Cheng, Joanna and Smith, Ian (2017) The mechanisms of psychological therapy with people with long-term physical health conditions. PhD thesis, Lancaster University.
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Abstract
This thesis comprises a literature review, a research paper and a critical appraisal of the research process. Qualitative literature was systematically reviewed using a meta-ethnography, with the aim of understanding how people with long-term physical health conditions (LTCs) experience psychological therapies. Thirteen articles were identified. Six themes emerged from the synthesis: i) ‘therapists’ expertise and empathic approach led to positive relationships’; ii) ‘therapy was a safe and neutral space’; iii) ‘therapy prompted change in LTC management’; iv) ‘psychological awareness reduced isolation and increased control’; v) how physical ill health interacts with being able to participate in therapy’; and vi) ‘time-limited therapy did not always match service users’ illness trajectory’. The findings were discussed in relation to the values of psychological therapy for people with LTCs and the current way services are delivered to people experiencing co-morbid mental health difficulties. The research paper comprised a qualitative study using a Discursive Action Model approach, which aimed to develop an understanding of how practitioners and service users construct resources and preferred futures within solution-focused therapy sessions. Eight participant dyads were recruited, formed by pairs of practitioners and service users. Data were collected via audio recordings. Four discourses were highlighted: i) ‘practitioners' use of assumptions drew out resources’; ii) ‘explicit commentaries construct change’; iii) ‘de-contextualising for goal construction’; and iv) ‘removing the blame, effort and failure’. The results highlighted the discursive mechanisms which enabled construction of resources and goals. The trans-theoretical applicability of the discourses, clinical implications and recommendations for future research were discussed. The critical appraisal discusses the importance of discourse in clinical psychology practice. The drivers behind conducting this thesis, strengths and weaknesses of the study, and lastly reflections on future practice in clinical psychology were offered.