Psychology and Psychotherapy-Theory Research and Practice最新文献

Objectives: Current evidence on the impact of personal trauma on health care professionals is mixed. Some studies suggest a personal history of trauma can be a risk factor for secondary traumatisation. Other research suggests that personal experiences of trauma can help professionals to better recognise their patients' trauma symptoms. Staff working in forensic mental health services face challenges, such as exposure to patient self-harm and suicide. This study aimed to understand the impact of personal trauma on staff working in forensic mental health services and how this impacts their ability to give compassionate care in a challenging environment.

Design: Qualitative methodology was used. Participant interviews were analysed using Interpretative Phenomenological Analysis.

Methods: Seven participants were recruited from forensic mental health services across the Northwest of England who had personal histories of trauma. Participants completed a semi-structured interview and questionnaires recording traumatic life experiences. Interviews focused on how staff were impacted by their experiences of trauma and if this had an impact on them giving compassionate care.

Results: Three main themes were identified from participant interviews: reliving the past in the present, true empathy as both a gift and a burden, and the costs and benefits of gaining personal meaning and being changed by the work.

Conclusions: Participants reported that trauma had both positive and negative impacts on their work. Overall, a common thread that emerged in all interviews was that trauma did not appear to be a barrier to compassion but rather a facilitator.

Purpose: Cognitive-behavioural therapy for psychosis (CBTp) achieves small to modest effect sizes, which invites the question, 'What clinical modifications might improve outcomes?' This paper proposes an integration of CBTp with a neuropsychoanalytic approach that in clinical practice might extend the gains achieved by CBTp alone.

Methods: The author conducted a focused review of CBTp research bearing on trauma as well as a review of neuropsychoanalytic conceptions of psychological symptoms ('neuropsychoanalytic' meaning principally psychoanalytic ideas about how the brain maintains affective homeostasis) to identify similarities and differences in these approaches relevant to clinical practice.

Results: CBTp-oriented research shows that not only is childhood trauma associated with psychosis, but psychotic symptoms often contain de-contextualized memories of trauma and embody narrative themes that echo the person's trauma history, findings that mark psychosis as a trauma-related disorder in which psychotic symptoms constitute disguised representations of a person's trauma history. This paper expands the definition of trauma to include the symbolic meaning of events and relates psychosis to a neuropsychoanalytic model of the mind in which affect plays a central role, a conceptual lens through which delusions can be seen as meaningful adaptive attempts to maintain affective homeostasis in the aftermath of traumatic experiences. The paper offers an explanation of the developmental origins of the cast of characters and plot lines often encountered in delusional narratives.

Conclusions: There is considerable potential conceptual overlap between CBTp and neuropsychoanalytic approaches to psychosis, which if integrated might lead to better clinical outcomes, in particular in a collaborative development of schema therapy for psychosis.

Objective: Hearing voices is often experienced as being controlling, powerful, threatening or critical. This study aimed to examine the lived experiences of autonomy among people who hear voices.

Design: Employing a qualitative design, this study sought to examine the personal narratives and meaning-making processes of voice hearers and gain deeper insights into the nuanced ways autonomy is experienced, diminished, attempted, re-established and constructed by those who hear voices.

Method: In-depth semi-structured phenomenological interviews with six voice hearers were analysed using interpretative phenomenological analysis to capture the ways participants interpret and respond to their experiences.

Results: Participants' accounts revealed that autonomy was continuously negotiated, requiring reflection, adaptation and self-regulation. Three superordinate themes were identified in the data. First, participants reflected on how hearing voices challenged their sense of self, individuality and the space available for self-authorship. As such, developing a personally meaningful narrative was crucial for re-establishing autonomy. Second, they portrayed a co-existing dynamic where autonomy and power were shared and negotiated with voices. Third, participants described how hearing voices interfered with their perceived competence, and decision-making, introducing limitations to their ability to navigate life on their own terms. Participants' capacity for integration, and perceptions of their ability to influence and cause change, affected the extent to which they felt self-determined.

