Abstract
Background
A recent narrative review of the research literature (Ben-David & Kealy, 2019) found that identity-related concerns were an important aspect of young people’s experiences in the early stages of psychosis. Themes across articles suggested that the emergence of psychosis leads to identity disruption, which in turn may contribute to additional mental health risks. Moreover, studies indicated the salience to young people of addressing personal identity during the recovery process. Understanding clinicians’ perspectives on issues related to identity in early psychosis is an important next step, particularly to determine needs for knowledge development, clinician support, and intervention practices. The current literature on clinician’s perspective on early psychosis and identity is limited, with more attention placed on clinician’s perspectives on the use of medication, and psychosocial interventions (e.g. cognitive behavioral therapy (CBT)). The purpose of the present study was to understand the perspectives of early psychosis intervention (EPI) clinicians on identity related concerns among young people in the early stages of psychosis.
Methods
An online questionnaire was distributed to 331 EPI clinicians in the province of British Columbia, Canada. Participants were asked about their opinions on identity in the early stages of psychosis using fixed and open response questions. The open-ended response question “what kinds of interventions do you think would strengthen clients’ personal identity in the early stages of psychosis?” was coded by two investigators, using content analysis methodology.
Results
The response rate was 30%. Of the participants, 98% agreed that personal identity is an important issue for clinical attention among young people in the early stages of psychosis, and 99% agreed that schizophrenia spectrum disorders can have a negative impact on a young person’s identity. Despite near-unanimous acknowledgement of identity as a critical issue in early psychosis, only 53% of clinicians endorsed a high level of confidence in their ability to address issues related to identity in treatment, and only 28% agreed that current intervention practices adequately address personal identity. Seventy-four percent of the participants provided qualitative responses regarding intervention approaches that they believed would strengthen clients’ personal identity in the early stages of psychosis. Common themes included social connection and peer support, therapeutic interventions (e.g. CBT, mindfulness, narrative therapy, psychoeducation), focusing on the youths strengths, involving family in the work, connecting youth to personal identity (e.g. exploring culture, values, interests and sources of meaning, storytelling), and enhancing relationships between service providers and youth.
Discussion
EPI clinicians in British Columbia agree that personal identity in the early stages of psychosis is an important issue. However, they indicated feeling markedly less confident in their ability to address issues related to identity in treatment. Findings suggest that EPI programs should invest in identity- related training for clinicians. Future research can focus on the impact of identity-related interventions with regard to treatment engagement and client recovery outcomes.
The Disjuncture between Medication Adherence and Recovery-centered Principles in Early Psychosis Intervention: An Institutional Ethnography
