Ogbonnaya, Comfort C.; (2024) Relational Identity, Race and Racial Discourse: Exploring AVATAR therapy with Black service users and clinicians. Doctoral thesis (D.Clin.Psy), UCL (University College London).

Text Thesis_final_volume1_Ogbonnaya_exclconfid.pdf - Accepted Version Access restricted to UCL open access staff until 1 October 2029. Download (6MB)

Abstract

NARRATIVE REVIEW / Aim: This narrative review summarises studies exploring the association between ethnic density and psychosis in Black people. The review aimed to explore underlying factors and possible mechanisms for the ethnic density effect. / Method: The studies included in this review were identified through a systematic search of the literature using PsycINFO and Web of Science. 16 studies were analysed on their outcomes, measurements of ethnic density, confounding factors and mechanisms. / Results: Studies differed in their conceptualisation of ethnic density areas and the types of psychosis-related variables measured. Higher ethnic density was found to offer protection against increased psychosis risk in Black people in the majority of the studies. The ethnic density effect was proposed to operate through mechanisms of reduced racist encounters and greater levels of social support. / Conclusion: The ethnic density effect is found to be protective in Black populations. This paper expands on the literature by offering a detailed review of the possible mechanisms for the association between ethnic density effect and psychosis in Black people, with racism and social support as the most cited. Limitations, research and clinical implications for the findings were highlighted. / EMPIRICAL REVIEW / Background: Black people living in countries like the UK, where they have a racialised minority status are more likely (9x if Black Caribbean and 5x if Black African) to receive a diagnosis of schizophrenia spectrum disorder, be compulsory admitted, and prescribed injectable antipsychotic medication compared to white counterparts. Black people are under- represented in the provision of NICE recommended psychological intervention for psychosis with reduced likelihood of being offered and of completing such interventions. This has prompted a move to investigate the cultural acceptability of these interventions. Clinicians and Black experts by experience have identified several areas requiring adaptation of CBTp and FIp, including addressing racial trauma and considering the role of religion and spirituality, as well as therapist ethnicity. AVATAR therapy is an effective new relational therapy in which people who hear distressing voices engage in dialogue with a digital representation of the voice that they hear (avatar). AVATAR therapy has recently been found to be more effective than supportive counselling. To date there has been no research specifically looking at the experience of AVATAR therapy amongst Black people and clinician’s experiences of delivering AVATAR therapy to Black people. / Aim: The study aims to explore how Black people with psychosis who hear distressing voices experience AVATAR therapy, and how AVATAR therapists experience therapy delivery to Black people. Method: 12 Black Experts by Experience and 7 clinicians were interviewed. Semi-structured interviews were conducted and analysed using Foucauldian-informed Reflexive Thematic Analysis. / Results: One discourse, Blackness as unconsidered, and four superordinate themes: 1) Nuances of identity, (2) Accessing support, (3) Technology and blackness: relational opportunities and challenges, and (4) Relational Beings were identified. / Conclusions: The findings of this study contribute to the literature of Black peoples experience of therapeutic interventions for psychosis. The study highlights how Blackness, and racial discourse more generally, are positioned by both Black service users and clinicians in AVATAR therapy. Links to how Blackness acts to underpin identity, wellbeing practices and life experiences are highlighted. Implications of the results for AVATAR therapy are discussed at clinical and research levels.

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