Clients' understanding of distress and context : ignorance is bliss?

Robust research evidence shows a higher incidence of psychological distress is endured by those living in deprived social and economic contexts. Yet psychological interventions often focus on self-scrutiny which could over estimate the individual's ability to change their situation. The current research aimed to develop an account of how distressed individuals understand the relationship between distress and context. This knowledge is essential if professionals wish to avoid being regarded by clients as insensitive to the effects of contextual inequalities (e.g. Williams, 1996). Six ex-clients of clinical psychologists were selected and interviewed about their experience of distress, and in particular what they understood about the role of context. Grounded theory methodology was used to guide data collection and analysis. A theme which frequently re-occurred in the data was that distressed individuals sought to ignore their context. This was reflected in the participants' perception of their distress as a personal, internal and unique phenomenon. Consequently efforts to overcome distress emphasised self-management rather than changing context. Interpretation of the results considered how ignoring context might seem beneficial for a distressed individual. However it was also recognised that society had much to gain if distressed individuals did not perceive context to be important in the resolution of distress. It was proposed that clinicians need to question public discourses which seems to encourage distressed individuals to ignore context. Therapeutic interventions should seek to achieve a balance between recognising and valuing private accounts of distress, and challenging any understanding which ignores context.