Background
The private theories interview patient version (PTI-P)
The attributional framework
Locus of control (internal vs. external)
Stability of causal attribution (stable vs. instability)
Attribution of stigma (internalized vs. externalized)
Methods
Setting
Participants
Participant no. | Age | Gender | Level of education | Diagnosis |
---|---|---|---|---|
Patient 01 | 20 | Male | University | Major depressive disorder |
Patient 02 | 19 | Male | High school | Substance induced psychosis |
Patient 03 | 18 | Female | College | Secondary enuresis |
Patient 04 | 22 | Female | University | Schizoaffective disorder |
Patient 05 | 19 | Female | High school | Depression |
Patient 06 | 24 | Female | University | Depression and epilepsy |
Patient 07 | 20 | Female | High school | Conduct disorder |
Patient 08 | 22 | Male | College | Somatic disorder |
Patient 09 | 19 | Male | High school | Substance induced psychosis |
Patient 10 | 20 | Female | College | Post-traumatic stress disorder |
Sampling
Ethical approval and considerations
Instruments
Private theories questions | Attributions focussed domains |
---|---|
What is it that leads you to seek treatment today? | Internal locus of control External locus of control |
What are your thoughts about the psychological issues you are experiencing? | Controllability Uncontrollability |
Tell me about some or other important experiences or events in your life that you associate with your difficulties and how these problems | Stability Instability |
In relation to the problem (MI) how do you see yourself and others around you? | Experiencing stigma Not experiencing stigma |
What do you desire that would ease your pain/distress? | Desired treatment plan or cure |
Data collection
Data analytic plan
IPA as a scientific principle
IPA as a specific method in this study
Results
Interview questions | attribution dimensions | Core themes |
---|---|---|
What is it that leads you to seek treatment today?
| Internal locus of control or dispositional attributions: based on behaviour within the client | Negative emotions and thoughts misconduct behaviour Transitional challenges-from teen to adult life Poor performance in school Self-stigma and shame of disclosure |
External locus of control or situational attributions: Based on behaviour (from others) to the individual | Negative childhood Experiences Strained relationships with parents and other family members Rejection from others and stigma Lack of finances Decline in social life | |
What are your thoughts about the psychological issues you are experiencing?
| Controllability: if the individual is personally able to guide, influence or prevent the situation | Negative emotions and Thoughts |
Un-controllability: if the individual is personally not able to guide, influence or prevent the situation | Negative childhood experiences Strained relationships with parents and other family members Rejection from others and stigma Lack of finances Decline in social life | |
Tell me about some (other) important experiences or events in your life that you associate with your difficulties and how the problems began.
| Stability: unchanging causes | Death of loved ones |
Un-stable: changing/fluctuating causes | Negative emotions and thoughts | |
In relation to the psychological issues, what is your view on others and yourself?
| Stigma from others and self | Self-stigma |
Stigma from others | ||
What do you think is needed for your illness to be cured or might ease your pain?
| Treatment preference | Need for therapy |
Need for medication |
Psychosocial triggers of distress
Negative thoughts and emotions
“I had a disagreement with mum. She wants me to be like her and I cannot. She separated with my dad and now she wants me to go live with my uncle who is very tough. She is also planning to go for further studies abroad.” 20-year old young man.
“[…] I had a tough childhood; my brother uses drugs and abuses me. I also lost my dad at a young age…” 22-year old female participant.
“My dad does not care. Since the illness started from childhood, he has never sent money for medication. He went and got another wife. He only sends money for food for me and my sister. But for my medication, he has never sent … money. My mother who lives with me does not work. She is a house wife and depends on the small amount send my father…” 24-year old female participant diagnosed with epilepsy.
“[…] I used to love my father but when my sister was born, it’s like he forgot about me. He only cared about her. I started talking to boys and eventually lost my virginity. I still feel bad about it…” 19-year old female participant.
“My mum died. I still don’t know how to deal with that. She was the most important person in my life. Always cheering me… I was her only child. I have no dad. I felt lost and never gotten over this. I do not understand myself anymore.” 25-year old female participant.
Adjustment and behavioral problems in school and college
“My friend and I had a phone in school. During prep time, the teacher on duty caught us playing games. We have been suspended for 2 weeks and told to go back to our parents…” 19-year old female participant.
“I started taking alcohol after high school. I thought it was normal for those in university to take alcohol since now you are a grown-up and other people especially my friends were taking it. So I thought, why not join them? I hope to stop completely as it is the cause of Bell’s palsy that I have now…” 21-year old male participant.
Familial challenges and lack of support in transitioning process
“I repeated form IV then joined university where I am studying mass communication. In the first semester, I started having weird feelings and thoughts. I felt like I do not fit into the school culture. People were just having fun. Right left and center. Then I got myself in this group of girls who had money from their boyfriends and older men. I wish I did not join them. Somehow I lost my virginity…..” 22-year old female participant.
