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Original

Understanding a complex intervention: Person-centred ethnography in early psychosis

Pages 333-345 | Published online: 06 Jul 2009
 

Abstract

Background: Mental health interventions are increasingly “complex” as it is recognized that a holistic, integrated or “biopsychosocial” approach is required to provide adequate treatment and support. While randomized controlled trial (RCT) studies are applied to assess clinical outcome, the actual workings and experiential effectiveness of this type of intervention are poorly understood and documented.

Aims: To discuss the value of a social science perspective of interpretive understanding (verstehen) and existential phenomenology to study sociocultural processes in a complex intervention, in particular when taking an ethnographic approach.

Methods: A person-centred ethnographic study of a Danish early intervention in psychosis service involved two years participant observation and repeated interviews with 15 clients.

Results: The study detailed therapeutic encounters in the intervention, supplemented by clients' reflections and insights generated through dialogue. Following first episode psychosis clients experienced an existential crisis, and the intervention offered therapeutic engagement, support and systems of explanation that provided meaning and life direction through the recovery models of “episodic psychosis” and “chronic schizophrenia”.

Conclusions: The person-centred ethnographic approach provides rich insights into the sociocultural and personally experienced workings of a complex mental health intervention, which allow a critical understanding of therapeutic processes and how they may be improved.

Notes

1 When referring to the broad notion of “social sciences” I agree with the arguments put forward by Richard Jenkins (Citation2002, pp. 22 – 27) that, rather than seeking to narrowly identify – and thus limiting – discrete academic disciplines, it is theoretically and methodologically more fruitful to operate with a “generic sociology” that naturally embraces the intertwined intellectual resources of disciplines like sociology, cultural and social anthropology, cultural studies, social history, social policy and social psychology. In Britain there is a strong academic tradition for such a generic approach to sociology, for example at the University of Sheffield and Keele University.

2 In this paper the term “client” is used to refer to the mental health service users. In fact, this issue was frequently debated in the multi-professional OPUS teams and at different times and in different social circumstances various terms were used: “patient”, “participant”, “client”, “user” and “the young people” (de unge).

3 I have provided a fuller description and examination of the sociocultural aspects of the therapeutic work in OPUS elsewhere (Larsen, in press).

4 The names of informants are pseudonyms.

5 The quote is translated by the author from Danish to the nearest equivalent English. Where words are used that have a special meaning in Danish these are provided in square brackets and italics.

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