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Feeling stuck: exploring experiences of junior doctors

Published online by Cambridge University Press:  25 March 2021

Lauren Alexander ,
Eimear Counihan ,
Deirdre McNally  and
Leonard Douglas
Lauren Alexander*
Affiliation:
Department of Psychiatry, Beaumont Hospital, Dublin, Ireland
Eimear Counihan
Affiliation:
DETECT Early Intervention in Psychosis Service, Blackrock, Co Dublin, Ireland
Deirdre McNally
Affiliation:
Department of Old Age Psychiatry, Carew House, St Vincent’s University Hospital, Dublin, Ireland
Leonard Douglas
Affiliation:
Department of Old Age Psychiatry, Carew House, St Vincent’s University Hospital, Dublin, Ireland
*
*Address for correspondence: Dr L. Alexander, Kilbarrack Mental Health Services, Foxfield Crescent, Raheny, Dublin 5, Ireland. (Email: lalexander30@gmail.com)
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Abstract

Objectives:

Staff working in mental health services provide care for individuals with a variety of difficulties, which can pose treatment challenges. Perceived lack of progress in patients can engender uncomfortable feelings within the clinician, such as frustration, ‘heartsink’ and ‘feeling stuck’. The aim of this study was to explore the phenomenon of ‘feeling stuck’ amongst NCHDs in psychiatry.

Methods:

A total of 30 participants were recruited from three psychiatric hospitals to complete a 15-item questionnaire. The survey was designed to pursue a thematic analysis. Participants were asked to complete the survey anonymously, either online or paper version. The analysis was carried out by two researchers using open coding, with themes finalised through collective discourse.

Results:

Three themes were elicited from the data. The central theme – ‘causes of feeling stuck’ – consisted of three subthemes (patient, doctor and system factors). Participants were adept at describing patient and system factors, but reflected on doctor factors, such as countertransference, less often and in less detail. Other themes, explored in less detail by respondents, were ‘the experience of feeling stuck’ and ‘responses to feeling stuck’, with participants tending to seek solutions to, rather than an understanding of, these feelings.

Conclusions:

Trainee psychiatrists can clearly identify the situations where they are ‘stuck’ with clinical interactions. In spite of clinical supervision and reflective practice groups, they desire further training in managing these scenarios. NCHDs would benefit from further training, using these ‘stuck’ interactions as material, to further develop their understanding of the underlying factors in both themselves and their patients.

Keywords

Psychiatry traineespsychotherapyreflective practice
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 41 , Issue 1 , March 2024 , pp. 4 - 10
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of College of Psychiatrists of Ireland

