Clinical psychologists’ views about talking to people with psychosis about sexuality and intimacy: A Q-methodological study

Sexuality and intimate relationships are crucial to individual wellbeing, yet individuals
experiencing mental health difficulties struggle to access social and relationship
opportunities. Despite recent efforts to improve access to sexual health services in
the United Kingdom, people with mental health difficulties report the lowest sexual
satisfaction in population studies. For people with psychosis, concepts of sexual
relationships are dominated by research that focuses on physiological side-effects of
antipsychotic medication or perceptions that sufferers engage in deviant sexual
practices. There is a paucity of research exploring the psychological and social
barriers that prevent people with psychosis from developing intimate relationships
from a lived experience perspective. This qualitative literature review and thematic
synthesis includes nine articles and identifies five overarching factors that limit
prospects for people with psychosis, including psychological and social barriers, lack
of external support, concerns about the content of relationships, personal barriers
and systemic barriers. A major barrier is the indirect traumatising and distressing
psychological consequences caused by side-effects of antipsychotic medication that
are frequently overlooked by mental health professionals. Findings are
conceptualised within recovery models of mental health care. Implications for clinical
practice include the need for specific assessment tools and support for professionals
to explore sexual and relationship needs with service-users.