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This study aims to understand how staff in homelessness services conceptualise readiness for change in the individuals they support and how this informs their decision-making in practice.

A qualitative design was used. Ten staff members participated in semi-structured interviews. Data were examined through inductive–deductive thematic analysis, using a social constructivist epistemological lens.

Five main themes were constructed: “multiple complex needs mean multiple complex changes”, “talk versus behaviour”, “change is not a linear trajectory”, “the role of consistent boundaried relationships” and “change is not solely within the individual’s control”.

This research challenges existing notions of “readiness for change” as located within individuals and a prerequisite for using support from services. It has implications for staff and services, particularly those which are time-limited and address only single problems; service users may not be ready for some changes, but it should not be assumed they are not ready for change in other areas of their life. The offer of supportive relationships may precede and contribute to readiness for positive changes. Support should be offered based not only an individual’s intra-psychic readiness for change but also how the system might actively work to promote hope that change can be achieved and maintained.

To the best of the authors’ knowledge, this is the first study to explore staff members’ conceptualisations of readiness to change in relation to individuals with multiple complex needs and how this might influence practice.

This study aims to explore the perceptions of staff in four teams regarding the implementation of psychologically informed environments (PIE) across a community service and three hostels supporting individuals facing severe and multiple disadvantage.

Using a pre-post design, the PIEs Assessment and Self-Development for Services (known as the Pizazz) was completed by staff before the implementation of PIEs and at a six-month follow-up. A narrative review of the results and thematic analysis of the qualitative data are presented.

The majority of the Pizazz elements were rated as improved following PIE implementation. Thematic analysis developed three themes influencing staff members’ ability to develop a PIE: Complexities of Our and Wider Systems; Ready-made or Baked from Scratch; and Reflective and Responsive Staff.

A planned one-year follow-up was obstructed by the coronavirus pandemic, limiting understanding of longer-term impact. Having only gathered data from staff members, the results cannot corroborate staff members’ perceptions. Further research could explore other stakeholder perspectives, as well as the impact of PIE implementation on staff perception of resources, and of a possible ceiling effect for hostels trying to develop PIE.

To the authors’ best of knowledge, this is the first UK study to use the Pizazz to evaluate the implementation of PIE.

Peer support (PS) workers are being employed despite uncertain evidence for clinical and cost-effectiveness. Psychological theories have been proposed to explain the mechanisms of PS but these lack empirical validation and specificity to professional PS. The purpose of this paper is to develop a substantive interpretive grounded theory of service-users’ experience of professional PS work.

Constructivist grounded theory was used throughout. Semi-structured interviews were conducted with ten service-users who had engaged with a professional PS worker.

Three overarching themes were constructed. “The process of disclosure” describes how disclosure of mental health difficulties, experiences as a service-user and wider disclosure about life experiences, interests and values facilitate the development of a shared identity with the PS worker. “The product of disclosure” highlights the sense of being understood as a result of the disclosure and marks a deepening of the relationship. “Dual roles” describes the tenuous position of holding both a professional relationship and friendship.

Future research should seek to refine the theory developed and compare the effects of therapist self-disclosure with that found within PS. There were limitations within the study, including limited diversity within the sample as well as difficulties with recruitment.

This study connects service-users’ accounts of receiving PS with existing psychological theory to move towards an understanding of the relationship between receivers and providers of professional PS.

The purpose of this paper is to conduct a systematic search of the peer-reviewed qualitative literature investigating the lived experience of seclusion for adults with mental health difficulties, to appraise the quality of the existing literature and synthesise findings. Background: seclusion is a controversial intervention for the short-term management of unsafe behaviours in inpatient mental health services. There has been some sporadic interest in service users’ experiences of this.

Systematic literature review and meta-synthesis: data sources – databases MEDLINE, EMBASE, CINAHL and PSYCINFO were searched in July 2015; review methods – the Joanna Briggs Institute’s Qualitative Assessment and Review Instrument tools for critical appraisal and data extraction were used to review papers and synthesise findings.

A small number of papers were found, which were of mixed quality.

