"Hear Us Speak" : listening to women's experiences of perinatal distress and the Transactional Analysis psychotherapy treatment they received
This PhD study examines Transactional Analysis (TA) psychotherapy as a treatment for perinatal mental illness, by listening to the experiences of women who have received it within a private practice, psychotherapeutic setting. The study also addresses the gap in research into women’s experiences of perinatal mental illness. In this study, ‘perinatal mental illness’ includes stress, anxiety, depression and puerperal psychosis. Perinatal mental illness is common and has wide-reaching consequences. Historically, research has focused on postnatal depression. However, many women become unwell in pregnancy, and research shows that stress and anxiety could be more prevalent than depression. Significant barriers to treatment are stigma and shame, causing women to silence themselves as a consequence. Engaging women into treatment and subsequent compliancy is difficult. Conventional treatment, of antidepressants, is controversial due to the risk of medication in utero and breast milk. Women say they would prefer psychological therapy, yet there is little research into suitable types. TA psychotherapy offers a plausible, diverse and versatile treatment, which can be shaped towards the client needs, an important factor in perinatal mental illness.A qualitative, narrative approach has been used to facilitate an exploration of women’s experiences. Data collection was by Free Association Narrative Interviewing and a creative methodology, forming a deeper, richer understanding of personal perspective, using the visual and the narrative as a co-creative construction. Data analysis used The Listening Guide Method to highlight difference and hear the multiple voices in one person’s narrative, as well as taking notice of temporal movement within the narrative.Key findings: i) TA psychotherapy was found to be a useful and treatment for the five participants; ii) TA addressed the specificity of illness; iii) TA was found to be a durable treatment; iv) the relational dyad was found to be a factor in treatment; v) TA offered a plausible alternative to CBT and medication; vi) TA was found to be useful in each format – couples, one-to-one or group therapy; vii) all participants had experienced mental illness in their past, and again in the perinatal period; viii) TA psychotherapy had a role within treatment for puerperal psychosis for one participant; ix) stigma and shame remain significant barriers to treatment; x) there is a need for a change in terminology within both the medical profession and wider society, to encompass all types of mental illness within the entire perinatal period; xi) language held significance through co-creation of language in therapy and within the interview; xii)TA offered a ‘shared’ language that was easily understood, demystified the treatment process and clarified what was happening. The contributions to knowledge are: i) this is the first study to ask women about their experiences of their therapy; ii) this is the first study to explore TA psychotherapy in relation to its use in perinatal mental health and the first qualitative TA study; iii) this is the first TA research study to use narrative analysis; iv) this is the first study on perinatal mental illness to use narrative analysis; v) the use of creative objects as part of the data collection process is unique in psychotherapy research; vi) the use of FANI for data collection, in combination with the Listening Guide analysis style is unique; vii) the Listening Guide style of analysis highlighted Ego State theory in TA, which is a unique contribution to TA theory; viii) this is the first study to highlight psychotherapy as a possible adjunct treatment for puerperal psychosis; ix) the durability of TA therapy has not been studied before; x) the immediacy and usefulness of TA language and the ability for it to be shared between therapist and client was evident within this study; xi) couples therapy as a suitable style of therapy for perinatal mental illness has not been researched prior to this study.There are implications for psychotherapy and midwifery practice, as well as for maternal mental health. These are: i) there is a need for more treatment to be offered within the NHS, specifically broadening the scope to incorporate wider ranges of treatment to address specificity of illness. Funding allocation remains a difficulty within the NHS and may prove a difficulty for research; ii) the ‘booking-in’ appointment is an ideal opportunity of targeted diagnosis, although this would need to be backed up with suitable treatment pathways. iii) a protocol for using TA psychotherapy for perinatal mental illness would be a useful addition to theory. This may be a combination of treatment and psycho-education to enhance knowledge of this condition. An element on couples therapy for this condition would also be useful.
Networked Digital Library of Theses and Dissertations