The importance of practitioner and client accounts of context in mental health

With no accepted definition, conceptualisations of ‘context’ can range from considering relationships or material circumstances to the impact of wider socio-political factors and an individual’s place in society. Substantial evidence of the potential harms of contextual difficulties across all of these levels exists, whether difficulties in relationships, the impact of living in poverty or belonging to a group which society stigmatises. This thesis aimed to explore personal accounts of the importance of context, including individual experiences with contextual difficulties and the experiences of professionals hoping to understand and intervene with such difficulties. The example of stigma towards people who inject heroin is the subject of the literature review, aiming to synthesise qualitative research of individuals’ accounts of stigma experiences. This meta-ethnography produced four themes: 1) The impact of stigma: Outcast, escape and concealment; 2) I’m an addict – not a junkie: Inter-group stigma; 3) Multiple identities: Layering stigma or positive alternatives? and 4) Perpetuating stigma: From institutions to internalisation. These findings contribute a richer understanding of the complex, individual experiences of stigma and provide an example of how contextual influences can range from stigma experienced from family to the importance of institutional and societal level stigma. In acknowledgement of the impact of contextual difficulties on mental health, the research paper explored how context is understood and addressed in clinical practice by psychologists. A thematic analysis of interviews with eight clinical psychologists produced four themes: 1: The need to justify working with context; 2: The need to work with context beyond the therapy room; 3: “My context is their context”: Influences on the ability to work with context; and 4: Sources of validation for working with context. The findings revealed a desire to work with context and examples of successes but also the potential for significant barriers. Finally, the critical appraisal discusses implications of the dominance of the medical model as a barrier to both research and practice involving context, suggestions for clinical psychology training and a reflective account of completing the thesis