The existing research is limited in both quantity and quality. Although most participants from the existing research described seclusion as mostly negative with the potential for causing iatrogenic harm, some described more positive experiences, often in the context of compassionate interactions with staff.

Extant literature exploring service user (SU) involvement in clinical psychology training has been limited by its sampling from singular training programmes and its restricted application of psychological theory. This research seeks to counter limitations by exploring SUs’ experiences across multiple clinical psychology training programmes in the UK and by deductively applying psychological theory relating to power, recovery, identity and group development.

Semi-structured interviews were conducted with 14 participants. A deductive thematic analysis was used to analyse qualitative data.

Five main themes were identified: environment determines sense of safety; meeting challenges; sense of purpose, worth and value; the person you see now is not the person I was; and wanting to break the glass ceiling.

Carers are underrepresented and the sample does not contain SUs who were no longer involved in training.

It is important that the environment fosters psychological safety for SUs, via positive and supportive relationships with trainees and staff, with SUs being treated as equals and financially reimbursed as such. SUs and professionals need to explore managing and sharing power to enable SUs to feel valued and to reap benefits from involvement, including developing a positive sense of identity.

The research is part of the early literature exploring SUs’ experiences of involvement in clinical psychology training and is, to the best of the authors’ knowledge, the first to explore the personal effects of involvement across multiple programmes.

The purpose of this paper is to explore how those engaged in service user involvement (SUI) initiatives perceive involvement and recovery; whether involvement is related to their recovery process and, if so, how.

An exploratory qualitative method, social constructionist grounded theory, was adopted throughout the research process. Nine semi-structured interviews were undertaken with participants who self-defined as having current or previous mental health problems and who were engaged in SUI initiatives.

Most participants identified explicit links between their own experiences of SUI and recovery. These links represented a connection between the characteristics they perceived to be inherent to involvement and their personal definitions of recovery. In contrast, experiences of consultation and involvement as patient service users was limited and identified as an area for improvement. The core of the tentative grounded theory constructed suggests that individuals found in involvement elements which were concordant with and supported their own definitions of recovery and which were not apparent in their experiences as patients.

The small sample and narrow constituency of participants limit the nature of the claims made by the study.

This study highlights the value of involvement in promoting recovery and indicates the merit of promoting meaningful involvement across the spectrum of the service user experience.

This study offers a unique contribution to the current literature, highlighting the links made between involvement and personal recovery.

The involvement of service users within clinical psychology training is written into policy. However, the practice of evaluating involvement from both trainees’ and service users’ viewpoint is minimal. The purpose of this paper is to evaluate recent service user involvement in psychometrics and formulation teaching on a clinical psychology training programme, from both service user and trainee perspectives.

Focus groups were held with service users (n=3) involved in the teaching, as well as trainees (n=3). Additional questionnaire data were captured from trainees (n=11). Service user and trainee data were analysed separately using thematic analysis. Themes generated for trainees were also mapped on to a competency framework for clinical psychologists.

Both parties found the teaching beneficial. Service users enjoyed supporting trainees and engaged positively in their roles. They identified relational aspects and reflections on their own therapy as other benefits. Trainees reported enhanced clinical preparedness, critical and personal reflection. Trainee anxiety was evident. Learning mapped well to competency frameworks.

The samples were small and some data truncated. Findings speak to broader issues and may transfer to other involvement contexts.

A good degree of meaningful involvement can be achieved through such initiatives, to mutual benefit and enhanced learning.

Nature of the exercise and dual-aspect approach to evaluation described here helps to minimise tokenism. The mapping of findings to competency frameworks supports evaluative processes and helps to legitimise involvement initiatives that challenge the boundaries of existing practice.

Implementing trauma informed care (TIC) for individuals facing homelessness and multiple disadvantage is proposed to help both service users and staff work effectively and therapeutically together. However, the effectiveness of implementing TIC via training is debatable. This study aims to explore the effects of a four-day TIC and psychologically informed environments training package in such services.

The analysis explores the effect of this training on the degree of TIC as measured by the TICOMETER, a psychometrically robust organisational measure of TIC. The study examines group and individual level changes from before training and again at six-month and one-year follow-up time-points.

