Balancing closeness and distance through identity enactment: Psychological therapy assessments explored through the assessor-client dyad

ABSTRACT

Whilst encounters in psychology are typically experienced relationally, qualitative dyadic research in psychology is relatively rare. This study used qualitative dyadic research to understand psychological therapy assessments, exploring how experiences are actively created through situated, relational encounters. Seven dyads participated in qualitative semi-structured interviews, predominantly from services for trauma survivors. Thematic dyadic analysis explored a third space, distinct from the experiential knowledge of individuals. We found that clients and assessors balance closeness and distance through enacting aspects of their identities impacting on connection, safety, trust and disclosures. Whilst assessors and clients come together as strangers, human beings, experts, collaborators and, at times, survivors, the key determining factor shaping the encounter is how successfully assessors communicate their humanity. We conclude that dyadic qualitative inquiry is a feasible and rich method for understanding the relational in psychological healthcare encounters.

KEYWORDS:

• Dyadic research
• identity
• assessment
• client
• assessor

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors’ contributions

AS led the study including design, development of study materials, data collection, data analysis and write up. KB was involved in the first round of analysis. AK was involved in the final stage of analysis. SG oversaw and mentored the study, and contributed to design and development. SC, MI and GK were Advisory Group members, and SC and MI attended a data workshop on the emergent findings. All co-authors commented on drafts of the paper.

Additional information

Funding

This work was supported by the National Institute for Health Research under Grant PDF-2013-06-045

Notes on contributors

Angela Sweeney

Dr Angela Sweeney is Senior Lecturer in User-Led Research and Director of the Service User Research Enterprise (SURE) at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. 

Katie Kelly

Dr Katie Kelly currently holds the post of Specialist Clinical Psychologist at Tower Hamlets Early Intervention for Psychosis Service (THEIS), East London NHS Foundation Trust and also participates in service-user involvement projects under her identity as a Psychiatric Survivor.

Angela Kennedy

Angela Kennedy is an NHS clinical psychologist who has worked in the NHS since 1990. She is mental health lead for the Northern England Clinical Network and facilitates a national community of practice for trauma informed change for NHS-E.

Sarah Clement

Dr Sarah Clement has worked in various London universities as a lecturer and health services researcher. She now undertakes occasional freelance research.

Mary Ion

Mary Ion is an NHS Cognitive Behavioural and EMDR therapist at South London and Maudsley Foundation NHS Trust. She has a special interest in working with people who have experienced trauma. She has a background in mental health nursing, education and research.

Gemma Kothari

Dr. Gemma Kothari is a Principal Clinical Psychologist within a mental health team in South West Yorkshire Partnership NHS Foundation Trust. She has a background in social and clinical research.

Steve Gillard

Steve Gillard is Professor of Mental Health Research at City, University of London. His research is undertaken collaboratively with survivor researchers and focuses on the increasing role people play in producing the mental health services they make use of.