'Doing fence-sitting': a discursive analysis of clinical psychologists' constructions of mental health and its impact on service-users

Lofgren, Axel (2013) 'Doing fence-sitting': a discursive analysis of clinical psychologists' constructions of mental health and its impact on service-users. DClinPsy thesis, University of Nottingham.

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Introduction: The notion of mental health has been used to designate a range of concepts and a great deal of controversy surrounds discussions about the meaning of the construct. Despite its elusive nature, there is a growing body of research indicating that the ways in which healthcare professionals conceptualise mental health may have important clinical implications. It is argued that the quantitative methodologies employed by previous studies have not been able to capture the complexity of healthcare professionals’ accounts.

Objective: This study aimed to explore clinical psychologists’ accounts of mental health and its effects by using a qualitative methodology sensitive to the performative, variable and contextual aspects of discourse.

Design: A discursive psychological approach was taken in the analysis of data from semi-structured interviews.

Method: Data was collected from eleven interviews conducted with clinical psychologists in the East Midlands region of the UK.

Results: The findings demonstrated a wide range of constructions of mental health available to clinical psychologists, implying that their accounts are considerably more complex and flexible than previous quantitative studies have outlined. The study demonstrated how clinical psychologists use various discursive strategies to construct their accounts as credible and to manage issues of accountability. Clinical psychologists who constructed mental health in realist terms tended to draw on a biopsychosocial framework and employ discursive strategies such as case examples and stake inoculation to present their accounts as factual. Those who viewed mental health as a social construction focussed on the language associated with mental health and the implications of using this. This functioned to warrant a political analysis and to create a rationale for introducing alternative views of mental health. Participants drew on a discourse of moral concern for clients in considering the effects of their ideas about mental health on their clinical work thus allowing clinical psychologists’ talk to be viewed from a moral framework where accountability could be managed within interactions.

Discussion: The study offers a novel approach to the exploration of mental health, highlighting the various difficulties that clinical psychologists face in negotiating this concept and its effects. The constructs and discursive strategies drawn on by clinical psychologists in this research were consistent with past discursively informed studies, showing a cross-topic relevance by demonstrating how clinicians rely on particular rhetorical devices to ‘get things done’ in verbal interactions. The results of this study suggests that there is a need for clinicians to be honest about the contingent and situated nature of their language and knowledge and to be mindful of the effects of their use of language on different stakeholders in talking about mental health. Clearly, if clinicians are not open about such issues there is a risk of service-users passively complying with a process that they do not understand or feel they benefit from, thereby ethically compromising clinical psychologists’ practice.

Item Type: Thesis (University of Nottingham only) (DClinPsy)
Supervisors: das Nair, R.
Hewitt, V.
Keywords: Clinical psychologist, Healthcare professionals, Mental health, Mental illness, Constructions, Conceptualisations, Discourse analysis, Discursive psychology
Subjects: W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools: UK Campuses > Faculty of Social Sciences, Law and Education > Institute of Work, Health and Organisations
UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 13655
Depositing User: EP, Services
Date Deposited: 13 Feb 2014 10:13
Last Modified: 15 Dec 2017 22:48
URI: https://eprints.nottingham.ac.uk/id/eprint/13655

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