Exploring metacognition in the narratives of therapeutic ruptures with staff within forensic mental health

Hunter, Stephanie Victoria Elizabeth (2015) Exploring metacognition in the narratives of therapeutic ruptures with staff within forensic mental health. D Clin Psy thesis, University of Glasgow.

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Abstract

Introduction: It has been argued that a capacity for metacognition in relation to others could be a key underpinning quality required in a mental health worker to develop positive therapeutic relationships. It is likely that forensic mental health staff are exposed to difficult and potentially threatening situations as a result of their patients’ complex backgrounds and risk. Aims: The study aimed to pilot and develop a methodology to explore and code metacognition and causal attributions in the context of staff reflecting on their experiences of resolved and unresolved therapeutic ruptures. In addition the study sought to explore associations between metacognition and measures of ward atmosphere and staff burnout. Methods: Twenty members of staff working within a medium secure forensic mental health service volunteered to participate in the study. Participants were asked to recall two experiences where there had been a rupture in the therapeutic relationship, one where the situation had been resolved, and one where it was unresolved. Participants also completed the Ward Atmosphere Scale (WAS) and the Maslach Burnout Inventory (MBI). Interviews were transcribed and coded using the Metacognitive Assessment Scale (MAS) and the Leeds Attributional Coding System (LACS). Results: Analysis of the MAS found that participants had significantly lower levels of metacognition for the unresolved situation than the resolved situation. Positive correlations were found between overall MAS scores and three of the WAS subscales. The majority of attributions made were where the patient was the Agent/Cause and the staff-member/speaker was the Target. Discussion & Conclusion: We were able to identify changes in metacognition across different experiences of ruptures in the therapeutic relationship. These findings have implications regarding the suggestion of further research on a larger scale with improved methodology. These studies may prove useful in developing methods to enhance staff metacognition in response to therapeutic ruptures.

Item Type: Thesis (D Clin Psy)
Qualification Level: Doctoral
Keywords: metacognition, forensic mental health, metacognitive assessment scale, attributions
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Colleges/Schools: College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Funder's Name: UNSPECIFIED
Supervisor's Name: Gumley, Professor Andrew
Date of Award: 2015
Depositing User: Dr S.V.E Hunter
Unique ID: glathesis:2015-6718
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 02 Oct 2015 08:40
Last Modified: 08 Oct 2015 12:07
URI: http://theses.gla.ac.uk/id/eprint/6718

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