At the group level analysis, three of the five TICOMETER domains (knowledge and skills, relationships, and policies and procedures) were higher when compared to pre-training scores. The remaining two domains (service delivery and respect) did not improve. Individual-level analysis showed some participants’ scores decreased following training. Overall, the training appeared to modestly improve the degree of TIC as measured by the TICOMETER and these effects were sustained at one-year follow-up.

Findings are limited by the design and low response rates at follow-up.

Training is necessary but not sufficient for the implementation of TIC and needs to be complemented with wider organisational and system-level changes.

This paper is the first UK study to use the TICOMETER.

The purpose of this systematic review was to address two questions: what is the qualitative evidence for the effects of the Wellness Recovery Action Plan (WRAP) training, as perceived by adults with mental health difficulties using it? What is the quality of qualitative literature evaluating WRAP?

Five electronic reference databases and the EThOS database for unpublished research were systematically searched, as well as two pertinent journals. Study quality was assessed using Critical Appraisal Skills Programme criteria and results analysed using thematic synthesis.

Of 73 studies, 12 qualitative papers met inclusion criteria and were generally good quality. Analyses demonstrated expected findings, such as increased understanding and active management of mental health in the context of group processes. Results also highlighted that WRAP training promoted acceptance and improved communication with professionals. Peer delivery of WRAP was highly valued, with contrasting perceptions of peers and professionals evident. Some cultural considerations were raised by participants from ethnic minorities.

WRAP training participation has positive self-perceived effects beyond those captured by measures of recovery. Broader implications are suggested regarding earlier access to WRAP, professional support and communication between professionals and service users. Recommendations for further research include the relationship between social support and illness self-management and peer-delivered acceptance-based approaches. Multiple time-point qualitative studies could offer insights into WRAP training processes and whether changes are sustained.

As the first review of qualitative evidence regarding WRAP training, value is offered both through increased understanding of outcomes and also guidance for future research.

This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD) symptomatology for individuals who misuse substances.

Systematic searches across six databases (PsycINFO, Embase, Scopus, Medline, CINAHL and ProQuest), hand searching and citation chaining were conducted between June and August 2021. Key search terms included BPD, substance use, therapy and effect. Study and sample characteristics, interventions, outcome measures and key findings were extracted. Quality assessment and a narrative synthesis approach were used to explore strengths, limitations and relationships between and within studies.

Seven eligible reports were included and showed mostly adequate quality. Mixed samples, designs, outcomes, definitions and implementation varied. Treatment completion did not differ significantly between those who did and did not misuse substances. Interventions demonstrated effectiveness in relation to psychiatric symptoms, hospital admissions, self-efficacy and impulsive and self-mutilating (cutting, burning, etc.) behaviours. No effects were found for suicidal or parasuicidal (threats, preparation and attempts) behaviours.

This review only considers individuals with diagnoses of BPD who are not accessing substance misuse treatment. Radically open dialectical behaviour therapy (DBT), therapeutic communities and other interventions are available as interventions for substance misuse (Beaulieu et al., 2021). Based on the findings of this review, it should not be assumed that such interventions affect substance misuse rather than BPD symptomatology. Therefore, future research might explore the effectiveness of these interventions on BPD symptomatology despite this not being the primary target for intervention.

Despite McCrone et al. (2008) noting the cost of this population’s difficulties to both themselves and services, the limited number of studies in this area is astonishing. Despite a lack of quality in the data available, there i some evidence to support the use of DBT and general psychiatric management (GPM) interventions for those with BPD and concurrent substance misuse. It is therefore of principal importance that health and social care services action Public Health England’s (2017) recommendations. Individuals with coexisting BPD and substance misuse would then receive support from any professional they see, who could then refer for psychological therapies.

Although the reports appear to show that DBT, integrated therapies and GPM may be effective for this population, conclusions cannot be drawn with high levels of confidence due to heterogeneity among studies. The findings indicate that future, high-quality research is needed to test the effects of interventions on BPD symptomatology for those who misuse substances. Randomised controlled trials with sufficient statistical power, homogeneous outcomes and standardised methodological approaches are needed.