Download A Narrative Study Exploring Survivor/Service-User Professionals' Accounts of Sharing Personal ... PDF

TitleA Narrative Study Exploring Survivor/Service-User Professionals' Accounts of Sharing Personal ...
LanguageEnglish
File Size5.1 MB
Total Pages195
Table of Contents
                            RW amended thesis
Appendix VI - letters of ethical approval and change of title
	ETHICAL PRACTICE CHECKLIST (Professional Doctorates)
	RESEARCHER RISK ASSESSMENT CHECKLIST (BSc/MSc/MA)
Appendix VII - worked example of analysis
Appendix VIII - XI -tables of part andstrophe titles
Appendix XII - reflexive research notes post viva amendments
                        
Document Text Contents
Page 1

A Narrative Study Exploring Survivor/Service-User Professionals' Accounts

of Sharing Personal Experiences at Work

Rowena Wasyliw

A thesis submitted in partial fulfilment of the requirements of the University of

East London for the Doctoral Degree in Clinical Psychology

November 2014

Word Count: 34,972

Page 2

ABSTRACT

Fighting for voice, equal rights and greater power has been central to the

survivor/service-user movement. 'User involvement' (UI) can be seen as a State

response to this. UI proliferates throughout policies but is neither routine nor

extensive. Limitations may relate to contradictions between assumptions/

practices underlying UI, and other dominant discourses constructing

survivors/service-users (especially with ‘psychosis’) as irrational, incapable and

dependent on ‘expert’ professionals. UI neglects survivor/service-user

professionals but limited research (Adame, 2011; Lindow & Rook-Matthews,

1998) suggests similarities with 'peer workers'. Aiming to understand the function

of UI, this research explored how survivor/service-user professionals negotiate

these different discourses, and to what effect, through asking: How and why do

mental health professionals who have experienced ‘psychosis’ share their

personal experiences in their work?

A social constructionist epistemology was employed, with a qualitative,

'unstructured' interview design. Four professionals working in the 'mental health'

system in England, who self-reported a label of 'psychosis', participated. Data

was analysed using a 'critical poetic breaks' (Emerson & Frosh, 2004) approach

to narrative analysis, which sits within Mishler's (1995) politics of narrative group

of models, working with 'narrative as praxis' (Mishler, 1999).

Different narrative forms storied: a precarious, chameleon-like position; the ability

to share changing over time; that being believed is key (and paradoxical); a

relationship between ‘crossed-roles’, power and safety.

A mirroring of the narratives and UI literature informs an understanding of UI,

'mental illness' and 'professional boundaries' discourses, functioning to maintain

power relations. Strategies of resistance are highlighted, with survivor discourse

key for constructing an alternative subjectivity. Recommendations are made for

research, policy, service planning/delivery, and education/training.

1

Page 97

There were differences between participants in whether these negative

assumptions motivated them to share or inhibiting them from sharing their 'mental

health' experiences. Laura positioned sharing as something she did with

colleagues to contest their negative construction of service-users (with whom she

did not deliberately share), using her identification as the denigrated ‘other’. Ian

reversed this; these negative constructions were a reason for not sharing with

colleagues but a reason for sharing with service-users, positioning himself

alongside them. Christine similarly narrated that she shared with service-user

colleagues to identify with them and provide hope. When directly constructed as

incompetent by non-service-user colleagues (e.g., being told not to do things by

her co-director), Christine contested this by ignoring such commands and

demonstrating her ability. For Bethany, negative constructions seemingly

underlay her wanting to detach herself from a 'mentally ill' position and the

'repulsion' she narrated when empathising with service-users.

Furthermore, Laura and Ian positioned these negative constructions as

preventing sharing or asserting a survivor/service-user position specifically when

having a ‘bad day’, and creating a need to present themselves as always 'strong'

and 'capable’. The potential for managers to use this discourse to coerce him into

'mental health' services again, was positioned by Ian as a barrier to asking for

(needed) support/flexibility. The prior establishment of Christine’s service-user

position would preclude the options taken by Laura and Ian. However, her ability

to 'ignore' attempts to control her were perhaps enabled by this, to some extent,

as well as by the power of her senior post.

