοντας τη διεθνή βιβλιογραφία αιχμής στο συγκεκριμένο πεδίο. Στο πρώτο μέρος, αναπτύσσεται μια επιστημονικά τεκμηριωμένη ανασκόπηση της σύγχρονης βιβλιογραφίας αναφορικά με την κατανόηση και αντιμετώπιση της ψύχωσης. Στο δεύτερο μέρος, παρουσιάζονται ευρήματα μιας πρωτότυπης, πρωτογενούς έρευνας που εφάρμοσε αφηγηματική βιογραφική προσέγγιση για την ανάδειξη των μαρτυριών των ανθρώπων με ψύχωση. Μέσα από τις μαρτυρίες των συμμετεχόντων, αναδεικνύονται οι εμπειρίες της ζωής πριν την εμφάνιση της ψύχωσης και οι κοινωνικοί παράγοντες που πιθανόν συντέλεσαν σ’ αυτήν. Χαρτογραφούνται, επίσης, οι τρόποι με τους οποίους βίωσαν, νοηματοδότησαν και διαχειρίστηκαν τις ψυχωτικές τους εμπειρίες. Με δεδομένη τη δυναμική ενσωμάτωση νέων επιστημονικών πεδίων, όπως της κοινοτικής κλινικής ψυχολογίας και της κοινωνιολογίας της υγείας και της ασθένειας, στα Προπτυχιακά και στα Μεταπτυχιακά Προγράμματα Σπουδών, η Μονογραφία αναμένεται να αποτελέσει έναν χρήσιμο βιβλιογραφικό πόρο σε φοιτητές/-τριες, ερευνητές/-τριες και επαγγελματίες που επιθυμούν να εργαστούν προς μια ανθρωπιστική κατεύθυνση κατανόησης και αντιμετώπισης του ψυχικού πόνου και να αναπτύξουν επαγγελματικές πρακτικές υποστήριξης της ανάρρωσης, κάτι το οποίο αποτελεί εκπεφρασμένο στόχο και ζητούμενο για τους σύγχρονους επαγγελματίες ψυχικής υγείας.
... Noiseux & Ricard, 2008. Αντίστοιχα, οι στρατηγικές που υιοθετούν τα άτομα προκειμένου να επιτύχουν την ανάρρωση περιλαμβάνουν προσωπικό αγώνα και ενεργοποίηση, κινητοποίηση διαπροσωπικών υποστηρικτικών σχέσεων και επαφή με επαγγελματίες και υπηρεσίες ψυχικής υγείας (Dilks, Tasker, & Wren, 2010. Nixon, Hagen, & Peters, 2010. ...
This paper provides a methodological review of qualitative studies on the lived experience of psychosis. It aims to present the main research trends on psychotic experience and to assess their usefulness and appropriateness for examining the role of social factors in the emergence, experience and management of psychosis. The following trends are presented: (a) the phenomenological approach, which aims to identify the essence of psychotic experience, (b) the narrative and dialogical approaches, which focus on the constitution of the self in psychosis through the examination of self-narratives, (c) the social constructionist approach, which, through analysing the discourse of persons in distress, examines the construction of mental distress,and finally (d) empirical studies employing thematic type qualitative analysis on interviews with persons in distress in order to highlight their experiences and views regarding various aspects of their life with psychosis. For each of the approaches, the paper addresses: (a) its epistemological paradigm, (b) the view of psychosis and mental distress adopted, (c) the research methodology used regarding data collection and analysis, (d) the main findings and conclusions, and (e) the role attributed to social factors and processes.
... However, even after an acute mental health crisis has resolved, it is very common for people to experience persistent residual, or attenuated, psychotic symptoms [2,3]. People may also experience barriers to re-integrating into society due to the stigma of their diagnosis [4], and the on-going impact of symptoms on everyday functioning [5]. ...
Background
There is no current guidance on where Mindfulness for Psychosis groups should best be situated within care pathways. The objectives of this paper are to (1) describe a novel care pathway tested out in a psychiatric outpatient service in Hong Kong, and (2) to present feasibility outcomes on attendance and drop-out, and routine clinical outcomes.
Methods
A new mindfulness pathway was set up, for service users with psychosis who had first completed a course of Cognitive Behavioural Therapy for psychosis (CBTp). After attending an orientation ‘taster’ session, service users could then attended a 4-session weekly Mindfulness for Psychosis group, followed by optional monthly follow-up sessions.
Results
A high proportion of service users referred into the pathway (19/22; 86%) went on to attend a Mindfulness for Psychosis group after attending an orientation ‘taster’ session. Attendance at group sessions was high, with all participants attending at least 2/4 group sessions, and no drop-outs. Attendance at monthly follow-up groups was also high, with 84% (16/19) attending at least one monthly follow-up. Routine clinical outcome data showed a reduction in negative symptoms of psychosis, and an increase in mindfulness and mindful responding in daily life, from pre- to post group.
Conclusions
Offering service users with psychosis the opportunity to attend a mindfulness for psychosis group after completing a course of CBTp was highly acceptable, as evidenced by high attendance, and low drop-out. Possible benefits in terms of improving negative symptoms may be particularly important in promoting recovery through improved everyday functioning.
