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'In the Same Boat, Helping Each Other': a Grounded Theory of Growth and Emancipation in Peer-Led Hearing Voices Groups

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'In the Same Boat, Helping Each Other': a Grounded Theory of Growth and Emancipation in Peer-Led Hearing Voices Groups Middlesex University Research Repository An open access repository of Middlesex University research http://eprints.mdx.ac.uk Langley, Elvis (2020) ‘In the same boat, helping each other’: a grounded theory of growth and emancipation in peer-led hearing voices groups. DCPsych thesis, Middlesex University / Metanoia Institute. [Thesis] Final accepted version (with author’s formatting) This version is available at: https://eprints.mdx.ac.uk/30758/ 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 ‘In the Same Boat, Helping Each Other’: a Grounded Theory of Growth and Emancipation in Peer-Led Hearing Voices Groups __________________________________ Elvis Langley Middlesex University and Metanoia Institute Doctor of Counselling Psychology and Psychotherapy by Professional Studies 2019 This research is dedicated to my co-researchers and everyone else who hears voices and acts as a lifeline for others. Also many thanks to Rossana, for her helpful discussions and interest, my loving wife Antigony, my family, my colleagues, and everyone else who helped along the way. I have appreciated your emotional and practical support, so vital to this research. Abstract In this project, I present a grounded theory of how peer-led Hearing Voices Network Groups (HVNGs) impact people who attend them. By conducting intensive interviews and attending groups as an observer, I developed a theory of the outcomes and processes of change that people experience in peer-led HVNGs. I used member- checking (Charmaz, 2014) to make sure my analysis was consistent with the experience of people who took part. Through this considered and thorough process of conversation and collaboration with people who hear voices, I have developed a theory grounded in the knowledge and insight of people’s lived-experience of HVNGs. HVNGs provide support that is fundamental to the well-being of people who attend them. Therefore research in this area has the potential to impact people’s lives by contributing not only to the growing evidence base regarding the benefit of HVNGs, but also by understanding how this benefit is achieved. Based on my analysis, I have theorised that the impact of hearing voices groups includes fundamental shifts in i) how voices and the voice-hearing experience are understood, ii) the sense of agency in their lives, and iii) an enhanced sense of valuing oneself and others, developed through sharing mutual support (the experience of ‘being in the same boat, helping each other’). In order to understand the impact of hearing voices groups, I also consider the voice- hearing experience (Blackman, 2001) as a whole. Based on my data, I conceptualise this as a holistic experience that includes perceptual/sensory, social and meaning- making/agentic factors. I consider the stigma, loss of agency and confusion of meaning that can attend negative voice-hearing experiences in relation to trauma research, as well as other approaches. The contribution of this research to the field of counselling psychology and psychological therapies is the creation of a theory of what voice-hearers value and experience in peer-led HVNGs. This research represents the first attempt at a full theory construction of this topic using an accepted methodology. Theory creation in this area is important for a number of reasons. Firstly, since hearing voices groups represent an increasingly popular approach both within NHS Trusts and other settings, it is increasingly necessary to understand the processes and mechanisms of change in these groups. Secondly, without basing theory construction on the actual experiences of people who hear voices, research in this area is susceptible to misinterpretation and misunderstanding. Finally, insight into the experience of hearing voices and how peer-led hearing voices groups address this experience can inform work in the wider field of hearing-voices research. Contents 1. Introduction 1 1.1 Overview 1 1.2 Introduction to Hearing Voices Groups 1 1.3 Background to my interest in Hearing Voice Groups 1 1.4 Reflections on my Relationship to the ‘Hearing Voices’ approach 3 1.5. The focus of my research 