Downloaded By: [Swets Content Distribution] At: 23:26 15 January 2008 Understanding a complex intervention: Person-centred ethnography in early psychosis JOHN AGGERGAARD LARSEN University of Surrey, European Institute of Health and Medical Sciences, Guildford, UK Abstract Background: Mental health interventions are increasingly ‘‘complex’’ as it is recognized that a holistic, integrated or ‘‘biopsychosocial’’ approach is required to provide adequate treatment and support. While randomized controlled trial (RCT) studies are applied to assess clinical outcome, the actual workings and experiential effectiveness of this type of intervention are poorly understood and documented. Aims: To discuss the value of a social science perspective of interpretive understanding (verstehen) and existential phenomenology to study sociocultural processes in a complex intervention, in particular when taking an ethnographic approach. Methods: A person-centred ethnographic study of a Danish early intervention in psychosis service involved two years participant observation and repeated interviews with 15 clients. Results: The study detailed therapeutic encounters in the intervention, supplemented by clients’ reflections and insights generated through dialogue. Following first episode psychosis clients experienced an existential crisis, and the intervention offered therapeutic engagement, support and systems of explanation that provided meaning and life direction through the recovery models of ‘‘episodic psychosis’’ and ‘‘chronic schizophrenia’’. Conclusions: The person-centred ethnographic approach provides rich insights into the sociocultural and personally experienced workings of a complex mental health intervention, which allow a critical understanding of therapeutic processes and how they may be improved. Keywords: Complex intervention, ethnography, existential phenomenology, interpretive sociology, psychosis, understanding Introduction In this paper I argue that although mental health services in general are subject to comprehensive research, evaluation and audit, there is a need for social sciences to contribute to this empirical knowledge-base with a critical investigation based in the tradition of inter- pretive understanding. In particular, the person-centred ethnographic approach has much to offer to our understanding of complex therapeutic processes that currently remain largely unexamined, or are merely theoretically and instrumentally presupposed. Current research on mental health services is predominantly designed according to the medical research ‘‘gold standard’’ of randomized controlled trials (RCTs), paying exclusive attention to quantifiable measures for outcome. Consideration of the actual service content and delivery are in these studies traditionally reduced to compliance with protocol that can be monitored according to quantitative standards. This situation reflects a more general Correspondence: John Aggergaard Larsen, University of Surrey, European Institute of Health and Medical Sciences, Duke of Kent Building, Guildford GU2 7TE, UK. E-mail: j.larsen@surrey.ac.uk Journal of Mental Health, June 2007; 16(3): 333 – 345 ISSN 0963-8237 print/ISSN 1360-0567 online Ó Shadowfax Publishing and Informa UK Ltd. DOI: 10.1080/09638230701299186