“I used to think that they were all abnormal. And I was the normal one”: conceptualizing mental health and mental health treatment under Improving Access to Psychological Therapies (IAPT)

Background: Improving Access to Psychological Therapies (IAPT) was introduced in the United Kingdom in 2006 to provide more effective and efficient services to people experiencing mild to moderate mental ill health. The model represents a paradigm shift in how we provide psychological care to large populations. Aims: We wanted to document how the IAPT programme impacted on patients’ understanding of their mental health, and mental health treatment. Methods: We used Foucauldian Discourse Analysis to analyse six semi-structured research interviews with patients from one IAPT service in a major UK city. Results: Participants constructed their mental health problems as individual pathologies. Constructions of mental health and of treatment evidenced the privileging of personal responsibility and social productivity over dependency on others and the state. Conclusions: Services are functioning well for some. The role of IAPT in pathologising those who are dependent on people and services requires further commentary and action. Declaration of interest: The first author was employed by the same organisation that delivered the IAPT service, although through a separate staffing and management line.

Developmental Antecedents of Proactive and Reactive Rebelliousness: The Role of Parenting Style, Childhood Adversity, and Attachment

Adolescence is a time of developmental transition that for one in five young people is characterised by feelings of oppositionality, rebellion, and negativism. Despite the prevalent experience of teen turbulence and despite its significance within the phenomenological framework provided by reversal theory (RT), the childhood antecedents of rebelliousness in adolescence and adulthood have not been given extensive empirical attention within RT, although such work has been carried out using other constructs and theories. We examined recalled parenting style, childhood adversity, and attachment style in adulthood as correlates of proactive and reactive rebelliousness in a sample of 80 participants, aged 18 to 50 years. Each participant responded to a questionnaire package containing the revised Adult Attachment Scale, the Parental Bonding Instrument, the Childhood Experience of Care and Abuse Questionnaire, and the Negativism Dominance Scale. We found that paternal abusive parenting, followed by paternal parenting style, paternal neglect, and paternal antipathy were independently predictive of scores on proactive rebelliousness, the sensation-seeking form. Maternal and paternal indifferent parenting styles each were found to equivalently and independently predict scores on reactive rebelliousness, the interpersonal disaffection form. The results of this study suggest these two forms of rebelliousness may have distinctly different antecedents. A longitudinal study is needed to examine the potentially causal pathways that are suggested by the results of this cross-sectional research. We consider reversal theory explanations of these results and contrast them with complementary theoretical frameworks.