UoM administered thesis: Phd

  • Authors:
  • Lauren Wolfenden


Evidence addressing the impact and bidirectional influence of being a parent and experiencing psychosis is relatively sparse, and often fails to adopt a strengths based approach. The purpose of this thesis was to combine multifaceted evidence bases, examine approaches to intervention and give a voice to parents experiencing serious mental illness (SMI). Throughout this thesis, a multi-method approach was utilised. This included reviewing a complex evidence base and conducting cross-sectional, longitudinal and qualitative research. Currently, there is a paucity of research investigating the role of parental emotion and cognition and how parenting interventions (PIs) can be perceived and utilised by families. To address this, Chapter 1 provided an in-depth narrative review of the literature regarding expressed emotion (EE), attributions, parenting and mental health. Following this, chapter 2 describes the methodological approaches employed within each study. Next, Chapter 3 (Empirical study one) reports the findings from the first study to explore EE and attributions with parents experiencing psychosis (PEP) (n = 20) and parents with no SMI history (n = 20). This was conducted due to the debilitating nature of psychosis and the interference it can cause for social, emotional and psychological functioning. Being a parent is both a risk and protective factor for mental health; however, up to 50% of parents experiencing SMI lose custody of their children. It was therefore important to explore and understand how the family environment (as evidenced by EE) and potentially dysfunctional interpretations and beliefs (attributions) impact the parent-child relationship or parenting capabilities. Greater awareness and insight into the relationship between mental health, child-blaming attributions, hopelessness, criticism, warmth and positive remarks offers insight into intervention approaches. To encourage the development of appropriate and optimum parenting support, the use of an existing PI with PEP was explored using a case series methodology (chapter 4; Empirical study two). This is the first study to employ the 10 week self-directed variant of the Triple P – Positive Parenting Programme with PEP (N = 10). The PI was offered in a supportive capacity using a weekly case series approach with three and six month follow-up. The PI provided structured guidance on strategies and skills that could enhance parenting. Exploring the acceptability and feasibility of the PI helped to understand the factors driving motivation, attrition and retention in the PI. The findings contribute to the evidence base concerning parenting and psychosis, and show that a self-directed PI with support can lead to positive outcomes. Clinically significant levels of change were reported across measures of mental health, well-being, self-efficacy, parenting and parent-child interaction. All parents reported improvements; parents who ended the PI early also demonstrated similar levels of improvement compared to those completing all 10 weeks. The PI appeared to build on parents’ awareness of their mental health and the connections SMI can have with parenting. This study aimed to lay the foundations for future work offering appropriate PI for those experiencing SMI. Reported within Chapter 5 (Empirical study three) is an Interpretative Phenomenological Analysis (IPA) exploring the use of the guided self-help PI for PEP (N = 5). During parents’ reflections, their perceptions of change, empowerment, passion and pride following the PI were discussed. Finally, Chapter 6 presents a general discussion encompassing this programme of work and provides suggestions for future work.


Original languageEnglish
Awarding Institution
Award date1 Aug 2019