How do mental health practitioners experience and understand resilience: The risk of death in mental healthcare

Wharne, Simon James (2019) How do mental health practitioners experience and understand resilience: The risk of death in mental healthcare. DCPsych thesis, Middlesex University / New School of Psychotherapy and Counselling. [Thesis]

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Abstract

Resilience is conceptualised differently (Dunkel, Schetter & Dolbier, 2011), suggesting conflicting priorities. If it is gained by facing adversity, no rationale exists for providing compassionate welfare. If it is just bouncing back, there is no need to learn from trauma. However, if it is a pre-existing trait that some people lack, then these vulnerable people must be protected. With increasing demands and reduced funding, practitioners are under pressure to toughen up, making their work stressful and meaningless (Bazzano, 2016). Alternatively, existential resilience might enable an emotional engagement in which balance and meaning are retained. The study explores how mental health practitioners understand and experience resilience in the face of potential and actual client deaths, being held to account, while having limited control.

Seven semi-structured interviews were transcribed and analysed, following van Manen (1990).

Themes:
1: Not-disengaging in an emotional process. To not disengage, but to stay with feelings and concerns in the face of death. Being with, in the moment, under the pressure of time, often with conflicting expectations around risks and responsibilities.

2: Growth through enduring difficulties. Post Traumatic Growth leads to a desire to be closer to others, feeling stronger through self-understanding, valuing what they have and wanting to help others; in contrast to a resilience that relies on pride, control and imagined indestructibility; driven by fear.

3: Being human under the scrutiny of authority. While scrutinised, participants accept their flawed humanity. Resilience happens when they are mutually experienced as human and emotionally engaged.

The unpredictable trauma of death can then be experienced as strengthening, as participants are pulled into being present and more engaged.

Recommendations:
Each practitioner’s will and personal desire to make a difference should be recognised as the driving force behind mental healthcare. Practitioners need regular supervision, support, with adequate time and space for reflection.

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