Too close to home? Experiences of Kurdish refugee interpreters working in UK mental health services.

BACKGROUND: Despite their essential role in the National Health Service, there is limited research on the experiences of refugee interpreters. AIMS: To explore Kurdish refugee interpreters' experiences of working in UK mental health services. METHOD: Six participants were interviewed and data collected were analysed using interpretative phenomenological analysis. RESULTS: The results showed that interpreters often felt overwhelmed by the emotional impact of interpreting in mental health services, particularly at the beginning of their careers. Interpreters struggled to negotiate complex and unclear roles and responsibilities. Interpreting for refugees with shared histories was particularly challenging. CONCLUSIONS: The study recommends that interpreters working in mental health services receive training on mental health issues and self-care and are assisted by frameworks to help make sense of the impact of the work, such as supervision.

Exploring the personal and professional impact of reflective practice groups: a survey of 18 cohorts from a UK clinical psychology training course.

OBJECTIVES: Given the importance of reflective practice within clinical psychology and a lack of empirical research, this study aimed to investigate the personal and professional impact of reflective practice groups (RPGs) for former trainees. DESIGN: This study followed an analytic survey design utilizing a convenience sample of qualified clinical psychologists from a UK training programme. METHODS: A RPG questionnaire (RPGQ) was developed for the purposes of the study. Following initial pilot work, 297 qualified psychologists were invited to complete the RPGQ. RESULTS: One hundred and twenty-four psychologists (42%) completed the RPGQ. Factor analysis yielded two underlying constructs labelled 'value' and 'distress'. The RPGQ demonstrated significant internal and test-retest reliability. The majority rated the RPGs as valuable for personal and professional development and learning about group processes. Just under half however reported distress as a result of the groups. Whilst some trainees, who reported distress, were able to view the challenges positively, one-sixth were not. Potency of facilitation and group size significantly predicted levels of perceived value and distress. CONCLUSIONS: In view of the ethical issues raised by compulsory RPGs, recommendations were made to keep group sizes within an average of 10-13, utilize facilitators with sufficient training in group processes and ensure additional methods of reflective practice development are available. Further suggestions and recommendations for future research in relation to coping and personal learning style were also made.

A qualitative study exploring the life-course experiences of young offenders with symptoms and signs of ADHD who were detained in a residential care setting.

BACKGROUND: An association between attention-deficit/hyperactivity disorder (ADHD) and offending is increasingly being recognised among youths in the criminal justice system, but is poorly understood. METHODS: Using the qualitative methodology of Interpretive Phenomenological Analysis, we explored the self-reported life-course experiences of five adolescents in a young offenders' secure unit; all had been rated by teachers on Conner's scale as having ADHD, although only one had received a clinical diagnosis. RESULTS: Three master themes were identified: loss, a search for belonging and responses to confinement. The themes suggest that both the ADHD and the offending behaviour of these young men need to be understood in the context of losses that they have suffered and their responses to these losses. They showed a preoccupation with family matters and a desperate wish to find a way to belong; they almost seemed to welcome some aspects of their confinement. CONCLUSION: These themes suggest that 'being held' may, to some extent, fulfil a self-identified need for belonging and reattachment after major losses. Therapeutic interventions may need to take account of the possibility that this confinement may also validate for these young men a tendency to attribute the course of their lives to external factors.

Dual relationships between clinical psychologists and their clients: a survey of UK clinical psychologists' attitudes.

OBJECTIVES: To collect information from a large number and broad range of UK clinical psychologists in order to examine the relationships between their attitudes towards dual relationships and various other characteristics, for comparison with the results of previous studies (mainly in the USA). DESIGN: The study was an anonymous postal survey. METHOD: Questionnaires were sent out by the British Psychological Society Direct Mail Service to 1,000 randomly selected full members of the Division of Clinical Psychology (total membership 3,330). The questionnaire covered attitudes in respect of the management of dual relationships, general demographic information and questions about training, supervision and work experience. RESULTS: Of the questionnaires, 424 (42.4%) were returned with data available for analysis. The results appear to be consistent with other studies and, in general, the expected associations between variables were found. Overall, the dual relationship scenarios were rated as professionally appropriate only in limited circumstances; most consensus was found regarding the inappropriateness of sexual dual relationships. CONCLUSIONS: The findings are discussed in terms of their relationships with previous research. Implications for clinical psychology training and the profession of Clinical Psychology are considered.

Addressing psychological aspects of physical problems through sandplay: a grounded theory study of therapists' views.

OBJECTIVES: This study aimed to explore therapists' understanding of how people with a wide range of physical problems address the psychological aspects of these problems through sandplay, what happens for them in the process, what changes they experience and what sandplay can contribute to working with such people. DESIGN: This exploratory qualitative study used grounded theory to systematically analyse the data and construct a substantive theory of therapists' understanding of the processes and themes involved in sandplay therapy with people with physical problems. METHODS: Semi-structured interviews were carried out with nine sandplay therapists with the participants asked about their experiences of using sandplay to address physical problems. RESULTS: The participants offered evidence of their clients' ability to address their physical problems and the corresponding psychological issues through symbolic expression in the sand. The emergent theory suggested that such symbolic expression could facilitate access to feelings and experiences that can be difficult to address through verbal therapy alone, thus facilitating the process of integration and recovery. CONCLUSIONS: The theory suggests how therapists thought that clients may address their physical problems through sandplay and what is important in that process. There was also a suggestion that the focus and themes unfolding in sandplay process may vary depending on whether the clients present with somatisation, chronic illness, or terminal illness.

Being men with eating disorders: perspectives of male eating disorder service-users.

This study aimed to explore experiences of men currently using eating disorder services. Eight men from two eating disorder services were interviewed about their experiences of seeking and receiving treatment. Two superordinate themes emerged from Interpretative Phenomenological Analysis: (1) difficulty seeing self as having an eating disorder; and (2) experiences of treatment: how important is gender? The underlying themes varied in their specificity to men, with some echoing findings from the female eating disorder literature. Difficulty admitting the eating disorder may link with eating disorder psychopathology as well as gender-specific issues. Implications for clinical practice and future research are discussed.

Group cognitive-behavior therapy for bulimia nervosa: statistical versus clinical significance of changes in symptoms across treatment.

BACKGROUND: Cognitive-behavior therapy (CBT) is the most effective treatment to date for bulimia nervosa. The current study investigated the effects of group CBT treatment (including some interpersonal elements) for bulimic clients. METHOD: Twenty-nine patients completed the Stirling Eating Disorder Scales, the Beck Depression Inventory, and the Beck Anxiety Inventory at assessment, pretreatment, end of treatment, and at 6 months follow-up. Symptom change was explored in two ways. Statistically significant change was determined using repeated-measures analyses of variance and clinically significant change was determined using criteria proposed by Jacobson & Truax (1991, Journal of Consulting and Clinical Psychology, 59, 12-19). RESULTS: There was an overall improvement in dimensional measures of bulimic and restrictive attitudes and behaviors (maintained at the 6-month follow-up), which was most closely matched by clinically significant changes in bulimic behaviors. Depression (but not anxiety) was also targeted effectively. Statistically significant improvements in psychological functioning were evident only for assertiveness, but the analysis of clinical significance showed improvement for some participants in self-evaluation (self-directed hostility). DISCUSSION: Group CBT (including interpersonal elements) is broadly effective when treating bulimia nervosa, but it does not work in all cases (and may lead to enhancement of restrictive characteristics in some cases). Tests of statistical and clinical significance provide different information, which can inform practice and aid in the development of treatments for patients who respond less well to current best practice.