Doctorate in Clinical Psychology: Main Research Portfolio

: 1) Interventions to address empathy-based stress in mental health workers: A scoping review); 2) Young people’s experiences of a theatre in education programme aimed at preventing and raising awareness of child sexual exploitation: A service-related project; 3) Having permission not to remember: Perspectives on interventions for post-traumatic stress disorder in the absence of trauma memory.

Abstract

Interventions to address empathy-based stress in mental health workers: A scoping review

Objective: Despite the benefits of empathic mental health care; consistently engaging with the distress of clients can have negative consequences for mental health workers (MHWS). Various terms have been used to describe this phenomenon, which has led to conceptual inconsistencies. This review will therefore use the umbrella term empathy-based stress (EBS). Existing reviews of interventions for EBS have grouped MHWs with other healthcare professionals or excluded them. However, due to the nature of their roles MHWs may be particularly required to empathically engage with the distress of others. This review therefore aimed to identify and describe available interventions for EBS in MHWs. Method: A systematic scoping review of the literature concerning interventions for EBS in MHWs between 1970 and 2021 was undertaken in five electronic databases. Results: The review included 48 studies which varied significantly with regards to: the rationale for and interventions used; study methodology and theoretical underpinnings. Studies were grouped into three categories based on the level at which they aimed to address EBS. These included: individual (i.e. personal resilience; awareness-raising and role training); team and organisational approaches. The majority of studies intervened at the level of the individual, with only one study reporting an organisational intervention. Conclusions: Providing individually focussed interventions for EBS may not be the most helpful route of intervention considering that the proposed causes of this problem are largely organisational. Furthermore, it is unclear how most interventions were theoretically linked to the origins of EBS. Recommendations include: establishing conceptual clarity regarding EBS; intervening at the level of the organisation; more methodological consistency in studies and; linking interventions to the proposed causes of EBS.

Young people’s experiences of a theatre in education programme aimed at preventing and raising awareness of child sexual exploitation: A service-related project

Child sexual exploitation and abuse (CSEA) has grave implications for the mental health and wellbeing of young people. It has been linked to a wide range of mental health problems which may extend into adulthood and constitute a significant burden on public services. School-based programmes that aim to help prevent CSEA are popular but have historically lacked robust and consistent evaluation. This service related project aimed to evaluate the impact of a school- based Theatre in Education (TiE) programme on young people’s awareness and understanding of CSEA. Consultation was sought from the service providing the programme and from a secondary NHS mental health service that commonly provides therapy for adult survivors of CSEA. Four focus groups were conducted with young people from two schools where the TiE programme was delivered. Template analysis of data revealed a number of themes that were grouped into two categories; ‘Information and Detail Delivered’ and ‘Format and Timing’. Themes suggested participants had acquired new awareness and understanding related to CSEA, as well as how to avoid harm and what to do ‘if bad things happen’. Participants also reported that the use of theatre helped them to connect to and remember the content, that the programme was delivered to them at the right time, and that younger people could also benefit from it. In addition, areas for improvement were identified in terms of the delivery of the programme, and the issue of victim blaming. Recommendations for the TiE programme and broader implications are discussed.

Having permission not to remember: Perspectives on interventions for post traumatic stress disorder in the absence of trauma memory

Objective: It is possible for people to have post-traumatic stress disorder without memory of the trauma event (PwM), such as in drug-facilitated sexual assault. However, there is little evidence available on providing treatment for PwM and the appropriateness of existing psychological interventions for this population. This study aimed to address this gap by exploring the experiences of people who have had psychological intervention for PwM. Method: This study used interpretative phenomenological analysis to explore the lived experience of nine women with PwM. Participants were recruited via social media and completed semi-structured interviews online and over the phone. Results: Identified themes concerned two broad areas: i) the challenges of having therapy whilst lacking memories; and ii) what was helpful in therapy. Challenges included: delayed help-seeking; having emotional/sensory trauma reactions in the absence of recognisable triggers; experiencing therapy as more applicable to remembered trauma (over unremembered); and difficulty discussing and processing unremembered trauma. However, participants also described helpful aspects of therapy including: feeling safe and supported in therapy; working with emotional and sensory forms of experience; having scientific explanations for trauma and memory; and having ‘permission’ from therapists not to remember. Conclusions: Recommendations for clinicians included: being aware that clients with PwM may have more difficulty accessing treatment and perceive it as less applicable to them; focussing on clients’ emotions and sensations (not cognitive memories) in therapy; and supporting clients to develop a more self-compassionate understanding of their experiences and lack of memory- thus supporting them to accept that not remembering is ‘permitted’. Findings are discussed in relation to the wider literature on interventions for PwM and trauma-informed care.

Date of Award	15 Sept 2021
Original language	English
Awarding Institution	University of Bath
Supervisor	Catherine Hamilton-Giachritsis (Supervisor), Rachel Paskell (Supervisor), Emma Griffith (Supervisor), Josie Millar (Supervisor), Juliane Kloess (Supervisor), Chris Gillmore (Supervisor) & Michael West (Supervisor)