Issue 1 - Research Coventry and Warwick Clinical Psychology

Issue 1 - Research
Coventry and Warwick
Clinical Psychology
Doctorate
Training
News
Welcome!
From the course team…
Welcome to the first edition of the Training News, the newsletter of the Coventry and Warwick Clinical Psychology
Programme. For those of you not familiar with the programme, we are a three-year full-time postgraduate training
course for Trainee Clinical Psychologists in the West Midlands, situated within the Department of Psychology and
Behavioural Sciences in the Faculty of Health and Life Sciences at Coventry University and within the Department
of Psychology at the University of Warwick
Training is a collaborative
venture between Coventry and
Warwick universities and Clinical
Psychologists in the West Midlands
region. The training scheme is
seen as part of the local clinical
psychology community and seeks to
encourage full mutual participation
between the course and local
National Health Services.
The needs of the NHS, both nationally
and locally, are a major influence on
programme content. In particular, the
programme aims to be responsive
to the service and staffing needs of
NHS Trusts in the West Midlands
by providing flexible programme of
study, which reflects changing health
priorities and develops trainees who
are equipped to deal with the problems
which have a high priority in the NHS at
any one time.
The Coventry and Warwick course
is one of three clinical psychology
courses in the West Midlands,
commissioned by Health Education
West Midlands.
Trainees have an employment contract
with Coventry and Warwickshire
Partnership NHS Trust and will spend
60% of their time (three days per week)
on clinical placements providing direct
clinical work with clients, indirect work
with clients via consultancy with MDT
colleagues and research input including
conducting service-relevant audit and
evaluation projects within the various
NHS teams that they work in.
The programme also has a part to play
in large-scale collaborative research,
clinical projects and post-qualifying
training in clinical psychology, with its
Continuing Professional Development
(CPD) programme for qualified
NHS staff.
Our programme newsletter aims to
share news of developments and
activities taking place on the course
that are relevant to NHS colleagues
at all levels, to placement supervisors
and academic partners, to the course’s
Service User and Carer Strategy
Group and to our Trainee Clinical
Psychologists.
This first issue of Training News takes
a research focus, highlighting research
conducted by trainees from the
course as well as recent and current
research developments. We hope you
find the content both informative and
stimulating! If indeed you are motivated
to become involved in small or largescale clinically relevant research, either
as a clinical supervisor or as a member
of staff who has an idea for a service
evaluation project with a mental health
or service improvement focus, please
do get in touch with us by email using
the contact details at the back of the
newsletter.
Course Research News
Mental Health in
Football
Second year Trainee Clinical Psychologist, Sue Wood, was recently interviewed by BBC Coventry and Warwickshire Sport about a research project she is currently developing. The research aims to understand the experiences of footballers who have had mental health difficulties, a topic that has recently seen a lot of media interest
and debate.
Mental health in football is under the spot light following
a number of high profile cases, such as Gary Speed’s
suicide. A handful of former players have also started to
speak about their experiences of mental health. Many
others continue to fall under the radar. For example the
young player whose career ends following a knee injury,
who starts to battle with depression and gambling, before
taking his life at just 23 years old.
1 in 4 people experience mental health problems and
research in France and Australia has found a similar
prevalence in sports people across a range of disciplines.
The ages of 16-34 are the most common for the onset
of mental health difficulties and many elite sports people
would fall in this category. Male footballers are vulnerable
due to the pressurised and ‘macho’ environment of
football. Their identity is defined by football. They tend
to experience more stigma and negative attitudes. They
are less likely to seek help and are at greater risk of
committing suicide.
Increased awareness of these difficulties has resulted
in more support being available to footballers, such as
24 hour help lines. Worryingly, a 2014 survey of Dutch
professional football clubs found that only 7% of clubs
undertook mental health investigations. There remain
huge gaps in our knowledge of diagnosis, treatment, risk
factors and unique experiences of footballers with mental
health difficulties.
If you are in contact with footballers who may be
interested in participating in this research, please
pass on the details below. Please do not hesitate to
email for further information.
[email protected]
Division of Clinical Psychology
Conference Presentations
Two of our current third year trainees from the 2012 cohort are due to present findings from Service
Evaluation they conducted during clinical placements
in two of our local NHS Trusts at the upcoming Annual
Conference of the West Midlands Branch of the Division
of Clinical Psychology (DCP) in Birmingham in December.
We thought you may be interested in hearing about the
service evaluation work that Trainee Clinical Psychologists
carry out while on placement in local NHS mental health
and psychology services.
