Jade Elliston - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: adoption
developmental trauma
early adversity
attachment
dissociation
voice-hearing

Systematic Review of the Literature:
Previous empirical research has suggested that traumatic experiences in childhood may be linked to the development of hallucinations via dissociative processes. The current review aimed to assess the extent and quality of evidence supporting this mechanism to establish greater specificity in the understanding of how traumatic experiences confer risk of later psychopathology. A systematic search was undertaken using PsycINFO, Web of Science, PubMed, Embase, Medline, Global Index Medicus and KoreaMed. Titles and abstracts were screened, with eligible articles reviewed in full. Nineteen papers were identified, referring to twenty independent studies of varied methodologies, including both clinical and non-clinical populations globally. Although findings supported the role of dissociation as a mediator, with emerging evidence of specific pathways between trauma, dissociation and hallucinations across modalities, evidence is currently limited by cross-sectional methodologies and poor control of confounding variables. Implications for clinical practice and future research are discussed.
Service-improvement Project:
Legislative reform in the UK has prioritised the welfare and rights of children where there are safeguarding concerns. Parents’ views have comparatively less weight and children may be placed in long-term alternative care without their birth parents’ consent, a process colloquially referred to as ‘forced adoption’. This service-improvement project aimed to explore parent and staff perspectives about processes related to forced adoption with a view to support a therapeutic service for vulnerable families consider how to address unmet needs. Eleven semi-structured interviews were undertaken with four parents and seven professionals. Five key themes were derived from birth parents’ interviews related to experience of service processes, parents’ investment in parenting, injustice, the impact of adoption and required support. Six key themes were derived from staff interviews related to service context, circumstances around adoption, competing role priorities, the observed impact for families, the impact of adoption and required support. Recommendations are made to the service based on birth parents and professionals’ experiences and reflections, shown alongside responses from the Clinical Lead for the service. Implications for birth parents, professionals and services are discussed.
Theoretically Driven Research Project:
Objectives: Although the relationship between childhood trauma and voice-hearing is well- established, theoretical mechanisms that may explain this relationship remain exploratory. This study aimed to examine the specificity of the role of interpersonal trauma compared to non-interpersonal trauma in relation to voice-hearing by comparing the experiences of individuals who hear voices with individuals who do not hear voices. Methods: 114 individuals, comprised of 47 voice-hearers and 67 non-voice-hearers completed a series of questionnaires related to voice-hearing, childhood trauma, dissociation and attachment either online, via the telephone or face-to-face.
Results: After controlling for confounders and non-interpersonal trauma, interpersonal trauma was found to significantly predict voice-hearing, with greater exposure corresponding to an increased risk of hearing voices. Levels of dissociation and disorganised attachment were higher for voice-hearers and were implicated in a series of mediation models designed to examine relationships between interpersonal childhood trauma, dissociation and attachment.
Conclusions: There may be some utility in distinguishing between interpersonal and non- interpersonal childhood trauma in the context of vulnerability to voice-hearing. Findings are also suggestive of a complex mechanism of psychological processes underlying the relationship between childhood trauma and voice-hearing, though attributing causality should be approached tentatively in light of methodological limitations and issues of generalisability.