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Cited by 28Psychiatric care and mental health servicesPsychotherapy Techniques and ApplicationsCounseling, Therapy, and Family Dynamics

Individual psychological therapy in an acute inpatient setting: Service user and psychologist perspectives

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Small, Catherine, Pistrang, Nancy, Huddy, Vyv, Williams, Claire·2018·Psychology and Psychotherapy Theory Research and Practice
DOI 10.1111/papt.12169
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Abstract

OBJECTIVES: The acute inpatient setting poses potential challenges to delivering one-to-one psychological therapy; however, there is little research on the experiences of both receiving and delivering therapies in this environment. This qualitative study aimed to explore service users' and psychologists' experiences of undertaking individual therapy in acute inpatient units. It focused on the relationship between service users and psychologists, what service users found helpful or unhelpful, and how psychologists attempted to overcome any challenges in delivering therapy. DESIGN: The study used a qualitative, interview-based design. METHODS: Eight service users and the six psychologists they worked with were recruited from four acute inpatient wards. They participated in individual semi-structured interviews eliciting their perspectives on the therapy. Service users' and psychologists' transcripts were analysed together using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) method of thematic analysis. RESULTS: The accounts highlighted the importance of forming a 'human' relationship - particularly within the context of the inpatient environment - as a basis for therapeutic work. Psychological therapy provided valued opportunities for meaning-making. To overcome the challenges of acute mental health crisis and environmental constraints, psychologists needed to work flexibly and creatively; the therapeutic work also extended to the wider context of the inpatient unit, in efforts to promote a shared understanding of service users' difficulties. CONCLUSIONS: Therapeutic relationships between service users and clinicians need to be promoted more broadly within acute inpatient care. Psychological formulation can help both service users and ward staff in understanding crisis and working collaboratively. Practice-based evidence is needed to demonstrate the effectiveness of adapted psychological therapy models. PRACTITIONER POINTS: Developing 'human' relationships at all levels of acute inpatient care continues to be an important challenge for clinical practice. Due to the distress of individuals and the constraints of the acute inpatient environment, psychologists need to be flexible and adaptable in delivering individual therapy. Making meaning and psychological formulation can give service users a sense of hope and empowerment, and can contribute to a shared understanding within the ward team of service users' difficulties.

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  • Patients often present more severe and comorbid mental health problems compared to outpatient psychiatric and psychotherapeutic care.

    “Additionally, patients often present more severe and comorbid mental health problems compared to outpatient psychiatric and psychotherapeutic care [34].”

    From Blended care in in-patient acute psychiatric care. The example of a group training for social competences in adults—A pretest–posttest feasibility study (2021) · cites this paper as [34]

    The Introduction says that acute inpatient service users tend to present with more severe and comorbid mental health problems. It does not compare them specifically with patients receiving outpatient psychiatric or psychotherapeutic care; the stated context is a rising threshold for inpatient admission. No page number is available in our copy. (LLM, conf=0.85)

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Research works printed but not linked: 1

  1. Clarke, I., & Wilson, H. (2009). Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units: Working with Clients, Staff and the Milieu. London: Taylor & Francis.

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Authors
Small, C., Pistrang, N., Huddy, V., & Williams, C.
Affiliations
  • University College London (GB)
  • North East London NHS Foundation Trust (GB)
Corresponding author
Small, Catherine
ORCID
Venue
Psychology and Psychotherapy Theory Research and Practice
Publisher
Wiley
Published
2018-01-18
Volume
91
Issue
4
Pages
417-433
ISSN
  • 1476-0835 (ISSN-L)
  • 2044-8341
DOI
10.1111/papt.12169
OpenAlex
W2792601385
Cited by
28
References
35
Citations by year
2026: 1 · 2025: 2 · 2024: 8 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 1 · 2018: 1
FWCI
2.93
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Psychology and Psychotherapy Theory Research and Practice (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
Keywords
acute inpatient care, therapeutic relationship, service user experiences, meaning-making, psychological formulation, therapist flexibility
MeSH terms
Adult, Attitude of Health Personnel, Mental Disorders, Female, Hospitals, Psychiatric, Humans, Inpatients, Interviews as Topic, London, Male, Mental Health Services, Middle Aged, Physician-Patient Relations, Psychotherapy, Qualitative Research, Young Adult

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