‘Creative risk’: an IPA study of psychologist’s experiences of and perspectives about working with substance misusers with histories of complex trauma
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Date
02/07/2013Author
Penney, Claire Philippa
Metadata
Abstract
Background: A history of complex trauma alters basic self-structure, attachment system
and core areas of interpersonal functioning and relationships. There is increasing
recognition of the high proportions of complex trauma histories within substance misusers
and limited research into the sequelae of complex trauma, particularly in relation to
comorbid complex trauma and substance misuse. There is a distinct lack of adequate
theory and guidelines for treatment. Research Aim: to explore psychologist’s experiences
of and perspectives about their work with substance misusers with a history of complex
trauma. Complex trauma is a term used to describe experience’s which arise from severe,
prolonged and repeated trauma which is often interpersonal in nature. Courtois & Ford
(2009) have defined complex trauma as “involving stressors that: are repetitive or
prolonged, involve direct harm and/or neglect and abandonment by ostensibly responsible
adults, occur at developmentally vulnerable times in the victim’s life, such as early
childhood, have great potential to compromise severely a child’s development.” (p1). The
prototype trauma that was first described under the term complex trauma was child abuse
and neglect. Method: Semi-structured interviews were conducted with eleven clinical and
counselling substance misuse psychologists working across four health boards in Central
Scotland. The data was analysed using Interpretative Phenomenological Analysis (IPA).
Results: Six main superordinate themes emerged from the data: 1. Challenges in
negotiating therapeutic relationship; 2. Balancing relational forces; 3. Walking the tightrope
of comorbidity; 4. Conceptual dearth (surrounding complex trauma); 5. Emotional impact of
Work, and, 6. Core role of therapeutic relationship (in treatment and recovery). Discussion:
Participants accounts suggest there are many risks to balance as well as paradoxes inherent
in this type of work. The nature of a history of complex trauma means that often clients
have difficulties with attachment and relational aspects in their lives, which in turn affect
their engagement in the therapeutic relationship. The findings of this study suggest that it
is precisely because relationships seem so threatening and challenging for these clients,
that the therapeutic relationship appears to form such a vital role in the therapeutic
treatment and recovery process for these client.