Pieter W. Nel

Close encounters of the uncertain kind: reflections on doing problem‐based learning (PBL) for the first time

Problem‐based learning (PBL) has been employed for over 30 years by a variety of disciplines and professional training programmes. Nevertheless, introducing PBL into a professional training programme for the first time can present many challenges for both trainers and trainees. This paper reports on the process of introducing PBL into a doctoral training programme in clinical psychology at a university in the UK. In particular, it provides some personal reflections from both trainees and trainers on the uncertainties created by doing PBL for the first time. These reflections are used as a foundation to discuss the role of the facilitator, strategies of dealing with uncertainty, and implications for clinical psychology training.

Reaching the journey’s end: reflections on the final phase of a problem‐based learning group

This paper represents the final phase of a journey within a self‐directed problem‐based learning group occurring on the Doctorate in Clinical Psychology Programme based at the University of Hertfordshire. It provides personal reflections from the trainees and trainers on the process of this type of experiential learning. We explore themes related to this experience, such as the emotional experiences evoked and strategies used to manage these; issues of power and responsibility; and the transitory nature of these experiences. We conclude with implications for the participation and facilitation of experiential learning groups within clinical training.

The use of an advanced simulation training facility to enhance clinical psychology trainees’ learning experiences.

The University of Hertfordshire (UH) has recently opened a new simulation centre for its healthcare students. Although the centre is primarily used by nursing and paramedic students for its simulated clinical and community environments, its use for other professional training such as clinical psychology is evident. In this paper a brief history and description of the simulation centre is provided, before describing and reporting on a scenario-based simulation training exercise designed and implemented for clinical psychology doctorate trainees at UH. Trainee feedback on the effectiveness of the exercise was obtained via pre- and postsession self-report questionnaires. Trainees reported that they benefitted from taking part, increasing their clinical skills and confidence in joint working. They also valued the nonassessed and experiential nature of the exercise. Some of the main advantages of using interactive simulation training are outlined, as well as some of the challenges in using this advanced technology effectively.

In the eye of the storm: should I stay or should I go? Reflections on the middle phase of a problem‐based learning group

This paper reports on the middle phase of a problem‐based learning (PBL) group undergoing clinical psychology training at the University of Hertfordshire (UH). Trainers and trainees involved in PBL at UH provide some personal reflections on their experiences, highlighting some of the unique characteristics and dilemmas of participating in this middle phase of PBL. We explore themes around the dynamics within the group, the emotional experiences evoked for participants, and some of the strategies used to manage these emotions. We conclude with implications of this type of learning for clinical training.

Negotiating motherhood as a refugee: experiences of loss, love, survival and pain in the context of forced migration

Abstract The mental health of refugees has been an increasingly researched area, but has been criticised for having an individualised and symptom-focused approach to understanding the experience of forced migration. This paper attempts to respond to calls to address this culturally limited and incomplete way of conceptualising responses to experiences of persecution and terror bound up within global hegemony and power inequalities. Interpretative phenomenological analysis was employed to analyse semi-structured interviews undertaken with six refugee mothers, with the aim of exploring how participants made sense of, and created meaning around parenting and family life in the UK. Three main themes emerged from the data analysis (a) loss as a constant companion to parenting; (b) a shifting view of the self as a mother; and (c) taking the good with the bad in family life. Methodological limitations, as well as implications for future research and clinical practice are discussed.

The NICE guideline on the treatment of child and adolescent depression: a meta-review of the evidence for individual CBT

The National Institute for Clinical Excellence in the UK published its guideline on the treatment of children and adolescents who have been diagnosed with depression in 2005. Although the guideline has not been updated since, it is widely used in Child and Adolescent Mental Health Services in England and Wales to advocate that all children and young people who have been diagnosed with depression should have access to individual cognitive-behavioural therapy (CBT) through the Children and Adolescent Improving Access to Psychological Therapies (CYP-IAPT) project. This article critically reviews the guideline in terms of the evidence that NICE cites for the efficacy of individual CBT. In particular, it provides a meta-review of four randomised control trials where the effectiveness of individual CBT was compared to another psychological therapy intervention, a non-specific control intervention and/or a wait-list. Each trial is considered separately, before looking at the overall evidence that they provide when the findings are considered as a whole. A trial comparing individual CBT to a non-psychological intervention (medication) is discussed separately. This review found that on present evidence, individual CBT cannot be viewed as evidence-based psychological therapy for children and young people who have been diagnosed with depression.