... Some participants saw their written formulation as a resource for the future, which again replicates previous research findings (Pain et al., 2008). The finding that some preferred to keep their formulations private due to concerns that others may become upset by them, or due to perceptions of stigma, is in line with previous literature (Dilks et al., 2010). ...
Objectives
This study set out to explore service user experiences of formulation during individual therapy for psychosis, and develop a grounded theory of the processes involved.
Method
Semi-structured interviews were undertaken with 11 service users and two clinical psychologists with experience of formulation in therapy for psychosis.
Design
Grounded theory was used to examine the qualitative data collected.
Results
An emerging model was constructed to conceptualise the processes that occur during the sharing of a formulation. “Linking previous experiences with current ways of being” and “Building the therapeutic relationship” emerged as core, reciprocally influential processes. “Making use of new understandings” was also identified as an important process.
Conclusions
The findings suggest that formulations should be developed collaboratively and progressively with service users, and that care should be given to the emotions that arise as a result. Further research is necessary to elaborate our understanding of formulation given the importance placed on it in United Kingdom clinical psychology.
... Noiseux & Ricard, 2008. Αντίστοιχα, οι στρατηγικές που υιοθετούν τα άτομα προκειμένου να επιτύχουν την ανάρρωση περιλαμβάνουν προσωπικό αγώνα και ενεργοποίηση, κινητοποίηση διαπροσωπικών υποστηρικτικών σχέσεων και επαφή με επαγγελματίες και υπηρεσίες ψυχικής υγείας (Dilks, Tasker, & Wren, 2010. Nixon, Hagen, & Peters, 2010. ...
This paper provides a methodological review of qualitative studies on the lived experience of psychosis. It aims to present the main research trends on psychotic experience and to assess their usefulness and appropriateness for examining the role of social factors in the emergence, experience and management of psychosis. The following trends are presented: (a) the phenomenological approach, which aims to identify the essence of psychotic experience, (b) the narrative and dialogical approaches, which focus on the constitution of the self in psychosis through the examination of self-narratives, (c) the social constructionist approach, which, through analysing the discourse of persons in distress, examines the construction of mental distress, and finally (d) empirical studies employing thematic type qualitative analysis on interviews with persons in distress in order to highlight their experiences and views regarding various aspects of their life with psychosis. For each of the approaches, the paper addresses: (a) its epistemological paradigm, (b) the view of psychosis and mental distress adopted, (c) the research methodology used regarding data collection and analysis, (d) the main findings and conclusions, and (e) the role attributed to social factors and processes.
Στην εργασία αυτή επιχειρείται μια μεθοδολογική ανασκόπηση ποιοτικών μελετών της βιωμένης εμπειρίας της ψύχωσης. Στόχος είναι η παρουσίαση των κεντρικών ερευνητικών ρευμάτων της ψυχωτικής εμπειρίας και η αποτίμηση της χρησιμότητας και καταλληλότητάς τους για τη μελέτη του ρόλου των κοινωνικών παραγόντων στην εμφάνιση, βίωση και διαχείριση της ψύχωσης. Στην εργασία παρουσιάζονται: (α) η φαινομενολογική προσέγγιση, που στοχεύει στον προσδιορισμό της ουσίας της ψυχωτικής εμπειρίας, (β) η αφηγηματική και διαλογική προσέγγιση, που επικεντρώνονται στη συγκρότηση του εαυτού στην ψύχωση, μέσω της εξέτασης των χαρακτηριστικών των αφηγήσεων του εαυτού, (γ) η κοινωνική κονστρουξιονιστική προσέγγιση, που μέσω της ανάλυσης του λόγου ατόμων με εμπειρία ψυχικού πόνου εξετάζει την κοινωνική κατασκευή του ψυχικού πόνου, και τέλος (δ) εμπειρικές μελέτες που χρησιμοποιούν θεματικού τύπου ποιοτική ανάλυση συνεντεύξεων με άτομα με εμπειρία ψυχικού πόνου, προκειμένου να αναδείξουν τις εμπειρίες, απόψεις και θέσεις των ατόμων αυτών σχετικά με ποικίλες πτυχές της ζωής με την ψύχωση. Σε καθεμία από τις προσεγγίσεις εξετάζονται: (α) το επιστημολογικό παράδειγμα που υιοθετείται (β) η θεώρηση της ψύχωσης, και του ψυχικού πόνου εν γένει, (γ) η ερευνητική μεθολογία που ακολουθείται, αναφορικά με τη συλλογή και την ανάλυση του ερευνητικού υλικού, (δ) τα κεντρικά ευρήματα και συμπεράσματα των μελετών, και (ε) ο ρόλος που η κάθε προσέγγιση αποδίδει στις κοινωνικές παραμέτρους και διεργασίες.
... As for the degree of understanding of the experience of individuals living with mental illness, previous studies focus on specific aspects of this phenomenon [27,37,38], thus the number of studies exploring the entire spectrum of the experience of SMI are relatively limited. In particular, a vast amount of literature focuses on involuntary hospitalization during the acute phase of the illness [39,40] or recovery process [41][42][43][44]. Other researchers have explored the coping mechanisms applied by people living with mental illness in order to combat their illness [37,45,46]. ...
Background
Research evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way.
Methods
A qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews.
