A Meta-ethnography of Qualitative Accounts of Personal Recovery from Depression and, a Qualitative Study Exploring Engagement in the Early Stages of Psychotherapy for Depression

Abstract

This thesis consists of a literature review and research study. The literature review employed a meta-ethnographic approach to synthesise first person accounts of recovery from depression. Critical appraisal was used to contextualize the rigour of studies. The final synthesis conceptualised recovery as an non-linear process over time, encapsulating periods of relapse and gains over baseline functioning, which could be represented as growth through adversity. A number of interlinked processes worked in concert to support recovery: “recovery toolkit”, “agency”, “being-in-relationships”, “insight”, “stigma”, “resilience” and “hope”. Findings converged with the existing literature on recovery, suggesting that recovery from depression is governed by similar processes to other mental health conditions. The review highlighted the limitations of retrospective accounts and the need for studies which could evaluate the identified gains following recovery on future well-being. The empirical study used Template Analysis to explore common process of early engagement across two psychotherapies for depression from the clients’ perspective. Sixteen transcripts representing the first two sessions for eight clients receiving either Cognitive Behavouiral Therapy or Counselling for Depression were analysed. The analysis found that, in order to engage, clients: (i) must learn about the tasks and principles of therapy; (ii) are active in adapting and managing the relationship with their therapist, and (iii) must be able to flexibly and responsively assert their own agency. The results argue for the active role of the client in managing early engagement. Future research directions and methodological shortcomings are outlined