Empowerment per triad: overlap and differences

Following from the previous section, 4.2 where individual participant conceptualisations of empowerment were explored, the researcher considered the similarities and differences in

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the findings regarding empowerment per triad. This has been presented in Table 4.3 and is summarised in this section.

Triad #1

In Triad #1, client Sid had been referred due to recurrent depression and all involved considered that he had made progress since engaging in the therapy sessions: becoming happier in mood, more relaxed, more confident and participating more actively in life. Table 4.3 shows that there were many overlapping themes relating to empowerment in this triad, with Sid valuing the therapeutic relationship, the positive changes in his life in the areas of mood, work, achievements and general engagement, whilst again affirming the importance he placed upon trust in the therapeutic relationship and feeling heard. Therapist Eve also highly value the therapeutic relationship and mentioned the importance of choice and control in terms of helping PWLD feel empowered in their lives (and specifically Sid). Differences in this triad included Eve’s use of a new, novel approach, which she had not tried before in her work with PWLD but detailed how useful and relevant she found a compassion focused approach in helping Sid through his emotional journey. Eve also spoke about not always needing to share information with others and she explained that there may be times when a joint, MDT approach is not always best for the client. Support Worker Robert agreed with this point and also stressed the importance of confidentiality and respect for a client’s wishes.

Robert spoke about the importance of the work placement that he was involved in, in terms of values, person-centred ideals and the encouragement of empowerment. Robert agreed with most other facilitators about the fundamental importance of support for PWLD in the therapeutic healing process.

Triad #2

In Triad 2, client Jacky again spoke about the importance to her of the therapeutic relationship in terms of empowering outcomes from the therapy; again, this included the importance of trust and rapport, which had been essential for allowing sensitive disclosures

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of information and being able to engage fully in the therapeutic process. Jacky reported increased empowerment in terms of confidence and self-esteem, as well as being better able to make choices and experiencing more control over her own life. Individual differences could be seen in terms of the particular work carried out by therapist Nichole, although she concurred with the empowering improvements mentioned by Jacky; she referred to specific details such as a reduction in self-harming behaviours which were mentioned by both in their interviews and Jacky being less affected by previously traumatic memories. Nichole also mentioned specific empowering therapeutic adaptations and choices that had been made in the therapy sessions to enable Jacky’s understanding and progress – these included the use of mixed approaches according to need and the timeline (of Jacky’s life) they were following.

These differences arguably still contain much overlap in terms of general processes and results from the therapy, when compared with other triads. Nichole reinforced the overlap regarding therapeutic adaptations which had helped facilitate empowerment and positive outcomes in her work.

Support worker Malcolm showed agreement with most other support workers in terms of the mutual satisfaction gained from the support and therapeutic work involved between the three in this triad, speaking about the rewarding nature of his work, as a result of the relationship involved, and the empowering outcomes experienced by all of them. Malcolm also was in agreement with the importance of MDT involvement, which he considered assisted

empowering outcomes for Jacky in areas ranging from finances, her physical health and attending GP appointments. His emphasis upon the helpfulness of practical support

resonated with other support workers, as he explained that empowerment had been evident as a result of the travel training he was involved with, support around social and independent living skills, increasing levels of assertiveness and a gradual reduction in exploitation as a result of all of these and the MDT support in Jacky’s life.

131 Triad #3

In Triad 3, client Edward had participated in therapy sessions with Tim over a long period of time, originally due to workplace bullying and a crisis in his mental health. Throughout the duration of the sessions and via a series of important stages facilitated by Tim and the support of Edward’s parents and a team of support workers, Edward experienced considerable empowering improvements in his life situation, both physically and

psychologically. One of the key differences in Edward’s therapy sessions was the fact that he had requested his parents to attend and share all the information elucidated and explored by Tim. He considered that this had contributed to the success of the therapy. Overlapping themes relating to empowerment included the gratitude and appreciation he felt for the sessions and all involved, which Edward spoke warmly about. He also mentioned the

importance of trust and understanding on the part of his therapist Tim, which he experienced as non-judgemental and helpful – another overlapping theme, which his support worker Ray also mentioned, as did many of the other participants in other triads.