Results
Several main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants’ perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants.
Conclusions
The present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.
... An episode of psychosis can be experienced as a major assault on the sense of self, changing perceptions of identity and self-control (Koivisto et al 2004). Separate consideration of the self from the mental health problem, such as psychosis, has been suggested as a significant part of recovery (Davidson 2003, Dilks et al 2010, Eklund and Backstrom 2005, Mezzina et al 2006. Davidson (2003, p31) has referred to this as 'living outside mental illness'. ...
Date Presented 4/16/2015
This participatory action research aimed to find out what helps people in everyday life, from the perspective of those with experience of psychosis. The findings are presented along with the collaborative process that creatively overcame barriers between consumers and professionals.
... An episode of psychosis can be experienced as a major assault on the sense of self, changing perceptions of identity and self-control (Koivisto et al 2004). Separate consideration of the self from the mental health problem, such as psychosis, has been suggested as a significant part of recovery (Davidson 2003, Dilks et al 2010, Eklund and Backstrom 2005, Mezzina et al 2006. Davidson (2003, p31) has referred to this as 'living outside mental illness'. ...
Introduction
The purpose of this research was to deepen understanding of what is helpful to those who have experienced psychosis, in order to facilitate best practice within mental health services. Psychosis presents challenges for people on an everyday basis, yet strategies can be developed to facilitate living with psychosis. Investigating the service user's perspective is crucial for informing recovery oriented occupational therapy practice.
Method
Initiated and designed by a service user research group, this research was exploratory and, primarily, participatory. Data were gathered from two focus groups, involving 13 people with experience of psychosis, facilitated by service user researchers and an MSc student. Data analysis was systematic and based on grounded theory principles
Findings
Participants shared experiences and thoughts about their everyday lives. Data analysis revealed six elements of the self: the social self; the occupational self; the integrated self; the unsupported self; the stigmatised self and the isolated self. The importance of balancing these six facets of the self is theorised as being essential to successfully managing the experience of living with psychosis.
Conclusion
This emergent theory could underpin occupation-focused approaches to living with psychosis, with interventions aimed at enabling service users to balance the experience of psychosis with satisfying and contributing lives or recovery.
... Pinfold, 2000, elements that are intricately linked to empowerment (Nelson, Lord & Ochocka, 2001). Correspondingly, the strategies adopted by persons in order to achieve recovery include personal struggle, mobilization of interpersonal supportive relations and contact with mental health professionals and services (Dilks, Tasker, & Wren, 2010. Nixon et al., 2010ab. ...
During the last decades there has been increasing research interest in examining mental disorders from the perspective of those who experience them, mainly though the use of qualitative methodologies, in an attempt to grasp the lived experience of these disorders, the ways in which they are understood and managed by those who experience them, as well as their effects on people's lives. This talk attempts a methodological review of qualitative studies of the lived experience of psychosis, which has been conducted as part of a research project on the role of socioeconomic inequalities in the emergence, experience and management of psychosis. I will present (a) the phenomenological approach, which aims to define the essence of the psychotic experience, (b) the narrative and dialogical approach, which focuses on the constitution of the self in psychosis, through examining the characteristic features of self narratives, (c) the social constructionist approach, which through discourse analyzing the talk of people with experience of psychosis examines the social construction of distress, and (d) qualitative empirical studies which employ versions of thematic analysis to analyse interviews with people in distress, in order to highlight their experiences and views regarding various aspects of life with psychosis. For each of the approaches I examine the view of psychosis adopted, the research methodology employed, the main research findings and conclusions, as well as the role accorded to social factors and processes in the emergence, experience and management of psychosis.
... Along similar lines, psychosis has been described as entailing severe dialogical disruption, which is evidenced in compromised capacity for dialogue between self-positions (Lysaker, Glynn, Wilkniss, & Silverstein, 2010) as well as in a sense-reduced agency (e.g., Lysaker & Leondhardt, 2012;Roe & Davidson, 2005). Individuals with psychosis often describe feeling at the mercy of their symptoms and experience reduced volition, while agency is projected into their symptoms (Lysaker et al., 2010;McCarthy-Jones, Marriott, Knowles, Rowse, & Thompson, 2013); they also describe loss of identity and a sense of dehumanization as they "become an illness," in a process with stigmatizing and selfstigmatizing effects (Dilks, Tasker, & Wren, 2010;Pitt, Kibride, Welford, Nothard, & Morrison, 2009). In addition, the psychiatric discourse itself and the practices associated with it negatively affect the diagnosed person's agency, limiting his or her position repertoire and thus constraining possibilities for self-understanding and action (Avdi, 2005;Harper, 1995;Holma & Aaltonen, 1998;Karatza & Avdi, 2010). ...
This study aims to further theoretical and clinical discussions regarding the therapy of psychosis from a dialogical perspective and to contribute to the contemporary research literature that works toward developing methods for studying the dialogical processes in therapy. Three videotaped sessions of a therapy with a heterosexual couple, in which both partners had psychotic experiences, were analyzed using the Dialogical Investigations of Happenings of Change, a method developed with an aim to capture the dialogical qualities of multiactor conversations. The analysis illustrated shifts in the dialogical characteristics of the conversation through the sessions and associated shifts in the clients’ positioning, toward increased agency, as well as enrichment of the narratives regarding their difficulties. The gradual development toward more dialogical conversations, evidenced mainly in increased sharing of dominance and therapist responsiveness and participation, seemed to facilitate the joint construction of new words and meanings, the expression of strong feelings, the narration of difficult experiences, and increased agency. The findings support the view that a client's sense of agency, which can be particularly impoverished in psychosis, can be reconstructed in the context of dialogue, in which clients have a central place in telling their story.
