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Baxter, Lydia Bridget (2021) Therapeutic relationships with people experiencing psychosis within an acute mental health care setting: a critical discursive evaluation. Doctoral thesis, London Metropolitan University.
Literature review:
The therapeutic relationship is considered a pivotal underpinning of counselling psychology and is a key determinant of positive therapeutic outcomes in various forms of therapy. Health care professionals (HCPs) utilise the therapeutic relationship within acute mental health settings (AMHS); however, little is known about how this is achieved, particularly with people experiencing symptoms of psychosis who have often experienced interpersonal trauma in their history.
Rationale:
There are various discourse resources relating to the therapeutic relationship, AMHS, and psychosis that HCPs draw on to construct their sense-making of; the patient, their professional role, the institution of AMHS and the diagnosis of psychosis. However, there has been no research to date that has explored how HCPs use discursive processes to make sense of the therapeutic relationships they form within this setting and with people experiencing psychosis.
Method:
Six semi-structured interviews were conducted with nurses and counselling psychologists, who had experiences of working in AMHS and with people experiencing psychosis. These were transcribed and analysed using Critical Discursive Psychology (CDP; Potter and Wetherell, 1986).
Findings:
Four interpretive repertoires were identified within the data: the therapeutic relationship bridges the mental health system and the person experiencing psychosis; the therapeutic relationship as a means to manage psychotic experiences with a boundaried, yet flexible approach; meeting the person experiencing psychosis through the therapeutic relationship; and the therapeutic relationship is more than just a dyad – the MDT. Limitations of this research were addressed, implications for future research and clinical practice were highlighted, and reflexivity was employed and conveyed throughout this work.
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