| Popis: |
BACKGROUND: There is a dominant discourse within the literature that collaboration is the ideal way of working when formulating in CBT and particularly with clients experiencing psychosis. Despite formulation and collaboration being considered key principles for this widely evidence-based approach, the literature deconstructing these concepts or explicating the way these add value to CBT for psychosis is insufficient. The literature does not acknowledge complexities, challenges or inconsistencies regarding this dominant discourse. This may be due to methodological challenges of investigating such variable and abstract constructs. However discourse analysis is a productive way of investigating inconsistent and complex constructs. Foucauldian Discourse Analysis was utilised within this study to investigate how clinical psychologists talk about and construct collaboration within this context, discourses drawn upon, tensions apparent, and ways of managing these. DESIGN: Semi-structured interviews were conducted with 12 clinical psychologists working across 3 NHS trusts in England. All participants self-reported working with clients experiencing psychosis and developing cognitive-behavioural formulations with these clients. A local collaborator within each trust provided names and contact details of clinical psychologists working with this client group, all of whom were sent participant invitation letters. Interviews were transcribed verbatim using a light version of Jeffersonian transcription, according to the level of analysis. ANALYSIS: Foucauldian Discourse Analysis was used to analyse the data and the guidelines of Willig (2008) were heavily drawn upon. This involved investigating how collaboration was constructed in accounts and inconsistencies or variations in this; discourses drawn upon; close examination of the discursive context and the action orientation of talk within the interview; subject positions adopted; and the relationship between discourse, practice and subjectivity. RESULTS: Collaboration in the context of formulation in CBT for psychosis was constructed in diverse and inconsistent ways by participants. Collaboration was often initially presented as a straightforward process whilst accounts quickly moved on to construct this as complex and ambiguous. Clinical psychologists adopted multiple and seemingly conflicting positions within their talk such as ‘collaborator’ but also ‘expert’ and ‘protector’. Tensions were apparent between conflicting discourses drawn upon such as ‘collaboration as the ideal’ but also ‘openness and transparency as dangerous’ and the ‘importance of a shared understanding’ alongside ‘accepting multiple perspectives’. CONCLUSION: Current understandings of collaboration presented in the literature are inadequate and a more nuanced understanding of the complexities, tensions and variations of collaboration in CBT for psychosis, as presented by participants is called for. The research highlights that collaboration may be more usefully constructed as being made up of a range of approaches rather than as a singular way of working. It may be useful to consider an approach similar to the ‘matching hypothesis’ seen in health and social psychology literature when determining type of collaboration and therapeutic alliance suitable for the individual. |
