Individuals' experiences and opinions of psychological therapies for psychosis: A narrative synthesis

• This is the first synthesis available on beliefs about therapies for psychosis.
• Individuals' expectations and experiences are consolidated and explored.
• Service users hold multi-faceted views about psychological therapy.
• Significant biases in the literature have been highlighted and discussed.
• Discrepancies between expectations and valued outcomes are considered.

Beliefs, attitudes and expectations about therapy are likely to influence engagement, adherence and outcomes in psychological therapy but despite increased research interest in this area, the evidence has not been systematically reviewed or synthesised. This review is the first to explore service user beliefs by synthesising existing quantitative and qualitative research in order to develop a comprehensive understanding of beliefs about psychological therapy in people with psychosis and to identify gaps in the literature. Thirty-five papers were included in this review and synthesised. Themes and subthemes of both service user expectations (including outcomes, process and barriers) and experiences (including satisfaction, outcomes, process and therapist characteristics) are described. High levels of satisfaction and positive regard towards therapy for psychosis were found. However, many clients refuse, do not attend or withdraw from psychological therapy. Data were primarily limited to people who have completed therapy. Expectations about therapy have not been adequately addressed and warrant further exploration. Understanding and managing expectations, including consideration of fears, misconceptions, and potential challenges, could promote engagement. Exploration of beliefs, particularly in those who refuse or terminate therapy, is essential to further our understanding of factors affecting services users' decision-making processes, as well as the efficacy of therapy.