“I am not comfortable with my life. I have not achieved the things I have wanted to achieve. Just the way my life is going…..my career…Everything is moving slowly. Am in a stage where I want to do new things and find my own place in life” 24-year old male participant.
“Since I went to boarding school in class six my performance dropped and was always punished for it….” 20-year old male participant.
“I used to think a lot after failing my KCSE1. I was wondering what next? This is when I started having too much headache and a lot of fear.” 22-year old female participant.
Strained relationships with parents and other family members
“Dad started neglecting me and it is like all the love I had for him ended. He still prefers my sister and I feel like she is more special than me. Maybe it is because she is named after mum to my dad.” 19-year female participant.
“I grew up with my extended family since mum had travelled out of the country for further studies. When she came back, she was a stranger to me. We still do not have a relationship.” 19-year old male participant.
“I stay with my mum and brother. We are not close to each other and I am not free to talk to them since they do not care about my opinion. I just keep quiet.” 20-year old male participant.
“I am angry at my dad. Really very angry. He listens to his relatives more than he listens to us. Like now I wanted to go further my education in UK but a sister to my dad said I should not go because I am epileptic. My dad agreed with her. He does not like supporting me. But one day I will prove them wrong. I will work hard and show them that epileptic people can do great in life.” 24-year old female participant.
Stigma and rejection from significant others and a tendency towards self-stigma
“When am alone, I feel great. But when am with my mother [sic] I feel bad because my mum thinks am unimportant.” 19 years old male participant.
“My friends used to undermine me because my mum was old, deaf and dumb. And we were very poor. I had no friends when growing up. They hated me.” 25-year old female participant
“I used to be an active child but am now introverted. I do not want my friends to know that I came for counselling. I also did not tell my mum…….. Also, when I feel like everyone knows am not a virgin. I don’t want to hang out with boys so that they do not find out about this.” 19-year old female participant.
“After being caught with bhang, people viewed me as a peddler making me feel so bad and couldn’t face people after that incident. My self-esteem was affected. Some friends deserted me.” 19-year old male participant.
Biological conditions and psychopathologies limiting intervention
“I was diagnosed with epilepsy when I was a young child. Growing up as an epileptic person is very challenging. People do not want to be associated with you, my father does not care about me. Maybe he thinks I am a burden, since he doesn’t buy my medicine. Were it not for epilepsy, I would be so happy. I have never been happy in my entire life. But I will prove people wrong. I want to show them that I can achieve my goals despite being epileptic.” 24-year old female.
“I cannot feel one side of my mouth. It is not there. I have gone for physiotherapy but still… so my dad being a psychiatrist thought I counselling would help solve the issue. But am fine. It is only this side of the mouth that is bringing me down and I am not myself.” 22-year old male
“..…..Then I started getting headaches. Too many fears and thoughts. When I went to hospital, the doctor said I had psychosis. Yes I have tried to Google what that means. It is not easy to live with that and when you tell people they say you are ‘chizzy’ (means ‘mad’ in Kiswahili).” 22-year old female
Preferences and views on cure
Affirmation of psychotherapy as the most appropriate and helpful intervention
“My dad often takes us for counselling just to make sure all is well. Prayers are good but I prefer something tangible such as counselling.” 22-year old male participant.
“I believe I need to control myself with regards to my anger. The only person I cannot control is my dad. So I let him be. But I need to know how to stop over reacting when I get angry.” 24-year old female participant.
“I still do not know how to deal with her demise. I want to understand myself better and be more productive in life. I am growing old. I need to know how to deal with mum not being around.”
“If I had listened to my inner voice that was telling me to avoid those guys, I would be so ok. I would be in school like other students. I will be attentive to my thoughts when asked to do something next time.”
“If I get the scholarship to UK, I will be happy. I want to be a better person and be busy. Being busy has helped me a lot. Now I do not concentrate on dad not buying medicine. I also do some volunteering work and get paid. Being busy helps a lot. But when idle, I get to think a lot and get angry over small issues.”
“I used to go to church and share with my girlfriends but I was not content. I also think peer counselling would also be good.” 20-year old female.“I tried alcohol, cigarettes and generally going out for social events to feel ok but the pain was too deep in me. Especially after losing my dad and the insults I get from my brother. But the drinks did not help….” 19-year old female participant.
“I do not share my issues with other people. People are superficial and cannot be trusted. I prefer counselling. My friend had advised me to ask for anxiety drugs but I am not ready for medication…” 22-year old male participant
“If possible, I will ask my mum to come with me in next session. May be if the counsellor told her that I cannot be like her she will understand and stop being too harsh on me and having so high expectations form me.” 9-year old male participant
Valuing psychopharmacological support in their overall treatment
“I am not a people person at all. Am hoping to be given some stress medicine and I will be good. Talking to people feels strange especially for a man. Men do not share their personal information.” 20-year old male participant diagnosed with major depressive disorder.