Therapist Tim referred to overlapping themes such as the value of the therapeutic relationship, which he stressed had been of greater importance than the psychological approaches used, for creating empowering outcomes. Other overlapping themes raised by Tim included the appropriate sensitive sharing of confidential information, which assisted trust and engagement in the empowerment process, as well as the importance of applying reasonable adjustments and flexibility in working with PWLD. The main difference mentioned by Tim was linked to Edward’s wish to have his parents present in the therapy sessions:

systemic empowering benefits were also evident, including for his parents and support workers, as their lives were positively affected by Edward’s life improvements, such as now being able to take holidays and support workers benefitting from Edward’s generally calmer and more content state of mind. The key difference mentioned by Support Worker Ray relating to the empowering outcomes in this triad involved the way that the therapy did not stop once Tim left Edward’s house: Ray continued discussing the important themes of the

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session with Edward, engaging in de-briefs, follow-up practical work together and offering additional support. Overlaps referred to by Ray included the importance of support networks which contributed to facilitating empowering outcomes and also the fact that such positive, empowering outcomes evidently did occur as a direct result of the therapeutic process (with improved communication and social skills, community access and involvement and

significant life changes such as Edward moving into his own house).

Triad #4

In Triad 4, Abbey clearly experienced empowering and life-enhancing benefits as a result of her psychological therapy sessions with Penny. Her relationship dynamics were affected, and improvements were particularly noticeable in the area of self-confidence, communication and self-awareness. Overlapping themes reported by Abbey again included the value of the therapeutic relationship, which she attributed to therapist sensitivity, with a professional who was encouraging and not patronising of her, enabling her to feel trust towards Penny and allowing for important disclosures during the duration of the sessions. Differences were also highlighted by Abbey, which included specific outcomes personal to her situation, such as gaining meaningful insights about past relationships, through processing, analysing and exploring relevant issues. Abbey was the only client interviewed who was married, another striking difference in this triad; her empowering outcomes had involved focus upon her relationship with her husband and previous difficult relationship dynamics.

Abbey’s therapist Penny revealed several overlapping themes, such as the mutual

satisfaction she felt from engaging in the therapeutic relationship, which helped bring about some of the empowering results for Abbey. Similarly, use of adaptations to enable Abbey’s understanding during the therapeutic process were an overlapping theme mentioned as crucial by Penny. Differences however, she described in terms of Abbey’s husband (also her support worker) being an integral part of the sessions, although for different reasons to those described in triad 3: Kevin was important in the empowerment process because of the

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educational, LD training and sign-posting elements which were involved and that Penny had endeavoured to make available for Kevin, in order to help both him and Abbey in improving their relationship. Penny also considered her therapeutic approach (PCA) as increasingly niche within the NHS, which she felt keen to protect as well as to promote as helpful and empowering, largely she felt, due to the three core conditions involved. Support worker Kevin was unusual in the research due to his position as Abbey’s husband and having a role as her support worker; he said that the close therapeutic work between the three parties was very helpful in the facilitation of empowerment for Abbey. Overlaps referred to by Kevin included mention of the practical tasks which were helpful for Abbey, ranging from journaling, logging her thoughts, practising independent travel, goal-setting and help with coping strategies. As with other support workers, Kevin discussed positive, helpful benefits arising from the therapy (Abbey ‘moving on’ from her past, releasing difficult memories - instead of taking them out on him - and being more able to cognitively analyse past processes).

Triad #5

In Triad 5, Neil had benefitted from therapeutic sessions with Janice which started whilst he was in the process of leaving school, to go to college and struggling with his mental health problems due to PDA and OCD-related issues. Neil was different to the other clients interviewed as it emerged that following eventual IQ assessment, he did not meet the service criteria due to being much more intellectually able and linked to this was his greater career aspirations, which affected his views about whether he thought empowerment was actually a good thing or not. Neil highlighted drawbacks and limitations to empowerment, reporting feeling bored and lonely being on his own in his flat all the time and complaining that no amount of therapy would change his neighbours. Despite this Neil acknowledged the progress and positive outcomes since the start of his therapy, which included increased self-insight and awareness, which was linked to being more empowered and independent than he had been previously – an overlapping theme in this and other triads.

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Therapist Janice mentioned the chief area that was different as dealing specifically with Neil’s PDA diagnosis, which both facilitators experienced as difficult to work with and

involved additional adaptations, with greater need for patience, flexibility and a definite need to go at a slower pace in terms of session length requirements. Overlaps however were described by Janice as the more general adaptations needed in her work with PWLD and to take into account individual differences in order to help bring about empowering outcomes.

