Clinical Psychology Research Group
Clinical Psychology research is clinically focused, applied to people's real lives and contexts, and committed to ensuring our health and care services meet the needs of those we serve. Members of the Clinical Psychology Research Group are passionate about promoting a research culture within clinical psychology and more widely in the NHS and social care, and within clinical psychology training. Equity, inclusion and accessibility in health and social care, and in clinical psychology training, is at the heart of all we do.
Within this group we apply varied epistemological and methodological approaches to answer research questions related to diverse areas, including: Psychosocial aspects of medical conditions (e.g., Diabetes self-management, Eating difficulties and Eating disorders), Mental health interventions, End-of-life care, Families in the care system, Parental and family bereavement, Perinatal mental health, Parental mental health, Rehumanising approaches within health and social care, Cultural and spiritual awareness and sensitivity of services, Clinical Psychology training and pedagogy, Staff wellbeing in the health and care workforce, and Leadership, consultation and supervision in Clinical Psychology.
Research is an integral aspect of the identity and skill set of a clinical psychologist, a "scientist-practitioner". During the doctoral programme in Clinical Psychology, trainees complete both a service-related and a major research project, equipping them with knowledge and skills to undertake high-quality research within their practice, enabling the critical appraisal of literature, and the adoption of an evidence-based approach to clinical practice, ultimately resulting in a drive towards higher standards within the profession of Clinical Psychology.
We aim to inspire a passion for applied research that takes place with meaningful participation and public involvement. We also approach this work with a commitment to equity and inclusion, and a decolonisation of research approaches that have been adopted by the profession. As a result, the research activity that takes place is often done creatively and in collaboration with external partners, such as with communities, NHS trusts, and charitable organisations.
Research projects undertaken by Clinical Psychology staff and trainees utilise a variety of methodological approaches and are organised around three broad research streams, aligning with the wider research strategy of the University of Hertfordshire:
Clinical Psychology Training and Professional Issues
Including examining pedagogy, problem-based learning approaches, and reflective practice, and also considering inclusion, widening participation in the workforce, leadership, consultation, supervision, team-working and staff wellbeing.
Health and Wellbeing
Including research focused on illness and identity, equitable and inclusive health and social care, long-term health conditions such as diabetes and eating disorders, as well as death, dying, and bereavement.
Family Wellbeing
Including research focused on parent and family wellbeing in parental and perinatal health, child protection and the care system, parental and family bereavement, and family-service provider relationships to rehumanise our services.
What we provide:
- research knowledge and teaching, with specific expertise in a variety of qualitative methodologies as well as quantitative methods
- research collaboration and consultation in clinically relevant research areas
- opportunities to collaborate and offer audits and service evaluations for health services, social care services and the third sector
- mentoring, support, and Continuing Professional Development opportunities related to research practices and supervision
- developing and sharing best practice in research in clinical psychology.
Health and Wellbeing Case Study
The impact of flash glucose monitoring on adults with type 1 Diabetes' eating habits and relationship with food
Background
In 2017, the FreeStyle Libre (FSL) flash glucose monitor became available via NHS prescription for many people living with type 1 diabetes (T1D), offering an alternative to drawing blood via finger-prick blood glucose level checking. Associated with improved medical outcomes, and positively associated with measures of quality of life and treatment satisfaction in adults with T1D, the FSL was well-received by patients and clinicians.
Previously, changes in diabetes management methods have been shown to cause changes in food beliefs and behaviours. Dr Jennifer Heath was working clinically in local diabetes services and was concerned that, as the required focus on food consumption in diabetes management has been suggested to contribute to the development of disordered eating, such an intervention aimed at target setting and tracking to stabilise blood glucose within optimum levels could encourage perfectionist tendencies, another risk factor associated with disordered eating and eating disorders.
The impact of the FSL on eating and individuals' relationship to food appeared to have received little attention, despite it being known that increased self-awareness through tracking can prompt adoption of rigid approaches to food intake, including disordered eating behaviours. Considering the volume of data collected and presented by the FSL, it felt necessary to explore the impact of the devices use on T1D adults' relationship with food as this could be helpful in identifying T1D populations at particular risk of disordered eating or diabetes distress associated with food and eating.
What did the researcher do?
Dr Tamara Wallace used reflexive thematic analysis to analyse data collected via semi-structured interviews with 15 adults living with T1D to explore their experiences of the FSL regarding its impact on their eating habits and relationship with food.
What has the research found?
The FSL was a vehicle for new opportunities and discoveries resulting in increased self-efficacy, confidence, and flexibility around managing blood glucose and eating a variety of foods. Participants were able to access a higher level of understanding of their blood glucose levels and bodily processes, with new insights into food content that changed where, what, and how much participants chose to eat. Equipped with data, participants felt empowered to share their new expertise with peers and professionals but there was also recognition of challenges. Participants re-evaluated diabetes with some believing that exact science could lead to well-controlled diabetes and others acknowledging that perfect control was in fact unreachable.
