Shifts in subjectivity during the therapy for psychosis.

Abstract

This paper examines the process of therapy with families in which a member has a diagnosis of psychosis. On a methodological level, the study aims to demonstrate the usefulness of discourse analysis as a method for analysing texts produced in therapy in the context of process research. On a clinical and theoretical level, it aims to contribute to the literature that approaches psychosis and its treatment from the viewpoint of narrative and discourse. Several contemporary conceptualizations emphasize the role of discursive processes, such as a collapse of meaning and narrative and an alienation from shared communicative practices, in psychosis. Drawing from this perspective, discourse analysis was used on family therapy session transcripts to empirically examine these processes. Moreover, given that in different conceptualizations psychosis is seen to entail a profound disturbance to the person's sense of self, the analysis focuses more specifically on the identified patients' subjectivity. Seven sessions were analysed, drawn from the beginning, middle, and end phases of two therapies with families with a member with a diagnosis of psychosis. Discourse analysis was used and the analysis focused on the transformation of meaning and more specifically on shifts in the subject positions occupied by the identified patient in the clinical dialogue. With regards to the identified patients' subjectivity, the analysis suggests that (a) psychosis was associated with the 'patient' being rigidly positioned exclusively through the psychiatric discourse in the first case and the lack of a voice in the second, and (b) that therapeutic change was associated with increased flexibility in the subject positions that the identified patient occupied in the first case and with the emergence of a personal and reflective voice in the second. The findings in this study suggest that an important aspect in clinical work with families with a member with a diagnosis of psychosis relates to de-centring the dominant, pathology maintaining accounts and to the emergence of a wider range of less problematic explanatory frames.