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THERAPISTS' EXPERIENCES of THERAPEUTIC MISTAKES David William Aaron Submitted in Accordance with the Requirements for the Degr

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THERAPISTS' EXPERIENCES of THERAPEUTIC MISTAKES David William Aaron Submitted in Accordance with the Requirements for the Degr THERAPISTS’ EXPERIENCES OF THERAPEUTIC MISTAKES David William Aaron Submitted in accordance with the requirements for the degree of Doctor of Clinical Psychology (D. Clin. Psychol.) The University of Leeds Academic Unit of Psychiatry and Behavioural Sciences School of Medicine August 2012 The candidate confirms that the work submitted is his own and that appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. © 2012 The University of Leeds David William Aaron i Acknowledgements I would firstly like to thank Carol and Sheila who supervised me throughout the study. To Carol, I would like to thank you for challenging me yet also containing my anxiety as I embarked upon the greatest learning experience in my short career so far. I have gained so much from working with you and feel I have developed both personally and professionally as a result. I will carry this learning with me as I begin my life as a qualified Clinical Psychologist. To Sheila, I would like to thank you for sparing me some valuable hours in your ever busy schedule. I have learnt much from our conversations. I would like to thank my wonderful wife Louise and beautiful new born son Charlie for providing me with the inspiration to complete the study in spite of some challenging times both on and off the course. I would like to acknowledge the invaluable support from my family, course mates and friends outside the course; you have helped me to cope, each in your own way. Finally, I would like to thank the participants who gave up their time to take part in the study and provide such rich data for what was a fascinating study to conduct. ii Abstract Introduction: In contrast to the extensive literature on related areas such as therapeutic boundaries, alliance and ruptures, little empirical research has been conducted on therapeutic mistakes. Existing research based predominantly on case studies and observations have focused on systems for categorising mistakes. Empirical research on therapeutic mistakes has focused on supervisors’ and clients’ perspectives. This study is the first to explore therapists’ experiences of therapeutic mistakes. Method: Seven psychological therapists were interviewed using semi-structured interviews on their experience of therapeutic mistakes in therapy sessions. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Initially, individual transcripts were analysed separately, resulting in a number of themes for each participant. A group analysis was then conducted across participants, yielding super-ordinate themes and sub-themes, based on their psychological relatedness. Results: A seven-stage process was identified across participants’ accounts (including participants’ experience of before the session, in the session, the emergence of a problem, in the midst of the problem, ‘The aftermath’, making sense and ‘How I’m left’), detailing the experiential themes for participants at each stage. Some of the main themes that emerged were a sense of ‘something brewing’, feeling criticised by their client or self-criticism, relief and recovery, reflecting on roles and responsibility and pre-occupation with the mistake. Four key findings were presented including participants’ complex constitution of mistakes, the role of emotion in participants’ experiences of mistakes, participants’ on-going meaning making process and participants’ experience of mistakes as an interpersonal negotiation. The findings also suggested a difference between how participants constituted mistakes in principle (more aligned with the literature on boundary transgressions and categorisations of mistakes) and the mistakes they shared in their accounts (which reflected more ordinary and minor mistakes, e.g. administrative errors or sharing an interpretation that was not well received). iii Discussion: The findings were examined in relation to existing literature. An evaluation of the methodology was presented, resulting in suggestions for future research. Finally the clinical implications of the study for therapists, supervisors, clients and services were discussed, including recommendations for clinical practice. iv Table of contents List of tables ...................................................................................................................... vii List of figures ................................................................................................................... viii Abbreviations ..................................................................................................................... ix CHAPTER ONE ............................................................................................................... 10 Introduction to the study ............................................................................................... 10 Literature review ........................................................................................................... 10 Process of conducting the initial literature review ................................................... 10 Ethical guidelines and codes of conduct ................................................................... 11 Clinical competence .................................................................................................. 13 Decision making ........................................................................................................ 14 Boundaries ................................................................................................................ 15 The therapeutic relationship: therapeutic alliance and ruptures ............................. 21 Therapeutic Mistakes ................................................................................................ 23 A gap in the literature ............................................................................................... 29 Summary of current literature ................................................................................... 30 Research questions .................................................................................................... 31 CHAPTER TWO .............................................................................................................. 32 Methodological approach .............................................................................................. 32 Interpretative Phenomenological Analysis ............................................................... 32 Alternative methodological approaches ................................................................... 34 Sampling ................................................................................................................... 34 Data collection .......................................................................................................... 35 Interpretative Phenomenological Analysis: The process .......................................... 36 Method .......................................................................................................................... 36 Research Design ....................................................................................................... 36 Sampling and recruitment ......................................................................................... 37 Information & Consent ............................................................................................. 37 Ethical issues ............................................................................................................ 38 Procedure .................................................................................................................. 39 Interviews .............................................................................................................. 39 Interview schedule ................................................................................................ 39 Data Analysis ............................................................................................................ 42 v Organising different types of data ......................................................................... 42 IPA Procedure ....................................................................................................... 43 Quality checks: reliability and credibility................................................................. 45 Reflexivity .................................................................................................................. 46 CHAPER THREE ............................................................................................................. 48 Results ........................................................................................................................... 48 Participants ............................................................................................................... 48 Pen Portraits ............................................................................................................. 49 Alex ....................................................................................................................... 49 Linda ..................................................................................................................... 51 Elaine ...................................................................................................................
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