The exploration of parenting styles and psychosis: individuals with lived experience of psychosis/caregiver retrospective subjective experiences of parenting

Background: Psychosis is lived not only individually but within families, cultural contexts, and communities. Parenting practices, such as warmth, boundaries, communication, and responses to stress, shape how distress is understood, expressed, and managed over time. This thesis comprises a systematic review and a qualitative study examining how parenting experiences are interpreted by adults with lived experience of psychosis and caregivers, and how these relational contexts intersect with adversity, culture, and recovery. Aims: The research aimed to: (1) evaluate the quality and scope of evidence linking parenting features with psychosis-related outcomes; (2) explore how individuals with lived experience of psychosis and caregivers retrospectively describe parenting within family relationships; and (3) examine how broader emotional, cultural, and structural contexts shaped these experiences. Methods: A PRISMA-aligned systematic review with narrative synthesis appraised empirical studies using the Mixed Methods Appraisal Tool (MMAT), with attention to design, measurement, and cultural context. The qualitative study used Reflexive Thematic Analysis (RTA) of semi-structured interviews with a UK-based purposive sample of adults with lived experience of psychosis and caregivers (not necessarily related), reflecting a small but information-rich dataset. A dual-perspective design enabled both groups’ interpretations to be analysed together while attending to points of convergence and divergence. Results: The review mostly identified retrospective, single-informant studies using standardised self-report measures, with moderate methodological quality. Across studies, lower warmth and higher control were more frequently associated with greater symptom distress, while warmth with structure related to better functioning; adversity and contextual stressors amplified these effects. The qualitative analysis generated four themes. Theme 1: Emotional Climate and Relational Safety described climates marked by criticism, control, or inconsistency, alongside protective routines, repair after conflict, and steady, non-intrusive parental presence. Theme 2: Parenting Style as a Pathway to Mental Health and Psychosis captured how permissiveness, role reversal, and blurred boundaries shaped participants’ experiences of safety, autonomy, and early interpretations of distress. Theme 3: Meaning-Making and Identity Reconstruction examined how participants reframed earlier experiences, moving from blame or confusion toward more nuanced understandings of parenting under strain and developing resilient identities. Theme 4: Trauma, Belief, and the Emotional Ecology of Psychosis encompassed experiences of trauma, intergenerational loss, and cultural and spiritual framings of distress, alongside the stabilising effects of acceptance, love, and emotional presence. Across themes, parenting was portrayed as dynamic, culturally embedded, and context-dependent: a relational environment in which psychotic experiences were interpreted and managed, rather than a singular causal factor. Conclusion: Findings highlight non-blaming, feasible levers for practice, including supporting warmth with structure, protecting sleep and daily routines, enabling repair after conflict and role clarity, and working with families’ cultural and spiritual frameworks while recognising the structural pressures that constrain caregiving. The thesis emphasises psychosis as relationally and contextually shaped, and it offers developmentally and culturally sensitive implications for family-inclusive and trauma-informed care.