Explorations of mental health professionals' views on hope and austerity:the synergy of a paradox?

This thesis consists of a literature review, research paper and a critical appraisal. In an attempt to explore how mental health professionals conceptualise hope, and the factors which influence this, a thematic synthesis of eight qualitative papers was completed. Findings demonstrated that professionals understand hope to be: ‘The dynamic driving force of the therapeutic process’. This theme provided a higher order conceptualisation of four additional themes, each encapsulating the factors which affect hope: 1) Experiencing and observing progress; 2) A joint venture: The role of the therapeutic alliance; 3) Trusting the process; and 4) Managing contextual barriers. While maintaining hope was regarded as essential to the role, contextual and systemic factors challenged professionals’ capacity to maintain hope. The research paper aimed to explore how austerity impacted on the work of psychological therapists. Thematic analysis of qualitative data yielded from 12 semistructured interviews led to the development of six related themes: 1) “There's a general atmosphere of threat”; 2) “You’re squeezed”: Increasing pressure; 3) “It’s just maths”: Service users are becoming less of a priority; 4) “You're definitely more limited in what you're able to do”; 5) “It’s just so upsetting”: Added emotional strain; 6) A fight, flight or freeze response: The mediating role of hope. These findings demonstrate that working in a climate of austerity has provoked numerous challenges for therapists. Coping strategies were adopted, yet these were guided by therapists’ level of hope. Retaining hope in a time of austerity may seem paradoxical, however findings suggest that hope is integral for mobilising professionals to overcome the associated adversities. It is therefore imperative that clinical psychologists embrace the developing role of the profession, by innovating services and endorsing compassion at a systemic level, for hope to be fostered throughout mental health services