Marius Veseth

Toward Caring for Oneself in a Life of Intense Ups and Downs: A Reflexive-Collaborative Exploration of Recovery in Bipolar Disorder

In this article, we discuss processes of recovery in bipolar disorder. We utilized a hermeneutical-phenomenological approach developed within a reflexive-collaborative framework to examine what individuals do to promote improvement and positive change in their own lives. The study was designed and carried out in collaboration with an expert-by-experience group of 12 coresearchers with firsthand experiences of mental distress and recovery. In-depth interviews were conducted with 13 participants who acknowledged having lived and dealt with a bipolar disorder. Four core themes were drawn from our analysis: (a) handling ambivalence about letting go of manic states; (b) finding something to hang on to when the world is spinning around; (c) becoming aware of signals from self and others; and (d) finding ways of caring for oneself. Interrelationships between the four themes, along with limitations, strengths, and implications of the study are discussed.

Negotiating the coresearcher mandate - service users' experiences of doing collaborative research on mental health

Purpose: Traditionally, the voices of service users have been silent in research into mental health issues. A Norwegian research network, however, recognizes the importance of involving service users as coresearchers and initiated a training program in research methodology and design intended to empower them as active participants in research projects. In this article, we explore how these coresearchers with a mental health service user background experience their participation in projects as well as in attending the training: What is it like being a service user coresearcher in collaborative studies on issues in mental health? How do coresearchers negotiate their roles and mandate? Method: We used focus groups as our data collection method, transcribed the group discussions verbatim, and analyzed the transcriptions using qualitative methodology. We then took the preliminary analyses back to the participants for discussion, auditing, and reanalysis. Results: We identified themes that represent important social processes around which the participants developed a consensual understanding: self-definition, constructive differentiation and negotiations. Conclusion: Our findings generate hypotheses on how participatory research into mental health issues can be fruitfully organized, in a way that empowers service users to active and constructive participation. Implications for Rehabilitation Participatory research on issues in mental health holds potential for empowering service users. Collaborating with service users in research puts weight on the lived experiences of mental distress and on the expertise of the first person perspective. Organizing a formal training and peer group context in this kind of research can contribute to the service user coresearchers process of defining their own mandate in the research process as well as to help them constructively differentiate themselves from the roles of other researchers.

How to Enhance the Quality of Mental Health Research: Service Users’ Experiences of Their Potential Contributions Through Collaborative Methods

The voices of service users are often silent in mental health research issues. A Norwegian mental health research organization, however, recognizes the importance of involving service users as coresearchers, and it has initiated a training program in research design and methodology intended to empower them as active participants in research projects. In this study, we use qualitative methods to explore how coresearchers with mental health service user background experience their participation as coresearchers and how they experienced attending an academic training program in research methodology. We invited 12 coresearchers with service user background to be participants in the study. We used focus groups as our data collection method, transcribed the group discussions verbatim, and analyzed the transcriptions using qualitative methodology. We then took the preliminary analyses back to the participants for discussion, auditing, and reanalysis. We identified three core themes that represent important coresearcher functions around which the participants developed a consensual understanding: the advocate for usefulness, the brakeman, and the interpreter. There is increasing political will to involve service users in research. Our findings explore how the service user coresearchers experience their potential functions and quality enhancing contributions after having taken part both in a research training course and actual research projects.

The role of work in recovery from bipolar disorders

Being in recovery from bipolar disorder involves work-related concerns. The specific aims of this study are to: 1) understand the role of work in recovery from bipolar disorders, and 2) understand how people with such disorders deal with work-related challenges. These topics are examined from the stance of the recovery process, in which work-related activities were explored. Semi-structured, qualitative interviews were conducted with persons who had experienced recovery from bipolar disorder. Analysis was performed through thematic and phenomenological analysis, with hermeneutic phenomenology and reflexive methodology as a framework. The findings are presented through the following themes: 1) many types of work – finding meaning and a focus; 2) helpful roles and contexts – to be much more than a person with an illness; 3) making work possible – the role of supportive relationships and supportive medications, and 4) the costs of working too much – finding a meaningful and healthy balance.

This is what I need a clinical feedback system to do for me: A qualitative inquiry into therapists’ and patients’ perspectives

Abstract Routine outcome monitoring and clinical feedback systems (ROM/CFSs) are promising methods of providing naturalistic research data and enhancing mental health care. However, implementation in routine care is challenging, and we need more knowledge about clinicians’ and patients’ needs from such systems. Objective: We aimed to study perspectives of clinicians and patients to explore how ROM/CFS can be helpful and acceptable to them. Method: We interviewed 55 participants in focus groups and individual interviews and analyzed the data through rigorous team-based qualitative analyses. Results: We report 3 overarching domains: (a) Shared needs, (b) Specific patient needs, and (c) Specific therapist needs. Shared needs, in which perspectives of different stakeholders converge, was the dominant domain in the material. Under each domain, we report 3 specific themes: (a1) Degree of trust in therapy, (a2) Allowing for openness, (a3) Monitoring joint objectives; (b1) Life functioning, (b2) Canary in the coal mine, (b3) Holistic report; and (c1) Emotional presence and style, (c2) Monitoring risk and symptoms, and (c3) Agency and ownership of process. Conclusions: In what should increase our confidence toward core aspects of ROM, we suggest that an integration of relational feedback concepts and stringent clinical dimension tracking into the ROM/CFS can be beneficial.