These narratives suggest that the 'too incompetent-or-unrepresentative' catch-22

which prevents there being a 'suitable' service-user to involve (Felton & Stickley,

2004), is not just a mechanism for resisting involving survivors/service-users but

a strategy to prevent survivor/service-user workers constituting evidence that

challenges dominant discourse and power relations. This can be seen to operate

through disciplinary power (Foucault, 2003; 1997). Specifically, the structures that

enforce what is endorsed as 'professional practice' or 'fitness to practice',

particularly supervisory/management systems, provide 'surveillance' (McHoul &

96

Page 98

Grace, 1993) and sometimes direct control. In order to prevent this control and

their fitness to practice being challenged, participants narrated that they

monitored and governed their behaviour to present an image of ‘wellness’.

The ability of survivor/service-user workers to act as a 'model of hope' by sharing

their 'mental health' experiences with service-users, must surely be limited by

presenting an unrealistic (and, therefore, unattainable) image of 'wellness'. Thus,

this also prevents dominant 'mental illness' discourse being contested with those

subjugated in an 'ill' position, for whom such contention could offer an alternative,

more positive subjectivity. Furthermore, Bethany's 'repulsion' challenges

assumptions that 'empathy' is necessarily a positive influence in survivor/service-

user workers' relationship with service-users (e.g., Frese and Davis, 1997).

Finally, professional responsibilities and other institutional demands (e.g.,

Christine’s duty to ensure her team performed) limited participants' ability to act

from an empathic position, similarly to how these demands limited UI (e.g.,

Basset et al., 2007).

5.2.1.2 'Professional boundaries'

The ability to act as a 'model of hope' is further limited by a 'professional

boundaries' discourse (which subsumes 'self-disclosure') that inhibits survivor/

service-user workers from sharing their experience with service-users. This

discourse was used by Laura and Bethany to question the 'appropriateness' of

sharing with clients, although both also contested it. Ian presented it as

something which made sharing 'unsafe' and which had been used by his

university to prohibit students from disclosing their 'mental health' experiences

with service-users.

Laura presented numerous considerations from the self-disclosure literature to

justify not sharing, such as her motivation/intention, who it would benefit and

therapeutic effect (Henretty & Levitt, 2010; Knox & Hill, 2003). However, the

conclusion that these considerations should lead to non-disclosure was

presented ambivalently and contested. To some extent, this contention was part

of a dominant self-disclosure discourse as it involved arguments which are made

97

Page 194

do. They don't accept a damaging subjectivity as true, they resist it.

 Laura says these are problems anyone might experience and questions

the rightfulness of her supervisor checking up on her, she doesn't accept

this is 'illness' and such monitoring is valid. Christine ignores her co-

director when told not to do things and says in the interview even when ill,

people can still work, can still make their own decisions. Bethany refutes

my conclusion people make her doubt herself and says others doubt her

and attribute everything as illness – she presents her view as real. And Ian

claims the right to make his own decisions, to keep control and presents

the response of others as putting people in mad boxes.

 None of this is accepting subjugation. And they all contest the arguments

against self-disclosure, whether they feel able to share or not. There is so

much resistance! They seem to appreciate what it has taken me this long

to realise, which is that there are more subtle, subversive ways to affect

change. And it starts with constructing ourselves from a different

discourse, claiming a different, more empowering subjectivity. I'm surprised

I didn't see this sooner, it's what I've done!

 It's interesting to see how much the order of the interviews seem to mirror

my journey through placements, although this might just be what I've

connected with, the placements making salient particular things in the

narratives and probably overlooking other things.

 But then, there must have been an effect of the interviews, of hearing their

stories, that then influenced how I was understanding my work and what I

was connecting with there.

 Interactive feedback loops between a number of different aspects, all

coming together to form the context within which this research (and my life

over the last 4 years) has been conducted, and which must be considered

when judging the coherency of what has been produced.

 In a way, I feel like I've come full-circle (although, to end up at a different

place, so maybe it's a circle in a spiral!)

193

Page 195

 I started at the point of how to be a survivor worker, how to use

experiences to change the system and, through a journey back to the

beginning of the experiences that drove me mad, being a service-user,

feeling broken and despairing, then wanting to use this to make a

difference by becoming a professional.

 It's been a crazy journey but along the way I have picked up many other

stories that have given new ways to think about things, new strategies,

new hope. And I feel ready and eager to take this forward!

194

Similer Documents