5 2. Literature Review 6 2.1. Outline 6 2.2. Historical perspectives 6 2.3. The Hearing Voices Movement 7 2.4 Theories about Hearing Voices 10 2.4.1 Biopsychosocial models 10 2.4.2 Cognitive theories 11 2.4.3. Trauma and dissociation 12 2.4.4 Group process and interpersonal neurobiology 13 2.5 Hearing Voices Group research 14 2.5.1 Different definitions of what a ‘Hearing Voices Group’ is 14 2.5.2 Outcomes studied by Hearing Voices Groups 15 2.5.3 Hearing Voices Network Groups 17 2.5.4 Methodological issues 19 2.6 Why conduct research in this area? 19 3. Methodology 21 3.1 Aims of the research 21 3.2 Research Methods 21 3.2.1 Grounded Theory 21 3.2.2 Deciding on a research method 22 3.3 Philosophical Approach 24 3.3.1 Ontology 24 3.3.2. Epistemology and Values 25 3.3.3 Implications 26 3.4 Situating myself in the research 26 3.4.1 My professional stance 26 3.4.2 Reflexive exploration 27 3.5 Conducting the literature review 29 3.6 Data collection 29 3.6.1 Participants (co-researchers) 29 3.6.2. Data collection methods 32 3.7 Data analysis 34 3.7.1 Transcribing 34 3.7.2 Initial coding 34 3.7.3 Focussed coding 35 3.7.4 Developing my research title 35 3.7.5 Theory construction and member checking 36 3.8 Assessing quality in data analysis and theory construction 36 3.9 Ethical Considerations 39 3.9.1 Design 39 3.9.2 Recruitment and Data collection 39 3.9.3 Anonymity and presenting verbatim data 40 3.9.4 Ending with groups 40 4. Findings 41 4.1 Overview of this section 41 4.2 Personal reflections on the process of developing a grounded theory 41 4.2.1 Reflexivity in regards to ‘data’ 41 4.2.2 Attending to ground and context 42 4.3 Overview of findings 42 4.3.1 Summary of categories and properties 43 4.4 Category 1: Hearing voices 48 4.4.1 Perceptual factors 49 4.4.2 Meaning-making and agentic factors 54 4.4.3. Social factors 60 4.4.4 Summary of category 1 findings 64 4.5 Category 2: Understanding voices differently 65 4.5.1 Contextualising 66 4.5.2 Normalising 68 4.5.3 Making Links 69 4.6. Category 3: Reclaiming agency 71 4.6.1 Sharing coping strategies 72 4.6.2 Changing your relationship with voices 73 4.6.3 Making your own choices 75 4.7. Category 4: Valuing yourself and others 77 4.7.1 Sharing mutual support 78 4.7.2 Having a consistent source of support 80 4.7.3 Having open discussions 82 4.7.4 Feeling solidarity through sharing similar experiences 84 4.7.5 Building hope 85 4.8. Interactions between categories 87 4.8.1 Links between change mechanisms and outcomes of peer-led HVNGs 88 4.8.2 The impact of peer-led HVNGs on hearing voices 90 4.9 Closing remarks 92 5. Discussion 5.1 Overview of this section 93 5.2 Personal reflections on the research process 93 5.2.1 My role as a researcher 94 5.2.2 Research methodology and scope 96 5.2.3 Etiological paradigm 97 5.2.5 My role as a counselling psychologist and psychotherapist 98 5.2.4. The role of existing theoretical perspectives 98 5.3 Contribution to the field 99 5.4 Category one: Hearing voices 100 5.4.1 Hearing voices: a holistic and meaningful experience 100 5.4.2 Negative voice-hearing experiences and trauma 101 5.4.3 Summary 104 5.5 The impact of peer-led HVNGs 104 5.5.1 Understanding voices differently 104 5.5.2 Reclaiming agency 111 5.5.3 Valuing yourself and others 118 5.5.4 Summary 124 5.6 Strengths, limitations and future research 125 5.6.1 Strengths 125 5.6.2. Limitations 126 5.6.3 Further research 128 5.7 Summary of Discussion 129 6. Conclusions 130 7. References 131 Appendices Appendix 1: Information sheet and consent forms 155 Appendix 2: Intensive interview sheet 164 Appendix 3: Ethics approval letter 165 Appendix 4: Example of initial coding - Group session one 166 Appendix 5: Example of Incident Coding that led to ‘Having Open Discussions’ 204 (Excerpts from Paul’s Interview) Appendix 6: Example of focussed coding (Betty’s Interview) – grouped data 206 Appendix 7: Selected tables and diagrams 211 Diagrams Diagram 1: Hearing voices 49 Diagram 2: Understanding voices differently 65 Diagram 3: Reclaiming agency 72 Diagram 4: Valuing yourself and others 78 Diagram 5: Growth and emancipatory processes in peer-led HVNGs 88 Diagram 6: Impact of peer-led HVNGs on hearing voices 91 Diagram 7: Reflexive issues relating to research 94 Tables Table 1: Co-researcher interviewees 30 Table 2: Group observations 33 Table 3: The impact of peer-led hearing voices network groups 44 Table 4: Hearing Voices 49 1.
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