Super-Ordinate Theme 4: Positive Outcomes

The fourth major theme to emerge was that of positive outcomes from the psychological therapy and support work provided. This came from all three groups of participants and was found within all five separate triads. There was a clear agreement amongst all participants interviewed, about the importance and usefulness of empowerment as facilitated by psychological therapy, for PWLD, most of whom agreed that they felt better about

themselves and more confident as a result of the therapy sessions. Perhaps as expected, given the non-concrete nature of the notion of empowerment, the therapists and support workers were more able to clearly articulate their opinions about the importance of empowerment.

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4.1.4.1 Sub-theme 4.1 - Positive, empowering, outcomes experienced from therapy.

As a result of their therapy sessions and the interventions involved, the PWLD generally spoke about experiencing very positive, empowering changes in their lives, which were categorised as follows: i) general and more specific improvements, ii) gratitude and appreciation for the therapy; iii) sometimes however it was a struggle to perceive positive changes.

In terms of making improvements, the clients interviewed explained these in both general and more specific descriptions. Edward for instance, gave general feedback about some of the improvements in his life: “he’s keeping me on an even balance…” (Edward – PWLD - Triad 3 - 4.115); Jacky similarly gave examples of her improvements, such as: “I never used to walk to the shops on me own…I never used to come down here on me own…But I do now” (8.211). She was also able to specify changes in hearing voices, which had previously been more of a problem for her prior to working with Nichole: “I still hear things, but I know they’re not there” (8.216).

Sid was able to explain that Eve had helped him in terms of overcoming his persistent negative thoughts: “I think it’s just talking and relaxing and keeping my mind away from … from my thoughts” (Sid – PWLD - Triad 1 - 3.88). He also spoke about participating in new activities and feeling proud about achievements since engaging in the therapy sessions, “I feel… I can do things more… And I’ve passed my chain-saw course, so that’s made me feel better” (6.159). Abbey also described in some detail her feelings of personal improvements as a result of the therapy with Penny, “It’s really helped… made me release

everything...realise what I couldn’t see, and I felt so weak… I just didn’t know what to do and now I feel so much more stronger –“ (Abbey – PWLD - Triad 4 - 4.101). With a clear link

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here to empowerment, Abbey added, “But now I’m stepping up to the mark and doing more things, realising things” (3.74).

Gratitude and appreciation for the therapy was evident and in abundance with most of the clients interviewed, such as Edward’s warm description of Tim’s input in his life: “and Tim…

mainly broke the ice really… and helped me to get through it actually… and I’m a better person… to this day, thanks to him…” (Edward – PWLD - Triad 3 - 4.105). Abbey also expressed effusive appreciation of the help she had received from Penny: “Definitely, definitely, it’s really helped me” (3.69) which she reinforced with, “If anything, it’s really helped – it’s really helped me move on –“ (5.114).

Sometimes however, it was a struggle to perceive positive changes. This was the

experience of Neil, who declared, “No amount of therapy sessions is going to make me like the neighbours” (Neil – PWLD - Triad 5 - 10.262). Nevertheless, Neil was able to distinguish between difficult life experiences and his own increased capabilities in coping with them: “I’d say since the earlier sessions, my life has got more difficult… The difference is how I’m dealing with things” (4.105). Neil also explained, “I still get very – sort of pissed off, about life in general… But I don’t tend to feel so much – depressed, about in general” (7.178). So even Neil’s initial reluctance to admit positives could not conceal some of the improvements evident as a result of the therapeutic and supportive influences he had experienced with Janice and Paul.

Interestingly, all client participants also expressed warmth, appreciation and agreement to having an empowering focus in their lives, apart from Neil, who pointed out that sometimes empowerment can have its drawbacks: “It’s very boring, ‘cos all I seem to do is sit around in the flat all day!” (6.170). This highlights that for some PWLD, empowerment and

self-determination is not enough; they may also need support and encouragement to plan

activities and meaningful occupation. This may sometimes be linked to a lack of engagement

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in meaningful activities, which further reinforces the importance of appropriate support for PWLD.

4.1.4.2 Sub-theme 4.2 - Therapeutic approach used and presenting problem affected type of empowering outcome

The therapeutic approaches used by each of the therapists involved are included in the therapist table in Appendix F. This is in addition to the other participant background

information and reasons that referrals had been made for the clients to access psychological services. There was some suggestion of an evidence of empowerment operating differently, based upon firstly the approach used by the facilitator, as well as secondly, the presenting problem necessitating therapeutic intervention.

As mentioned, the therapeutic approaches of the therapists varied considerably, although most tended to utilise more than one model, as summarised here for example: “yes it was quite a mixture of different approaches really.” (T -Nichole 3.83). However, it was generally found that when humanistic-orientated models were used for self-esteem related problems, the kind of empowering outcome to emerge tended to show an increase in confidence, a more relaxed attitude towards their lives and an ability to be more self-reliant. A rationale behind choice of approach in such circumstances was described by therapist 1 Eve: “I thought from the start that I had in my mind, from the referral information… that working in a compassion-focussed, therapeutic model, would be helpful given his presentation, mood and his history, and as I met him over the first few sessions it was apparent that that did seem a good way of working with him” (T -Eve 1.23). Client 1 Sid’s improvements were also

reflected an increase in personal empowerment as he spoke about enjoying his work placement again and was starting to interact more socially, as well as achieving the goals described in earlier themes.

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Client responses towards their therapists appeared more trusting, (linked to super-ordinate theme 2) when focussed attention was particularly paid to the relationship dynamics

between the receiver and provider of the therapy. This also links again to the importance of the therapeutic relationship. When cognitive-orientated and skills-specific plans were applied, the PWLD showed improvements in their coherent patterns of thinking and behaving, able to articulate more clearly information about the goals they had achieved or targets they had been able to work towards, due to following a very structured programme.

Nichole discussed her use of specific approaches for particular problems: “we used some neuro-linguistic programming, to do with some of the past traumas... And I used some energy therapies as well, to help decrease her state of arousal” (T – Nichole 3.83).

Secondly, and possibly more convincingly, the type of presenting problem affected the nature of the empowering outcome, as those clients wanting to work with issues relating to how they felt about themselves and to process painful past memories, were keen to communicate these intentions to their therapist and possibly most willing to engage in the therapeutic process. Initial motivation, intentions to overcome emotional challenges, as well as an ability to communicate with their supporters, appeared helpful in terms of successful outcomes of therapy. Clients such as Edward and Neil, who were referred for psychological therapy due to behavioural problems and significant displays of anger, required longer to make noticeable improvements, especially where they had experienced difficulty with accessing or exploring their emotions at the onset of the therapy.

Similarly, some clients responded angrily at first to therapeutic challenge, although all were fortunately able to work through difficulties with committed therapists and support workers as well as benefitting from extended periods of therapeutic involvement. Therapist 3 Tim

described the Gestallt approach being useful for such challenge, having already built up a firm foundation using a Centred Approach: “initially, on the onset I chose Person-Centred, Rogerian – primarily to build up the sort of therapeutic relationship between us…

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Which were great for the foundations you know… And then I brought into it... Gestallt, Fritz Perls… and that were to help me with the therapeutic challenge” (T -Tim 3.108). Tim’s client Edward spoke enthusiastically about the therapy, so they had clearly worked through any difficulties encountered earlier in the therapy.