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References

Angermeyer, MC, Matschinger, H, Carta, MG, Schomerus, G (2014). Changes in the perception of mental illness stigma in Germany over the last two decades. European Psychiatry 29, 390–395.CrossRefGoogle ScholarPubMed
Balint, M (1957) The doctor, his patient and the illness.CrossRefGoogle Scholar
Bernard, HR, Wutich, A, Ryan, GW (2016). Analyzing Qualitative Data: Systematic Approaches. Thousand Oaks, CA: SAGE publications.Google Scholar
Bion, WR (1995). Attention and interpretation. Lanham, MD: Jason Aronson.Google Scholar
Boyatzis, R (1998). Transforming Qualitative Information: Thematic Analysis and Code Development. Case Western Reserve University, USA, Sage.Google Scholar
Braun, V, Clarke, V (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.CrossRefGoogle Scholar
Department of Health (2020). Sharing the Vision: A Mental Health Policy for Everyone. Dublin: Stationary Office.Google Scholar
Department of Health And Children (2006). A Vision for Change: Report of the Expert Group on Mental Health Policy. Stationary Office: Dublin.Google Scholar
Douglas, L, Feeney, L (2017). An established practice in new surroundings: concepts, challenges, pitfalls and guidelines for NCHD Balint Groups. Irish Journal of Psychological Medicine 34, 1–5.CrossRefGoogle ScholarPubMed
Ellis, C (1996). Chronic unhappiness. Investigating the phenomenon in family practice. Canadian Family Physician 42, 645.Google ScholarPubMed
Jimenez, X, Thorkelson, G (2012). Medical countertransference and the trainee: identifying a training gap. Journal of Psychiatric Practice® 18, 109–117.CrossRefGoogle ScholarPubMed
Kealy, D, Halli, P, Ogrodniczuk, JS, Hadjipavlou, G (2016). Burnout among Canadian psychiatry residents: a national survey. The Canadian Journal of Psychiatry 61, 732–736.CrossRefGoogle ScholarPubMed
Koekkoek, B, Van Meijel, B, Hutschemaekers, G (2006). “Difficult patients” in mental health care: a review. Psychiatric Services 57, 795–802.CrossRefGoogle ScholarPubMed
Loerbroks, A, Glaser, J, Vu-Eickmann, P, Angerer, P (2017). Physician burnout, work engagement and the quality of patient care. Occupational Medicine 67, 356–362.CrossRefGoogle ScholarPubMed
Maguire, M, Delahunt, B (2017). Doing a thematic analysis: a practical, step-by-step guide for learning and teaching scholars. AISHE-J: The All Ireland Journal of Teaching and Learning in Higher Education 9, 3351–33514.Google Scholar
Main, TF (1957). The ailment. British Journal of Medical Psychology 30, 129–145.CrossRefGoogle ScholarPubMed
Mckensey, A, Sullivan, L (2016). Balint groups–helping trainee psychiatrists make even better use of themselves. Australasian Psychiatry 24, 84–87.CrossRefGoogle Scholar
Moustakas, C (1994). Phenomenological research methods. Sage.CrossRefGoogle Scholar
Musich, S, Wang, SS, Slindee, L, Kraemer, S, Yeh, CS (2019). The impact of internal locus of control on healthcare utilization, expenditures, and health status across older adult income levels. Geriatric Nursing 41, 274–281.CrossRefGoogle ScholarPubMed
Nulty, DD (2008). The adequacy of response rates to online and paper surveys: what can be done? Assessment & Evaluation in Higher Education 33, 301–314.CrossRefGoogle Scholar
Nunn, K (2017). Mental health of health professionals. Journal of Paediatrics and Child Health 53, 735–736.CrossRefGoogle ScholarPubMed
O’dowd, T (1988). Five years of heartsink patients in general practice. The British Medical Association 297, 528–530.Google ScholarPubMed
Ravitz, P, Lawson, A, Fefergrad, M, Rawkins, S, Lancee, W, Maunder, R, Leszcz, M, Kivlighan, DM (2019). Psychotherapy competency milestones: an exploratory pilot of CBT and psychodynamic psychotherapy skills acquisition in junior psychiatry residents. Academic Psychiatry 43, 61–66.CrossRefGoogle ScholarPubMed
Sellers, RV, Salazar, R, Martinez, C, Gelfond, SD, Deuter, M, Hayes, HG, Ketchum, N, Pollock, BH (2012). Difficult encounters with psychiatric patients: a south Texas psychiatry practice-based research network (PBRN) study. Journal of the American Board of Family Medicine 25, 669–675.CrossRefGoogle Scholar
Stone, L (2014). Blame, shame and hopelessness: medically unexplained symptoms and the’heartsink’experience. Australian Family Physician 43, 191.Google Scholar
Swart, R (2019). Thematic Analysis of Survey Responses From Undergraduate Students. Thousand Oaks, CA: SAGE Publications, Limited.CrossRefGoogle Scholar
Tufford, L, Newman, P (2012). Bracketing in qualitative research. Qualitative Social Work 11, 80–96.CrossRefGoogle Scholar
Wilkinson, PJ (2019). Stuckness in psychiatric practice. Mental Health Review Journal 24, 195–211.CrossRefGoogle Scholar
Winnicott, D (1947) Hate in the countertransference. London: Tavistock.Google Scholar