... While the process of recovery from severe mental illness, such as eating disorders, schizophrenia, and bipolar disorder, has been explored (Borg & Davidson, 2008;Dilks, Tasker, & Wren, 2010;Pettersen et al., 2012;Veseth et al., 2011), these processes have been understudied among survivors of childhood trauma. We have only located two qualitative studies of recovery following trauma. ...
The aim of this study was to explore how female survivors of childhood trauma who have sought treatment experience ways to positive change. Little knowledge exists regarding the first-person perspective of the recovery process following childhood trauma, and getting access to this perspective might contribute to better understanding of these processes, hence offering opportunities for health promotion. All clients (31, including 3 who dropped out) from six stabilization groups for women exposed to human-inflicted traumas were invited to participate in the study. Experiences of the recovery process were not restricted to the period of receiving treatment, and all clients who volunteered were included in the study. Qualitative, in-depth interviews with 13 consenting clients were carried out shortly after completion of the group treatment. All interviews were transcribed verbatim, and a hermeneutical-phenomenological approach to analysis was applied. The analysis resulted in five interrelated, but distinct main themes: finding new ways to understand one's emotions and actions, moving from numbness toward vital contact, becoming an advocate of one's own needs, experiencing increased sense of agency, and staying with difficult feelings and choices. The themes support, yet supplement trauma theory, by underlining the relationship between emotional contact and meaning-making, while downplaying the necessity of symptom elimination in the experience of recovery. The findings also underline that the active role trauma survivors play in their processes of recovery.
... The 97 studies (reporting 87 new conceptualisations of recovery) in the original search were listed in the general paper (Leamy et al. 2011). In the updated search, 18 new studies were identified (Vogel-Scibilia et al. 2009; Romme et al. 2009; Dilks et al. 2010; Kartalova - O' Doherty & Tedstone Doherty , 2010 ; Kelly et al. 2010 ; Mansell et al. 2010 ; Mezey et al. 2010 ; Noiseux et al . 2010 ; Romano et al . ...
Aims:
Mental health policy internationally varies in its support for recovery. The aims of this study were to validate an existing conceptual framework and then characterise by country the distribution, scientific foundations and emphasis in published recovery conceptualisations.
Methods:
Update and modification of a previously published systematic review and narrative synthesis of recovery conceptualisations published in English.
Results:
A total of 7431 studies were identified and 429 full papers reviewed, from which 105 conceptualisations in 115 papers were included and quality assessed using established rating scales. Recovery conceptualisations were identified from 11 individual countries, with 95 (91%) published in English-speaking countries, primarily the USA (47%) and the UK (25%). The scientific foundation was primarily qualitative research (53%), non-systematic literature reviews (24%) and position papers (12%). The conceptual framework was validated with the 18 new papers. Across the different countries, there was a relatively similar distribution of codings for each of five key recovery processes.
Conclusions:
Recovery as currently conceptualised in English-language publications is primarily based on qualitative studies and position papers from English-speaking countries. The conceptual framework was valid, but the development of recovery conceptualisations using a broader range of research designs within other cultures and non-majority populations is a research priority.
This study sought to understand how the experience of family interventions (FI) for psychosis helped family members to develop their thinking about their attachment experiences and the attributions made about a relative, and how these discussions helped to inform their understanding about problem‐maintaining cycles, that is, the interactional way in which difficulties could be maintained. Ten individuals who had attended an FI service participated in a semi‐structured interview. The transcript analysis used interpretative phenomenological analysis. The analysis yielded four themes: a supportive therapeutic relationship and safe therapeutic space; understanding patterns of relating and identifying when family interactions become unhelpful; making sense of psychosis and developing a sense of agency. The FI was experienced as helpful in bringing about changes in the way family members construed each other and psychosis, and this influenced patterns of relating.
Practitioner points
A safe therapeutic space for both client and family can help them discuss sensitive issues, restore emotional connections and reach better understandings of psychosis.
Exploring family relational experiences, attachment and attributions can be helpful in gaining understanding of how problems in psychosis are maintained.
Family intervention can help families identify helpful versus unhelpful interactions and make positive changes.
The voice of each individual is a unique and self-defining characteristic, a way of freely expressing the essence of our very being and a basic human right protected under international law. However, for so-called psychiatric voice hearers (PVHs; The term ‘PVH’ as used in the present context, is not meant to demean or denigrate the experience but to distinguish between those who hear voices and those whose voice hearing experience is synonymous with being labelled mentally ill.) whose voice hearing experiences are synonymous with a diagnosis of mental illness this principle has added and far reaching consequences. This collaborative paper draws on and integrates the dual and respective inside out and outside in perspectives and subjectivities of a PVH and a mental health practitioner arguing that while recovery is very much in vogue if it is defined predominantly by psychiatric contexts, illness saturated environments founded on professional disciplinary power, it misses the point. Rather recovery is considered as an essentially contested concept which must be self-defined and self-directed by the ideographic narratives of those who own and are living with the experience. In what has become an increasingly risk adverse culture of the care management system, the mental health social worker as a transitional participant is strategically placed to bridge and integrate the disparate but interrelated internal and external worlds of the psychiatric client living in the community. Managing and validating the totality of their experience to establish a radical, collaborative and life sustaining relationship which promotes real and meaningful recovery.
