Do clinical psychologists working in early psychosis connect clients’ experiences of trauma with current presentation and does this inform therapy processes?

Introduction: Trauma and adversity are recognised as important risk factors for the development of psychosis. Clinicians should assess clients’ trauma histories and address this appropriately, as recommended in recent National Institute for Health and Care Excellence (NICE) guidelines for psychosis. However, it is unclear how commonly clinical psychologists working in early psychosis assess trauma-related factors, how they make sense of potential links with clients’ experiences, and how this impacts on therapy processes. Method: Eleven qualified clinical psychologists were recruited from seven National Health Service (NHS) Early Intervention Psychosis (EIP) services. The study adopted an individual vignette-semi-structured telephone interview approach to elicit relevant aspects of participants’ understanding and approaches. Interviews were transcribed and analysed using content analysis and thematic analysis techniques. Responses explicitly relating to ‘severe adversity, abuse, and trauma’ were coded using the abbreviation ‘AAT’. Analysis led to the formation of a conceptual map, displaying relationships between important codes and themes. Results: Assessment procedures were both collaborative and client-led. Participants commonly acknowledged AAT-related factors; however, multiple factors not explicitly related to AAT were also highlighted. Participants commonly worked with wider issues of distress, beyond ‘psychosis’. Indirect roles of AAT were commonly identified, particularly in making sense of schematic development and later impacts on distressing experiences. Mechanisms underlying AAT-psychosis links were largely unclear. Cognitive Behavioural Therapy (CBT) models were the most commonly cited theoretical and intervention-based approach; links between AAT and psychosis, and wider distress, were commonly addressed through collaborative sense-making processes of joint formulation. However, participants discussed the need for appropriate timing, client willingness, and the role of clinical judgement. There was some limited evidence of direct AAT-processing based interventions. Overall, however, the data were suggestive of heterogeneous conceptualisations of psychosis and wider distress, and varied approaches to clinical intervention. Discussion: Findings were examined in relation to existing research literature. While AAT was one key factor, among others, links with psychosis were clearly complex in practice. Participants appeared to operate within a more heterogeneous world than researchers may sometimes be willing to promote. Following exploration of study limitations, the theoretical and clinical implications are outlined, and finally topics for future research.