Chief Complaint Orientated Cognitive Behavioural Therapy for Psychosis in Conditions of High Security: An Organisational Case Analysis.

Introduction.

Chief complaint orientated CBTp (C-Co) is a high secure (HS), context specific variant of individual Cognitive Behavioural Therapy for psychosis (CBTp) developed from the researcher’s academic studies and own experience of psychosis. This research analysed the impact of C-Co on typically non-adherent, treatment resistant HS patients and on non-accredited C-Co nurse practitioners.

Methods.

A feminist facet-based methodological framework was adopted. A multi-component organisational case analysis of routinely gathered data, comprising eight discrete, innovative, award-winning research studies, was used to determine C-Co impact. A reflexive autoethnography of the researcher’s first psychiatric assessment provided transparency. Modality fidelity and praxis competency were assessed to attribute causality. Descriptive single case analysis (n=1) provided an in-depth description of C-Co application. Group game development was used to consolidate and explore patient and practitioner experiences (n=15). A thematic analysis of supervision transcripts researched C-Co impact on practitioners (n=6). An exploratory, quasi-experimental, statistical analysis of repeat measures data was used to determine C-Co impact on patients (n=11). Descriptive analysis and statistics were used to determine dissemination strategy impact (n=22). Finally, a summative synthesis via triangulation was used to determine component convergent validity.

Results.

A high level of component convergent validity was achieved. C-Co had a positive and transient negative impact on patients and a positive and negative impact on practitioners. Component result dissemination resulted in national and international peer reviewed publications, conference presentations, awards, and collaborations.

Conclusions.

Although results may not be generalisable beyond the research samples, the research makes a significant and original contribution to professional practice and knowledge. C-Co is the only adapted, systematically deployed, individual HS CBTp approach, nationally and internationally, with proven efficacy with non-adherent, treatment resistant HS patients. This challenges HS medical model dominance, the hegemony of practitioner accreditation, and the norms of HS research methods. The deployment of C-Co across multiple HS sites and the further dissemination of component results are recommended.