Felicity Walker’s project was undertaken while Felicity
was on clinical placement in Coventry and Warwickshire
Partnership NHS Trust based at the Nuneaton and
Bedworth CMHT and was developed in collaboration with
Dr Hayley Richardson, Principal Clinical Psychologist.
The project aimed to evaluate the effectiveness of an
Affect Management Skills Training (AMST) group for
adults aged 18-65 in a NHS secondary care mental health
service. AMST is aimed at increasing emotion regulation
skills; unlike other emotional regulation therapies AMST
is unique, incorporating techniques from Eye Movement
Desensitization and Reprocessing Therapy (Omaha,
2004). Previously, AMST has only been delivered on an
individual basis. Locally, clinical psychologists adapted
the intervention into a group programme.
Results demonstrated that there was a statistically
significant improvement in emotional dysregulation,
psychological wellbeing and interpersonal difficulties
following the AMST group, and at 6 weeks follow up.
Secondly, the service evaluation demonstrated that, on
average, the group required less clinical hours to deliver,
and service users received more clinical hours, than if
the same intervention was conducted individually. Of
important note, all service users indicated that they would
recommend the AMST group to a friend.
Locally the positive result of this service evaluation has
enabled AMST to be considered as an intervention under
care clusters 3-6. However, it is hoped that AMST will also be considered for care clusters 7-8, particularly because people often need to learn to regulate their
emotions before engaging in more focused therapy,
such as those with complex trauma presentations. It is
important to note that without this service evaluation,
demonstrating the effectiveness and suggested efficiency
of AMST in a group format, AMST may not have been
considered and service users would have had less
diversity in the intervention packages offered.
Rachel Squires’ project was carried out while she was
on a clinical placement in Worcestershire Mental Health
Partnership NHS Trust based at the Wyre Forest Older
Adult CMHT with Janice Walker, Clinical Psychologist.
The project evaluated the effectiveness of two ‘Coping
with Forgetfulness’ groups for older adults with early
stage dementia or mild cognitive impairment and their
family caregivers. The groups were facilitated in an NHS
secondary care mental health service for adults over the
age of 65. They aimed to provide psycho-education about
memory difficulties and compensatory strategies, as
well as signposting clients to other helpful services (e.g.
Alzheimer’s Society), all within the context of a structured,
peer-support group.
The results showed a statistically significant increase in
clients’ use of memory strategies at one month follow
up. Qualitative feedback indicated that the group was a
satisfying experience for both service users and carers.
The majority noted that attending the group helped them
cope more successfully and reduced their stress levels.
The positive outcome of this evaluation highlighted
that clients in this service would benefit from continued
facilitation of ‘Coping with Forgetfulness’ groups.
Recommendations were made for improving the
evaluation process to capture richer information about
the socially supportive nature of the group, as well as
demonstrating long-term outcomes to inform decisions
about continued support. The project also highlighted
possible adjustments to improve the course itself.
Paul Matthews
The use of questions in care
programme approach (CPA) meetings
(Supervisors-Helen Liebling & Simon
Goodman).
Paul carried out his research on the care
programme approach within Coventry and
Warwickshire Partnership NHS Trust.
Recent graduates from the 2011 cohort at the Warwick University 2014 Postgraduate Research Conference:
Photo shows left to right; Sam Lowry, Natalie Lowe, Damian Wilde, Jo Lloyd, Paul Matthews, Nikala Kumari,
Tom Patterson (Academic Director), Sarah Flanagan, Tim Dore, Jenny Thompson and Helen Mortimer.
University of Warwick
Postgraduate Conference
At the 2014 University of Warwick postgraduate research conference our clinical
psychology trainees presented their empirical research as posters. This is a jointly
held yearly event between Warwick University postgraduate psychologists and
Warwick and Coventry University Clinical Psychology staff and trainees.
11 posters were displayed and trainees axnswered
several questions about their research, which was
good preparation for their Vivas in June 2014.
Examples of some of our trainees’ empirical
research, which was presented follows:
Helen Mortimer The lived experience of malignant melanoma: diagnosis, treatment and beyond (Supervisors-Eve Knight,
Carolyn Gordon & Kate Martin). Helen is now working as a clinical psychologist in acute services in Coventry and
Warwickshire NHS Partnership Trust.
Abstract
A diagnosis of malignant melanoma can result in a range of emotional reactions and psychological distress. In spite of
this, little research has been conducted into the experiences of malignant melanoma survivors, from their perspectives.
