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Factors That Help Or Hinder Personal Recovery in People with a Schizophrenia Diagnosis: a Different Sort Of'therapeutic'relationship

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Factors That Help Or Hinder Personal Recovery in People with a Schizophrenia Diagnosis: a Different Sort Of'therapeutic'relationship Middlesex University Research Repository An open access repository of Middlesex University research http://eprints.mdx.ac.uk Cameron, David (2017) Factors that help or hinder personal recovery in people with a schizophrenia diagnosis: a different sort of ’therapeutic’ relationship. Other thesis, Middlesex University. [Thesis] Final accepted version (with author’s formatting) This version is available at: https://eprints.mdx.ac.uk/22273/ Copyright: Middlesex University Research Repository makes the University’s research available electronically. Copyright and moral rights to this work are retained by the author and/or other copyright owners unless otherwise stated. The work is supplied on the understanding that any use for commercial gain is strictly forbidden. A copy may be downloaded for personal, non-commercial, research or study without prior permission and without charge. Works, including theses and research projects, may not be reproduced in any format or medium, or extensive quotations taken from them, or their content changed in any way, without first obtaining permission in writing from the copyright holder(s). They may not be sold or exploited commercially in any format or medium without the prior written permission of the copyright holder(s). Full bibliographic details must be given when referring to, or quoting from full items including the author’s name, the title of the work, publication details where relevant (place, publisher, date), pag- ination, and for theses or dissertations the awarding institution, the degree type awarded, and the date of the award. If you believe that any material held in the repository infringes copyright law, please contact the Repository Team at Middlesex University via the following email address: [email protected] The item will be removed from the repository while any claim is being investigated. See also repository copyright: re-use policy: http://eprints.mdx.ac.uk/policies.html#copy Middlesex University and Metanoia Institute Factors that help or hinder personal recovery in people with a schizophrenia diagnosis: a different sort of “therapeutic” relationship Dr David Cameron Doctor of Counselling Psychology and Psychotherapy by Professional Studies Date: October 2016 Words: 43187 I HEREBY CERTIFY THAT THIS MATERIAL WHICH I NOW SUBMIT FOR ASSESSMENT, ON THIS PROGRAMME OF STUDY, IS ENTIRELY MY OWN WORK AND HAS NOT BEEN TAKEN FROM THE WORK OF OTHERS, SAVE AND TO THE EXTENT THAT SUCH WORK HAS BEEN CITED, AND ACKNOWLEDGED WITHIN THE TEXT OF MY OWN WORK AND IN THE LIST OF REFERENCES. Student Signature: CONTENTS 1. Abstract 1 2. The “subject” matter and the subjects: The conundrum of schizophrenia – 2 a biological a disease of the brain or an essentially contested concept? 2.1 Collaborative inquiry 2 2.1.1 The Collaborative inquirer 2 2.1.2 Principle inquirer 3 2.1.2.1 Broadmoor Special Hospital 3 2.1.2.2 Residential therapeutic psychiatric alternatives 4 2.1.3 The subjectivity of the inquirer 7 2.2 Historical overview – cultural context 7 2.2.1 The construction of the concept of schizophrenia 8 2.2.2 Schizophrenia as an essentially contested concept 8 2.2.3 The medical model – the psychiatric signs and symptoms 9 2.2.4 A psycho-social trauma based model 13 2.2.5 The mask of psychotic diagnosis 15 2.2.6 The unheard “voice” of madness 16 2.2.7 Different subjectivities and the co-construction of meaning 16 2.2.8 Aims and objectives 17 3. The therapeutic relationship in psychotherapy and the non-relational 19 schizophrenic 3.1 The therapeutic relationship 19 3.1.1 Psychodynamic – analytically oriented perspectives 19 3.1.2 Humanistic – person centred and existential perspectives 20 3.1.3 The cognitive behavioural perspective 20 3.1.4 Contextual or pan-theoretical models 21 3.1.5 The evidence base 21 4. The Therapeutic relationship in “anti-therapeutic” psychiatric environments 24 4.1 The therapeutic relationship in psychiatry 25 4.1.1. The nurse-patient relationship 27 4.1.2 Community based psychiatric alternatives, the keyworker – 30 client relationship 4.1.3 The therapeutic relationship as therapy 33 5. Method 36 5.1 Design 36 5.1.1 Collaborative inquiry 36 5.1.2 Mixed Methods 36 5.2 Ethical approval 37 5.2.1 Ethically important