Qualitative studies have played an important role in elucidating the lived experience of psychosis and there has recently been an increase in the number of such studies. There is now an urgent need to draw together the findings of these studies. This paper performed a meta-synthesis of inductive qualitative peer-reviewed research into psychosis. Ninety-seven articles were identified for systematic appraisal. Four themes, “Losing,” “Identifying a need for, and seeking, help,” “Rebuilding and reforging,” and “Better than new: gifts from psychosis,” were identified. Central to the first and third themes were the loss and regaining of basic human needs such as sleep, physical and financial security, relationships with friends and family, self-esteem, and hope. The important implications of the four themes for clinical practice, and for future research are examined, and it is demonstrated how the experience of psychosis is much more than simply just hallucinations and/or delusions.
Objectives. The aim of this study is to explore the meaning and significance of family interventions (FI) for the individual who experiences psychosis, and its significance for recovery.
Design. A qualitative in-depth interview design was used to explore individuals’ experience of FI and its meaning to them.
Methods. Seven individuals recovering from psychosis attending integrated FI sessions were interviewed using a semi-structured interview schedule developed with service user input. Interviews were recorded, transcribed verbatim, and explored using Interpretative Phenomenological Analysis.
Results. Three central themes highlighted the participants’ experience: (1) They welcomed the shared experience with their families and felt contained and valued by the therapists; (2) They felt the sessions contributed to changed patterns of relating within the family and the creation of new meaning through the validation of multiple perspectives; and (3) They described how the family sessions supported a new positioning in the world, a sense of their own empowerment and personal responsibility, greater self-acceptance, an increased ability to manage emotions, and hope for the future.
Conclusions. Conditions in the family sessions provided an environment for changes in patterns of relating, personal meaning, and emotions to take place. Recovery, for these individuals, appeared to be about repositioning themselves in the world. The shared experience of sessions and the recognition of multiple perspectives within a containing environment may be related to recovery via the development of new perspectives and a more robust sense of self. This has clinical implications for the focus of FI sessions.
Background:
Recent conceptualisations of recovery from psychosis have recognised the importance of psychosocial aspects as well as the presence or absence of symptoms. Qualitative research and personal accounts of recovery highlight its subjective and idiosyncratic nature. This study aims to explore subjective judgements of recovery from the perspective of service users, and examine the agreement and consistency in such judgements across different measures of recovery. It also aims to investigate the relationships between subjective judgements of recovery and psychosocial factors.
Methods:
A total of 122 participants with experience of psychosis completed three self-report measures of recovery judgements, as well as measures of psychological functioning (including self-esteem, optimism, anxiety and depression) and socio-demographic measures.
Results:
Judgements about recovery from psychosis across the three measures, while showing a trend, also show within-person variability. Recovery judgements were significantly correlated with each other and with all psychological variables, but were not associated with socio-demographic variables except for age. Regression analyses showed that recovery judgements were predicted by mood, optimism and self-esteem.
Conclusions:
Subjective judgements of recovery were seen to be idiosyncratic, with people appearing to have different thresholds for perceived recovery. The conclusions of the existing qualitative research and first-person accounts appear generalisable to larger samples.
Sir: David Whitwell ( Psychiatric Bulletin , October 1999, 23 , 621-622) argues that ‘recovery’ is a myth, promulgated by over-optimistic therapists of all persuasions. If ‘recovery’ means getting back to exactly how you were before (as he argues), then no doubt he is right, at least for
This paper reports on a systematic study of the beam quality of solid-state dye lasers for different resonator designs. The resonators investigated include: multimode stable, hard-edge unstable, and unstable with a graded-reflectivity mirror (GRM) output coupler. The purpose of the work was to investigate the conditions under which good beam quality can be achieved, and to examine the possible trade-off between beam quality and energy extraction efficiency. Beam quality was quantified through conventional M-2 measurements. A hard-edge unstable resonator of magnification congruent to 2.5 produced a beam of M-2 congruent to 11 - 12 at a PRF of 2 Hz and a pump flux of 5 MW/cm(2). The value increased to congruent to 18 - 19 at a pump flux of 20 MW/cm(2). This can be compared with an M-2 of congruent to 140 - 150 with the multimode stable resonator. preliminary measurements with the GRM resulted in M-2 values of congruent to 5 to 6 at 5 MW/cm(2).
Signs (e.g., words, gestures, tokens, pictures) point to something besides themselves and are observable. Using signs, events can reproduce themselves (in part) across time and space. Signs change meaning each time they are used, but they also accumulate meanings from each use. Voices are active subdivisions (or collectivities) of people, internalized agents representing people, and events formed from traces of previous experience. People can Ire understood as communities of voices. Most theoretical approaches to psychotherapy recognize some forms of multivoicedness. Multiple voices may represent depth of resources and flexibility or fragmentation and dissociation, depending on the strength of the meaning bridges between the voices, which are constructed of signs. This article reviews research findings and problems that led me to my interest in signs and voices, and gives psychotherapy case examples of sign-mediated assimilation of problematic voices into the client's community of voices.