Psychosis and sexual abuse: an interpretative phenomenological analysis

OBJECTIVES This study aimed to investigate the first-person perspective of psychosis sufferers who survived childhood sexual abuse. METHODS Interpretative phenomenological analysis was employed to explore the experiences of 7 women with a history of sexual abuse and psychosis. RESULTS Analysis generated six themes: (a) degradation of self, interlinking shame, guilt, and sometimes disgust; (b) body-self entrapment, experiencing bodily constraint and distortion; (c) a sense of being different to others, involving interpersonal problems; (d) unending struggle and depression, a pervasive sense of defeat; (e) psychotic condemnations and abuse, describing psychotic phenomena related to harm and sexual abuse; and (f) perception of links to the past, the links made from past abuse to current functioning. CONCLUSION Participants suffered extreme psychological, physical, and interpersonal difficulties past and present. Psychotic experiences reported exhibited themes of condemnation by external entities and reflected the topic of sexual abuse. Participants did not generally link psychosis to their past abusive experiences.

Transitioning together: A narrative analysis of the support accessed by partners of trans people

ABSTRACT Historically trans people have often wrongly been advised that the gender role transition process would result in the breakdown of their relationships, and couples have often been provided with little support through this process. This paper presents an in-depth narrative analysis of the accounts of six cisgender women who have been partnered with trans individuals. It focuses on the support that non-trans partners accessed while their partner progressed through their gender transition. Support was deemed important by all participants in relation to their aim of remaining together with their partners. In terms of whom they accessed support from, participants spoke about interactions with other people in similar situations, with professional therapists, with the Gender Identity Clinics (GICs), and with their partners. In regard to therapy, some reported that their partners transition was a topic they did not need to discuss. Many reported they had to take an “educator” role in therapy, suggesting that more training for therapists is required. Those who attended GICs with their partner were ambivalent about whether they would have utilised support there if it had been available there, stating that locally situated support was preferable. The paper draws out the clinical implications in relation to these areas.

Can voicing conflict within experiential learning groups facilitate connection? : Building and developing effective multi-disciplinary team-working skills

Abstract In the UK, Clinical Psychologists (CPs) work in a variety of settings within the National Health Service (NHS), often within Multi-Disciplinary Teams (MDTs). Problem-Based Learning (PBL) within CP training at the University of Hertfordshire (UH) offers unique opportunities to combine scientist-practitioner and reflective-practitioner models to learn about group dynamics from the personal experience of working within an experiential learning group. Further, given Trainees work three days per week on placement within MDTs in the NHS, the learning gained within a ‘safer’ PBL context can be utilised within these clinical settings. For two years, Trainees at UH have to work in small PBL groups with five or six members learning to work together to achieve a goal (four assessed presentations) negotiating their own personal and professional journey, as well as a group journey. Consequently, PBL offers trainees opportunities to learn (1) how individuals work within a group; (2) how personal experiences influence this process; (3) how others influence them and are influenced by them; and (4) how a group of diverse individuals conceptualise, understand and convey case vignettes to an audience. Within these groups, many Trainees learn to speak out, reflect, listen attentively, empathise, validate and accept diverse experiences. Further, when differences dominate they often learn to negotiate these, finding a way to maintain effective team working in order to complete the presentation. Focusing on the conflict that can occur within (any) group, this paper explores themes from the reflective narratives of six trainees: parallels and differences between MDTs and PBL groups, striving for and achieving authenticity; and conflict as a ‘swear’ word. We conclude that exploring the role PBL can play in training individuals to work effectively in teams may be of benefit within the training of other professional groups.

Time for courage : A reflective dialogue on the state of the clinical psychology profession

Articulated via an interplay of internal and external dialogues between the ‘author’ and imaginary/real-life characters, this piece offers a reflection on the state of the clinical psychology profession in the UK. Drawing purposefully on the narrative structure of Life of Pi, a common theme emerging in these dialogues is a concern that the profession is in danger of being devoured by a dangerous lack of tolerance for diverse models of psychological therapy. Like Pi, some in the profession will require courage to survive in the company of such intolerance.