A discourse analysis of how participants in a final family therapy session negotiate their understanding of the therapy process and its outcome

Introduction: Meaning making has been shown to be beneficial to family wellbeing and has been explored in terms of problem construction at the beginning of therapy. However, there have been no studies which have looked at how meaning of change is negotiated at the end of family therapy. The final session is a pivotal point for these meanings to be discussed and these will be the understandings that the family take with them after therapy. This thesis aims to address this gap in the literature base by exploring how the participants in a final family therapy session negotiate their understanding of the therapy process and its outcome. Method: Video recordings of six final family therapy sessions were analysed using a discursive psychology method. The data were selected from a pre-existing database from the Self Harm in Family Therapy (SHIFT) trial, which studied family therapy for adolescents who self-harm. Each transcript was analysed using a protocol based on the guiding principles of discursive psychology and then extracts were selected as significant examples of how the therapy process and outcomes were discussed in the session. Results: The analysis found that the outcomes of therapy that were constructed were; increased family resilience and functioning, changes in problem meaning and a reduction in stress. Two interpretative repertoires were drawn upon for constructing agency in the therapy process; change comes from the family system and change comes from the therapists and the therapy forum. This analysis found that of the six families, four worked collaboratively together to develop a shared understanding of the therapy and two families resisted the therapeutic process and a shared understanding did not appear to have been reached. Discussion: Different actions were taken by the various stakeholders in the session, which seemed to either support or hinder the shared meaning making process at the end of therapy. The therapists supported the collaborative process by attempting to maintain alliances through neutrality, empowering individuals as well as the family as a whole and by fostering ‘realistic’ hope for the future. The parents, as well as the therapists, acknowledged the developmental stage of the young person and this appeared to have different outcomes based on the young person’s perspective on this. Finally, the young people seemed to take one of two courses of action in the final session; either to participate in the session and collaborate with the others in the room or they took the action of protesting and not engaging with the session