DOCTORAL THESIS What is the need, if any, for therapeutic education in mental health nursing? An empirical phenomenological study of mental health nurses’ responses to this question McSherry, Anthony Award date: 2018 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 23. Sep. 2021 What is the need, if any, for therapeutic education in mental health nursing? An empirical phenomenological study of mental health nurses’ responses to this question By Anthony McSherry BSc, MSc, H. Dip. (Nursing), MSc (Psychotherapy) A thesis submitted in partial fulfilment of the requirements for the degree of PhD Research Centre for Therapeutic Education Department of Psychology University of Roehampton 2018 ii Abstract This study explores how some mental health nurses are therapeutic, in terms of the art of healing, and how they have learned to be this way. The study originated in my experience of feeling abject while working as a mental health nurse. The research question addressed this situation through exploring whether or not therapeutic education was needed in mental health nursing. Ten mental health nurses participated in the study. Giorgi’s (2009) empirical phenomenological method was chosen because of its established status, and its grounding in Husserlian phenomenology which places a primacy on experience. A review of the literature included commentaries, qualitative empirical studies, case studies, and theoretical models, and indicated that mental health nurses may be therapeutic in idiosyncratic ways. A crucial aspect to these ways unfolded in this study as openness, through which the other may come to be in her own truthfulness. Significant methodological considerations were how we ‘constitute’ meaning, how meaning can ‘force itself’ like a gestalt, empathy may be self- alienating, and words ‘sedimented’ in tradition. These linked to how we can question being captivated in ‘experiences of truth’. Findings from Giorgi’s (2009) method were that mental health nurses are therapeutic through ‘being with’ others, through innate characteristics, that learning is through openness, and is facilitated through a therapeutic environment. Giorgi’s (2009) method is critiqued, and compared to a phenomenology of the therapeutic in relation to the research interviews (after Husserl and Merleau-Ponty). It was shown that the phenomenological ‘opens up’ language while method narrows meaning. The phenomenology showed that allowing an uncertain relation between two people was crucial, and how recognising the sensual aspect of meaning opened a healing space for another to be, through which a person’s own truthfulness may emerge. Openness appears to be innate, indicating one question for further study. iii iv Contents Abstract ............................................................................................................................................... iii Acknowledgements............................................................................................................................. xi 1. Introduction ................................................................................................................................. 1 1.1 Introduction ............................................................................................................ 1 1.2 The origins of the research question ..................................................................... 2 1.3 Origins of the methodology ................................................................................... 7 1.4 Definitions as ‘family likenesses’ and non-technical ......................................... 10 1.5 An overall view of mental health nursing .......................................................... 14 1.6 Summary of chapters ........................................................................................... 18 2 Theory ........................................................................................................................................ 23 2.1 Introduction .......................................................................................................... 23 2.2 The focus of the research question within the wider view of nursing ............. 28 2.3 The therapeutic as the art of healing .................................................................. 38 2.3.1 Openness to others and one’s self ............................................................................ 42 2.4 Openness to oneself and others through method............................................... 47 2.4.1 Peplau’s psychodynamic nursing model ................................................................. 48 2.4.2 Openness to the other person in distress ............................................................... 52 2.4.3 Openness to an uncertain encounter in mental health nursing ............................ 55 2.4.4 Openness to abjection in mental health nursing .................................................... 59 2.5 Openness to one’s self and others through speaking and ‘being with’ ........... 61 2.6 Implications of openness for mental health nursing ........................................ 64 2.6.1 Situated learning, intuition, emotional labour and tacit knowledge .................... 66 2.7 The therapeutic as openness to others ................................................................ 75 3 Methodology .............................................................................................................................. 79 3.1 Introduction .......................................................................................................... 79 v 3.2 Arriving at a research methodology.................................................................... 84 3.3. Descriptive and hermeneutic approaches to phenomenology ........................... 85 3.4 Philosophical background informing the research methodology ..................... 93 3.4.1 Husserl’s view of the ‘crisis’ of science................................................................... 94 3.4.2 Background to Husserl’s view of the crisis ............................................................ 94 3.4.3 Idealised ‘Ideas’ as transcendent in tension with experience.............................. 96 3.4.4 Descartes and the origins of the scientific method ............................................... 98 3.4.5 Living in descriptions ............................................................................................ 104 3.5 Husserl’s phenomenology.................................................................................. 105 3.5.1 The epoché and the reduction ............................................................................... 111 3.5.2 Constituting subjectivity and intersubjectivity, and empathy ........................... 115 3.5.3 The experience of truth – the truthfulness of experience ................................... 126 3.5.4 Intentionality and operative intentionality .......................................................... 128 3.5.5 Givenness in Husserl, and the intentional arc and gestalt as revealing sense in Merleau-Ponty ........................................................................................................................ 132 3.6 Speaking and spoken speech, and linguistic meaning as gestalt.................... 137 3.7 Sedimented horizons of experience ................................................................... 142 3.8 Plato’s Ideas and Husserl’s transcendental subjectivity as imaginary .......... 143 4 Method .................................................................................................................................... 146 4. Introduction ........................................................................................................ 146 4.2 An assumption about context in psychology .................................................... 147 4.3 An overview of Giorgi’s empirical method....................................................... 148 4.4 How Giorgi sees his method as phenomenological and descriptive ............... 154 4.5 Meaning in perspective ....................................................................................... 161 4.6 Giorgi’s move from transcendental to empirical ............................................. 162 4.7 Giorgi’s empirical descriptive method .............................................................. 165 4.7.1 Two principles ........................................................................................................ 166 4.7.2 Sampling and sample ............................................................................................. 168 vi 4.7.3 Interview procedure ..............................................................................................