Clinical Psychologists' Constructions of Insight in Adult Mental Health

Insight is a term used in adult mental heath to try to think about and understand how service users’ understand their difficulties. There has been a growth in interest in its potential use in practice. This has led to the development of multiple theories and scales. Research in this area has yielded a vast array of results. Although to date, this enterprise has yielded inconsistent results. While the various insight theories implicate different factors in their models, there is convergence on three recurrent themes: acceptance of mental illness, agreement with treatment, and ability to label experiences as pathological. However, insight in adult mental health is a term that is often used but rarely defined. This research took a social constructionist stance to explore the way insight is deployed by clinical psychologists in practice. It sought to explore the degree to which ideas about insight are used in practice. Conversely it also looked to explore if insight was not used what, if any, analogous psychological theories were deployed in their day-to-day work. The research actively explored a variety of contexts in which clinical psychologists might encounter “insight talk” and how they negotiate these contexts. Nine clinical psychologists working in a variety of adult mental health services within one NHS trust were recruited. Semi-structured interviews were used to explore if, and how, insight is used. The transcripts were analysed using a mixed design of Discursive Psychology and Foucauldian Discourse Analysis. The results suggest that insight and analogous terms are used at different levels of practice. In terms of service user contact (micro-politics) “insight talk” considered insight as psy-model, narrative insight, and formulation. In discussion with colleagues (meso-politics), psychologists constructed their colleagues “insight”. At a system level (macro-politics) psychologists constructed systems as lacking insight and the promotion of a psychologically minded workforce

Clinical psychologists' constructions of insight in adult mental health

Insight is a term used in adult mental heath to try to think about and understand how service users’ understand their difficulties. There has been a growth in interest in its potential use in practice. This has led to the development of multiple theories and scales. Research in this area has yielded a vast array of results. Although to date, this enterprise has yielded inconsistent results. While the various insight theories implicate different factors in their models, there is convergence on three recurrent themes: acceptance of mental illness, agreement with treatment, and ability to label experiences as pathological. However, insight in adult mental health is a term that is often used but rarely defined. This research took a social constructionist stance to explore the way insight is deployed by clinical psychologists in practice. It sought to explore the degree to which ideas about insight are used in practice. Conversely it also looked to explore if insight was not used what, if any, analogous psychological theories were deployed in their day-to-day work. The research actively explored a variety of contexts in which clinical psychologists might encounter “insight talk” and how they negotiate these contexts. Nine clinical psychologists working in a variety of adult mental health services within one NHS trust were recruited. Semi-structured interviews were used to explore if, and how, insight is used. The transcripts were analysed using a mixed design of Discursive Psychology and Foucauldian Discourse Analysis. The results suggest that insight and analogous terms are used at different levels of practice. In terms of service user contact (micro-politics) “insight talk” considered insight as psy-model, narrative insight, and formulation. In discussion with colleagues (meso-politics), psychologists constructed their colleagues “insight”. At a system level (macro-politics) psychologists constructed systems as lacking insight and the promotion of a psychologically minded workforce

Existential support needs following cancer treatment with curative intent

Aims Research in recent years reveals that people can experience a range of existential difficulties following the end of cancer treatment. However, few studies have examined how to best support people with these needs. The aim of this study is to explore what support may be required to help people manage their existential concerns following the end of treatment. It is the second part of a study that examined the existential concerns of the same participants (Lagerdahl, Moynihan and Stollery 2014). Method Eight participants recounted their post-treatment experiences through qualitative methods, and inductive thematic analysis was used to systematically organise those experiences. Results Participants wished for greater continuity of care and information following the end of treatment, and requested mandatory and holistically focused follow-up appointments, as well as specialised psychological support. Conclusion In accord with National Cancer Survivorship Initiative goals, there is a need to establish holistic support in hospitals with follow-up consultations that acknowledge existential experiences, to effectively aid patients in their transition to life beyond cancer

A reflective evaluation of a feeding clinic intervention—Parents as a reflecting team

