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ABSTRACT
Objective
Over the last decades, psychotherapy of psychosis has increasingly gained attention. The quality of the therapeutic alliance has been shown to have an impact on therapy outcome. Yet, little is know about the influence of the therapeutic stance on the alliance. In this study, we explore psychotherapists‘ stance towards persons with psychosis with the aim of better understanding its characteristic—hindering and helpful—aspects.
Method
6 semi-structured interviews with psychotherapists from three different schools (CBT, PD, ST) were analysed with Grounded Theory. Credibility was checked through external and peer-researcher-supported debriefing.
Results
4 core categories were generated and interrelated in a theoretical model. Therapists‘ stance was initially characterized by uncertainty. Different ways of dealing with uncertainty yielded different stances: a monological and an open one. A helpful stance was conceived as stemming from openness and was characterized by a dialogical structure. A co-presence (or „dosing“) of you and I was conceived as its core aspect.
Conclusion
These findings specify the interpersonal dynamics arising from different stances and their impact on the therapeutic alliance and process. Research is still needed to further understand the characteristics of helpful and hindering therapeutic stances, which should also inform the training of psychotherapists.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Ethical approval
The research presented in this paper has been conducted in accordance with the Declaration of Helsinki. It has been approved by the ethics committee of the Brandenburg Medical School (reference number E-01-20201117). The ethics committee of the Brandenburg Medical School is chaired by Steffen Lebentrau (email: [email protected]).
Notes
1. This was especially the case with regards to interviewees‘ statements on personal openness.
2. The interviewees used the word “Unsicherheit“ which in German can refer to both uncertainty in terms of not being sure of something (e.g., oneself, i.e., as “Selbstunsicherheit“) and insecurity (the German “Sicherheit“ meaning security). We mostly translated this term with “uncertainty” as it was semantically better fitting to participants’ narratives. Still it should be noted that the semantic aspect of “insecurity” was often tacitly present, especially when participants spoke of acute psychotic phases. That is why we also use the word “insecurity” at some points.
3. This uncertainty and inner struggle is not only a source but also an integrative part of the stance. Indeed, patients can immediately perceive it in the relationship with therapists. Interestingly, in one focus group with persons with psychosis, the first answer to the question “how do you experience your therapist?” was: ”they are overwhelmed” (This data was collected within the same study but it is not published yet).
Additional information
Funding
Notes on contributors
Laura Galbusera
Laura Galbusera is currently employed as guest professor for clinical psychology and systemic psychotherapy at the Brandenburg Medical School. She holds a doctoral degree in psychiatry (Dr. Sc. hum) and has focused in her research on psychotherapy for persons with psychosis.
Ralph Endres
Ralph Endres is a male psychiatrist who works at the Brandenburg Medical School as a clinician and researcher. He has started training in psychodynamic therapy 4 years ago and has 4 years of clinical expertise in psychiatry.
Thelke Scholz
Thelke Scholz is a person with lived experience who is working as a peer support trainer and lecturer in social psychiatry. She is employed at the Brandenburg Medical School as a researcher on recovery from schizophrenia.
Emilia Jirku
Emilia Jirku is a clinical psychologist who focused on psychotherapists’ stance in the treatment of psychosis in her clinical degree. She is a trainee on trauma focused psychodynamic therapy and is currently working as a clinical psychologist at the department for psychiatry of the University Medicine in Halle (Saale).
Samuel Thoma
Samuel Thoma is a male psychiatrist and psychotherapist with a degree in medicine (PhD) and philosophy (PhD) employed at the Brandenburg Medical School as a clinician and Postdoc researcher.