Morris, Lucy (2014) The process of change in non-residential therapeutic communities. PhD thesis, Faculty of Health and Medicine.
Abstract
Staff working with individuals with a diagnosis of personality disorder may experience difficulties within this work (Cleary, Siegfried & Walter, 2002; Fraser & Gallop, 1993). This may impact on service users’ experiences of mental health care. Thus, understanding more about the experience of this work may help improve staff’s experiences and provision of health care for service users. Correspondingly, a meta-synthesis exploring staff’s experiences was conducted using guidelines outlined by Noblit and Hare (1988). From the analysis, four themes were developed: the value of caring; the paradigm of caring; the need for containment; us and them. An overarching theme of moving between extremes was also established. The meta-synthesis highlighted the dynamic nature of this work and difficult experiences in providing care. The research paper explored the process of change in non-residential therapeutic communities using grounded theory methodology. Eleven participants were interviewed and shared their perception of the process within the therapeutic community. A model was developed which highlighted a difficult process of joining the group, which required commitment to continue. As group members began to feel more comfortable they learnt how to talk within the group and used this to create a safe place. Group members integrated into the group and took on the identity of a group member, through which a reciprocal process was described where individuals used the group for themselves and acted as the therapeutic input for others through challenging, offering advice and sharing their own experiences. This enabled individuals to develop an increased understanding of their own difficulties and utilise the safety of the group to initiate change. Finally, the critical appraisal considered themes of invisibility and marginalisation apparent across the experience of conducting the literature review and research paper.