moment 37 5.3 Philosophical assumptions 39 5.3.1 Paradigm method fit 39 5.3.2 The best paradigm 40 5.4 Phenomenological inquiry 40 5.4.1 Heidegger and the double hermeneutic 40 5.5 Participatory action research 41 5.5.1 The participatory attitude 41 5.5.2 Critical inquiry 42 5.5.3 Evenly suspended attention 42 5.6 Validity 43 5.6.1 Social validity 43 5.6.2 Reflexivity 44 5.6.3 Adequacy of data 44 5.6.3.1 Adequate amounts of evidence – rigour 44 5.6.3.2 Adequate variety in types of evidence 45 5.6.3.3 Interpretative status of evidence 45 5.6.3.4 Adequate disconfirming evidence discrepant cases 46 5.7 Paradigm specific validity 46 5.7.1 Constructivism 46 5.7.2 Postmodern critical inquiry 47 5.8 Ethical procedures 47 5.8.1 Ethics as process 48 5.8.2 My ethical character 49 5.9 Procedure 49 5.9.1 A priori deductive framework 49 5.9.2 Discursive dialogue between myself and Paddy 49 5.9.3 Credible exemplars 50 6. Data Analysis 56 6.1 Analytic Method 56 6.1.1 A priori coding framework 57 6.1.2 Thematic analysis 57 6.1.2.1 Discursive dialogue between myself and Paddy 57 6.1.2.2 Discourse with credible exemplars 58 6.1.2.3 Verification 59 6.1.3 Thematic networks 59 7. Findings 61 7.1 A priori deductive framework 61 7.1.1 Attitude towards “illness” 62 7.1.2 Authenticity 62 7.1.3 Inter-subjectivity 63 7.1.4 Relational ambivalence 64 7.2 Hybrid thematic analysis and global themes 65 7.3 Multiversal space 66 7.4 Global theme one context, meaning making and identity 67 7.4.1 Organising theme attributions for non-consensual experience 68 (helped) 7.4.1.1 It happened for a reason 68 7.4.1.2 Getting my own interpretation 69 7.4.2 Organising theme, language and identity (helped) 70 7.4.2.1 More than the diagnosis 70 7.4.2.2 No sort of gobbledegook 71 7.4.3 Organising theme attributions for non-consensual experience 72 (Hindered) 7.4.3.1 What was going on? 72 7.4.3.2 You’re fucking sick 73 7.4.4 Organising theme, language and identity (hindered) 74 7.4.4.1 Code words and mumbo jumbo 74 7.4.4.2 My trade was to be mad 75 7.5 Global theme two interpersonal relationships (helped) 76 7.5.1 Organising theme Humanistic 76 7.5.1.1 Just being there 76 7.5.1.2 Preaching what she spoke 76 7.5.1.3 To be listened to not to be judged 77 7.5.2 Organising theme Triadic Transitional (helped) 78 7.5.2.1 Walking the walk 78 7.5.2.2 A different sort of relationship 79 7.5.2.3 Stepping into the fire 80 7.5.3 Organising theme authoritarian dogmatic 81 7.5.4 Organising theme inflexible unilateral 83 7.5.4.1 Expected to get along with life 83 7.5.4.2 You can’t do this - you have to do that 84 7.5.4.3 Pushed onto me 85 7.6. Global theme three systems – pathological organisations 87 7.6.1 Police state 87 7.6.2 Remotely controlled 89 8. Discussion 90 8.1 Deductive coding categories 90 8.1.1. Attitude towards “illness” 90 8.1.2 Authenticity 91 8.1.3 Inter-subjectivity 91 8.1.4 Interpersonal relational ambivalence 92 8.1.5 Divergent truths 93 8.2 Thematic analysis and global themes 95 8.3 Global theme one context, meaning making and identity 95 8.3.1 Organising theme attributions for non-consensual experience 95 (Helped) 8.3.1.1 It happened for a reason 95 8.3.1.2 Getting my own interpretation 96 8.3.2 Organising theme language and identity (helped) 97 8.3.2.1 More than the diagnosis – 97 no sort of gobbledegook 8.3.3 Organising theme attributions for non-consensual experience 98 (hindered) 8.3.3.1 What was going on? – You’re fucking sick 98 8.3.4 Organising theme, language and identity (hindered) 99 8.3.4.1 My trade was to be mad – code words 99 and mumbo jumbo 8.4 Global theme two interpersonal relationships 101 8.4.1 Organising theme triadic transitional 101 8.4.1.1 Walking the walk 102 8.4.1.2 Expected to get along with life 103 8.4.1.3 A different sort of relationship 104 8.4.1.4 You can’t do this – you have to do that 105 8.4.1.5 Stepping into the fire 105 8.4.1.6 Pushed onto me 107 8.4.1.7 Humanistic 108 8.4.1.8 Authoritarian dogmatic 109 8.5 Global theme three Pathological organisations 111 8.5.1 Police State 111 8.5.2 Remotely controlled 111 8.6 Implications for practice 114 8.7 Limitations 118 8.8. Conclusion 120 9. Epilogue – personal reflections 122 10. References 129 11. Appendices 158 Appendix I Information leaflet 158 Appendix II Written Consent Form 159 Appendix IIIa Codes to themes 160 Appendix IIIb Codes to themes 163 Appendix IVa Basic to organising to global themes 166 Appendix IVb Basic to organising to global themes 168 Appendix V Table of Categories 170 Appendix VI Examples of Transcripts 198 12.
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