Delia Cushway

Stress in Clinical Psychologists

This paper summarises the findings of a series of studies of British clinical psychologists and discusses them in relation to the (mainly US) literature. Four main questions are addressed: (1) How stressed are clinical psychologists? (2) Which psychologists are most stressed? (3) What are the main sources of stress for clinical psychologists? and (4) What coping strategies are used by clinical psychologists? A figure summarises the main risk factors emerging from the literature which appear to be important mediators between the stressor and the psychological outcome variables. These are: (1) low job satisfaction; (2) low range of active coping strategies; (3) high use of avoidance coping strategies involving denial; (4) stressor not externalised and objectified; (5) stressor threatens other roles/relationships; (6) low experience in job; (7) no quality relationship with confidant(e)/poor quality relationship with partner; and (8) female.

Stress and well­being in health­care staff: the role of negative affectivity, and perceptions of job demand and discretion

A questionnaire survey was administered to volunteer staff from the Surgical and Mental Health Directorates of an English hospital district. The aim was to investigate the relationships between job stressors, coping strategies, job satisfaction and well-being, in light of Karaseks demand–discretion model. The effects of controlling for age, gender and negative affectivity were also of interest. After controlling for these factors, there was found to be no interaction between job demand and discretion for either job satisfaction or psychological distress, so Karaseks model was not supported. Both job dissatisfaction and psychological distress were found to be influenced by lack of resources, while perception of demand was strongly influenced by workload; these were also the stressors that differentiated the two hospital directorates, with the surgical staff suffering higher levels of both. Controlling for negative affectivity had a stronger influence on the measure of distress than on job satisfaction and the two outcome measures were not interchangeable. Recommendations centred on improving structural conditions, especially for surgical staff, and on reducing levels of anxiety and hostility by promoting stress management.

Tolerance begins at home: Implications for counsellor training

In recent years there has been an increasing body of literature investigating the motives of counsellors and psychotherapists. Although there are considerable methodological problems with researching this area, the consensus in this literature seems to be that one determinant for becoming a counsellor may be a conscious or unconscious wish to make good the unresolved difficulties of early childhood. The unsurprising findings that counsellors have had as least as much trauma in their early lives as the general population raise questions about the impact of this for counsellors in training. This paper summarises the literature relating to the concept of the ‘wounded healer’ and examines the implications of this for tolerating distress among trainee counsellors. A model is presented that aims to address this distress and teach the trainee to practice effective preventative self-care.

Evaluation of counselling in primary care : how can research be made more useful for practitioners?

The paper presents a literature review of research on counselling in general practice critiqued from the perspective of the Practice Counsellor. It is noted that existing studies all focus primarily on outcome of psychological interventions in comparison to routine GP care. The contributions and limitations of these studies are discussed, and the methodological difficulties of conducting controlled trials in this context are explored. It is proposed that future research on counselling in primary care needs to draw on the paradigm shift in psychotherapy and a range of alternative research methodologies which will be more likely to produce research of relevance to Practice Counsellors.