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The impact of interpersonal and intersubjective factors on engagement with psychological services in individuals who repeatedly display deliberate self-harm (DSH) behaviour

Cohen, Itamar; (2019) The impact of interpersonal and intersubjective factors on engagement with psychological services in individuals who repeatedly display deliberate self-harm (DSH) behaviour. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

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Abstract

This thesis focuses on the relationship between individuals who repeatedly self-harm and healthcare services. It investigates potential barriers within this relationship that limit the access of service users to psychological therapies for self-harming behaviour available in the NHS. As repeated self-harm has a substantial economic burden, Part 1 presents a review of economic evaluations of psychological treatments for people diagnosed with Emotionally Unstable Personality Disorder, who often use deliberate self-harm as coping mechanisms. Twenty studies were included following a systematic search of the literature. Overall, Dialectical Behavioural Therapy has the highest chance to be considered as cost-effective, followed by Schema Focus Therapy and Mentalisation Based Therapy. Part 2 presents a qualitative study where semi-structured interviews were conducted with service users who repeatedly self-harm, and mental health professionals working in Accident and Emergency (A&E) department. Additionally, one focus group took place with mental health professionals working in the community. All data were analysed using Framework Analysis. Results suggest current clinical care and service structures do not meet the needs of some individuals who repeatedly self-harm. Clinical and organisational changes were suggested to increase the use of psychological interventions. Part 3 of this thesis is a critical appraisal that reflects on some of the issues that arose during working on the project. It focuses on three topics: difficulties with conducting research with individuals who do not engage with health services, personal difficulties involved in the interviewing process, and the relevance of health-economic knowledge among clinical psychologists. This is a joint thesis, carried out with Daniel Harris (DClinPsy, 2019); a summary of the contributions of each author to this study is given in Appendix A.

Type: Thesis (Doctoral)
Qualification: D.Clin.Psy
Title: The impact of interpersonal and intersubjective factors on engagement with psychological services in individuals who repeatedly display deliberate self-harm (DSH) behaviour
Event: UCL
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10085858
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