| Abstract | In recent years public policy and research has placed unemployment at the
forefront of designing and evaluating mental health services, which led to
support for development of the service model, Increasing Access to
Psychological Therapies (IAPT). Most of the research that has informed this
shift has explored the relationship between mental health and unemployment
from a positivist framework, which has provided a focus on describing the
psychological symptoms that people experience as a result of unemployment.
However, this research has been criticised for its limitation in ignoring the
causes and the context of unemployment. The aim of the study was to explore
the impact of the change in emphasis on unemployment for therapists practice,
the ideas they draw on to inform their work, and how therapists manage any
potential conflicts. A critical realist approach was used to explore these aims
with seven therapists working in IAPT services. In drawing on a critical realist
approach, the study was interested in exploring the relationship between a
number of phenomena: materiality (e.g. the reality of the nature of available
employment), institutional practices (e.g. government policies) and social
discourses (e.g. therapists understanding of the causes of unemployment). The
data from the interviews were analysed using thematic analysis. The first theme
indicated that the service context raised a number of challenges for therapists;
theme two described therapists opposition to the employment agenda; theme
three explained how therapists managed conflicts between their personal and
professional perspectives by using the employment agenda minimally and
complying with the demands on an administrative level; and, finally, theme four
described the approaches that therapists drew on to formulate client’s
difficulties with employment and its implications. The data was interpreted using
psychoanalytic and critical ideas in order understanding how therapists’
experienced and responded to the unemployment agenda of IAPT service
(Layton, 2009). The data was analysed by drawing on mechanisms of splitting,
denial and repression to explain societies and mental health services,
compliance, acceptance and support for political discourses that disadvantage
the most vulnerable within society (Layton, 2009). The implications of the
findings are discussed for practice, research, training and policy. |
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