Clinical Psychologists’ Talk About Inpatient Service Users’ Sexual Expression and Its Implications on Restrictive Practice: A Foucauldian Discourse Analysis

Background
Sexual expression is restricted in psychiatric inpatient settings, supported by a riskfocused body of literature, often produced by medical professionals. Little research has been conducted into the nature of clinical psychologists’ views, influences, and roles.

Aims
This study sought to understand how clinical psychologists talk about inpatient service users’ sexual expression and its impact on restrictive practice. Several subquestions were developed:

- How do clinical psychologists construct inpatient service users’ sexual expression?
- What discourses influence clinical psychologists’ talk about inpatient service users’ sexual expression?
- How do clinical psychologists describe their roles and responsibilities in relation to inpatient service users’ sexual expression, and how does this relate to restrictive practice?

Method
To contrast with literature characterised by quantitative studies, a social constructionist qualitative approach was taken, using semi-structured interviews conducted with 15 UK clinical psychologists. Foucauldian Discourse Analysis (FDA) highlighted constructions, roles and responsibilities, and the influence of wider discourses.

Findings
The clinical psychologists constructed inpatient service users’ sexual expression as being risky, pathological, conflicting with social norms, useful for recovery, and a part of being human. These constructions allowed the participants to adopt roles as protectors, diagnostic experts, and moral governors, which tended to support restrictive practice, and pseudo-occupational therapists and advocates, which tended to resist restrictive practice.

Discussion
By using FDA, it has revealed systemic, intra-team, and social power dynamics in relation to sexual expression and restrictive practice. These findings are used to suggest new approaches to research and practice.

Conclusion
The clinical psychologists’ talk was nuanced, reflecting their thought and care, and the difficulties of resistant practice within a medicalised setting. They are subject to the disciplinary structures of the hospital and consequently recreate medicalised and risk-focused discourses which support restrictive practice. However, they also use discourses which have been under-represented in the literature and resist this.