This study aimed to explore in detail the experiences of people who have had melanoma and the sense that they have
made of their experience. Six participants were recruited to this study. Semi-structured interviews were conducted and
analysed according to Interpretative Phenomenological Analysis (IPA). Three superordinate themes emerged from the
data; ‘It is serious, isn’t it?’, ‘Finding an equilibrium’ and ‘A chapter closed?’. Participants’ experiences were characterised
by a tension between malignant melanoma being a serious life event, or not. This was influenced by their own and others’
perceptions. Their ways of restoring balance for themselves and coping with their situation and the value of support
emerged as a significant part of their experience. Finally, participants considered the ongoing impact of having had
melanoma, and the longer-lasting effects of this experience.
Abstract
The care of people with complex mental
health difficulties in England is organised
through a process called the Care
Programme Approach (CPA). A key part
of the approach is the review meeting
where care is planned with the service
user and shared decisions are made.
Research to date has not addressed how
such meetings are actually structured in
practice and therefore it is not known if this
supports service user participation.
Paul Matthews with his poster presentation
The current study uses discourse analysis to investigate the way that questions are used by participants in CPA review
meetings. Questions are described that fulfill six functions in the review meeting; switching discussion to a different topic,
prompting the service user to add further information, avoiding overt conflict, bringing the conversation back on topic,
ensuring that the meeting follows a particular structure, and offering the service user the opportunity to ask questions.
The implications of the findings are discussed in relation to service user participation in the CPA process.
Ellie Brown
Mothers’ experiences of relationships
during domestic violence. Ellie also presented
her research (supervised by Helen Liebling, Tony
Colombo & Kim Golding). This research was
also presented by Helen Liebling at the Coventry
University Interpersonal Violence & Aggression
Conference in November 2014.
Photo shows on the left side: Helen
Liebling (Supervisor / Research Tutor) and
Ellie Brown (right side of photo)
Abstract
Previous research has examined the effects of domestic violence (DV) on the mother-child attachment relationship through
the use of questionnaires and observations. The current study, consistent with feminist methodology, seeks to increase
knowledge of women’s experiences of their relationship with their child during DV. Interpretative Phenomenological
Analysis (IPA) of seven interviews revealed that the women interviewed had experiences of shame and worried they
were a ‘bad mother’. They attempted to distance themselves from this uncomfortable emotion by the use of defensive
projection and as a result experienced their child as a ‘bad child’, which was a protective strategy to preserve the women’s
resilience. As well as reflecting on the negative ways in which DV had impacted upon their relationship with their child, the
women interviewed demonstrated areas of resilience and agency by altering their parenting style and consequently their
relationship with their child once leaving the relationship.
Covering diverse subjects ranging from dementia,
psychosis, veteran projects and survivors of sexual
and gender-based violence and torture including
refugees and asylum seekers.
Dr Helen Liebling, Research Tutor, presenting applied
research on experiences of trauma counselling services,
carried out in northern Uganda and staff-trainee research.
Dr Tony Colombo, Research Tutor at HLS faculty
research conference
Faculty of
Health & Life
Sciences
Research Conference 2014
At this year’s Faculty of Health and Life Sciences annual conference, the Doctorate
Course in Clinical Psychology displayed published articles and posters arising out of
staff-trainee publications covering diverse subjects ranging from dementia, psychosis,
veteran projects and survivors of psychological trauma. The conference was well
attended by professionals and researchers from within and outside of the University.
A number of trainee thesis research projects go on to
be published in highly regarded peer reviewed journals,
reaching both local and international audiences and
contributing to the development of evidence-based
practice in several important domains of clinical
psychology. Recent publications include:
Clare, M., Goodman, S., Liebling, H. & Laing, H. (2014)
“You Keep Yourself Strong”: A Discourse Analysis of
African Women Asylum Seekers Talk about Emotions’.
Journal of International Women’s Studies 15 (1), 83-95.
Cook, J., Knight, E., Hume, I. & Qureshi, A. (2014) The
self-esteem of adults diagnosed with attention-deficit/
hyperactivity disorder (ADHD): a systematic review of
the literature. ADHD: Attention Deficit and Hyperactivity
Disorders: Official Journal of the World Federation of
ADHD. Springer-Verlag Wien 2014. DOI 10.1007/s12402014-0133-2
Johl, N., Patterson, T.G. and Pearson, L. (in press.). What
do we know about the attitudes, experiences and needs
of informal black and minority ethnic carers of people with
dementia in the United Kingdom? A systematic review of
empirical research findings. Dementia: the International
Journal of Social Research and Practice.
DOI: 10.1177/1471301214534424.
