This blogpost is a repost of something I wrote for the TRP Collaborative, a new intiative started by Nev Jones, Ph.D. to increase service-user/stakeholder involvement in research on psychosis. The TRP Collaborative is a mix of people with lived experience, researchers, academics, activists, and clinicans (plus many members overlap in each catagory). The post I am sharing now is an opinion piece (from my perspective as a therapist) on the need to increase service-user involvement in the development of psychotheraputic practices and techniques in the treatment of psychosis. Check it out and also be sure to visit the TRP Collaborative website for other interesting blog posts on participatory research.
During the early days of psychotherapy, a clinician’s understanding of the therapeutic process was closely associated with personal experience. With the influence of psychoanalysis came an expectation that clinicians should undertake their own therapy. You had to be a patient in order to be a therapist, and it was assumed that you could not adequately understand the psychotherapeutic process without first having been a patient yourself. In this way, knowledge about treatment was primarily derived from a lived-experience perspective. Although it is easy to eschew psychoanalysis for reductive or distancing language (at least in its more classical iterations), it should not be forgotten that the psychoanalytic approach has always been grounded within a framework that sought not differentiate between oneself and one’s patients. All were seen as prone to the same intrapsychic conflict(s) and “common unhappiness” (Freud, 1895).
With institutional pressures forcing the pursuit of “evidence-based” research to determine psychotherapeutic “efficacy,” a radical shift has occurred— no longer is the scientist’s subjective experience considered worthy of serious attention. Instead, research is thought legitimate only when one upholds a (seemingly) objective stance. In turn, the individual participants or “stake-holders” of psychotherapy treatments are no longer active participants within the research and development of therapies. Instead, research is conducted primarily by outside observers and based on targeted outcomes created by third-parties. Although there has been some shift in in recent years, for example, with research into peer-support groups such as the Hearing Voices Network, the extent to which the experience of service-users now influences clinical practice is limited. When participating in research, peer perspectives are often ‘justified’ through a clinical framework, as opposed to clinical frameworks being influenced (or justified) by peer perspectives.
My interest in the TRP Collaborative is to bring back the role of stake-holders/service-users in the development of psychotherapeutic treatments/approaches. As a clinical psychology trainee and therapist, I am particularly interested in how therapy is experienced by those who attend it; what their ideas are for how we can improve it; and what outcomes they personally find meaningful. The TRP Collaborative is one place where this type of dialogue can begin to develop. Together, I look forward to seeing what shifts we can bring to psychotherapy research and practice.