Background This feeding clinic engaged parents as active participants in a group intervention. Parents' participated behind a two-way mirror. This novel approach to practice in this domain largely evolved from an integration of theory, service user feedback, service development and the local context. This review sought to understand how parents experienced being part of a reflecting team in this way. Methods Semi-structured interviews were completed and analysed using thematic analysis. The researchers took a critical realist approach to the research, data analysis and report writing. Findings Parents talked about benefiting from perspective taking that enabled them to see the child in context, which in part supported novel understandings of their child's feeding and their relationship to it. Three themes were identified: 1. “Connection and Distance” explored parents' experience of being behind the screen in terms of the dialectic potential that was created by being simultaneously close to and distanced from their children and the other parents. 2. “Playing with Techniques” describes the way parents valued learning in the group through discussion and working on techniques between sessions. In particular, they moved from looking for techniques to thinking about how and when to use “techniques” that is, second-order change. 3. “Unexpected Gains” describes how parents came to new and unexpected insights about their understanding of their children, the presenting issues and their relationships to these issues. Conclusion Parents' experiences suggest that there is merit in engaging parents in a reflecting team in a feeding clinic. This way of working with parents supports their engagement in change and positions them as active agents of this change. Parents taking up this position has the advantage of moving from passive consumers of health care to active and critical collaborators

A reflective evaluation of a feeding clinic intervention—Parents as a reflecting team

Background: This feeding clinic engaged parents as active participants in a group intervention. Parents' participated behind a two-way mirror. This novel approach to practice in this domain largely evolved from an integration of theory, service user feedback, service development and the local context. This review sought to understand how parents experienced being part of a reflecting team in this way. Methods: Semi-structured interviews were completed and analysed using thematic analysis. The researchers took a critical realist approach to the research, data analysis and report writing. Findings: Parents talked about benefiting from perspective taking that enabled them to see the child in context, which in part supported novel understandings of their child's feeding and their relationship to it. Three themes were identified: 1. “Connection and Distance” explored parents' experience of being behind the screen in terms of the dialectic potential that was created by being simultaneously close to and distanced from their children and the other parents. 2. “Playing with Techniques” describes the way parents valued learning in the group through discussion and working on techniques between sessions. In particular, they moved from looking for techniques to thinking about how and when to use “techniques” that is, second-order change. 3. “Unexpected Gains” describes how parents came to new and unexpected insights about their understanding of their children, the presenting issues and their relationships to these issues. Conclusion: Parents' experiences suggest that there is merit in engaging parents in a reflecting team in a feeding clinic. This way of working with parents supports their engagement in change and positions them as active agents of this change. Parents taking up this position has the advantage of moving from passive consumers of health care to active and critical collaborators

Exploring the positive impact of peers on adolescent substance misuse.

Background: Previous research has consistently shown the negative impact that peers can have on adolescent substance use patterns. Few studies have examined the positive influence adolescents can have on their peers. This study aimed to examine the relationship of positive peer influence with indices of substance use and also to compare abstinent adolescents and substance-using adolescents on positive peer influence. Method: One hundred fifty-four adolescents (age range 12–20 years) completed a questionnaire on positive peer influence and other correlates of adolescent substance use including mental health, family functioning, and social support. Results: Positive peer influence was a significant predictor of lower substance use behaviors in adolescents, with positive influence from close friends being the strongest predictor. Substance-using adolescents' scores were significantly different from abstinent adolescents' scores for positive peer support, mental health functioning, impulsivity, and social support. Conclusions: These results indicate that positive influence from adolescents' peers may act as a protective factor in substance use. This influence should be utilized to aid the design of prevention and intervention initiatives in adolescent substance use

Exploring the positive impact of peers on adolescent substance misuse

Background: Previous research has consistently shown the negative impact that peers can have on adolescent substance use patterns. Few studies have examined the positive influence adolescents can have on their peers. This study aimed to examine the relationship of positive peer influence with indices of substance use and also to compare abstinent adolescents and substance-using adolescents on positive peer influence. Method: One hundred fifty-four adolescents (age range 12–20 years) completed a questionnaire on positive peer influence and other correlates of adolescent substance use including mental health, family functioning, and social support. Results: Positive peer influence was a significant predictor of lower substance use behaviors in adolescents, with positive influence from close friends being the strongest predictor. Substance-using adolescents' scores were significantly different from abstinent adolescents' scores for positive peer support, mental health functioning, impulsivity, and social support. Conclusions: These results indicate that positive influence from adolescents' peers may act as a protective factor in substance use. This influence should be utilized to aid the design of prevention and intervention initiatives in adolescent substance use