Abstract:The findings highlight helpful ways of working with clients when they become paranoid about their therapist, and emphasize the importance of developing a therapeutic relationship that is radically collaborative, supporting a person-based approach to distressing psychotic experience.
“…I just said what had to be said but I did not open up . I had to suss (him) out to see if he was trustworthy … checking out … how well (he) dealt with the stuff that I brought up initially . (Lawlor et al, 2015, p. 493), Clients 3, 6 and 7.…”
Section: Resultsmentioning
confidence: 98%
“…I felt I had found someone who understood me . If I said something to (my therapist) … I'd get paranoid about what would happen to the information … I spoke to him about it and (it) helped me with my trust . (Lawlor et al, 2015, p. 497), Client 7 and Client 2.…”
Section: Resultsmentioning
confidence: 99%
“…As a whole, the majority of papers reported limited user involvement, with five not reporting any (Dilks et al, 2013; Halpin et al, 2016; Hazell et al, 2017; Messari & Hallam, 2003; Waller et al, 2015) and a further five limited; one used a pilot interview, others checked themes with participants or consulted people with lived experience regarding research design (Awenat et al, 2017; Birchwood et al, 2018; Lawlor et al, 2015; McGowan et al, 2005; Tong et al, 2019). One study was user led (Kilbride et al, 2013).…”
Section: Resultsmentioning
confidence: 99%
“…One study was user led (Kilbride et al, 2013). Further recurrent issues included not reporting researcher reflexivity; four papers did not report any researcher reflexivity (Birchwood et al, 2018; Lawlor et al, 2015; Waller et al, 2015; Wood et al, 2016), and a further four reported only limited details of researcher positionality or use of supervision (Bjornestad et al, 2018; Halpin et al, 2016; McGowan et al, 2005; Slater & Painter, 2016). These omissions may be due to limited space in publishing rather than the absence of consideration.…”
Objectives
Cognitive Behavioural Therapy for Psychosis (CBTp) demonstrates variable and at times mild to moderate effect sizes; thus, its therapeutic processes are important to explore. Establishing a secure therapeutic relationship is one such key process where barriers may exist, including those related to psychotic symptoms and associated stigma. This review synthesizes the available qualitative research pertaining to the experience of the therapeutic relationship from the perspective of those experiencing psychosis.
Methods
A systematic review was undertaken using PRISMA guidelines. Search terms included variants of ‘psychosis’, ‘therapy’ and ‘qualitative’. PsycInfo, CINAHL, EmBase, MedLine and Web of Science were searched, and reference lists were hand‐scanned. Yardley's quality appraisal tool was utilized and Noblit and Hare's seven‐stage process for conducting a meta‐ethnographic review. A line‐of‐argument synthesis is presented.
Results
Fourteen papers were identified using inclusion and exclusion criteria. Twelve papers were deemed to have satisfactory quality. The line‐of‐argument synthesis used attachment theory to propose four semi‐distinct stages to establishing a therapeutic relationship: beginning; safety, hope and trust; the practicalities of therapy; and branching out. Findings suggest that the therapist's persona and use of CBTp techniques such as collaboration and shared agency over the process were important in establishing for the patient a sense of self as normal, equal and worthwhile.
Conclusions
Attachment security may be an important strand of CBTp and warrants further research and clinical investigation as a process and an outcome. Future research can benefit from increased transparency regarding researcher positionality as a potential source of bias.
“…I just said what had to be said but I did not open up . I had to suss (him) out to see if he was trustworthy … checking out … how well (he) dealt with the stuff that I brought up initially . (Lawlor et al, 2015, p. 493), Clients 3, 6 and 7.…”
Section: Resultsmentioning
confidence: 98%
“…I felt I had found someone who understood me . If I said something to (my therapist) … I'd get paranoid about what would happen to the information … I spoke to him about it and (it) helped me with my trust . (Lawlor et al, 2015, p. 497), Client 7 and Client 2.…”
Section: Resultsmentioning
confidence: 99%
“…As a whole, the majority of papers reported limited user involvement, with five not reporting any (Dilks et al, 2013; Halpin et al, 2016; Hazell et al, 2017; Messari & Hallam, 2003; Waller et al, 2015) and a further five limited; one used a pilot interview, others checked themes with participants or consulted people with lived experience regarding research design (Awenat et al, 2017; Birchwood et al, 2018; Lawlor et al, 2015; McGowan et al, 2005; Tong et al, 2019). One study was user led (Kilbride et al, 2013).…”
Section: Resultsmentioning
confidence: 99%
“…One study was user led (Kilbride et al, 2013). Further recurrent issues included not reporting researcher reflexivity; four papers did not report any researcher reflexivity (Birchwood et al, 2018; Lawlor et al, 2015; Waller et al, 2015; Wood et al, 2016), and a further four reported only limited details of researcher positionality or use of supervision (Bjornestad et al, 2018; Halpin et al, 2016; McGowan et al, 2005; Slater & Painter, 2016). These omissions may be due to limited space in publishing rather than the absence of consideration.…”
Objectives
Cognitive Behavioural Therapy for Psychosis (CBTp) demonstrates variable and at times mild to moderate effect sizes; thus, its therapeutic processes are important to explore. Establishing a secure therapeutic relationship is one such key process where barriers may exist, including those related to psychotic symptoms and associated stigma. This review synthesizes the available qualitative research pertaining to the experience of the therapeutic relationship from the perspective of those experiencing psychosis.
Methods
A systematic review was undertaken using PRISMA guidelines. Search terms included variants of ‘psychosis’, ‘therapy’ and ‘qualitative’. PsycInfo, CINAHL, EmBase, MedLine and Web of Science were searched, and reference lists were hand‐scanned. Yardley's quality appraisal tool was utilized and Noblit and Hare's seven‐stage process for conducting a meta‐ethnographic review. A line‐of‐argument synthesis is presented.
Results
Fourteen papers were identified using inclusion and exclusion criteria. Twelve papers were deemed to have satisfactory quality. The line‐of‐argument synthesis used attachment theory to propose four semi‐distinct stages to establishing a therapeutic relationship: beginning; safety, hope and trust; the practicalities of therapy; and branching out. Findings suggest that the therapist's persona and use of CBTp techniques such as collaboration and shared agency over the process were important in establishing for the patient a sense of self as normal, equal and worthwhile.
Conclusions
Attachment security may be an important strand of CBTp and warrants further research and clinical investigation as a process and an outcome. Future research can benefit from increased transparency regarding researcher positionality as a potential source of bias.
“…Pour les professionnels, la relation semble plus difficile à établir avec les personnes vivant une psychose qu'avec celles vivant un autre problème de santé mentale (McCabe & Priebe, 2003;Roche, Madigan, Lyne, Feeney, & O'Donoghue, 2014). L'altération de l'autocritique (Kvrgic, Cavelti, Beck, Rusch, & Vauth, 2013), la dangerosité (Wahl & Aroesty-Cohen, 2010) et la symptomatologie qui accompagnent souvent la psychose constituent des obstacles au développement de la relation (Davis, Eicher, & Lysaker, 2011;Jung, Wiesjahn, & Lincoln, 2013;Lawlor, Hall, & Ellett, 2015). De plus, le contexte de l'OGE oblige l'infirmière à s'assurer que la personne soignée reste confinée dans l'unité de soins et respecte un certain nombre de règles.…”
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