Kahlon, S., Neal, A. and Patterson T.G. (2014).
Experiences of cognitive-behavioural therapy formulation
among clients with depression. Behavioural and
Cognitive Psychotherapies, e8, 7, 1-14. doi:10.1017/
S1754470X14000075.
Pooley. H., Highfield, J & Neal, A. (in press) A Contribution
to Supporting and Understanding the end Stage Renal
Failure Experience. Journal of Renal Care.
Ackner, S., Skeate, A., Patterson, P. & Neal, A. (2013)
Emotional Abuse and Psychosis: A Recent Review of the
Literature. Journal of Aggression, Maltreatment & Trauma,
22, 9, 1032-1049.
Ford, H. & Kent, S. (2013) The experiences of bilingualism
within the deaf and the hearing world: The views of deaf
young people. Deafness and Education International.
Service Projects
Small-Scale
Some examples
of recently
completed
service evaluation
projects carried
out by our
trainees are
presented here:
Each of our Doctorate trainees
completes a service-related
project as well as their
substantive Doctoral research,
in line with evidence-based
practice and health service
priority research agendas.
The Doctorate Course has
particularly strong links with
Coventry & Warwickshire NHS
Partnership Trust. The Trust
is the main employer of our
trainees and the majority of
their clinical placements and
research projects are carried out
within the Trust. Trust Clinical
Psychologists regularly provide
clinical and research supervision
for these projects, which are
linked to Trust priorities and
objectives. As a consequence,
it is important that these are
disseminated to provide local
and national impetus for service
improvements
Effectiveness of a Postdiagnostic Informational and
Psycho-educational Group
for Carers of People with
Dementia Damian Wilde, Trainee
Clinical Psychologist, Judith
Bond & Tom Patterson, Clinical
Psychologists, Coventry and
Warwickshire Partnership NHS
Trust
Abstract
Dementia caregiving has been
shown to be stressful and linked
to increased levels of mortality
(Schulz & Beach, 1999). The
Department of Health (2009)
published the National Dementia
Strategy recommending that
good quality information and
support services should be
available for clients and carers.
A number of studies have
evaluated the effectiveness of
interventions for carers of people
with dementia. Kurz, Wagenpfeil,
Hallauer, Schneider-Schelte,
and Jansen (2009) found that
carers receiving an educational
group reported significantly
higher satisfaction compared to
controls and found caregiving
became easier.
The Older Adult Psychology
Service investigated the
effectiveness of a postdiagnostic informational and
psych educational group they
provided for carers of people
with dementia. Data from
five consecutive groups was
evaluated. Group participants
(n = 50) were asked to complete
a carers’ course questionnaire
designed to collect both
quantitative and qualitative
information. Descriptive
statistics were carried out
and results showed that (n
= 34) 76.5% of carers found
the course ‘very helpful’, with
23.5% of carers finding the
course ‘quite helpful’. Thematic
analysis was carried out on the
qualitative data. Themes which
emerged included an increased
understanding of dementia,
finding support from others in
the group beneficial, feeling ‘not
alone’ and having increased
awareness of support services
available. Themes regarding
possible improvements included
longer duration of sessions and
provision of further information
(e.g. financial and legal).
The carers’ course provided by
the older adult service was found
to be effective with a number of
key benefits emerging.
A qualitative evaluation of
a post-diagnostic group
intervention for people with
mild cognitive impairment and
their carers Jo Lloyd, Trainee
Clinical Psychologist and Anna
Buckle, Clinical Psychologist,
Worcestershire Health and
Care NHS Trust
Abstract
Mild cognitive impairment
(MCI) is defined as a greater
than average decline in one
or more cognitive domains
whilst maintaining day-to-day
functional abilities. Research has
identified that people with MCI
have different needs to those
with dementia and therefore
Early Intervention Dementia
Service (EIDS) Worcestershire
developed a 3 session postdiagnostic group intervention
for people with MCI and their
carers. Having been positively
received, the service requested
a more detailed evaluation.
Interviews were conducted
with 5 carer/MCI dyads
recruited from two different
MCI groups. Thematic analysis
of the transcribed interviews
revealed 3 main themes relating
to the group, content and
shared experience. Subthemes
included positive experiences
of attending the group, despite
initial apprehension, and
praise for the structure and
facilitation. Participants found
the information provided helpful
and reassuring, yet also familiar
and tended to want more
answers to future uncertainty.
The shared experience was also
felt to be valuable, but for some
highlighted the individual nature
of the problem. The findings
are discussed in the context
of the existing literature and
recommendations are suggested.
