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Predicting and Understanding Four Types of Aggression on a Locked Psychiatric Hospital Ward Predicting and Understanding Four Types of Aggression on a Locked Psychiatric Hospital Ward A Portfolio of Practice, Study and Research Submitted for the Degree of Doctor of Psychology (Psych. D.) in Clinical Psychology (Conversion Programme) By; Brian Mark Levy University of Surrey Juiy 1998 ProQuest Number: 27606621 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete 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 27606621 Published by ProQuest LLO (2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLO. ProQuest LLO. 789 East Eisenhower Parkway P.Q. Box 1346 Ann Arbor, Ml 48106- 1346 Acknowledgements I would like to express my sincere thanks and appreciation to the following people for their help and support during the preparation of this portfolio. The Chief Executive and Board of Walsall Community Health Trust The Staff and Patients of Windermere Ward, Dorothy Pattison Hospital Mr. Jan Scott (Manager - Windermere Ward) Mrs. Pam Skinner (District Psychologist & Director of Clinical Services) Dr. Clive Eastman (Consultant Psychologist - Clinical Supervisor) Dr. Graham Fuller (Consultant Psychiatrist) Dr. Tim Hull (Clinical Psychologist - Research Advisor) Ms. Lisa Hillman (Assistant Psychologist) Ms. Sophie Mayhew (Assistant Psychologist) Dr. Glynis Laws (Academic and Research Advisor - Surrey University) Dr. Jonathan Foulds (Clinical Advisor - Surrey University) Dr. Claire Twigger-Ross (Research Advisor - Surrey University) Dr. Chris Fife-Schaw (Statistical Advisor - Surrey University ) Dr. Mohammed Mohammed (Senior Clinical Medical Officer) Contents Section 1: Personal Study Plan.....................................................4 Section 2: Clinical Dossier..........................................................14 Personal Professional History. ................................................................15 The Case for the Radical Restructuring o f the Clinical Psychology Profession ............................................................................. 65 Section 3: Academic Dossier.............. 76 Eye Movement Desensitisation in the Treatment o f Post- Traumatic Stress Disorder: Fact and Fiction ....................................... 77 Deconstructing Eye Movement Desensitisation for the Treatment o f Post-Traumatic Stress Disorder: A Review o f Contemporary Theory .............................................................................. 98 Section 4: Research Dossier......................................................118 Predicting and understanding four types o f aggression on a locked psychiatric hospital ward .......................................................... 119 Personal Styles in Attempted Suicide ...................................................259 Section 1 : Personal Study Plan Submitted as Part Requirement for the Degree of Doctor of Psychology Name: Brian Mark Levy Date: August, 1996 Date of Registration: April, 1996 Registration Number: URN 3518841 Overall Aim My overall aim is to enhance my practice as a Chartered Clinical Psychologist by engaging in a programme of academic study and research that will be of practical benefit to my patients, employer and the Trainee Clinical Psychologists on attachment to my specialty. By the end of this period of study, I hope to have improved my research skills and academic knowledge to a standard whereby I can contribute to the profession through the production of papers and articles. I hope to achieve this by producing a portfolio of work including an outline of my clinical experience and training (clinical dossier), two academic critical reviews (academic dossier) and a research thesis (research dossier). Clinical Dossier I propose to submit a detailed outline of my clinical experience over the 12 years since I first qualified. This will be based upon my ‘Personal Professional History’. Over the years, I have maintained this document instead of a Curriculum Vita and have included a copy with each post that I have applied for. In addition to containing details about my qualifications and post held to date, the document chronicles key aspects of my clinical and employment experience. The document also contains details of post-qualification training that I have undertaken. In many ways, my ‘Personal Professional History’ is akin to the training and experience logs that some professions (e.g. nursing) require to be maintained on a regular basis. - 5 - The second part of my submission for the clinical dossier comprises a paper entitled “The case for the radical restructuring of the clinical psychology profession”. This ‘professional issues’ paper argues that the development of the clinical psychology profession and its ambition to seek equivalence of pay and status with the medical profession is being damaged by the current structure of the profession. The paper asserts that career promotion within the profession should be linked to clearly defined continuing professional development to ensure that ‘Grade B’ or Consultant Clinical Psychologists are worthy of that status. Academic Dossier The Academic Dossier of the portfolio will comprise the following two 4500 word critical reviews. Eye Movement Desensitisation in the Treatment of Post-Traumatic Stress Disorder: Fact and Fiction A trawl of abstracts in the psychological literature since 1989 suggests that there has been considerable interest in Eye Movement Desensitisation (EMD) in the treatment of symptoms of Post Traumatic Stress Disorder (PTSD). Dramatic claims have been made for this technique and some practitioners appear to be using it for a wide variety of different disorders. In the first review, it is my intention to consider the efficacy of the technique as applied to solely to the treatment of PTSD. In the spirit of the Doctor of Psychology (Psych. D.) conversion course, I have deliberately chosen this area because I receive a significant number of referrals of patients with PTSD. In my experience, the intrusion symptoms of this disorder seem particularly difficult to eliminate. I am, therefore, interested in expanding my knowledge of this area. I do not anticipate any particular difficulties in completing this piece of work. However, it is my intention to submit drafts of the work to my academic 6 - supervisor as the work proceeds. In addition I will arrange appointments to discuss the work at various points. Deconstructing Eye Movement Desensitisation for the Treatment of Post-Traumatic Stress Disorder: A Review of Contemporary Theory My developing interest in Eye Movement Desensitisation (EMD) has led me to consider that clinicians have attempted to develop treatment methods without fully considering the theoretical construction of PTSD. Thus, my aim is to critically review recent theoretical models reported in the literature. In the spirit of the Psych.D. conversion course opportunity to demonstrate the development of academic knowledge, I have chosen this area partly because I have not attempted such a review in the past. I also feel that it will complement the work carried out for the first review. Together, both pieces of work will have practical implications for my role as a co-ordinator of the local counselling effort in the event of a major disaster. At present, I do not anticipate any difficulty in completing the work, although obtaining all of the literature revealed by a search may prove to be time consuming. As will be the case with the first review, it is my intention to submit drafts of the work to my academic supervisor as the work proceeds. Research Dossier The Research Dossier will comprise two research projects. The first of these will cover a new area of research prepared for the Psych.D. Conversion Course. The second project is a copy of my original M.Sc. research project which was originally submitted to Birmingham University in 1986 as a part- requirement for my current clinical qualification. -7 Project 1 Predicting and understanding four types of aggression on a iocked psychiatric hospitai ward. Research Supervisor: Dr. C. Eastman, Consultant Clinical Psychologist, Walsall Community Health Trust Background & Relevance Perhaps one of the key issues facing mental health professionals today is the expectation that we should be able to predict violence and aggression in psychiatric patients. Several British studies indicate that the rate of violence in psychiatric hospitals has been increasing over the past decade or so (Hodgkinson, Mclvor & Phillips, 1985; Haller & Deluty, 1988; Noble & Rodger, 1989; James, Fineberg & Shah, 1990; Whittington, 1994). Indeed Whittington (1994) suggests that whilst there is considerable variability in the rates of violence between different psychiatric units, on average there is an assault on a member of nursing staff every 6 to 11 days. He suggests that the cumulative effect of such experiences on staff amounts to a significant occupational stressor. Examination of the literature suggests that predictions of aggression and violence in psychiatric patients is notoriously inaccurate (sometimes being worse than chance). However, recent research indicates that the development of actuarial prediction methods may improve the situation significantly,
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