Degree Date

2024

Degree

Doctor of Philosophy (PhD)

Department

Social Work and Social Research

Abstract

Community mental health clients who experience psychosis, particularly Black and Latinx clients, are subject to numerous barriers to competent clinical care. The fundamental challenges of community mental health settings can be detrimental to clinicians’ belief that they can be effective while providing care to clients with psychosis in alignment with the common factors of therapeutic treatment and the principles of trauma-informed care. This dissertation proposes a grounded theory based on 16 participant interviews with community mental health clinicians in Philadelphia who have worked in outpatient settings with clients with psychosis. Using the frameworks of self-efficacy theory (Bandura, 1977), the common factors in therapy (Wampold, 2001), the principles of trauma-informed care (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023), and critical whiteness theory (Okun & Jones, 2016), but primarily relying on the findings of study participants, this dissertation provides evidence for the following grounded theory: When clinicians do not believe that they have the skills or ability to provide care to clients with psychosis, they may sacrifice the core elements of a safe therapeutic relationship and devalue empathic connection with clients in service of actions that give the therapists a sense of agency. Clinicians engage in behaviors that may be counter to the common factors of relational psychotherapy and trauma-informed care principles to achieve a sense of efficacy in their work with psychotic clients, because the environment in which they work, and its multiple and conflicting pressures hamper their ability to provide the care they need.

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