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Chinchetru, Raquel (2024) Understanding the work experiences and provider perceptions of working with people who suffer with chronic pain. Doctoral thesis, London Metropolitan University.
This portfolio and the competency folders contain over four years of reflective logs and evidence that I have met the requirements to complete the competencies for the Professional Doctorate in Health Psychology. Together, the teaching and training competence with two case studies, behaviour change interventions competence with two more case studies, one systematic review and research thesis constitute the wide range of knowledge and skills gained within health psychology theory and practice. These are accompanied by my professional skills, through which I have applied theories and constructs to practice within the NHS while working in the pain management clinic.
As part of being a trainee health psychologist, I have developed the generic professional skills competence, which has allowed me to collaborate within a multidisciplinary team of specialists in the field of chronic pain. My role as a clinical specialist delivering psychological interventions for the management of chronic pain has enabled me to promote health psychology theory and practice in order to enhance psychological adjustment to chronic pain and treatment, minimising distress associated with medical procedures, delivering health education, facilitating patient decision-making and implementing psychological interventions to promote healthy behaviours and self-management strategies to cope with chronic pain.
The systematic review process has contributed to my professional skills as an evidenced based practitioner health psychologist and arose as a result of identifying the need to understand more about psychological interventions for opiate reduction in the patients that I work with in the pain management clinic The client population in the area where I deliver pain psychology interventions has reported high levels of opioid prescription, and this inspired me to conduct the systematic review. The review's aim was to evaluate the efficacy of psychological interventions for opioid reduction and psychological outcomes in people with persistent non-cancer pain. A total of eight studies were identified for qualitative synthesis, and a quality check was conducted using the Critical Appraisal Skills Programme (CASP) tool. In regard to the quality check tools applied, it was very helpful to receive support and guidance from my supervisors, allowing me to apply an adequate tool specifically for randomised control trials and interventions. There is some evidence from this review that psychological interventions can help with opioid reduction, however from the reviewed studies it is difficult to establish the effectiveness of psychologically based interventions in reference to opioid reduction and opioid use disorder (OUD). High-quality studies with adequate sample sizes and methodology need to be conducted in the future. I found the findings so interesting at the end that I was pleased for choosing the "opioid" topic that in spite of the complexity of the area - it was definitely worth exploring the topic in depth.
The research competence is the largest section of this portfolio; this competence was very relevant in improving my skills as a researcher. I found it helpful to train in the new IPA (Interpretative phenomenological analysis) terminology before I started developing the process of analysis. I engaged with the data as an immersive experience, in which I found the process fascinating in terms of getting to the core of the participants' experiences in and views on working with chronic pain. The results of this study identified five master themes: 'Emotional dimensions of working with chronic pain'; 'Life values for working with chronic pain'; 'Building a therapeutic relationship'; 'Barriers to working with chronic pain'; and 'Protective factors for providers working with chronic pain'. These findings are relevant in providing an understanding of provider needs and difficulties when working in chronic pain, clinicians' interpretations of burnout and future career aspirations. The findings also have implications for improving the quality and management of the service as well as increasing the well-being of healthcare professionals.
The consultancy competence was the competence that took me longest to complete. The main outcome of my work was to produce an evidence-based manual to be used for professional training in the management of persistent pain. As a trainee health psychologist, I tried to bring a unique perspective, anchored in the knowledge and experience of applying health psychology theory to training and clinical practice. I felt that developing a sense of greater self-efficacy was an important factor to incorporate into the manual. Development of the manual took a year to complete, as the first draft was 150 pages and the second one 100 pages in total. Design of the manual was the most complex and challenging process, however composing the main contents and writing up were much easier after the design process. I enjoyed the delivery of the training based on the contents of the manual, as this helped me to gain valuable experience of teaching, gaining a deeper understanding of the audience's needs and reflect on future improvements.
The teaching and training competence consisted of a case study, teaching plan and teaching evaluation. The case study and teaching plan focus on the development, teaching and training of a 35-hour course for health professionals to provide specific training and guidance in the use of yoga therapy, mindfulness and ACT (Acceptance and Commitment Therapy) in the management of chronic pain. The teaching evaluation was part of the Yoga in Healthcare Conference organised by the Yoga in Healthcare Alliance in collaboration with the College of Medicine and University of Westminster (the organiser). The title of the session was "The role of yoga therapy and mindfulness in chronic pain", and it was delivered during the conference. This competence enabled me to develop and enhance my skills as a teacher/trainer in health psychology. It was challenging to face a large audience, but this supported me in gaining confidence in public speaking. I integrated tools to communicate effectively and applied models of reflection after each delivery to support me in improving my skills in teaching as well as training.
The behaviour change intervention was the one I felt most comfortable with, as I have delivered many pain psychology interventions in my work placement. Following my interest in opioid reduction, I delivered an individual behaviour change intervention; this intervention aimed to support a client with chronic non-malignant pain in tapering opioids in order to achieve long-term health benefits and improve quality of life as the primary outcomes, as well as a secondary outcome of increased pain acceptance. This allowed me to develop skills and gain more experience in the field of opioid reduction, and I was pleased with the outcome of the intervention in reducing opioid intake as well as increasing quality of life and providing self-management tools to maintain the behaviour change. The group behaviour change intervention focused on the design, delivery and evaluation of a health psychology intervention to support a group of clients with chronic pain, by reinforcing self-management skills and increasing self-efficacy and confidence in managing chronic pain as a primary outcome. The intervention was designed to also include a secondary outcome of increased pain acceptance. I included this secondary outcome, as I learnt from my previous intervention how relevant the role of pain acceptance is in managing chronic pain, as well as offering psychological support during the process of acceptance. I enjoyed the delivery of this intervention, as participants were highly engaged during the whole programme over six consecutive weeks. They showed a collaborative approach in reporting their experiences, as well as offering input to understand the barriers to self-management and how they can be overcome.
In conclusion, this portfolio is a manifestation of the journey and the learning process of becoming a health psychologist. I will continue to learn and gain further professional development as well as supervision and reflective practice. I feel grateful to have done this course, as I now feel more confident to continue developing my career in the field of health psychology and making my contributions to the field of chronic pain.
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