Bakhtin's (1973) polyphonic novel serves as a metaphor for a dialogical conception of the self. In line with this metaphor, it is argued that a narrative approach leads to a multivoiced conception of the self, in which the poles of a personal construct are related as opposing characters positioned in an imaginal space. In this space, the I fluctuates among positions in a dialogical fashion. Two main features of the relation between positions are discussed: intersubjective communication and dominance. These features form the basis of a theory and methodology that have led to the discovery of a particular phenomenon: dominance reversal. This phenomenon represents a radical change in the dominance relation of contrasting positions within a limited time period, in an apparent absence of causal factors. The implications of this phenomenon for the organization and reorganization of the self are discussed.
According to social constructionism factuality, the establishment
of accounts as corresponding to an objective external reality,
is an interactional accomplishment ordinarily achieved in everyday
conversations. In cases of disagreement regarding the interpretation
and nature of events, however, not only the plausibility of the
account, but also the rationality, integrity, and accountability of
the participants is at stake. Delusions present extreme cases of
such disagreement. This paper analyzes extracts from an interview with
an individual diagnosed as delusional focusing on the factualization
devices used in the negotiation of accounts. The question of whether
the observation of conversational rules documented in the interview
is sufficient to establish the plausibility of an account and the
rationality of its teller leads to arguments around the necessity of
shifting the focus from the grounded micro-analysis of talk to wider
social and institutional processes.
Asks the questions: How do personal narratives disintegrate in schizophrenia, and how should narrative issues in schizophrenia be addressed in individual psychotherapy? To examine these issues, this article presents a case analysis of 19 Ss suggesting that narratives in schizophrenia are compromised when internal dialogue either dissolves into cacophonous disarray or becomes too singularly and rigidly organized. It is suggested, therefore, that one way psychotherapy may be useful to persons with schizophrenia is to facilitate the reemergence of internal dialogue through external dialogue. In particular, psychotherapy can assist persons with schizophrenia to develop a narrative that allows for recovery by creating a context for increasing self-awareness and agency. The authors propose that, in the midst of the ongoing development of numerous psychosocial treatments for schizophrenia, the ability to facilitate narrative coherence may represent a unique psychotherapeutic contribution to recovery for persons with this condition. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In an era of evidence-based practice, outcome measurement is crucial. The nature of what getting better means to service users and staff and hence what outcomes might be measured is considered. A descriptive study is reported about users' ( n = 20) and staff's ( n = 10) constructions of what getting better means to them. The results show that both staff and users have quite complex multi-faceted notions of getting better. It was construed as involving not only improved mental state, but also improved well-being and relationships, empowerment, confidence and self worth, greater engagement in work and activities, being able to cope with every day life, having access to help and support, improved material well-being and improved physical health. Staff rated activities of daily living and access to help and support as more important than did users. Users rated improved material and physical well-being as more important than did staff. The results are considered in the context of a recovery paradigm. The need to incorporate such broad notions of 'getting better' in care planning, service provision and outcome measurement is discussed.
In this commentary, I highlight some of the difficulties encountered by those working within a modernist paradigm (eg Bayne & Pacherie and Klee) and go on to argue that this paradigm is ill-equipped to conceptualise issues which are essentially moral. Georgaca's suggestion that there is a need for researchers to focus more on the contexts which give rise to judgements of delusions and the assumptions which appear to underlie those judgements is a useful one and there is a need for researchers and clinicians alike to learn from the paradigm shift that is taking place in relation to the phenomenon of hearing voices. I suggest that we need to be open to service users’ own theories of the meaning of their beliefs and see our goal as helping them find better ways of living with them. Published (author's copy) Peer Reviewed
When an architect examines a Gothic structure by Grecian rules, he finds nothing but deformity (Richard Hurd, 1762)
The term reflective function (RF) refers to the psychological processes underlying the capacity to mentalize, a concept which has been described in both the psychoanalytic (Fonagy, 1989; 1991) and cognitive psychology literatures (e.g. Morton & Frith, 1995). Reflective functioning or mentalization is the active expression of this psychological capacity intimately related to the representation of the self (Fonagy & Target, 1995; 996; Target & Fonagy, 1996). RF involves both a self-reflective and an interpersonal component that ideally provides the individual with a well-developed capacity to distinguish inner from outer reality, pretend from ‘real’ modes of functioning, intra-personal mental and emotional processes from interpersonal communications. Because of the inherently interpersonal origins to how the reflective capacity develops and expresses itself, this manual refers to reflective functioning, and no longer of reflective-self functioning (see Fonagy, Steele, Moran, Steele, & Higgitt, 1991a), as the latter term is too easily reduced to self-reflection which is only part of what is intended by the concept.
I refer to and use as scholarly inspiration CHARMAZ's excellent article on constructivist grounded theory as a tool of getting to the fundamental issues on why grounded theory is not constructivist. I show that constructivist data, if it exists at all, is a very very small part of the data that grounded theory uses.
