Engagement in psychoeducational family interventions for psychoses
The aim of this study was to examine relationship and process issues in psychoeducational family interventions in psychosis with particular reference to engagement. A review of the literature in this field demonstrated that whilst such approaches are beneficial in reducing relapse and readmission rates, the implementation of family work into routine clinical practice remains problematic. It was argued that research addressing therapist and client factors and the process of therapy may assist in understanding implementation issues. Six papers examining family and client factors were discussed. The majority of the studies were quantitative and focussed on family factors. The literature demonstrated that family factors were important in engagement and the process of therapy. However, there appeared to be an absence of studies addressing therapist factors, in addition to the dominance of quantitative methods. It was argued that further research should address these issues. The first study in this thesis was a questionnaire survey relating to therapist assessment of engagement. Results suggested that therapists were able to identify signs of engagement as changing over time. The relative importance of the signs was also reported. The findings and the low response rate were discussed. The second study used qualitative methods to examine engagement in behavioural family therapy (BFT). Participants were workers trained in the approach and families who had engaged in the therapy. Data collected by semi-structured interview were analysed using a grounded theory approach. A model depicting the therapists’ experience of engagement emerged from the data. The core category of “humanity” and other categories were described. The implications of the model for research, theory and practice were suggested. The final paper in the thesis discusses the impact of the research process on the researcher.