VIKKI KELLY BSc (Hons) MSc DCHyp DClinPsychol SOCIAL CONSTRUCTIONS OF PSYCHLOPS (PSYCHOLOGICAL OUTCOME PROFILES) IN THE CONTEXT OF CBT FOR PSYCHOSIS Section A: Outcome Measurement, Recovery and Psychosis: A Literature Review Word Count 5925 Section B: PSYCHLOPS and Psychosis: A Foucauldian Discourse Analysis Word Count 9075 Section C: Critical Appraisal Word Count 4921 Overall Word Count 19921 A thesis submitted in partial fulfilment of the requirements of Canterbury Christ Church University for the degree of Doctor of Clinical Psychology JULY 2010 SALOMONS CANTERBURY CHRIST CHURCH UNIVERSITY 1 SECTION A ABSTRACT ................................................................................................................................ 8 INTRODUCTION ........................................................................................................................ 9 HISTORY OF OUTCOME MEASUREMENT .............................................................................. 9 How has the use of outcome measurement developed? ....................................................................... 9 What are we measuring? ................................................................................................................... 10 Purpose of measurement ................................................................................................................... 11 Changes in political context ............................................................................................................... 12 Extent of use of outcome measures ................................................................................................... 13 Attitudes to outcome measurement .................................................................................................... 14 Impact on therapeutic relationship ...................................................................................................... 15 Measurement and therapeutic orientation .......................................................................................... 16 Impact on service user experience ..................................................................................................... 16 TYPES OF MEASURES ........................................................................................................... 17 Idiographic versus nomothetic measures ........................................................................................... 17 Client based measures and the Personal Questionnaire (PQ) ............................................................ 19 FREQUENCY OF MEASUREMENT ......................................................................................... 21 Pre-post vs sessional ......................................................................................................................... 21 IMPACT OF OUTCOME MEASURES ...................................................................................... 22 PSYCHOSIS & MEASUREMENT IN PSYCHOSIS ................................................................... 22 Outcome measurement and the recovery model ................................................................................ 22 Measuring change in psychosis ......................................................................................................... 26 THE MEASURES USED IN THIS STUDY ................................................................................ 28 CORE-OM (Clinical Outcomes in Routine Evaluation-Outcome Measure) .......................................... 28 development ...................................................................................................................................... 28 PSYCHLOPS .................................................................................................................................... 30 Development ..................................................................................................................................... 30 Description ........................................................................................................................................ 31 PARTICULAR POTENTIAL OF PSYCHLOPS FOR USE IN PSYCHOSIS .............................. 31 FUTURE DIRECTIONS ............................................................................................................ 33 2 REFERENCES ......................................................................................................................... 35 SECTION B PSYCHOSIS AND RECOVERY ............................................................................................... 52 POWER AND CONTROL IN MENTAL HEALTH ...................................................................... 53 THE PSYCHLOPS MEASURE ................................................................................................. 54 PREVIOUS RESEARCH ON PSYCHLOPS ............................................................................. 57 RATIONALE FOR USING PSYCHLOPS WITH PSYCHOSIS .................................................. 57 RESEARCH QUESTIONS ........................................................................................................ 58 METHODOLOGY ..................................................................................................................... 60 DISCOURSE ANALYTIC APPROACHES ................................................................................ 60 EPISTEMOLOGICAL POSITION ............................................................................................. 61 RESEARCHER’S PERSPECTIVE ............................................................................................ 61 DESIGN .................................................................................................................................... 62 PARTICIPANTS ....................................................................................................................... 63 INCLUSION AND EXCLUSION CRITERIA .............................................................................. 63 PARTICIPANT CHARACTERISTICS ....................................................................................... 64 INTERVIEW .............................................................................................................................. 65 PROCEDURE ........................................................................................................................... 65 QUALITY ASSURANCE ........................................................................................................... 67 3 ETHICAL CONSIDERATIONS ................................................................................................. 67 ANALYSIS OF DATA ............................................................................................................... 67 RESULTS ................................................................................................................................. 68 PSYCHLOPS: THE ROAD TO SERVICE USER EMPOWERMENT?....................................68 PSYCHLOPS AS AN AID TO COLLABORATIVE WORKING AND REDUCING POWER DIFFERENTIALS ......................................................................................................................71 PSYCHLOPS AS INSUFFICIENTLY POWERFUL AGAINST THE BIOMEDICAL SYSTEM ... 74 CONSTRUCTION OF THE CORE-OM AS PART OF AN OPPRESSIVE SYSTEM ................. 75 MEASURES AS CONTAINING OR UNCONTAINING AND PSYCHOSIS AS CHAOS ............ 77 BEING ILL: MEDICATION AND HEALTH ................................................................................ 80 BALANCING STRENGTH WITH WEAKNESS......................................................................... 81 ENGAGEMENT AND PSYCHOSIS: THE ROLE OF THE OUTCOME MEASURE .................. 82 PSYCHLOPS AND PSYCHOSIS ............................................................................................. 84 PSYCHLOPS AS A MEASURE WITH INTEGRITY .................................................................. 86 DISCUSSION ........................................................................................................................... 87 LIMITATIONS OF THE STUDY ................................................................................................ 89 FUTURE WORK ....................................................................................................................... 90 CLINICAL AND RESEARCH IMPLICATIONS ......................................................................... 91 CONCLUSION .......................................................................................................................... 93 REFERENCES ......................................................................................................................... 94 4 SECTION C OVERVIEW ............................................................................................................................ 100 DEVELOPING THE IDEA ....................................................................................................... 100 EPISTEMOLOGY ................................................................................................................... 102 NARRATIVE ANALYSIS ........................................................................................................ 102 SOCIAL CONSTRUCTIONISM .............................................................................................. 102 USING A DISCOURSE ANALYSIS APPROACH