The discursive maze of dual diagnosis
: A Foucauldian discourse analysis of psychological practitioners’ accounts of working therapeutically with clients

  • Matthew Treadwell

Student thesis: PsychD


Dual Diagnosis (co-occurring mental health and substance use issues) is a pressing issue in health services. Despite its prevalence, research has demonstrated problematic practitioner-client relations; including stigmatisation and service-exclusion of clients, and confusion and fear among practitioners about working with this client group. There is also a referential ambiguity about the term dual diagnosis, and an absence of consensus among services about its definition. Dual diagnosis may therefore be considered a problematic discursive phenomenon, which is constructed in diverse and discontinuous ways. Practitioners’ experiences of working with dual diagnosis clients is an under-researched area, to date. Moreover, there is a dearth of research on dual diagnosis in general within the discipline of counselling psychology. To address these shortcomings this research aimed to investigate practitioners’ accounts of working therapeutically with dual diagnosis clients, to make visible these constructions and their power effects. Ten psychological practitioners (counsellors, psychologists and psychotherapists) were individually interviewed, and a Foucauldian Discourse Analysis was performed. The analysis identified several contradictory circulating contemporary dual diagnosis discourses, which circumscribed dual diagnosis practice. These discourses were deployed to resource five power-laden therapeutic subject positions. Four subject positions perpetuated asymmetric practitioner-client power relations, while one seemed to afford a more egalitarian practice. Overall, these findings are argued to contribute to the dual diagnosis literature by raising practitioners’ awareness of the power relations in their talk about working with clients. They may therefore offer practitioners a resource to develop a critical reflexivity in their practice, which may mitigate its harmful power effects. This is argued to be of particular relevance to counselling psychology, given its commitment to reflexivity and engagement with issues of power.
Date of Award27 Feb 2019
Original languageEnglish
Awarding Institution
  • University of Roehampton
SupervisorJanek Dubowski (Supervisor) & Jean O'Callaghan (Supervisor)


  • Dual Diagnosis
  • addiction
  • substance use
  • mental illness
  • counselling psychology
  • Foucault
  • Foucauldian Discourse Analysis
  • Poststructuralism
  • Qualitative Research

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