She similarly felt that empowerment was helped due to the therapeutic relationship, where trust and the development of a good rapport were particularly essential elements. Support Worker Paul mentioned a difference relating to empowerment in this triad whereby the facilitators noticed positive changes and progress more than the client Neil, which Paul partly attributed to Neil’s personality style and PDA diagnosis. Paul listed many overlapping areas such as facilitator satisfaction from achievements in the work and having a genuine desire to help; the importance of teamwork and MDT working in order to create empowering benefits;

plus and linked to his style of working, the importance of practical support (including social, goal-setting, independent living skills, and particularly attending appointments, police and court interviews with Neil).

135 Table 4.3: Empowerment across the triads: overlaps & differences Triad #

PWLD Value of therapeutic relationship.

Positive changes leading to improvements in mood, engagement with life, work, achievements.

Importance of trust and feeling heard.

Value of therapeutic relationship.

Importance of trust & rapport – important for disclosure, engagement & therapeutic progress.

Empowerment via increased confidence and self-esteem, choice & control and

responsibilities.

►Requested parental involvement in therapy sessions, contributing to their success &

empowering outcomes.

Gratitude & appreciation for the therapy sessions & attendees.

Importance of trust & understanding (non-judgemental).

Value of therapeutic relationship (therapist sensitivity, encouraging, not patronising, trust allowing disclosure).

►Specific, empowering outcomes included gaining insights form past relationships, processing & exploring issues.

►Client was married – empowering outcomes included focus upon this &

previous relationship dynamics.

►Higher IQ than other LD clients, service inclusion criteria & higher career expectations affected perception of empowerment.

►Highlighted drawbacks & limitations to empowerment (bored/lonely in own flat; can’t change neighbourhood).

Positive outcomes & progress (increased self-insight & awareness) linked to empowerment

Therapists ►Use of specific psychological approach (CFT)

Importance of choice & control Importance of therapeutic relationship

►MDT approach & information sharing not always appropriate or needed.

►Specific, empowering improvements – reduction in self-harming behaviours & less affected by past traumas.

►Specific empowering therapeutic adaptations & choices (mixed approaches according to need/timeline issue).

Therapeutic adaptations helped facilitate empowerment & positive outcomes.

Value of therapeutic relationship (more important that psychological approach used for facilitating empowerment).

Importance of applying reasonable adjustments

& flexibility in LD work, to enable empowering results.

►Systemic empowering benefits were also evident (including for parents & support workers).

Appropriate, sensitive sharing of confidential information assisted trust & engagement and the empowerment process.

►Use of specific, single psychological approach (PCA) considered helpful in empowering outcomes (importance of 3 core conditions).

►Including client’s husband (also support worker) was important in the empowerment process re LD educational, training & sign-posting elements.

Use of adaptations in therapy helped facilitate empowering outcomes.

Mutual satisfaction helped results.

Adaptations were needed to create empowering outcomes.

►PDA diagnosis was difficult to work with &

involved additional adaptations (patience, flexibility, slower pace).

Empowerment was helped via the therapeutic relationship (trust & a good rapport were essential).

Support

Workers ►Importance of voluntary placement (values, ideals & encouragement of empowerment).

►Sense of worth via

work/contribution to local community.

Fundamental importance of support via facilitators in healing process.

►Importance/respect of confidentiality.

Mutual satisfaction & rewarding work from the relationship/& empowering outcomes.

Practical support helped facilitate empowerment (travel training, social &

independent living skills, assertiveness, reduced exploitation).

MDT involvement assisted empowering outcomes (finances, physical health, GP appointments).

►Continued therapy work after the sessions (de-briefs, discussion, practice & additional support|

contributed to empowering results).

Importance of support networks contributing to facilitating empowering outcomes.

Empowering positive outcomes resulted from the therapy (improved communication & social skills, community access & involvement, life changes – e.g. moving into own house).

►Support worker was also client’s husband – close therapeutic work between 3 parties, assisted the empowerment process.

Practical tasks helped facilitate empowering outcomes (journaling, logging thoughts, independent travel, goal-setting &

help with coping strategies).

Positive, helpful benefits from the therapy (moving on from past, releasing difficult memories, analysing past processes).

►Facilitators noticed positive changes &

progress more than client (linked to PDA diagnosis/personality style).

Facilitator satisfaction from achievements

& progress, with genuine desire to help.

Importance of teamwork & MDT working for creating empowering benefits.

Importance of practical support (social, goal-setting, independent living skills, attending court & appointments).

Key: = overlap ►= difference

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5. DISCUSSION

This chapter provides an overview of the research findings, particularly in terms of the pertinent themes discovered and how these answered the original research questions; how these corroborate previous published research findings; the strengths and limitations of the research; clinical implications; suggestions for future research from the study; culminating with a conclusion about the research as a whole.