Recovering an emerging self: Exploring reflective function in recovery from adolescent-onset psychosis

Objectives. This paper investigates (1) the processes involved in how young people with adolescent-onset psychosis adapt to psychosis and (2) how processes of reflective function (RF) influence the adaptation process.

Design. This study used a qualitative design to inductively construct hypotheses about processes of adaptation and to deductively explore the influence of RF on adaptation.

Methods. Eight young people (aged 18-21) who had experienced clinically significant psychosis and attended a Child and Adolescent Mental Health Services (CAMHS) first-episode psychosis service participated in two interviews: (1) grounded theory open interview; (2) Adult Attachment Interview (AAI). Grounded theory methodology was used to investigate young people's experiences of adaptation to psychosis. Fonagy's manual of RF was used to identify passages with different levels of RF in the adaptation narratives and to assign an overall rating of RF with regard to attachment states of mind to AAI transcripts. Links between adaptation themes and RF were examined qualitatively across participants.

Results. Two main themes relating to adaptation and adolescent individuation emerged. Moderate RF was linked to primarily positive adjustment and successful individuation following psychosis. Impaired RF was associated with unresolved adaptation and blocked individuation post-psychosis.

Conclusion. Level of RF appeared to moderate adaptation and individuation processes post-psychosis and should be considered in the delivery of psychological therapies.