title: Conceptualizing the therapist's role in therapy in psychosis.
abstract: OBJECTIVE
  This paper reports on a subset of findings from a wider ranging grounded theory analysis of therapy and recovery processes in psychosis. It describes therapist activities involved in maintaining an observational perspective during therapy and the links between these and other therapist activities.
  
  
  METHODS
  Grounded theory was used to examine the qualitative data collected.
  
  
  METHODS
  An initial sample of 19 taped therapy sessions and 23 interviews with psychologists and their clients was collected. This sample was extended through the collection of three further interviews with psychoanalytically aware psychologists. The data were analysed using grounded theory.
  
  
  RESULTS
  A grounded theory model of therapy processes in psychosis was developed that conceptualized therapist actions as providing an observational scaffold to support the client's efforts in moving to new perspectives on their situation. Consistent with the understanding of the core therapy activity as a dialogical process, this set of therapist actions was understood as occurring alongside other therapist activities involved in managing emotion and building a relationship in therapy.
  
  
  CONCLUSIONS
  The central activity of therapy in psychosis was understood as a dialogical process continuously negotiated between therapist and client in conversation and was conceptually summarized in the grounded theory as 'building bridges to observational perspectives'. However, the active and strategic efforts of psychologists to sustain the dialogue implied a particular assumption of responsibility for maintaining this process. In particular, therapists appeared to be 'working to maintain observational perspectives', 'managing emotion', and 'doing relationship' during the therapy conversation as part of the joint effort with clients to build bridges to new observational perspectives on distress and psychosis.
authors: South London & Maudsley NHS Foundation Trust, London, UK. sarah.dilks@slam.nhs.uk
authors: Sarah
authors: S
authors: Dilks
authors: Fiona
authors: F
authors: Tasker
authors: Bernadette
authors: B
authors: Wren
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D019370:Observation; D024382:Professional Role; D011369:Professional-Patient Relations; D011582:Psychological Theory; D013811:Psychotherapeutic Processes; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D036301:Qualitative Research; D013222:State Medicine; D006113:United Kingdom