Fosuaah, Angella; (2022) Psychologists’ Experience of Exo-System Level Work in Community Psychology Projects. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Aims: One aim of psychologists working in Community Psychology projects/services with marginalised communities, is to intervene at the exo-system level. The purpose of these co-produced projects/services is to support community empowerment, challenge marginalisation, focus on prevention and target root social causes of mental distress. However, little is known about the experiences of psychologists working in these services, the practices/skills used in the exo-level work and how they may differ from the traditional clinical model of mental health service delivery. This qualitative study aimed to explore psychologists' professional journeys into exo-system level community psychology working, the competencies and practices used, barriers and facilitators to the work and implications for the psychological profession and NHS for optimal exo-system level working. Method: Thematic Analysis (TA) was used to explore the experience of psychologists working in statutory and non-statutory settings underpinned by Community Psychology principles. Purposive and snowball sampling was used to recruit participants. 17 clinical and counselling psychologists working with marginalised communities and intervening at the exo-system level took part in individual semi-structured interviews. All interviews took place via MS Teams and were transcribed verbatim. Results: The analysis resulted in eight superordinate themes: “Seeing problems in existing systems and finding a new answer”, “Exo-system: Looking inwards and Looking Outwards”, “Relationships at the core”, “Uncertainty in the work”, “Measuring what matters”, “Using psychological competencies at the exo-level”, “Working well with communities” and Continuing the journey”. Recommendations for professional psychology training courses and service development and delivery were also considered. Conclusion: To the author's knowledge no study has systematically explored the experience of psychologists working in community psychology services and intervening at the exo-system level in the U.K. The qualitative analysis highlighted significant early career experiences such as witnessing limitations of statutory mental health services that led to an interest in working with marginalised communities. Participants described using their core clinical skills flexibly, within and outside of the projects to effect change and support positive mental well-being. Relational trust with communities was highlighted as a key facilitator, particularly in the context of working alongside historically underserved communities. A key finding of the study was the large gap in knowledge and skills at the strategic level/ service development and working across organisations when psychologists first began exo-system level work. The need to formalise opportunities for individual and service level critical reflection was highlighted as crucial for managing potential risks of further harm when working with marginalised communities.

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