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Title: Service users' experiences of endings from NHS community personality disorder services
Author: Webb, Kimberly
ISNI:       0000 0004 8506 9882
Awarding Body: University of Lincoln
Current Institution: University of Lincoln
Date of Award: 2019
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Background: Endings are considered an important part of the therapy process, however, the empirical literature on the topic is sparse, and clinical guidelines supporting practice are limited. In particular, there is a lack of evidence derived from service users' subjective experiences that warrants further exploration. Aim: The key aim of this research was to explore service users' experiences of endings from NHS community Personality Disorder services. Method: Semi-structured telephone interviews were conducted with eight individuals discharged within a three-month period from one of four NHS community PD services. Interview transcripts were analysed using a deductive-inductive approach using an adapted version of Braun and Clarke's method of thematic analysis (2006). An additional 'refutational' stage was incorporated into the steps of analysis to ensure contrasting data was considered. Results: During the analysis, it became apparent that there were two distinct over-arching themes: service users' experiences of the process of ending and their clinical reactions and responses to the ending. It was therefore decided that two journal papers would be written, each focussing on their respective parts. Three main themes relevant to the process of ending were reported in paper one; 'Service users' experiences in the context of Reflective versus Reactive practice', 'Endings held in mind' and 'What next?' A further three themes emerged in relation to service users clinical experiences of endings, 'Loss', 'Responses to loss' and 'Boundaries'; these are discussed in paper two. Conclusions: In summary, service users experiences highlight the importance of taking a reflective approach to the management of endings: in particular, explicitly acknowledging the ending from the start, mentioning it throughout and 'marking' the ending of therapy were considered key features of service users' experiences. The findings also highlighted service users' readiness to end therapy as a potential area of intervention. The findings from the second paper emulate previous literature suggesting that endings are experienced as a loss and that endings evoke a dynamic range of emotional responses. Boundaries were also highlighted as having an important role in determining how service users' experience the loss of endings. Clinical recommendations are provided within each paper on how health professionals and services may manage endings within clinical practice. Suggestions for future research are also discussed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available