An interpretative phenomenological analysis of counselling psychologists' experiences of stress in NHS child and adolescent mental health tier 3 work settings

The aim of this study was to identify and understand counselling psychologists’ individual experiences of stress in NHS Child and Adolescent Mental Health Services Tier 3. The qualitative methodology of interpretative phenomenological analysis (IPA) was used to allow the emergence of each participant’s idiographic, personal experiences of the phenomenon of stress in their work settings, and the meaning each ascribed to it.
Data was collected from seven counselling psychologists (six females, one male) permanently employment by NHS CAMHS. Each participant was individually interviewed on two separate occasions with a period of up to six months between interviews. Each semi-structured 60-minute interview was digitally timed, audio-recorded, transcribed in full, and analysed using IPA. All first interviews were conducted in person on NHS site locations. Some of the second interviews were done over Skype video at participants’ NHS sites or in person and the same protocol was observed as in the first interviews. Fourteen interviews were collected in total.
A systematic analysis of the transcripts identified fourteen sub-themes which merged into four super-ordinate or master themes: (1) Impact of NHS changes on CAMHS Tier 3 work settings, (2) Therapy room impact, (3) Counselling psychologists’ well-being and morale, and (4) Professional identity issues.
The findings showed that all the counselling psychologists were experiencing intense stress in their working lives. The study took place in the political context of National Health Service (NHS) reform and austerity based economic restructuring which is ongoing. Counselling psychologists believed such economic cuts caused contextual changes in CAMHS settings which brought new stressors into their working lives. Their experiences of stress were similar to factors consistently identified in organisational stress research as burnout risk factors or burnout itself. As a result of the increased stress, they expressed either a desire to leave their posts or they were already seeking work elsewhere. Participants also shared stress experiences related to professional identity issues involved in being the relatively new and only other psychology discipline working and competing for jobs in NHS CAMHS Tier 3.
In many cases, a mitigating factor of the stress was a sense of meaning derived from their relationships and work with mentally unwell young people. Given the importance of the therapeutic relationship as a conduit for successful therapeutic outcomes, research on how best to support and protect against occupational stress experienced as impacting the early intervention work of NHS CAMHS counselling psychologists is an area for future research.