How Do People Experience Early Intervention Services for Psychosis? A Meta-Synthesis:

We conducted a study to explore how people diagnosed with first-episode psychosis experienced their contact with early intervention services for psychosis and the way these experiences relate to their recovery processes. Our aim was to integrate and describe the service users’ experiences in a rigorous and comprehensive way. A broad literature search was performed in June and July 2016. After screening, 17 qualitative studies were included. We analyzed the findings in two main steps: (a) translating studies into one another and (b) synthesizing the findings from the studies. Through these interpretative processes, we found five new and overarching themes: (a) something is wrong, (b) do for myself, (c) it’s about people, (d) a price to pay, and (e) ongoing vulnerability. We describe these themes as a process that service users’ maneuver through in their contact with the services. Our findings are discussed in light of relevant research.

What are “good outcomes” in public mental health settings? A qualitative exploration of clients’ and therapists’ experiences

BackgroundThe mental health field sees a surge of interest in Routine Outcome Monitoring, mandated by a wish to help better those not-on-track to recovery. What constitutes positive outcomes for these patients is not fully understood.AimsTo contribute knowledge into what constitutes meaningful outcome concepts in the experiences of patients with long and complex mental health suffering and treatment, and the clinicians who work to help them.MethodsA qualitative in-depth study of 50 participants’ experiences. Data are collected through focus groups and individual interviews, and analyzed using a team based structured thematic analytic approach.ResultsWe found an overarching theme of outcome as an ongoing process of recovery, with the four constituent themes: (1) strengthening approach patterns for new coping; (2) embodying change reflected by others; (3) using new understandings developed in dialogue; and (4) integrating collaborative acceptance.ConclusionsWe discuss our findings in light of existing empirical studies and different recovery concepts, and suggest that if outcomes monitoring is to become an integral part of routine practice, it might be beneficial to integrate an understanding of outcomes as ongoing processes of recovery within mental health suffering into these systems.

The central role of self-agency in clinical recovery from first episode psychosis

Abstract Purpose: While there is accumulating evidence for clinical recovery in a significant proportion of people experiencing a first episode psychosis, the mechanisms facilitating this form of recovery are less well known. Thus, the aim of this study is to investigate mechanisms of recovery after a first-episode psychosis as perceived by clinically recovered service users. Methods: Thematic analytic approach within an interpretative–phenomenological framework. Twenty clinically recovered service users were interviewed. Analysis followed an established meaning condensation procedure. Results: Main theme: Establishment of subjective self-agency. Subordinate themes: (1) Environmental support and gentle pressure, (2) Individually tailored assistance, (3) Antipsychotic medication: relinquishing personal responsibility, and considerable side effects. Conclusions: We suggest that an increase in sense of personal agency is a core mechanism driving recovery for participants in the study sample. Findings indicate that interventions aiming to boost subjective and behavioral agency in service users might be of great benefit, particularly in combating negative symptoms of psychosis.

Collaborating to stay open and aware: Service user involvement in mental health research as an aid in reflexivity

Abstract Research collaboration with people with first-hand knowledge of mental distress and recovery processes has been argued to hold potential of making studies more relevant and more rigorous. There is, however, less awareness of how service user involvement can increase reflexivity in research, which is another important component to evaluating the quality of studies. In this conceptual analysis, we explore our experiences of doing collaborative research and discuss these in relation to the concept of reflexivity. We argue that both in planning investigations, collecting the material as well as in data analytic phases, partnering up with service users can be a valuable way to stay open and aware in the process of conducting qualitative studies on issues in mental health. We identify reflexivity as a possible benefit of service user involvement in research and as crucial for actualizing the full potential of such research collaborations.

“With a little help from my friends” social predictors of clinical recovery in first-episode psychosis

Social functioning is a conglomerate of factors central to clinical recovery after a first-episode psychosis. There is a lack of studies investigating the relative impact of factors related to social interaction. Disentangling these could facilitate improvement of psychosocial interventions. This study aims to investigate the impact of social interactions on two-year clinical recovery in first-episode psychosis, by examining frequency and satisfaction of relationships with family and friends. A baseline sample of 178 first-episode psychosis individuals were followed up over two years regarding social functioning and clinical status. We longitudinally compared those who were to those who were not recovered using generalized estimating equations analyses. Our results showed that frequency of social interactions with friends was a significant positive predictor of clinical recovery over a two-year period. Perceived satisfaction with relationships, and frequency of family interaction did not show significant effects. We conclude that interaction with friends is a malleable factor that could be targeted for early intervention. This would facilitate protective factors through the preservation of existing social networks and thus reduce the risk of disability associated with long-term psychosis. Findings indicate that even individuals with an inclination towards social withdrawal and isolation could benefit from this type of intervention.