EMDR Therapy Quarterly

Introduction

In our previous paper, we reported on the quantitative findings from a service evaluation that was conducted on a single-session group intervention (G-TEP) that was implemented to reduce trauma-based symptoms and levels of distress for healthcare professionals working on (and associated with) acute adolescent psychiatric wards.  In this brief report, we give voice to the participants themselves. We report on the qualitative findings derived from a feedback form that was completed immediately after the single-session intervention and again at one month. This thematic analysis of G-TEP participant responses unwraps their personal experience of the intervention and helps to translate the quantitative findings from simply being statistically significant to being personally and functionally significant.

This is important because our aim was to support our staff who are increasingly subjected to verbal and physical assaults and are intervening in or attending to significant self-injurious or suicidal behaviour by patients. We know from the literature that such workplace stressors contribute to a higher risk of developing PTSD and other mental health difficulties. (Mento et al., 2020). We also know that workplace stressors have been linked with decreased productivity, increased staff absence and turnover, and reduced quality of patient care (Liu et al., 2019; Mento et al., 2020). We therefore wanted to provide a therapeutic intervention for staff that focused on reducing and managing trauma-based symptoms and the consequent risk of burnout following critical, traumatic events in psychiatric and healthcare settings, which would ultimately lead to improved patient care.

Methods

The methods have been described in detail in our previous paper in this publication, and further detail about the thematic analysis can be obtained from the authors.

There were 33 participants, ranging from psychologists to ward managers and health care assistants. Thematic analysis was used to interrogate the free-text responses that were given by the participants.

Findings

Five themes were identified, see Figure 1.

Theme 1: A safe space for processing work-related trauma

Overall, the staff who participated in the G-TEP sessions found them to be very containing. They were happy to be given the time and space to begin processing their emotions and memories of the incidents that were troubling them. They reported the benefits of quick access to the intervention, which was especially important as they needed to continue working in the same environment following an incident, and they were aware that this could reactivate some of the intense emotions. Staff reported how reassuring it felt to hear that their responses were natural and therefore not a sign of weakness or a question of their ability to work in such challenging environments. Importantly, at follow-up, the intensity of their distressing experiences had significantly reduced.

It made me realise that actually the feelings I experienced at the time were natural.

Theme 2: Personal and professional growth

Participants reported that the G-TEP sessions helped them develop psychological skills on a professional level. It also helped them become aware of their strengths and qualities and shifted the focus away from negative self-evaluation. They built on their repertoire of coping skills, such as tapping, visualisation, and compartmentalising memories and emotions into manageable pieces. They were then able to take this learning out of the workplace and into their personal lives, for example, when feeling stressed at home or struggling to sleep.

I did find the coping strategies helpful and was able to pass these on to others who were struggling with working with our young people.

Theme 3: Integrating G-TEP into the culture

There was a clear, identified need for more psychological input for staff on the ward during and post-incidents, such as regular, organised individual and group therapy options. Most staff wanted the opportunity to attend further G-TEP sessions and for these sessions to be offered to all staff. The idea of building these sessions into protected time was mooted. Patient care is typically viewed as a priority over forums for staff wellbeing, which makes it harder for staff to justify attending these sessions. Embedding staff care into the hospital culture and normalising staff attendance could encourage staff to access them.

A session with a  third party who was not involved and who could help me explore my remaining feelings without bias.

Theme 4: Releasing the pressure

Staff felt better able to carry out their roles more effectively because the impact of the memory was lessened and they felt more at ease and relaxed. There were reports of reduced anxiety levels, reduced distress, improved sleep and improved self-esteem.

It helped me process the memory to a lower state of anxiety, which allowed me to continue working more effectively without it causing frequent difficulties.

The level of anger that the memory brought up…was significantly reduced.

Theme 5: Environmental and emotional challenges

The G-TEP groups were held on the ward, which made them accessible but was not without its challenges. In addition to the emotional burden of facing difficult incidents and events, the nature of the environment meant that various noises from the ward could still be heard, making it hard to disconnect and feel settled in the room. An example of this was when alarms could be heard in the ward, initiating distress as participants knew that colleagues on the ward may need help. This made it difficult for some staff to concentrate and remain focused on the G-TEP process.

A few staff members reported that G-TEP techniques were new and confusing and that they would have appreciated having more time or more sessions to be able to understand, reinforce and practice the techniques thoroughly.

A more quiet space… it was hard to disconnect from being at work, hearing patients and alarms.

General feedback about sessions

Overall, the G-TEP sessions were considered to be ‘very helpful’ and ‘very useful’. They were effective at “making you stop and think about things you have supressed and try to address them.” Most participants found the exercises taught in the sessions informative and easy to administer. The majority of participants did not find anything unhelpful about the sessions and had no suggestions for improvements with the session content or structure itself. Only one participant reported that the session was unhelpful as it “just brought back experiences I didn’t want.” Others suggested that an off-site venue may have enhanced the intervention, though it might have limited accessibility.

Conclusions

The G-TEP sessions were initiated as a way of addressing the needs of staff who had been caught up in distressing incidents at work involving patients. Anecdotally, we were aware that staff were struggling with strong emotions arising from distressing memories of the incidents and that their ability to function well at work was diminished. Staff experienced a higher incidence of anxiety, insomnia and low mood. Participants did not have a formal diagnosis of PTSD, but they did have trauma-based symptoms. Our previous paper presented quantitative outcomes that clearly demonstrated a significant reduction in trauma-based symptoms. Quantitative data does not tell the whole story, and we felt it was important to share personal feedback and improved functional equivalents.

Workplace stressors are linked directly with productivity, absence and turnover (Liu et al., 2019; Mento et al., 2020). Taking care of staff by offering evidence-based interventions should help to reverse upward trends in the adverse sequelae caused by distressing incidents at work.

Our service evaluation shows that staff appreciated the care shown to them by making the G-TEP sessions available. The intervention helped them to process distressing experiences (even when people did not realise this was needed), and the skills learned were not only used in the sessions but also transferred into the workplace in general and into personal circumstances.

The analysis of the written feedback provides an insight into the desire of inpatient healthcare staff to learn skills that will help them better manage difficult emotions that arise from distressing incidents with patients.

Acknowledgments

Thank you to Beverly Coghlan for her editorial guidance.

John Mulhall is now in full-time private practice offering EMDR psychotherapy, IFS informed EMDR, EMDR supervision, Cognitive Analytic Therapy (CAT) and CAT supervision.