It’s like being in a little psychological pressure cooker sometimes! A qualitative study of stress and coping in pre-qualification clinical psychology
| Published date | 08 May 2017 |
| Pages | 134-149 |
| DOI | https://doi.org/10.1108/JMHTEP-05-2015-0020 |
| Date | 08 May 2017 |
| Author | John Galvin,Andrew Paul Smith |
| Subject Matter | Health & social care,Mental health,Mental health education |
It’s like being in a little psychological
pressure cooker sometimes! A qualitative
study of stress and coping in
pre-qualification clinical psychology
John Galvin and Andrew Paul Smith
Abstract
Purpose –The purpose of this paper is to investigate the stressors involved in pre-qualification clinical
psychology as reported by a sample of the UK trainee clinical psychologists. The main coping strategies
reported by the trainees are also explored.
Design/methodology/approach –One-to-one interviews were conducted with 15 trainee clinical
psychologists using qualitative research methods. Themes were established using the main principles of
thematic analysis.
Findings –Three themes were identified that described the pressures involved in applying to the course, the
support networks available to trainees, and the commonalities in their personalhistory, experiences and self-
reported personality characteristics.
Originality/value –It is important to investigate the sources of stress and coping strategies in trainees to
help them cope more effectively. The findings of the study are discussed within the context of clinical
psychology training.
Keywords Coping, Clinical training, Clinical psychology, Mental health training, Stressors,
Trainee clinical psychologists
Paper type Research paper
Introduction
Stress in mental health professionals
As pressure on mental health services increases, so too does the likelihood of excessive stress
impacting on those working and training in the mental health field (Paris and Hoge, 2010;
Rossler, 2012).Stress not only has consequences for the individual, but also on theorganisation in
which they work and the clientsthey seek to help. For example, 30 per cent of sickness absence
in the NationalHealth Service is due to stress, with a billto the service of around £300-£400m per
year (NationalHealth Service, 2015). Stress has beendefined as a “particular relationshipbetween
a person and their environment that is appraised by the personas taxing or exceeding his or her
resources and endangering his or her wellbeing”(Lazarus and Folkman, 1984, p. 19). This
definition suggests that stress occurs when an individual perceives an event or situation as
threatening,and lacks the appropriate coping strategiesto deal with it. Stress has been shown to
affect concentration, cause deficitsin problem-solving abilitiesand impact on learning and memory
(Kaplan andSaddock, 2000; Kuoppala et al., 2008). Therefore,stress is an important topicin need
of further investigation. This is particularly true in healthcare education settings, where stress has
the potential to interfere with trainee learning, functioning and performance.
High stress is related to low self-esteem (Mimura et al., 2008), suicidal thoughts (Hawton et al., 2011),
substance abuse (Melaku et al., 2015), psychological ill health (Galvin and Smith, 2015) and burnout
Received 1 May 2015
Revised 14 January 2016
8 April 2016
Accepted 25 January 2017
John Galvin and
Andrew Paul Smith are both
based at the School of
Psychology, Cardiff University,
Cardiff, UK.
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VOL. 12 NO. 3 2017, pp.134-149, © Emerald Publishing Limited, ISSN 1755-6228 DOI 10.1108/JMHTEP-05-2015-0020
(Lizano and Mor Barak, 2012). Burnout is defined as a syndrome consisting of emotional exhaustion,
feelings of ineffectiveness, and diminished interest at work (Maslach and Leiter, 1997), and
research shows it is most likely to occur in individuals exposed to stressful working conditions
(Rosenberg and Pace, 2006). Evidence suggests that working in the field of clinical psychology might
be particularly stressful (Cushway and Tyler, 1994; Hannigan et al., 2004), with many
clinical psychologists reporting feeling “stuck”,“overwhelmed”,and“incompetent”in their work
(Crowley and Advi, 1999).
Hannigan et al. (2004) conducted a systematic review of stress and coping in qualified UK clinical
psychologists based on the Carson and Kuipers (1998) stress model. The aim was to identify the
stressors, moderators and outcomes in the clinical psychology workforce. Identified stressors
included demands, workload, poor quality management and professional self-doubt (Cushway
and Tyler, 1994). Moderators included a wide range of coping strategies such as talking to
colleagues, a partner or engaging in a support group (Cormack et al., 1991). Outcomes included
high levels of burnout and psychological distress (Darongkamas et al., 1994). The authors
concluded that:
Mental health professionals are required to attend to the needs of people experiencing a range of
mental health difficulties. However, the evidence from this review is that many clinical psychologists
practicing in the UK are, themselves, experiencing significant levels of psychological distress.
(Hannigan et al., 2004, p. 239).
It should be noted that some of the stressors reported by mental health professionals are often
inherent to the job and are therefore unavoidable, for example, the organisational and
administrative t asks, frequent patien t contact and the nature of c aring for the mentally il l
(Nolan and Ryan, 200 8). For this reason, res earchers have also focuse d on the coping
strategies employed by these groups (Cushway and Tyler, 1994; Tully, 2004). Two broad types
of coping strategies were described by Lazarus and Folkman (1984): emotion-focused coping
and problem-focused coping. Emotion-focused coping involves reappraising the relational
meaning of the problem. An example of this strategy is avoidance coping, whereby the
individual avoids a stressful situation, or postpones taking any action to help resolve it
(Cohen et al., 2008). This may be the only realistic option when the source of stress is outside
the person’s control. On the other hand, problem-fo cused coping aims to remove or r educe the
cause of the stresso r more directly (Ben-Zur , 2002). Examples can inclu de taking one step
at a time to change th e situation, improving time man agement and obtaining in strumental
social support.
Stress and coping in pre-qualification clinical psychology
The journey towards becoming a clinical psychologist in the UK requires extremely hard work.
Individuals pursuing this career path must have at least a 2.1 psychology undergraduate degree
or conversion course and some experience in terms of clinical (e.g. assistant psychologist) or
research (e.g. research assistant) before being considered for a place on a three-year doctorate in
clinical psychology (DClinPsy) training course (Course and Application Procedures, Clearing
House for Postgraduate Courses in Clinical Psychology (CHPCCP), 2015). Once on the course,
trainees are expected to complete both academic and clinical work during their training
programme. The academic component of the course typically includes teaching days, essays,
reports, and a doctoral-level thesis, while the clinical component includes undergoing clinical
placements in the NHS.
As demonstrated by a recent review of the area, there has been a distinct lack of published
literature focusing on stress and coping in trainee clinical psychologists internationally (Pakenham
and Stafford-Brown, 2012). In this review, the authors found only one study that examined the
sources and levels of stress in trainees and, for this reason, mainly focused on findings from other
mental health practitioners in an attempt to generalise these findings. The sole study that did
focus on trainees was a questionnaire study by Cushway (1992), who found that 59 per cent of
trainees in the UK were reporting high levels of stress. The factors associated with stress were
workload, lack of social support, client difficulties and distress, self-doubt, course structure and
poor supervision.
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