Psychological practitioners' conceptualisations of the process of change in clients with chronic health conditions: A qualitative study.
PhD, University of the West of England.
- Accepted Version
A qualitative exploration was conducted of the conceptualisations of the process of change held by 10 independently employed health psychologist and counselling practitioners who work with clients with chronic health conditions in a context parallel to primary care. The health psychologists were in their early careers while the counsellors were older and had practiced longer. A thematic analysis of responses to semi-structured interviews found commonalities in intervention beliefs among the participants from the two professions, sharing two overarching themes of “Change can be prompted by expert techniques” and “Providing love and safety lets change happen”. These themes were believed to facilitate an end-state of healthy change in the patient/client. The health psychologists appeared to believe that techniques based on theories and evidence provided an appropriate basis for intervention while the counsellors appeared to believe that an eclectic mix of relational theory and selected techniques were sufficient to support their approach. The health psychologists and counsellors approached their clients/patients with different objectives, with the health psychologists focused on improved outcomes while the counsellors focused on the quality of the therapeutic relationship. A sub-theme of “Frustrated by lack of therapeutic skills” was derived from some of the health psychologists who believed that a lack of training in relational skills inhibited the quality and possibly the efficaciousness of face-to-face interventions whereas the counsellors appeared more confident in their practice and exhibited no similar frustration with their approach. It is suggested that the expert procedures in the Trans-Theoretical Model of behaviour change could provide the basis for additional relational training for health psychologists as this model derives from psychotherapeutic change theory and practice. Further research should be carried out to explore and test the utility of combining health psychological theory and evidence with relational approaches in health interventions in clients/patients with common chronic conditions.
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