Personal narratives are the stories people tell to themselves and others to place daily experiences in context and make meaning of them. They connect past to future, bringing together remembered and felt experience, lending coherence and structure to the foundations of identity. In schizophrenia, however, personal narratives often appear to have lost their synthetic power. Phenomenologically speaking, how do personal narratives disintegrate in schizophrenia, and how should narrative issues in schizophrenia be addressed in individual psychotherapy? To examine these issues, this article presents a case analysis suggesting that narratives in schizophrenia are compromised when internal dialogue either dissolves into a cacophonous disarray or becomes too singularly and rigidly organized. We suggest, therefore, that one way psychotherapy may be useful to persons with schizophrenia is to facilitate the reemergence of internal dialogue through external dialogue. In particular, psychotherapy can assist persons with schizophrenia to develop a narrative that allows for recovery by creating a context for increasing self-awareness, and agency. We propose that, in the midst of the ongoing development of numerous and effective psychosocial treatments for schizophrenia, the ability to facilitate narrative coherence may represent a unique psychotherapeutic contribution to recovery for persons with this condition.
Schizophrenia is widely considered the most severe and disabling of the mental illnesses. Yet recent research has demonstrated that many people afflicted with the disorder are able to recover to a significant degree. Living Outside Mental Illness demonstrates the importance of listening to what people diagnosed with schizophrenia themselves have to say about their struggle, and shows the dramatic effect this approach can have on clinical practice and social policy. It presents an in-depth investigation, based on a phenomenological perspective, of experiences of illness and recovery as illuminated by compelling first-person descriptions. This volume forcefully makes the case for the utility of qualitative methods in improving our understanding of the reasons for the success or failure of mental health services. The research has important clinical and policy implications, and will be of key interest to those in psychology and the helping professions as well as to people in recovery and their families.
About 60 autobiographical books and articles written by schizophrenics during or after their psychotic episodes were examined for descriptions of changes in the patients' perceptual and cognitive experiences. Frequently reported perceptual changes included both enhanced and muted sensory awareness and numerous specific auditory and visual disturbances. Often mentioned cognitive experiences included attentional deficits, both racing and retarded thinking, increased associations between ideas, mental exhaustion, lack of recognition of familiar words, people, and objects, memory deficits, thought blocking, disturbances in language production and comprehension, mistaking identities, and distorted sense of time.
The article includes many descriptive quotations that provide rich glimpses into the inner world of the schizophrenic. It presents an argument for the continued, systematic exploration of patients' subjective experiences.
There is nearly universal acceptance that persons with schizo-phrenia often experience a profound disruption in their basic sense of self. But what does this disruption in sense of self reflect? Is this the result of an internal catastrophe? If so, where and in what manner did this catastrophe occur? To address these issues this paper will review various perspectives on disruptions of self-experience in schizophrenia as well as literature regarding how sense of self among people in general normally develops out of dialogues both within the individual and between the self and others. Following this we will theorize that the subjective experience of personal incoherence in schizophrenia may reflect a collapse of the ability to maintain ongoing dialogue within the self, specifically arguing that as internal dialogues evaporate, self-experience and personal narrative can devolve into one of three forms: (a) a barren and empty self-organization; (b) internal cacophony; or (c) self constructions dominated by rigid, non-evolving monologues. Lastly, implications for treatment and recovery will be discussed, including the potential usefulness of a focus on interventions that might revitalize clients' internal and external dialogue.
The article that follows is part of the Schizophrenia Bulletin's ongoing First Person Account series. We hope that mental health professionals—the Bulletin's primary audience—will take this opportunity to learn about the issues and difficulties confronted by consumers of mental
health care. In addition, we hope that these accounts will give patients and families a better sense of not being alone in
confronting the problems that can be anticipated by persons with serious emotional difficulties. We welcome other contributions
from patients, ex-patients, or family members. Our major editorial requirement is that such contributions be clearly written
and organized, and that a novel or unique aspect of schizophrenia be described, with special emphasis on points that will
be important for professionals. Clinicians who see articulate patients with experiences they believe should be shared might
encourage these patients to submit their articles to Schizophrenia Bulletin, First Person Accounts, EEI Communications, 66 Canal Center Plaza, Suite 200, Alexandria, VA 22314.—The Editors.
A developmentally oriented commentary on the writer's own 1979 psychotic crisis is presented. In the writer's own case psychosis eventually encroached after real persecution, severe life stress and enhanced arousal and was prompted by an ascription of high distinctiveness to self and a low distinctiveness to others. The impact of coincidences generated and confirmed an interpretation of an externallocus of control. Abnormality (‘illness’) was reflected in a massive escalation of confirmation blas. It is argued that psychosis has its own intrinsic motivation; that life events must be understood in a developmental context; that cognitive factors, often critical, can sometimes be tied to emotional determinants and that gross damage to the self concept, with consequences for spiritual life, plays a causal role in psychosis. A genetic fragility, which biases ongoing emotional and cognitive life, is nonetheless strongly indicated.