Limitations of the study and
reflections are also presented.
A Service Evaluation
investigating the effectiveness
of a Compassion Focused
Therapy Group being delivered
within an Adult Community
Mental Health Team Nikala
Kumari, Clinical Psychologist
and Emma Price, Clinical
Psychologist, Coventry and
Warwickshire Partnership NHS
Trust
Abstract
Service users entering secondary
mental health services do so
due to the complex nature of
their difficulties. There are high
demands placed on CMHTs to
be able to offer evidence-based,
time-limited interventions, to
meet the needs of the clients.
This project aimed to evaluate a
Compassion Focused Therapy
Group for adults aged 18-65.
Mixed methods were employed
to evaluate whether general
mental health improved and selfcompassion developed using pre
and post measures. Thematic
analysis of an open-ended
questionnaire was also used to
gauge service users` experiences
of the group. Statistical analysis
demonstrated some positive
findings, and the group was
experienced as containing, a
space for personal growth, but
challenges acknowledged as
well. The results are discussed
in relation to previous research,
and future implications are
outlined.
What are the most beneficial
aspects of a monthly multiprofessional team meeting for
complex cases?
A qualitative study
Sarah Flanagan, Clinical
Psychologist and Toria Maybey,
Clinical Psychologist, South
Warwickshire Mental Health
Services, Coventry and
Warwickshire Partnership Trust.
Abstract
Background: The literature
base indicates that there are
substantial correlations between
staff well-being and patient
outcomes in the NHS. Emotional
exhaustion or ‘burnout’ has
been observed at its highest in
Community Mental Health Teams
(CMHT) over other tiers of care.
Method:
A focus group was conducted with several
multi-disciplinary health professionals within a
CMHT. Thematic analysis was conducted and
emerging themes were identified.
Results:
CMHT professionals identified two
overarching themes to explain the beneficial
aspects of attending a monthly complex
case meeting. These were i) enabling good
practice and ii) enabling collaborative
working. Limitations were noted in the sense
that benefits were only extended to staff in
attendance of the meetings and the clients
that they worked with.
Conclusions:
Increasing demands on staff resources are
likely to lead to greater levels of staff burnout
as indicated by the existing literature base.
Protective mechanisms to boost staff morale
are one means of reducing this impact
and maintaining a healthy workforce. The
supervisory and informal support available
to this CMHT during complex case meetings
appeared to play a key role in enabling the
discussed benefits.
Graduation Ceremony
Coventry Cathedral 2014
Every year our clinical psychology trainees attend the postgraduate graduation ceremony,
which this year was held at Coventry Cathedral and was attended by staff as well as
graduating trainees, all in full graduation regalia.
Below, on the left from left to right-Jo Kucharska, Clinical Director, Jacky Knibbs, Selection
Tutor, Lesley Pearson, Clinical Tutor and Helen Liebling, Research Tutor.
Karolina Wutke (left) and Emma Lever (right), 2010 cohort trainees at the Graduation
ceremony which took place at Coventry Cathedral in January 2014.
Acknowledgements
We hope you have enjoyed reading our first newsletter. We would like to express sincere appreciation and thanks to all our
research supervisors and colleagues in Coventry and Warwickshire NHS Partnership Trust and at Warwick and Coventry
Universities for their continued support and collaborations.
The course team is: Eve Knight (Course Director), Catherine Ashton (Programme Administrator), Tony Colombo (Research
Tutor), Carolyn Gordon (Academic Tutor), Ian Hume (Research Tutor), Jacky Knibbs (Selection Tutor), Jo Kucharska
(Clinical Director), Helen Liebling (Research Tutor), Magda Marczak (Clinical Tutor), Tom Patterson (Academic Director),
Lesley Pearson (Clinical Tutor) and Sarah Simmonds (Clinical Tutor).
Future Collaborations
If you have ideas for service relevant small scale evaluation projects or clinically relevant thesis research projects, or would
like to contact the Course, please get in touch with us as indicated below:
Dr Tom Patterson, Academic Director (Small Scale Service Projects/Academic Issues)
E-mail: [email protected]
Dr Helen Liebling, Research Tutor (Research theses/Research Issues)
E-mail: [email protected]
We look forward to hearing from you!
Dr Tom Patterson
Academic Director (Small Scale Service Projects/Academic Issues)
E-mail: [email protected]
Training News
Design - Marketing & Communications, Coventry University
Dr Helen Liebling
Research Tutor (Research theses/Research Issues)
E-mail: [email protected]
14329-14 Coventry University 2014