Conclusions: This study highlights the importance of supporting voice hearers in constructing meaningful, self-oriented narratives to strengthen their sense of autonomy. Future research should explore strategies that empower voice hearers to integrate their experiences constructively, thereby promoting resilience and autonomy.

Background: For voice-hearers from minoritised communities, voices may reflect interpersonal and societal discrimination, including experiences of feeling silenced or 'voiceless'. AVATAR therapy is a relational approach involving facilitated dialogues between a voice-hearer and a digital embodiment of their main distressing voice (the avatar). The aim is for the voice hearer to gain understanding, acceptance and empowerment.

Aims: This paper illustrates an extended form of AVATAR therapy (AV-EXT), which seeks to understand a person's voices within their developmental and relational context.

Methods: We present three therapy narratives in which voices mirrored experiences of discrimination and marginalisation based on aspects of the person's identity. Personalised avatars were used during dialogues to re-enact the lived experience of voice-hearing.

Results: Avatar dialogues offered opportunities to rescript disempowering experiences, target associated meanings and connect individuals with the power of their own identity.

Conclusions: Implications for the continued refinement of AVATAR therapy and other relational approaches are considered. This paper aims to support wider reflection on the impact of discrimination on distressing voices.

Background: Cognitive analytic therapy (CAT) offers a relational framework for understanding psychological difficulties, emphasising how early relational and socio-cultural experiences are internalised and shape the self through a repertoire of reciprocal roles (RRs).

Aims: This qualitative study seeks to explore the relational experiences of LGBTQ+ individuals using CAT theory, focusing on identity development (self-self relationships), self-other relationships, and self-society relationships.

Methods: Interpretative phenomenological analysis (IPA) guided interviews with 11 participants. CAT theory was applied as an additional framework to provide a clinically applicable understanding of these themes.

Results: Six group experiential themes (GETs) were identified: Coming Out: Discovering and Sharing Who I Am; Is it Wrong to be LGBTQ +? Questions and Beliefs about Being 'Normal'; Different Parts of Me; Feeling Safe in Relation to Others; Feeling Unworthy and Unlovable; and Being Authentically Me. Illustrations of themes were created. A CAT map was developed from the themes, outlining RRs, reciprocal role procedures (RRPs), and self-states. The findings highlight the influence of early caregiving relationships, the coming out process, and societal experiences on participants' self-development.

Conclusion: The CAT map captures the distinct RRs and procedures that the LGBTQ+ community may experience, emphasising the critical role of the self-society relationship in identity formation. It underscores the importance of the 'healthy island' concept and illustrates how healing RRPs can promote a more integrated and connected sense of self. This framework may help clinicians support LGBTQ+ individuals facing mental health challenges related to their relational experiences and sense of self.

Aims: This qualitative study explored the subjective experiences of psychologists in terms of the establishment and development of the therapeutic relationship with adults with intellectual disabilities (ID). It placed a particular focus on the psychologist's own process in their work.

Method: Sixteen psychologists took part in semi-structured interviews. Psychologists were asked to reflect on the process of developing a therapeutic relationship in addition to other relevant factors such as their attitudes, biases and the transferential relationship. The interviews were analysed using reflexive thematic analysis (RTA).

Results: Two main themes were developed including: (1) the relationship is key-a desire for friendship, balancing formality with informality and (2) letting go of what you know-psychologist's biases and the transferential relationship.

Discussion: The results highlighted the importance of the psychologist's process in the work with adults with ID, and the need for future research with adults with ID themselves to ascertain their views on the therapeutic relationship.

Objectives: Dissociation is a well-established mediator of the relationship between trauma and psychosis. Despite identified phenomenological similarities, there is limited research regarding the nature of the relationship between dissociation and delusions. The study aimed to identify dissociative experiences within delusions and examine whether these are associated with childhood trauma and its psychological sequelae.

Methods: Sixty-four young people were recruited from an early psychosis service and completed a cross-sectional assessment of childhood trauma, psychosis, PTSD and dissociation. A coding frame was developed to identify dissociative detachment and compartmentalisation within descriptions of delusions. Group comparisons were conducted to examine differences in the severity and frequency of trauma, PTSD, dissociation and psychosis between those with and without dissociative delusions.