This paper examines patients' experiences of psychosis and of the mental health community's rehabilitative efforts with them in such a way as to integrate 'insider' perspectives with those of professional clinical investigators. Hints and advice are given concerning the treatment of recovering psychotics in a broad spectrum presentation which ranges from spiritual and social issues to the study of psycho-dynamic and cognitive processes underpinning serious mental illness. Patients' experiences of spiritual crises, of the mental illness subculture, of re-accommodation and their personal, emotional and sexual lives, often at the bedrock of their illnesses, are given particular prominence. It is argued that an integration of qualitative and quantitative approaches at a single case level; a recognition of the facilitative effects of idiosyncratic events and the adoption of a 'person' orientated rather than 'symptom' orientated recovery programme would be beneficial for these patients. The paper is predicated on a bio-psycho-social-spiritual model of psychosis.
John Shotter argues that it is not in the writings of philosophers, sociologists, or other 'theorists' that we discover our 'ways of knowing.' He asserts that knowledge is founded in, and relevant to, the everyday civil life of ordinary people in society. In conversations and in practical knowledge people create the basic reality in which social institutions have their life. Shotter connects such 'theoretical' topics as 'realism' and 'foundations' to social concerns such as rights, citizenship, and access to public debate. He is concerned with human culture in the widest sense, with ideas of personal relationships, civil society, social ecology, identity, and belonging. "Cultural Politics of Everyday Life" is an important contribution to debates in social and cultural theory. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
give an overview of the origins, purposes, uses, and contributions of grounded theory methodology / grounded theory is a general methodology for developing theory that is grounded in data systematically gathered and analyzed (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The originators of the grounded theory approach to qualitative research now disagree on certain procedural aspects of the methodology, while agreeing on others, and dispute its epistemological implications. In this article it is argued that the rift can be traced to a conflict over the logic of justification of the approach. Strauss and Corbin endorse Dewey's instrumentalism, including its prizing of the experimental method, and introduce a form of hypothetico-deductivism into the grounded theory method. Alternatively, although subscribing tacitly to the experimental method, Glaser does not tie it in with instrumentalism, and insists that grounded theory properly involves only the inductive phase of inquiry. It is argued that both instrumentalism and induction are inadequate as rationales for the grounded theory method. A new logic of justification, termed methodological hermeneutics and derived from Margolis's reconciliation of realism and relativism, has been developed by the author. When applied to the two positions, it leads to the conclusion that Glaser's procedures are the most consistent with the objectives of the method. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Major trials of cognitive-behavioural therapy, personal therapy and family interventions were published this year. Their findings have major significance for clinical services and should be widely digested. Key studies and conceptual frameworks underpinning the early intervention paradigm have also appeared. Naturalistic investigations of psychosis in second generation immigrants to the UK and in the population of origin provided overwhelming evidence that sociocultural influences in the context of low genetic risk provide a significant pathway to psychotic illness, which may be reflected in the content of psychotic symptoms.
A cognitive approach to the understanding of psychotic symptoms that focuses on the interpretation of intrusions into awareness is outlined. It is argued that many positive psychotic symptoms (such as hallucinations and delusions) can be conceptualized as intru-sions into awareness or culturally unacceptable interpretations of such intrusions, and that it is the interpretation of these intrusions that causes the associated distress and disability. It is also argued that the nature of these interpretations is affected by faulty self and social knowledge and that both the intrusions and their interpretations are maintained by mood, physiology, and cognitive and behavioural responses (including selective attention, safety behaviours and counterproductive control strategies). The literature is reviewed and found to be compatible with such a model and the clinical implications are discussed.
Unlike other disciplines in the human sciences, psychology has undervalued the role of qualitative research methods in scientific inquiry. This has done a disservice to psychology, depriving its practitioners of skills which can simultaneously liberate and discipline the theoretical imagination. ‘Grounded theory’ is one useful approach to the systematic generation of theory from qualitative data, and alternative criteria can be advanced for judging the adequacy of research where qualitative methods have been used. An advantage of qualitative research is that theory is generated which is contextually sensitive, persuasive, and relevant.
We present a set of evolving guidelines for reviewing qualitative research, to serve four functions: to contribute to the process of legitimizing qualitative research; to ensure more appropriate and valid scientific reviews of qualitative manuscripts, theses, and dissertations; to encourage better quality control in qualitative research through better self- and other-monitoring; and to encourage further developments in approach and method. Building on a review of existing principles of good practice in qualitative research, we used an iterative process of revision and feedback from colleagues who engage in qualitative research, resulting in a set of seven guidelines common to both qualitative and quantitative research and seven guidelines especially pertinent to qualitative investigations in psychology and related social sciences. The Evolving Guidelines are subject to continuing revision and should not be used in a rigid manner, in order to avoid stifling creativity in this rapidly evolving, rich research tradition.
Soviet psychologists' views of the relationship between psychology and Pavlovian psychophysiology (or the study of higher nervous activity, as it is referred to in the Soviet literature) has long been a matter of curiosity and concern in the United States. Not accidentally, it has also been a matter of concern and dispute within the USSR. The following is an excerpt from a work by one of the Soviet Union's most seminal psychological theorists on this issue. Written in the late 1920s, this essay remains a classic statement of Soviet psychology's commitment to both a historical, materialistic science of the mind and the study of the unique characteristics of human psychological processes.
Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, "Generation Theory by Comparative Analysis," the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data," the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, "Implications of Grounded Theory," Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.