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Aguilera, Katrina (2018) A grounded theory study of time-limited therapy for complex trauma : how NHS psychologists manage the challenge of working with developmentally traumatised clients within a time-limited therapeutic frame. Doctoral thesis, London Metropolitan University.
Psychological research in the field of childhood trauma indicates that the earlier the age of onset and the more severe the traumatisation in terms of intensity, duration and repetition, the more extensively impaired individuals become. In such cases long-term, phase-oriented treatment is recommended. Over the last decade, the NHS has undergone significant changes in the delivery of psychological therapies. There has been a substantial rise in the use of evidence-based practice and time-limited psychological treatment has become a focal point in the delivery of clinical interventions within community mental health services working mainly with complex traumatised individuals. As such, there appears to be a tension between clinical need, resources available, and a requirement to adopt a more results-driven, time-limited therapeutic framework as the primary treatment. This research sought to examine how clinicians contend with the dilemma of working within a time-limited frame with developmentally traumatised clients. Semi-structured interviews were conducted with seven NHS psychologists. Findings suggest that the imbalance between demand and resources generates an imbalance of emotional resources and a tentative model is presented outlining the process of progressive emotional depletion experienced by participants as a direct result of the various and conflicting demands placed on them by the client, the organisation and the clinical task. Key implications arising from this research surround the implementation of Eye Movement Desensitization and Reprocessing (EMDR) for the management of dilemmas on a client, organisational and clinician level. Implications of this for theory and practice are discussed with an emphasis on enhancing knowledge in the field of Counselling Psychology and recommendations for future research are provided.
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