Tamara's findings highlighted the importance of professionals better understanding:
- patients' personal food story when introducing flash glucose monitoring to them, with awareness of their eating identity and who they are in relation to food, eating, or their body type
- post-diagnosis diet changes and food restrictions are associated with feelings of deprivation of freedoms and unfairness, with some patients saying goodbye to their most loved foods and/or adopting rigid routines to keep their blood glucose levels in range
- food rules form with beliefs about food, health, and eating being implied through choices suggestive of a dichotomous view of 'good' and 'bad' foods. Food can then be seen as functional as opposed to pleasurable or social when there is a belief that an appropriate type or dose of fuel should be consumed
- continuous data can lead to information overload and the body being treated as a machine, with the systems requirements overriding natural urges - patients may seek permission from the data to determine whether they are allowed to eat in the moment
- patients can feel judged solely by blood glucose level or HbA1c - they are more than just a number that their experience is reduced to. It is also important to identify negative self-talk participants experience in relation to their diabetes control and food choices. A compassionate approach is needed as a belief exists for many that they have got to be better. Many patients also feel stuck in a cycle of eating and insulin use that, whilst facilitating better diabetes control, impact on managing body weight.
Tanara's research has now been published in the journal Diabetes Research and Clinical Practice. She continues to influence this new field of research, co-supervising a follow-up project by Seth Mackie, alongside Dr Jennifer Heath.
Clinical Psychology Training and Professional Issues Case Study
Mental Health Nurses' Experiences of Nondisclosure within Individual Clinical Supervision.
Background
Inpatient mental health nurses are required to contend with a particular set of challenging circumstances including work with acutely unwell and risky individuals, shift-working patterns, and highly unpredictable environments. Although clinical supervision has the potential to provide an important space to reflect on such challenges, research with other professional groups has suggested non-disclosure to be a complex issue within the context of clinical supervision, with potential for impact on the quality of supervision and in turn for safe and effective clinical practice. Research into non-disclosure within clinical supervision is a small but growing area. This is the first time the research has been broadened to look at a nursing sample.
What did the researcher do?
Dr Stuart Farley, with the support of a team of mental health nursing consultants, interviewed ten inpatient mental health nurses about their experiences of clinical supervision and non-disclosure. Recruitment was carried out in a large mental health NHS Trust in the East of England spanning urban and rural areas. This was then analysed using thematic analysis.
What has the research found?
Nondisclosure in this study impacted upon nurse wellbeing and team dynamics which was considered to indirectly impact on patient care. With the ongoing nurse shortage, recruitment, and retainment issues, coupled with the 'perfect storm' of interacting variabilities in supervisor, content, and environment, it was concluded that facilitating a space that enables disclosure will imporve wellbeing and retention. Furthermore, if the broader patient safety agenda is to be realised, it is imperative that staff feel able to disclose concerns. In this way it is hoped that the voices of the mental health nurses who participated in this study will inform policy and practice going forward. Development of clinical supervision for nurses holds key importance in delivering safe, accountable care to our most vulnerable patients and in retaining well-supported practitioners.
Dr Farley's research has been submitted for publication and is currently under review. Additional research within the field is now being developed within the research group, including a focus on staff experiences in forensic inpatient settings.
Family Wellbeing Case Study
Birth families in the care system
Background
Dr Lizette Nolte has worked clinically and researched alongside families facing parental mental health challenges and facing safeguarding intervention for over 25 years. Parents in these families often encounter multiple challenges to their parenting and at worst lose their children to foster care or adoption. We are committed to highlighting the plight of these families and supporting the development of best practice in assessment and support, including in relation to parental and perinatal mental health care, safeguarding practices and birth relative support following child removal.
What does the research group do?
We collaborate with the NHS, social care and the third sector to undertake and publish research into the experiences of parents facing mental health difficulties and birth relatives whose children have been forcibly removed. We examine the effectiveness of birth family support services and research the experiences of practitioners working in child safeguarding. Our work includes:
- communication and meaning making in families living with parental mental health difficulties
- experiences of birth-relatives following involuntary child removal
- effectiveness of birth relative support following child removal.
What has the research found?
Communication and meaning-making of distress in families living with parental mental health problems are key factors determining the impact of parental mental health problems on children and on the parent-child relationship. However, parents' and other caregivers' communication with children are hindered by their wish to protect their child, societal stigma, and uncertainty about what to say. Practitioners should better support parents and families to enable age-appropriate coherent communication with children.
Read more about these findings in this article published in the Journal of Marital and Family Therapy.
Birth relatives whose children are forcibly removed face many challenges, including early life and ongoing trauma (e.g., domestic violence), mental health and substance use difficulties and poverty. Child removal is traumatic for parents and leads to lifelong grief, shame, and longing. Birth relatives experience multiple layers of stigma.
Read more about these findings in two articles published in the journal Adoption and Fostering:
- the experiences of birth mothers whose children have been taken into care or adopted
- raising the voices of birth mothers with substantial experience of counselling following the loss of their children to adoption or foster care.
Effective support for birth relatives is flexible, responsive, and accessible, embraces the parental identity of parents and sees them in their full humanity, beyond the child removal. A humanising and reciprocal therapeutic relationship is at the centre of effective support for birth relatives. See Adoptionplus resources.
Other work in progress
We are systematically reviewing current literature on birth parents' experiences of effective support.