Beliefs about psychological therapy for psychosis

Abstract

Beliefs about psychological therapy for psychosisA thesis submitted for the Degree of Doctor of Clinical PsychologyJoanne Cater Holding, University of Manchester, 2014The thesis provides a detailed exploration of the beliefs people with experiences of psychosis have about psychological therapy. It is presented in three papers: (1) a literature review, (2) an empirical study and (3) a critical evaluation and reflection on the research process.The literature review used a narrative synthesis approach to systematically review, explore and consolidate the existing qualitative and quantitative literature available on beliefs about therapies for psychosis. Thirty-five studies were identified for inclusion. Distinct themes and subthemes were developed for two distinct types of beliefs: Expectations and Experience. Within expectations, three themes were described: outcomes, process and barriers. Within experience, four themes were described: satisfaction, outcomes, process and therapist characteristics. Subtheme descriptions were used to highlight the multi-faceted and complex beliefs services users hold about therapy. Levels of satisfaction were high and many positive outcomes were reported. However, the available data is primarily limited to those who have completed therapy, resulting in an unbalanced account available in the literature. Data about expectations has also not been adequately addressed. Key areas for clinical intervention and future research opportunities are highlighted. The empirical study attempted to build on findings from the literature review and employed Q-methodology to explore beliefs about therapy for psychosis with young people in Early Intervention Services (EIS). Four distinct belief factors were identified: (1) Therapy is helpful and gives hope for the future; (2) Therapy is just talking, people need medication; (3) Therapy is useful but stigmatising; (4) Therapy is better than medication. Positive accounts of therapy were most strongly expressed within factor 1, but all factors contained some regard for the therapeutic process. Other important views were present in these accounts as well, including both the importance and dislike of medication, as well as concerns about potential stigmatisation. Q methodology proved to be a useful tool for engaging with young people and developing a rich understanding of a complex topic. The Q study has addressed some of the limitations described in the literature review and highlighted important areas for clinical consideration. Further research is still required to address outstanding issues, such as beliefs of people who are difficult to engage and people from Black and Minority Ethnic (BME) communities. The third paper is a critical evaluation of the research process in totality. This includes reflections on decision-making processes, as well as lessons learned for the future. It provides a final overview of the clinical and research implications highlighted by the previous two papers, concluding that beliefs about therapy are important and warrant further detailed exploration by clinicians and researchers, to improve practice and service user experience.

Date of Award	31 Dec 2014
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Gillian Haddock (Supervisor) & Lynsey Gregg (Supervisor)