Clinical Psychologists’ use of Reflection within their Clinical Work

Wheeler, Rosie and Daiches, Anna and Hodges, Suzanne and Duxbury, Anna (2021) Clinical Psychologists’ use of Reflection within their Clinical Work. PhD thesis, Lancaster University.

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Abstract

The therapeutic alliance is considered an important element of psychotherapy and a good alliance has repeatedly been linked with positive outcomes. Ruptures in the alliance can have negative effects, but if attended to, have been demonstrated to lead to even better outcomes than therapy when a rupture did not occur. A systematic literature review identified nine papers which included therapists’ experiences of working with ruptures in psychotherapy. Meta-ethnographic methods were used to synthesise the findings in these studies and the following themes were identified; hitting therapists where it hurts which highlights that ruptures often result in therapists questioning their fundamental and valued skills and qualities, ruptures as an opportunity where ruptures provided additional information or opportunities within therapy and understanding the causes of ruptures in which therapists attributed ruptures to their own mistakes, contributions from clients or influences from third parties. The review emphasises some of the positive impacts ruptures can have but also highlights how challenging they can be for therapists. Reflection is considered a vital skill within clinical psychology, but little is known about the processes involved when clinical psychologists reflect. Semi-structured interviews were completed with seven clinical psychologists and grounded theory methods were used to develop a model detailing the process of engaging in reflection. The model describes three internal stages to reflection; noticing something to reflect on, gathering information about this and then some form of internal change. This model provides an insight into the processes involved in reflection which can be used to support the teaching and further study of the skill. The critical review outlines the lead authors interest in these topics and discusses the limitations of the papers. A particular focus is given to the lack of ethnic diversity within the sample for the empirical paper and more broadly within psychology research.