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Title: A relational perspective on the development of psychosis
Author: Haq, Saba
ISNI:       0000 0004 7656 7660
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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This thesis provides an exploration into early interpersonal trauma, attachment styles, social functioning, reciprocal roles and procedures, dialogic and psychoanalytic processes associated with experiences of psychosis. Two papers encompass this thesis: (1) a systematic review examining the current literature on the relationship between adverse childhood experiences and social functioning of adults with experiences of psychosis, compared to those without adverse childhood experiences; and (2) an original qualitative study exploring cognitive analytic therapy (CAT) practitioners' reflections about their experiences of applying a preliminary model of CAT for psychosis (Kerr, Beard, Crowley, & Simpson, 2000) in practice and research contexts. This introductory chapter provides a brief overview of the two papers. Chapter 1: The systematic literature review explored the association between childhood adversity and social functioning of adults with clinical levels of psychosis, in comparison to clinical and non-clinical control groups without childhood adversity. Five databases (PubMed, Medline, PsycINFO, Scopus, and CINAHL Plus) were searched up to May 2018. Ten studies were identified, and each was appraised for methodological quality. Six of the studies showed significant negative associations between childhood adversity and premorbid social functioning (particularly during adolescence) within first-episode psychosis samples. Two of the studies showed no significant associations between sexual and/or physical abuse and current social functioning in chronic psychosis samples. The findings were discussed in relation to methodological limitations, and the clinical need to consider a history of interpersonal trauma and social functioning difficulties when working clinically with this population was emphasised. Chapter 2: The empirical study aimed to further develop and refine the preliminary model of CAT for psychosis (Kerr et al., 2000), from CAT practitioners' perspectives. A qualitative design using a constructivist approach to grounded theory methodology was chosen. Semi-structured interviews were completed with nine CAT practitioners working in secondary mental health services across the British Isles. A revised CAT-based model of psychosis emerged from analysis. A number of additional psychosocial processes were identified that could enrich the preliminary model, including individual and social context, insecure avoidant attachment styles, intolerable core emotions and internal dialogue, defence mechanisms, and specific maladaptive reciprocal roles associated with the development of delusional and hallucinatory experiences. These processes that underpin the final model were discussed in relation to existing research and theoretical developments in CAT, cognitive psychology, attachment, and neuroscience. Clinical implications, methodological critique, and suggestions for future research were also discussed.
Supervisor: Bennett, Kate ; Seddon, Claire ; White, Ross ; Williams, James Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral