A portfolio of study, practice and research SUBMITTED FOR THE DOCTOR OF PSYCHOLOGY (PSYCHD) IN CLINICAL PSYCHOLOGY Conversion Progrannne ® Tanya Sichel Clinical Psychologist September 1995 ProQ uest Number: 27750492 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent on the quality of the copy submitted. in the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 27750492 Published by ProQuest LLC (2019). Copyright of the Dissertation is held by the Author. Ail Rights Reserved. This work is protected against unauthorized copying under Title 17, United States Code Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106 - 1346 CONTENTS Page Acknowledgements 1 Section One: Professional Audit 2 Personal Study Programme 3 Record of Continuing Professional Development 11 Section Two: Academic Dossier 13 Essay I: The aetiology of stimulant drug misuse: 14 implications and challenges for treatment Essay II: Changing high risk behaviours: the application 30 of health education strategies to drug users Essay III: Critical issues in the field of sexual abuse with 47 special reference to people who misuse stimulant drugs Section Three: Clinical Dossier 64 Introduction 65 The Service Development Proposal 67 The Bid 90 The Treatment Manuals 95 Conclusion 1^^ Section Four: Research Dossier 109 MSc research: The role of the televisual media in preventive 110 mental health: an investigation PsychD research: The evaluation of an out-patient programme 182 for the treatment of stimulant drug misuse ACKNOWLEDGEMENTS A number of people have donated their time and talent to this PsychD thesis. Camden and Islington Drugs Services have funded and supported this work and I thank all my colleagues for their interest and input. In particular, I should like to thank Dr. Charlotte Feinmann, Senior Lecturer in Psychiatry, Middlesex Hospital London, for her continued supervision, encouragement and support; also Dr. Graham Powell and later Dr. Robert Edelmann and Paul Devonshire, Surrey University, for their supervision and comments. My appreciation and thanks also to: Luke Mitcheson, Clinical Psychologist, who helped me to run this programme and is a fantastic colleague; Dr. Ron Alcorn, Consultant Psychiatrist in Substance Misuse, who has always supported this work and provided invaluable clinical input and knowledge; Dr. Angela Byrne, for her generous help with methodology and design issues; and Emma Stubbs, for her continual availability and exceptional word processing skills. I should also like to acknowledge the input of the clients who took part in this pilot programme; their experiences have been most valuable to this service. Finally, my greatest thanks to Bruce Byron, my partner and most valued support, who has tolerated the process of this PsychD, and to our soon-to-be-born first child who has patiently accompanied me through the last months and had the generosity and thoughtfulness not to arrive prematurely! To our baby I dedicate this work. Section One PROFESSIONAL AUDIT PERSONAL STUDY PROGRAMME Psvch D in Clinical Psychology: Conversion Programme Name: Tanya Sichel Date of Registration: 25 April 1994 Registration number: 3316009 1. Overall Aims and Objectives As laid down by the course directives. 2.0 Academic 2.1 Aims Prime aim: To enhance academic competence in three specialist areas of clinical psychology so as to develop the services offered by the department or the profession. Additional aims: i) To provide a comprehensive overview of the breadth of current psychological and related literature within the substance misuse field: the boundaries and interactions. ii) To critically evaluate, compare and contrast the diverse range of psychological theories, therapies and measures developed within this field: critical issues and concepts. iii) To examine the possible applications of such theories, therapies and measures in the assessment and treatment of people who present with psychological difficulties relating to substance misuse: applicability, usability and explanatory power. 2.2 Objectives Prime objective: To complete three critical academic reviews, one for each of the three specialist areas. Additional objectives: i) To use the information gathered to form the basis of teaching sessions to colleagues within the multi-disciplinary team. ii) To underpin bids to purchasers for extra resources with well reasoned argument highlighting theory - practice links. iii) To use literature to provide a cogent and coherent rationale for the development of new services within the existing drug treatment services. iv) To present the academic reviews to the drugs services research advisory group with recommendations for future potential research projects within the service as indicated by gaps in the existing literature. 2.3 Rationale Camden and Islington Drugs Service is a busy, central London out patient treatment service offering a wide range of assessment and treatment options to a diverse, heterogenous drug using population. Providing a service to over 600 patients per month, the service has very little opportunity to spend time on research and development. The content of the academic reviews have been agreed with the lead academic and clinical consultants as useful both for individual and service development. The reviews will be available to all members of the team and will provide information on issues currently challenging the service. 2.4 Plan The above aims and objectives laid down by the academic audit will be achieved as follows: i) The aetiologv of stimulant drug abuse: implications and challenges for treatment. ii) Changing high risk behaviours: the application of health education strategies to drug users. iii) Critical issues in the field of sexualabuse with special reference to people who misuse drugs. 3.0 Clinical 3.1 Aims Prime aim: To develop the services offered by the department or the profession. Additional aims: i) To develop a new treatment service for a specific population of drug users who currently present with unmet treatment needs. ii) To enhance the assessment and treatment options for drug users with psychological difficulties related to their addictive behaviour. 3.2 Objectives Prime objective: To present a dossier on clinical activity that will describe service developments undertaken and their psychological framework. Additional objectives: i) To increase personal understanding of the process of service development, ie. knowledge of existing treatment models, knowledge about the clinical population, writing a bid, providing a cogent proposal for the service with a clear clinical framework that can be evaluated. 3.3 Rationale Camden and Islington Drugs Services offers a broad range of assessment and treatment options to a large number of inner city drug users. A recent service review highlighted a need to develop services for a growing population of users of stimulant drugs, (eg. cocaine, crack cocaine, amphetamine sulphate); currently, locally as well as nationally, such services do not formally exist. This group of drug users present with dependencies that appear to be underpinned psychologically rather than physiologically. This is supported by international literature which highlights the efficacy of cognitive - behavioural interventions with such drug users. The challenge exists for clinical psychology within the drugs treatment agency to develop such a service. 3.4 Plan The above aims and objectives laid down by the clinical audit will be achieved as follows: Title: Camden and Islington Drugs Services: Service Development proposal A proposed out patient treatment service for people who abuse stimulant drugs Service development proposal, including: i) review of the existing treatment literature: what it shows, what it lacks; ii) examination of the needs of the target population within Camden and Islington; iii) overview of proposed service delivery model; iv) service development bid; v) treatment manual providing an overview of sessions within each stage of treatment. 4.0 Research 4.1 Aims Prime aim: Either to increase research competence so as to develop the services offered by the department or profession, or to increase the knowledge available to the department or the profession. Additional aims: i) To pilot, evaluate and write up a treatment service for people who use stimulant drugs (see clinical dossier). 4.2 Objectives Prime objective: To develop a research dossier, part of which will be the original MSc dissertation, which will either make evident increased research competence or will present a contribution to knowledge. Additional objectives: i) To develop knowledge of qualitative and quantitative measures developed for the evaluation of services and their application. ii) To use the outcomes of research to improve service delivery of the proposed treatment model. iii) To use the research dossier to pull together work from the relevant academic and clinical dossiers. 4.3 Rationale Camden, and Islington Drugs Services propose to offer a comprehensive assessment and treatment service for stimulant drug users by 1995. In order to justify bids for the extra resources necessary, the proposed service should be piloted, thoroughly evaluated and written up. While this piece of work is conceptually very different to the original MSc dissertation, it will address issues that