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Conceptualizing the therapist's role in therapy in psychosis

Authors


Abstract

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.

Practitioner Points

  • • There is conceptual convergence in the field regarding the importance in psychological therapy in psychosis of the therapist both assisting the person experiencing psychosis to keep emotional intensity to a manageable level and assisting them in opening up new ways of thinking about their experiences.
  • • The therapist's strategic activities in working to maintain an observational perspective on both the process and content of therapy appears to support a collaborative endeavour with the client of building bridges to new perspectives on distress and psychosis. However, the apparent assumption of responsibility by the therapist for maintaining what appears to be a dialogical (i.e., joint) process underlines the importance of the therapist's efforts to maintain an observational standpoint relative to their own activities and views.
  • • The study emphasizes the therapist's use of theoretical/therapeutic models as observational tools supporting their active and strategic efforts to maintain an observational perspective during therapy in psychosis, rather than regarding those theories as representing fixed or final views of the client's situation.

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