Results: Thirty-four participants (59%) had at least one delusion that clearly included dissociative content. Compartmentalisation was identified in the descriptions of delusions for 25 participants (43%), and detachment was identified in the descriptions of delusions for 12 participants (21%). Three participants (5%) described a delusion that contained both compartmentalisation and detachment. All participants described at least one delusion without compartmentalisation or detachment. Those with dissociative delusions had a significantly higher frequency of PTSD diagnoses (χ²(1) = 5.32, p = .02, ϕ_c = 0.31).

Conclusion: Dissociative experiences are prevalent amongst those with early psychosis and can be reliably identified in the descriptions of delusions. It is likely that dissociation is phenomenologically important for the experience of some delusions.

Purpose: Body image is a transdiagnostic construct that seems poorly understood in psychosis. Poor body image is associated with paranoia, which makes it a theoretically meaningful treatment target in psychosis. We systematically reviewed associations between body image and psychosis symptoms in both the 'general' population and people living with psychotic disorders, synthesised known correlates of negative body image in people living with psychotic disorders and performed a meta-synthesis to understand the lived experience of body image in people with psychosis.

Methods: Ovid MEDLINE, OVID Embase, OVID APA PsycINFO, EBSCOhost Cinahl and the Cochrane Central Register of Controlled Trials were searched in January 2024. The methodological quality and risk of bias were assessed using the mixed-methods appraisal tool.

Results: 20,565 participants were included from 31 studies, of which 2127 (10.3%) were living with psychotic conditions, 18,294 from the general population, 129 people with other conditions being compared to psychosis (such as bipolar disorder) and 15 carers. There were 25 quantitative studies (24 cross-sectional, 1 prospective), 5 qualitative studies and 1 mixed-methods study. Cross-sectional evidence suggests associations between negative body image and psychotic symptoms, especially paranoia, as well as wider mental and physical health outcomes. Potential factors contributing to the persistence of poor body image include psychotic symptoms, worries about appearance-related judgements, negative self-concept, body ambivalence, appearance-related safety-seeking behaviours and traumatic memories.

Conclusions: Negative body image is relevant to the lives of people with psychosis spectrum conditions. Recommendations to guide and improve future research are reported.

Objectives: Accessing psychological therapy presents unique challenges for Muslims, who are underrepresented in primary care mental health services in the United Kingdom. This qualitative study sought the narratives of British Muslims to gain insight into the perceived barriers and facilitators to engagement with therapy.

Methods: Eighty participants responded to an online free-text survey question enquiring about their views on therapy with a non-Muslim therapist after completing a short experimental study. A structured tabular approach grounded in reflexive thematic analysis was used to analyse data.

Results: Three main themes were identified in our analysis: 'Fundamental differences', 'It's not worth the risk' and 'Overcoming barriers'. Within these themes we explore perceived interpersonal and systemic tensions, as well as facilitators to engagement with psychological therapy.

Conclusions: These findings are discussed in terms of implications for clinicians working with Muslim clients, with a focus on the importance of understanding and attending to faith and relational concerns.

Objective: Talking about the present-moment quality of a therapy relationship-sometimes termed immediacy or working in the here and now-has been recommended as a technique to enhance the therapeutic alliance and treatment outcome. The aim of the present study was to compare perceptions of therapy when the discussion was of the client's relationship with the therapist or with someone else.

Method: In the study, undergraduate participants were presented with an audio recording of a therapist and client discussing their relationship and another recording in which the discussion was of the client's relationship with someone else. For approximately half the participants, the relationships discussed were both positive; for the other participants, both relationships were problematic. After listening to each recording, participants rated the therapeutic bond and treatment credibility.

Results: Results revealed that the effect of discussing the therapy relationship depended on the relationship valence: When the valence was positive, participants rated the therapeutic bond and treatment credibility higher for discussions of the therapy relationship; when the valence was negative, ratings were higher for discussions of an outside relationship.

Conclusion: These findings suggest that focusing the therapy discussion on the therapeutic relationship may be more helpful when the relationship is positive than when it is negative.