Unearthing the complexity of stigma: a narrative inquiry into clients’ experiences of stigma and psychotherapy

This study aimed to capture the lived experience of stigma that surrounds psychological therapy through in depth interviews. Each participant had attended at least twelve sessions of weekly therapy whilst also acknowledging a sense of stigma attached to it. Interview conversations took place on a one-to-one basis with three participants, on two separate occasions. Taking a narrative inquiry approach, the study aimed to contribute much needed deeper understanding to a field which is dominated by quantitative studies. Following analysis and interpretation of the transcripts, three main themes emerged. First, stigma is a complex phenomenon, experienced as an entanglement of external and internal influences, with societal and familial culture shaping subjective experience at both explicit and implicit levels. The second theme was stigma revealing itself during the process of therapy, how it was associated with reasons for engaging, and with intersubjectivity between therapist and client. The final theme was the dilemma that participants faced around disclosing their engagement in therapy, and how connection and relationships were central to resolving this. The participants’ accounts conveyed stigma as a complex, interwoven, multilayered and multidirectional phenomenon. The understanding gained from the narratives led to the proposal of six areas of consideration for therapists in order to enhance practice. These were: paying attention to how stigma may present in the therapy room; the importance of assisting clients in tolerating uncertainty around mental health; how stigmatising beliefs may reflect deeper levels of psychological process; the potential for reframing and empowering; the value of the therapeutic relationship; and the importance of accommodation to the client’s process and momentum.