The Experience and Meaning of Relationships for People with Psychosis in a Rehabilitation Service: An Interpretative Phenomenological ApproachDiane Agoro1, Dr Alastair Cardno1, Dr Anjula Gupta2

1. Institute of Health Sciences, University of Leeds2. Leeds and York Partnership NHS Foundation

Trust

Introduction• Social functioning and psychosis• 2/3 have difficulties with social roles (Bellack et al. 2007)• Socially isolated (Stain et al. 2012)• Poorer interpersonal functioning (Collip et al. 2011)

• Theory of Mind• A deficit may prevent them from considering all the

circumstances of a situation (Bentall, 2003)• A deficit in being able to understand others may lead to poor

social functioning (Kosmidis et al. 2011)

• Attachment• FEP more likely to have attachment difficulties (Couture et al.

2007)

Aims

1) How do people with experiences of psychosis make sense of their relationships with important others?

2) How do they make sense of any difficulties they experience with important others?

Method

• Qualitative analysis (IPA)

• Participants recruited from a rehabilitation service

• Semi-structured interviews

Results: Group analysis

Feeling connected to

important others

Staying in contact

Being supported

Shared experiences, shared

understanding

Having psychosis can get in the

way of relationships

Being on the unit disrupts

relationships

A lack of understanding creates stigma

Being cautious around others

Distancing oneself for protection

Difficulty trusting others

Feeling connected to important others: Staying in contact

I see him once a week, just go to his house on a Friday and watch DVDs

Coz I meet up with them all the time, once a fortnight

Feeling connected to important others:Being supported

I keep in touch with them regularly, just talking about the hospital and being sectioned

At times with the voices she’s really been there

The staff here are important in my recovery…different areas of my life they help me with

Feeling connected to important others: Shared experiences, shared understanding

Just other sufferers and that….they know a lot more about it, the suffering, they understand

It helps because there’s common ground and common understanding of experiences

Having psychosis can get in the way of relationships: Being on the unit disrupts relationships

I haven’t done an awful lot with her because I’m on the unit

Then I got taken into hospital and I didn’t see him for a long time

I’m not around at the moment, I’m on the unit, she’s not used to my company

Having psychosis can get in the way of relationships: A lack of understanding creates stigma

I’m on a mental health unit so that’s not very attractive to girls at the moment

It [the voices] was getting scary at work, so I told them, they said resign or take redundancy

Because I’m mentally ill they think I’m not as capable to do things

Being cautious around others: Distancing oneself for protection

I used to go out but as soon as they heard about the voices I stopped going out

I tend to keep myself to myself here

Most of the time I stay in seclusion, I feel a lot safer

I’m not really sociable and I don’t really go out and meet friends or mingle

Being cautious around others: Difficulty trusting others

I tend to trust people and they let me down

It will be some time before I can trust them, I’ve been through so much

I’ll have to learn to start trusting otherwise I know I won’t get anywhere

Discussion

• How do people with psychosis make sense of their relationship with important others?• They are important for support• They provide a sense of belonging

• How do they make sense of any difficulties they experience with important others?• Lack of understanding and stigma• Relationships are vulnerable to change• Difficulty establishing new relationships

Recommendations• Strengthening the staff-service user relationship• For recovery and social support• Treating the service user as the expert in their experiences

• Facilitating family members’ understanding of individual experiences of psychosis• Going beyond psychoeducation• Learning about the lived experience of having psychosis

• Encouraging peer support from current and previous service users• Share experiences• Provide hope

• Individual interventions tailored towards the social needs of the service user• Less blaming and more validating

References• Bellack, A.S. et al. (2007). Assessment of community functioning in people with

schizophrenia and other severe mental illnesses: A white paper based on an NIMH-Sponsored workshop. Schizophrenia Bulletin, 33(3), 805-822.

• Bentall, R. (2003). Madness explained psychosis and human nature. London: Penguin Books.

• Collip, D. et al. (2011). Dynamic association between interpersonal functioning and positive symptom dimensions of psychosis over time. A longitudinal study of healthy adults. Schizophrenia Bulletin.

• Couture et al. (2007). Personality characteristics and attachment in first episode psychosis: impact on social functioning. Journal of Nervous and Mental Disease, 195(8), 631-639.

• Kosmidis et al. (2011). The impact of impaired “Theory of Mind” on social interactions in schizophrenia. Journal of the International Neuropsychological Society.

• Stain et al. (2012). Understanding the social costs of psychosis. The experience of adults affected by psychosis identified within the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry, 46(9), 879-889.

Thank you for listening….Any questions?