Service User Attitudes and Resistance Towards Psychological Therapies for Bipolar Disorder: Findings from Ethnographic Research

Psychotherapy used alongside medications for bipolar disorder has been associated with better outcomes than the use of medications alone (Lam et al., 2003; Parikh et al., 2014), and NICE guidelines recommend the use of... [ view full abstract ]

Psychotherapy used alongside medications for bipolar disorder has been associated with better outcomes than the use of medications alone (Lam et al., 2003; Parikh et al., 2014), and NICE guidelines recommend the use of psychological therapies in the treatment of those with a diagnosis of bipolar disorder (NICE, 2014). However, relatively few adults with bipolar disorder appear to access appropriate psychological interventions (Marwaha, Sal & Bebbington, 2014; Evans-Lacko, Kastelic, & Riley, 2011; NICE, 2014). This paper will present findings from an ethnographic study of British psychoeducation groups for bipolar disorder, focusing on how talking therapies were presented and discussed by participants. Drawing on individual interviews with participants, course materials, and group discussions regarding psychotherapy, findings will provide potential insight into service-user resistance towards psychotherapy, and will also explore some of the expressed barriers to positive therapeutic experiences. It is argued that the tendency to position bipolar disorder firmly as a brain disorder with its basis in neurochemical imbalances, whilst de-emphasising psychological and cognitive causal factors, may lead to assumptions that psychological interventions are irrelevant for this disorder. This may be due to a remaining tendency for mind/body dualisms to dominate thinking on mental health, whereby disorders thought to reside in the brain are viewed as beyond control by any means that are not perceived as directly targeting the brain (e.g. medication and ECT). In addition, psychotherapies may be associated with specific forms of stigma (e.g. Callard et al., 2010); interventions such as Cognitive Behavioural Therapy, for example, could elicit ‘volitional stigma’ (Easter, 2012) by emphasising cognitive causal processes and the role of personal responsibility in changing cognitive styles. This may be another potential barrier to therapy uptake and success.