Finding a Comfortable Fit: Practitioners’ Understanding of the Sociopolitical Context and its Role in Psychotherapy.

Abstract

Objectives: Inclusion of sociopolitical context in therapeutic interventions is under-researched, largely limited to practitioners’ addressing diversity issues in therapy. Relevant studies have shown both trainees and qualified practitioners experience anxiety and discomfort associated with uncertainties about effectively incorporating diversity and sociopolitical context. Although various models exist to aid systematic case conceptualisation incorporating sociopolitical factors, these are not widely used. The majority of relevant literature continues to concentrate on idiosyncratic conceptual models specific to theoretical approaches. This study aimed to discover how qualified practitioners currently conceptualise and incorporate diversity and sociopolitical factors into practice. Design: Given the lack of research available to inform the area, a grounded theory study was conducted as an exploratory exercise. The qualitative approach was adopted to investigate practitioners’ subjective experiences of their current practice. Constructivist assumptions underpinned the approach to the data, leading to use of Charmaz’s (2006) version of the grounded theory approach. Method: Theoretical sampling was used to recruit the 13 participants. Two focus groups and 8 individual interviews were conducted. Analysis: Two models emerged, representing the processes practitioners engaged in to “find a comfortable fit”, and the range of contexts within which the processes took place. Personal and professional dissonance emerged as a central feature of practitioner development. Discussion: The study highlighted the contribution of dissonance and the situated nature of the practitioner as major contributors affecting how sociopolitical issues are conceptualised and addressed in therapy. Further research is needed to clarify how these factors may most usefully contribute to best practice. However, multiple ecological contexts cited as levels of influence add a degree of complexity that will require operationalizing by those wishing to investigate this area in the future.