How can Mental Health Practitioners Utilise the Therapeutic Relationship to Effectively Support People with a Psychosis Spectrum Condition?

Brown, Katrina and Parry, Sarah (2024) How can Mental Health Practitioners Utilise the Therapeutic Relationship to Effectively Support People with a Psychosis Spectrum Condition? PhD thesis, Lancaster University.

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Abstract

This thesis explores how mental health practitioners (MHP) can the utilise therapeutic relationships (TR) to effectively support people with a psychosis spectrum condition. Section one documents a systematic literature review exploring how the TR can enhance self-concept clarity (SCC) for people with psychosis. Three themes emerged from a meta-ethnography of 22 papers: Coming into the TR, Initial Building of the TR, The Context of Safety in the TR. A fourth and final theme emerged from a final layer of synthesis: development of SCC in treatment and beyond. The resultant line of argument synthesis explained how the TR dynamically develops alongside development of aspects of the self, to enhance overall SCC. The discussion details strengths, limitations, the findings’ implications for MHPs’ practice, and recommended updates to the clinical guidelines that MHPs follow. Section two documents an empirical research study exploring the subjective experiences of young people experiencing early-onset psychosis (EOP), who engage in TRs with MHPs in early intervention services (EIS). Semi-structured interviews with four participants were analysed using Interpretative Phenomenological Analysis. Three major themes emerged: Pacing the TR, Fostering Autonomy, A Personalised Approach. These themes highlighted what the participants wanted and needed from their MHPs, for their TR to benefit their overall recovery. Strengths and limitations are discussed, as are the findings’ clinical value for MHPs supporting young people across the EOP spectrum. Recommendations include future research to broaden the scope of this previously under-researched phenomenon, and consideration of updates to the clinical guidelines followed by MHPs supporting these young people through their recovery journey. Section three documents a critical appraisal detailing cross-cutting themes across the review and study, study participants’ views of EIS overall, limitations in participant diversity across the review and study with related recommendations for future research, and personal reflections on the study data analysis process.