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Moore, Daniel (2024) A constructivist grounded theory analysis of how counselling psychologists in the UK navigate the therapeutic relationship in forensic settings. Doctoral thesis, London Metropolitan University.
Background:
The therapeutic relationship has been researched at length and found to be a key feature in psychological therapy. Several studies have found having a strong therapeutic relationship can ameliorate the opportunity for positive engagement even in settings which present challenges. Forensic settings have been found to present specific challenges when developing and maintaining a therapeutic relationship. Such challenges include the impact of systematic power inequalities, structural control, and features of coercion, amongst others. Patients are detained against their will, due to a combination of mental illness and risk. This presents a unique dynamic for patients, therapists, and wider stakeholders to navigate.
Rationale and aims:
Counselling psychologists hold at their core a humanistic and relational view in their understanding of others. At the centre of their practice is the therapeutic relationship which they value as a vehicle for change. Currently, no research has explored the intersection of the therapeutic relationship, forensic settings, and counselling psychology. This study aims to explore how counselling psychologists navigate the therapeutic relationship when working in forensic settings. The research will aim to better understand the processes therapists experience which both challenge as well as improve the development and maintenance of a strong therapeutic relationship.
Method:
A qualitative research method using constructivist grounded theory was used to explore the processes experienced by six qualified counselling psychologists. Participants had a minimum of one year working in either low or medium security forensic psychiatric hospitals in the UK. A model was developed to suggest a way of diagrammatically understanding these processes.
Results:
The results suggest participants found benefits in first understanding the setting and its constraints on patients, the process and themselves. Once engaged, building trust is suggested to be the focus of participants navigating the TR. Trust was impacted by several factors: therapist attributes, creative engagement, and non-judgemental communication. Although the potential for dissonance in the relationship through risk or rupture was ever present, the use of self-awareness and engaging in a human way is suggested to mitigate such intrusions.
Implications:
By engaging in the fundamental features of their training, counselling psychologists seem specifically well positioned to engage a patient group who are disproportionally at risk of being dehumanised and disempowered. Further research into the specific benefits of counselling psychology in this setting, may further the possibility of positive outcomes for navigating the therapeutic relationship in forensic settings in the future.
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