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Experiences of Impulsivity, Self-Harm and Dbt Groups: a Qualitative Enquiry in a Secure Setting

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Experiences of Impulsivity, Self-Harm and Dbt Groups: a Qualitative Enquiry in a Secure Setting EXPERIENCES OF IMPULSIVITY, SELF-HARM AND DBT GROUPS: A QUALITATIVE ENQUIRY IN A SECURE SETTING Anna Caroline Whalen Submitted in accordance with the requirements for the degree of Doctor of Clinical Psychology (D. Clin. Psychol.) The University of Leeds School of Medicine Academic Unit of Psychiatry and Behavioural Sciences March 2016 1 The candidate confirms that the work submitted is her 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. © 2016 The University of Leeds and Anna Caroline Whalen The right of Anna Caroline Whalen to be identified as Author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988 2 ACKNOWLEDGEMENTS My thanks to Gemma, Joan, Grace, Emily and Jessica for your bravery and trust. Without you this would not have been possible. I hope I have done justice to your words. I am grateful to the staff for a warm welcome and your commitment to do your best for those you work with by supporting me with this research. Thank you to my family and friends for your patience, tolerance and for hanging on in there for me. I’m lucky to have you. Finally, thanks to my supervisors, Carol, Amanda and Harry for keeping me grounded and nudging me along. 3 ABSTRACT Introduction This study was developed from a recognition of the lack of research exploring experiences of self-harm, impulsivity and the group component of Dialectical Behaviour Therapy for women in low secure forensic setting. Psychological understandings and models proposed do not consider self-harm within particular contexts. It is important to gain an understanding of impulsivity and self-harm, within the context in which they occur, to develop models of understanding and ensure therapies offered are adapted for the specific needs of the population. Method Using a combination of purposeful sampling and snowballing, a sample of six women, who were detained in a low secure forensic hospital, were recruited. They participated in semi- structured interviews which were transcribed and then analysed using Interpretative Phenomenological Analysis. Individual transcripts were analysed and three levels of themes were identified for each participant. Individual themes were then used to develop the group themes. Results Two sets of results are presented. The first focuses on how women make sense of their experience of self-harm and impulsivity. Three levels of themes were identified, the first level consisted of ‘I need you for safety but I fear you’, ‘I’m going round in circles and keep making the same mistakes’, ‘Living in a hostile world’, ‘A sense of losing and finding myself’. The second set of results focuses on experiences of Group Based Skills Training component of Dialectical Behaviour Therapy Two levels of themes were generated, the first level consisted of ‘Mistrust and vulnerability: denial and defences’, Making sense of GBST: Is it worth it?, Tentative changes’. Discussion The key findings of the study are linked to psychological theory, current models of understanding self-harm and previous research findings. The study adds to literature on experiences of self-harm and impulsive acts, in addition to, understanding the relationship between self-harm and impulsivity within forensic settings. It also adds to the minimal literature exploring the experiences of Group Based Skills Training for women within secure forensic settings. 4 Table of Contents Table of Contents .......................................................................................................................... 5 LIST OF TABLES ........................................................................................................................ 7 LIST OF FIGURES ...................................................................................................................... 7 ABBREVIATIONS ...................................................................................................................... 8 CHAPTER ONE: INTRODUCTION ........................................................................................... 9 Literature review ..................................................................................................................... 10 Understandings of Self-Harm ................................................................................................. 10 Psychological Understanding of Self-harm ........................................................................ 10 Borderline Personality Disorder (BPD) .............................................................................. 15 Impulsivity .............................................................................................................................. 16 Associations between Self-harm and Impulsivity ................................................................... 17 Qualitative Research on Self-harm ..................................................................................... 17 Qualitative Research on Impulsivity ................................................................................... 20 Summary of literature on self-harm and impulsivity .......................................................... 21 Dialectical Behaviour Therapy (DBT) .................................................................................... 22 Overview of the Evidence for Dialectical Behaviour Therapy ........................................... 23 Group Based Skills Training ............................................................................................... 24 Structuring Group Based Skills Training Sessions ............................................................. 26 Group Based Skills Training as a Stand-Alone Treatment in Forensic Settings ................ 28 How do Women Engaged in GBST Experience Group Based Skills Training? .................... 29 Rationale ................................................................................................................................. 30 Research questions .................................................................................................................. 31 CHAPTER TWO: METHODOLOGY ....................................................................................... 32 Section 1: Theoretical methodology ....................................................................................... 32 Section 2: Method ................................................................................................................... 32 Design ................................................................................................................................. 32 Participants .......................................................................................................................... 33 Section 3: Ethical considerations ............................................................................................ 36 Section 4: Theoretical considerations ..................................................................................... 38 Qualitative Methodological Approach ................................................................................ 38 Methodological Stance Taken; IPA and why? .................................................................... 40 Service User Involvement ................................................................................................... 41 Data Collection ................................................................................................................... 42 Chosen Method of Producing Data ..................................................................................... 43 Material ............................................................................................................................... 44 Section 4: Data Analysis ......................................................................................................... 45 5 Process of Analysis ............................................................................................................. 45 Section 5: Quality checks in qualitative research ................................................................... 48 Reflexivity ........................................................................................................................... 49 CHAPTER THREE: RESULTS ................................................................................................. 51 Pen Portraits ............................................................................................................................ 51 Results of the Group Analysis of Self-harm and Impulsivity ................................................. 64 Results of the group analysis of Group Based Skills Training ............................................... 78 CHAPTER FOUR: DISCUSSION ............................................................................................. 85 1. How do women engaged in Group Based Skills Training in a forensic setting make sense of impulsivity and self-harm? ........................................................................................ 85 2. How do women experience engaging in Group Based Skills Training? ......................... 92 3. How do women describe the impact of Group Based Skills Training on their impulsivity and self-harm? ........................................................................................................................
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