Young adults' dynamic relationships with their families in early psychosis:Identifying relational strengths and supporting relational agency

OBJECTIVES: Most existing research on the family context of psychosis focuses on the 'burden' of caring for people experiencing psychosis. This research is the first to ask young people experiencing early psychosis to 'map' and describe their experiences and understandings of their family relationships, and how they have related to their psychosis and recovery. DESIGN: The research took an inductive, multimodal hermeneutic-phenomenological approach (Boden, Larkin & Iyer, 2019, Qual. Res. Psychology, 16, 218-236; Boden & Larkin, 2020, A handbook of visual methods in psychology, 358-375). METHOD: Ten young adults (18-23), under the care of early intervention in psychosis services in the UK, participated in an innovative relational mapping interview (Boden, Larkin & Iyer, 2018), which invited participants to draw a subjective 'map' of their important relationships. This visual methodology enables subtle, complex, ambivalent, and ambiguous aspects of the participants' experiences to be explored. RESULTS: Findings explore the participants' accounts of how they love, protect, and care for their families; how they wrestle with family ties as they mature; and their feelings about talking about their mental health with loved ones, which was typically very difficult. CONCLUSIONS: This paper advances understanding of recovery in psychosis through consideration of the importance of reciprocity, and the identification and nurturance of relational strengths. The capacity of a young person to withdraw or hold back when trying to protect others is understood as an example of relational agency. The possibility for extending strengths-based approaches and family work within the context of early intervention in psychosis services is discussed. PRACTITIONER POINTS: Young adults experiencing early psychosis may benefit from support to identify their relational strengths and the opportunities they have for reciprocity within their family structures, where appropriate. Relational motivations may be important for a range of behaviours, including social withdrawal and non-communication. Services may benefit from exploring the young person's relational context and subjective meaning-making in regard to these actions. Young adults experiencing early psychosis may benefit from opportunities to make sense of their family dynamics and how this impacts on their recovery. Attachment-based and relationally oriented interventions that increase trust and openness, and reduce feelings of burdensomeness are likely to support family functioning as well as individual recovery

Moving from social networks to visual metaphors with the Relational Mapping Interview

This chapter describes how to undertake a relational mapping interview (RMI) and how to analyse the visual data created in this approach from an experiential research project that explored the relationships of young people (18-25 years) under the care of Early Intervention Services for Psychosis, which are community outreach services providing biopsychosocial interventions for first-episode psychosis. The RMI aims to be an encounter, not an interrogation, and so is not a linear set of questions but a framework for communicating relational experience in non-linear ways. Unlike a traditional semi-structured interview, RMIs follow an ‘interview arc’ and use the format of ‘draw–talk–draw–talk’. To aid both interviewer and participant to navigate the participant’s experience, the RMI consists of four touchpoints: mapping the self; mapping important others; standing back; and considering change. The RMI provides data that is rich and polysemous, whilst also being experience-near and subjective in focus

The dynamics of interpersonal trust: Implications for care at times of psychological crisis

'Trust' can describe many different positive features of our social relationships with others. In this exploratory paper, we reflect on some of the ways in which people orient themselves towards others in the context of a psychological crisis, a time when trust may be threatened or eroded. We draw upon qualitative data extracts from two previously reported studies, in order to illustrate and develop some observations about the dynamics of relational trust during such periods of acute distress. We show how these dynamics arise out of particular contexts and have particular consequences for psychological health. We discuss how, in a relationship mediated by trust, it can sometimes be an act of care - towards self, or towards others - to filter and limit the extent of what one entrusts to another. We suggest that further consideration by philosophers can be very helpful to the mental health field here, if we are to understand the negotiation of interpersonal trust in the context of mental health crises. We note that it would be extremely helpful to understand more about how to create the kinds of environments which afford trust

On the brink of genuinely collaborative care:experience-based co-design in mental health

Inpatient mental health services in the United Kingdom are currently dissatisfactory for service-users and staff. For young people with psychosis, being hospitalized is often distressing, and can lead to disengagement with mental health services. This article describes how we took three qualitative research studies about hospitalization in early psychosis (exploring the perspectives of service-users, parents, and staff) and translated them into service improvements developed in collaboration with a range of stakeholders, including service-users, carers, community and inpatient staff, and management. We used an adapted form of experience-based co-design (EBCD), a participatory action-research method for collaboratively improving health care services. The use of EBCD is still relatively novel in mental health settings, and we discuss how we adapted the methodology, and some of the implications of using EBCD with vulnerable populations in complex services. We reflect on both the disappointments and successes and give some recommendations for future research and methodological development

The experiential impact of hospitalisation in early psychosis:service-user accounts of inpatient environments

Early Intervention in Psychosis services aim to keep young people out of hospital, but this is not always possible. This research used in-depth interviews to explore the experience of hospitalisation amongst young people with psychosis. Findings describe fear and confusion at admission, conflicting experiences of the inpatient unit as both safe and containing, and unsafe and chaotic, and the difficult process of maintaining identity in light of the admission. We discuss the need to move from construing psychiatric hospitals as places for ‘passive seclusion’, to developing more permeable and welcoming environments that can play an active role in recovery