Marginalised from mainstream health and social care services : a grounded theory study of the therapy relationship in non-therapy trained workers and vulnerable clients.
Creators: name: De Rijk, Lisa
Publisher: name: University of Surrey
Year: 2020
Subjects: Brief therapy; non-therapists; third sector; charities; marginalised; vulnerable; therapy relationship; health care; social care; veterans; addictions; youth worker; ptsd; homeless

description: This thesis explores the experience of the working relationships for clients and their non-therapist workers who are marginalised from main stream health and social care in the third sector. Addressing psychological and emotional problems is traditionally the domain of trained psychotherapists, psychologists and counsellors - professions that draw upon clinical and practice based evidence. Third sector workers are often less qualified yet still provide psychosocial support to others, particularly the more vulnerable in society. Little research has explored the subjective experience of client and worker using brief therapy approaches in non-clinical third sector settings which support those who do not have access to mainstream health and social care services. This thesis explores the subjective experience of clients and their workers within the charity sector in three studies. Study 1 and 2 used thematic analysis and continued into study 3, using grounded theory methodology. Study 1 (n=8) explored the experiences of young people who were marginalised from mainstream education and mental health services and were accessing a workshop and manualised programme utilising brief therapy tools. Study 2 (n=5) explored the experiences of workers who had used the manualised workbook and programme to help these young people to manage their behaviour, with a view to returning to mainstream education. The findings of study 1 and 2 informed the development of a grounded theory exploration with an adult age population in study 3. This population were being supported by workers in a veterans Post Traumatic Stress Disorder (PTSD) charity. In addition, study 3 (n=11) also explored workers experiences in a veterans’ homeless charity and two addictions charities. The workers were using a range of brief therapy interventions from a range of approaches: Brief Solution Focussed Therapy, Cognitive Behavioural Therapy, Motivational Interviewing and Neurolinguistic Programming. The data from all 3 studies in this thesis were then synthesised to develop a middle range grounded theory. The findings of the thesis suggest that a therapeutic working relationship based on self-maturational models develops between worker and client. Both the workers and their clients have had disrupted attachment histories and see similarities in each other as part of their own healing journey. The relationship is sometimes uncontained with the workers lacking aspects of self-reflective functioning that would normally be supported through training, personal therapy and supervision of the qualified worker. The charity sector is an increasingly important economic contributor to the health and social care system. This thesis recommends a quality commissioning process that enables education and supervision of non-clinically trained workers to help develop and support their reflexive functioning.