Non-engagement in psychosis: a narrative analysis of service-users’ experiences of relationships with mental health services

Introduction: Non-engagement with treatment is a familiar problem for health services and has been identified as a particularly important issue for those who experience psychosis. The therapeutic relationship between service-users and clinicians is considered to be crucial to good engagement. The extent to which requirements of engagement with treatments and mental health services represent a threat to the individual’s autonomy is a potential factor in non-engagement. Reactance theory has attempted to explain this phenomenon. However, relationships are complex and reactance theory does not reflect this. The exploration of narratives is an opportunity to develop an understanding of the intricacies of these therapeutic relationships. Methods : Interviews were conducted with 11 participants who were recovering from an episode of psychosis. Narrative Analysis of the transcripts was undertaken. During the process interpretation of the transcripts required the introduction of Dialogical Self Theory. Results: Three self-positions were identified through which participant’s narrated their experiences. Defiant, Subordinate and Reflective-Conciliatory positions were described. Discussion: Narratives surrounding recovery and engagement with services can appear complex, contradictory and fragmented. They are narrated by different self-positions. This understanding of the complexity of narratives may be helpful in guiding clinicians in maintaining a wider awareness of the multidimensional nature of individuals’ understandings of their experiences of recovery and relationships with services