Organizational perspectives on outdoor talking therapy: Towards a position of 'environmental safe uncertainty'.

OBJECTIVES: There is growing support within the therapy professions for using talking therapy in alternative environments, such as outdoor spaces. The aim of the present study was to further understand how the organizational culture in clinical psychology may prevent or enable practitioners to step outside the conventional indoor consulting room. DESIGN: Informed grounded theory methodology was used within a pragmatist philosophy. METHODS: Participants (N = 15; nine male, six female) were identified using theoretical sampling. The sample consisted of experts and leaders within the profession of clinical psychology (e.g., heads of services, training programme directors, chairs of professional bodies, and developers of therapy models; M years in the profession = 34.80, SD = 9.77). One-to-one interviews and analysis ran concurrently over 9 months (April-December 2020). Mason's model of safe uncertainty was drawn upon to illuminate and organize themes. RESULTS: The main themes comprised organizational factors that either support a practitioner in maintaining a position of curiosity and flexibility towards the environment where therapy is located ('environmental safe uncertainty'), or push them towards adopting a more fixed position ('environmental certainty'). Themes included influences from therapy traditions, accessibility of alternative environments, internalized risk, workplace subcultures, business models, biomedical approaches, and the COVID-19 pandemic. CONCLUSIONS: Whether therapy is located in a consulting room, outdoors, clients' homes, or digitally, practitioners, clients, and services are encouraged to maintain a position of environmental safe uncertainty. PRACTITIONER POINTS: The therapy process and outcomes are influenced by the physical environment in which talking therapy is situated. Practitioners have often remained fixed in their preferred therapy environment, such as the indoor consulting room, without exploring the potential benefits of alternative environments or involving the client in this decision-making (i.e., 'environmental certainty'). Outdoor environments, as well as other alternatives to the consulting room (e.g., digital, home visits, and public places), can support access to therapy, subsequent engagement, and therefore health care equity. Practitioners and clients are encouraged to adopt a position of 'environmental safe uncertainty', which is defined as having openness, critical curiosity, and collaboration regarding the therapy environment and the possibility of other environments being more conducive to therapy.

Exploring the therapeutic opportunities, challenges and psychological mechanisms of integrating dogs into psychological therapies with adults.

The therapeutic benefits of Animal Assisted Therapy (AAT) are well-documented and AAT research often involves dogs. Despite growing research into the therapeutic value of therapy dogs' visitation within health and psychiatric contexts, research specifically into the integration of dogs into psychological therapies is limited. Current Dog Assisted Psychological Therapy (DAPT) research is novel and limited. DAPT research predominantly focuses on therapist perspectives and use quantitative or case study methodologies. Research into adults' experience of DAPT is limited. Therefore, this research explored the experiences of adults receiving DAPT, who self-identified as experiencing mental health difficulties. Specific aims were to gain a broad insight into the experienced opportunities, challenges and factors impacting participants' experience of therapy, to help inform the clinical implications of DAPT. Qualitative methodology was used by conducting semi-structured interviews with six participants sharing their experiences of DAPT. Interpretative Phenomenological Analysis (IPA) enabled exploration of important issues regarding participants' experiences. Five themes emerged: 1) Relationship with dog(s); 2) Providing a safe therapeutic atmosphere; 3) Distraction; 4) Facilitating personal insights; and 5) Concern for the dog's wellbeing. Relationships between the themes are illustrated, and the theoretical relevance to psychological models and clinical applications are discussed. This research demonstrated that, where clinically and ethically appropriate, DAPT can provide therapeutic opportunities to facilitate psychological therapies. The therapist's skills in managing interactions and potential distraction, the client's prior experiences of dogs and the dog's wellbeing are all important considerations to manage some of the identified challenges within DAPT. Further research is needed to inform practice guidelines, specifically in terms of which psychological models and patient groups DAPT might be best suited to, and further exploration of DAPT practice within different clinical and cultural populations.

High and happy? Exploring the experience of positive states of mind in people who have been given a diagnosis of bipolar disorder.

OBJECTIVES: To approach the experience of 'happiness' and 'mania' for people who have been given a diagnosis of 'bipolar disorder' and to explore how they might differentiate or associate between these experiences. DESIGN: A qualitative design was used in which four participants who had been given a diagnosis of 'bipolar disorder' were interviewed individually regarding their experiences and ideas about 'mania' and 'happiness'. METHODS: Transcriptions from the interviews were analysed using the iterative process of interpretative phenomenological analysis. RESULTS: Four superordinate themes were identified. Two highlighted the conceptual fluidity and similarities between their ideas about and experiences of 'happiness' and 'mania'. Two emphasized the differences between these notions for the participants, which reflected the destruction, disruption, and chaos of 'mania' in contrast to the importance of self-acceptance, peacefulness, and social connection for 'happiness'. CONCLUSION: There may be benefit in maintaining an active dialogue or 'poly-vocality' about the meanings of 'happiness' in clinical work with people who experience 'positive states' of mind, which are personally problematic. This can be supported by drawing on ideas and narratives about 'happiness' from the field of positive psychology.

Appalling and appealing: a qualitative study of the character of men's self-harm.

OBJECTIVES: To engage with the experiential phenomena of men's self-harm, to get a sense of its 'feel', its character, and to relate these things in a useful and authentic way. DESIGN: Qualitative in-depth interview study with design input from service users' groups. METHOD: Hermeneutic phenomenology. Two interviews with each of four participants in their homes, with the intention of developing understanding through dialogic interview and reflection. RESULTS: Some of the character of men's self-harm was recognizable from the psychodynamic and functional literature: soothing practices, dissociation, and an ambivalent stuckness around separation versus incorporation. There were other, unexpected structures present: existential vulnerability and openness, sacrifice, lack of boundary, and insatiability. CONCLUSIONS: Professionals who work with men who self-harm may like to be aware of these relational dynamics.