City Research Online City, University of London Institutional Repository Citation: Wachowska, Anna (2017). In the facets of powerlessness: agency as an essential aspect of the self. (Unpublished Doctoral thesis, City, University of London) This is the accepted version of the paper. This version of the publication may differ from the final published version. Permanent repository link: https://openaccess.city.ac.uk/id/eprint/16924/ Link to published version: Copyright: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. Reuse: Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. 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City Research Online: http://openaccess.city.ac.uk/ [email protected] In the Facets of Powerlessness: Agency as an Essential Aspect of the Self Anna Wachowska Portfolio for Professional Doctorate in Counselling Psychology (DPsych) City University London Department of Psychology February 2017 1 Table of Contents Acknowledgements .......................................................................................................... 7 City University Declaration ............................................................................................... 8 List of Appendices: ........................................................................................................... 9 List of Figures: ................................................................................................................ 10 SECTION A: PREFACE ...................................................................................................... 11 1. Overview .................................................................................................................... 11 2. Thematic Connection of the Portfolio: The Issue of Powerlessness ............................. 11 2.1 Research Thesis ........................................................................................................ 12 2.2 Professional Practice – Case Study ............................................................................ 13 2.3 Publishable Paper: Theoretical Article with Implications for Clinical Practice ............. 13 3. Personal Journey ........................................................................................................ 14 References ..................................................................................................................... 16 SECTION B: Doctoral Research ........................................................................................ 19 Abstract ......................................................................................................................... 20 Chapter 1: Introduction and Literature Review ............................................................... 21 1.1 Overview .................................................................................................................. 21 1.2 Rationale for the Present Study ................................................................................ 21 1.3 Study Aims and Relevance to Counselling Psychology ............................................... 24 1.4 Literature Review ..................................................................................................... 26 1.4.1 Involuntary Hospitalisation: Ethical and Moral Concerns ........................................ 26 1.4.2 The Issue of Trust................................................................................................... 29 1.4.3 Psychosis, Insight and Treatment ........................................................................... 31 1.4.4 Retrospective Views on Involuntary Treatment ...................................................... 33 1.4.5 Psychiatry and Biomedical Model .......................................................................... 34 1.4.6 The Traumagenic Neurodevelopmental Model ...................................................... 39 1.4.8 Psychodynamic Perspectives .................................................................................. 40 1.4.9 Cognitive Model..................................................................................................... 41 1.4.10 Intervention and Treatment ................................................................................. 42 1.4.11 Phenomenological Understandings and Views of Self-experience in Psychosis ........................................................................................................................ 43 2 1.4.12 Patient Experience of Psychosis ........................................................................... 44 1.4.13 Patient Experience of Involuntary Hospitalisation ................................................ 45 1.4.14 Impact of Involuntary Hospitalisation: Status and Identity ................................... 49 1.4.15 In-patient Ward: Safety and Risk .......................................................................... 50 1.4.16 Conclusive Remarks ............................................................................................. 51 Chapter 2: Methodology................................................................................................. 53 2.1 Overview .................................................................................................................. 53 2.2 Design and Research Approach ................................................................................. 53 2.3 Ontological and Epistemological Stance .................................................................... 53 2.3.1 Ontology ................................................................................................................ 54 2.3.2 Epistemology ......................................................................................................... 54 2.4 Theoretical Perspectives ........................................................................................... 55 2.5 Interpretative Phenomenological Analysis (IPA) ........................................................ 56 2.5.1 Rationale for IPA Methodology .............................................................................. 57 2.6 Ethical Considerations .............................................................................................. 59 2.6.1 Approval ................................................................................................................ 59 2.6.2 Confidentiality ....................................................................................................... 59 2.6.3 Consent and Withdrawal ....................................................................................... 60 2.6.4 Distress Management ............................................................................................ 60 2.7 Procedures ............................................................................................................... 61 2.7.1 Sampling Considerations ........................................................................................ 61 2.7.2 Recruitment ........................................................................................................... 62 2.7.3 Participants............................................................................................................ 63 2.7.4 Research materials ................................................................................................ 65 2.7.5 Interview Proceedings ........................................................................................... 65 2.7.6 Data Collection ...................................................................................................... 66 2.7.7 Pilot Study ............................................................................................................. 67 2.7.8 Transcription ......................................................................................................... 67 2.7.9 Data Analysis and Interpretation ............................................................................ 67 2.7.10 Results ................................................................................................................. 69 2.7.11 Discussion ............................................................................................................ 69 2.7.12 Resources ............................................................................................................ 69 2.8 Trustworthiness, Rigor and Quality ........................................................................... 70 2.9 Personal Reflexivity................................................................................................... 71 3 2.9.1 Ontological and Epistemological Awareness........................................................... 75 CHAPTER 3: RESULTS ......................................................................................................... 77 3.1 Overview .................................................................................................................. 77 3.2 Superordinate Theme One: A Struggle for Recognition ............................................