Person-centred therapy and pre-therapy for people who hear voices, have unusual experiences or psychotic processes : practitioner and client perceptions of helpful and unhelpful practice and perceived client changes

  • Wendy Louise Traynor

Student thesis: Doctoral Thesis


Psychotic processes may involve a wide range of experiences, including hearing voices or other hallucinations, delusions or paranoia, or unusual or disturbed thinking or behaviour. Some clients who experience psychotic processes may not be responsive to standard psychotherapy formats and can thus present challenges for therapies of all orientations. The mixed method research strategy presented in this thesis is an attempt to uncover more information regarding helpful and unhelpful practices and changes in clients who experience psychotic processes.;First, I explored UK therapists' practice with clients who have unusual experiences or 'psychotic processes' and their perceptions of helpful and unhelpful practices and changes in clients. Second, I investigated clients' perspectives on helpful and hindering factors in person-centred therapy (PCT) as well as post-therapy positive or negative changes. Third, I investigated, in detail, one case of a client with psychotic processes who received PCT, considering causal efficacy. The three related studies carried out also considered, to some degree, the context of treatments offered and other impacting factors.;The first study involved semi-structured interviews with 20 person-centred practitioners working with clients with psychotic processes. The interviews focused on what practices they had encountered that were helpful to or hindered practice with clients, as well as any positive or negative changes they had observed in clients.;In the second study, 20 adult clients who had self-identified as hearing voices, having other unusual experiences or psychotic processes were interviewed mid- or post-therapy using the Change Interview protocol (Elliott, Slatick, & Urman, 2001). Studies 1 and 2 were analysed using grounded theory (Corbin & Strauss, 2008).;The third study consisted of a hermeneutic single case efficacy design study (HSCED; Elliott, 2001) with a client who was experiencing psychotic processes and who received 22 sessions of PCT. This HSCED study involved rigorous analysis of qualitative and quantitative data gathered over the 22 therapy sessions. The data was presented to a sceptic adjudicator and formally debated in a quasi-judicial forum with five independent judges: two therapists, a carer and two experts by experience. Following integration of the results of the judgement stage, conclusions were reached regarding the possible impact of the therapy and the possibility and degree of causal efficacy.;Overall results raised themes regarding helpful or unhelpful practices and changes in clients, from the perspectives of both practitioners and clients. Results indicated that most practitioners incorporated pre-therapy and contact work into practice, with positive and sometimes surprising results. Practitioners often worked in multidisciplinary contexts with careful attention to supervision, self-care and boundaries.;They saw person-centred values and the real relationship as important. Unconditional positive regard (UPR) was the most critical condition named both by practitioners and clients in this client group, possibly because they often felt judged or diminished by those around them. Helpful practices were associated with person-centred values. Unhelpful factors included practices such as judgement and unwanted directivity, both of which deviated from the person-centred (PC) approach.;The main changes in all studies involved an increase in social abilities and positive sense of self, and an increase in specific aspects of wellbeing. There was some evidence of improvement in mood and reduction in unusual experiences.;Clients engaged in the real relationship in therapy. Studies 2 and 3 showed that most clients were evidently active agents in their own change process. Findings demonstrate that PCT can be helpful for adult clients with psychotic processes. Practice implications are discussed.;Limitations of the studies include the dual therapist-researcher relationship in the HSCED study, the homogeneity and small size of the samples, and concerns about data validity. Issues relating to measures used to ascertain changes in therapy are discussed. Results are promising and suggest that PCT can be effective for clients who experience psychotic processes, pointing to the need for further research.
Date of Award1 Aug 2019
Original languageEnglish
Awarding Institution
  • University Of Strathclyde
SupervisorRobert Elliott (Supervisor) & Mick Cooper (Supervisor)

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