Are you sitting uncomfortably? How access to the experience and expertise of mental health service users can enhance professional learning
3rd September 2020
Author: Charlotte Wilson, Assistant Professor in Clinical Psychology, School of Psychology, Trinity College Dublin, the University of Dublin
Email: [email protected]
There are not many individual moments I remember from my clinical psychology training. However, one teaching session stands out. We had been taught theories of substance misuse but in this teaching session three people came in to talk about their own experiences of substance misuse. That session, above all others, has stayed with me.
When I started training other psychologists, I found that I was not alone in having this experience. People got in touch with me who remembered service-user led teaching sessions from their own training years ago. They wanted to let me know how important it had been to them in their careers.
And this got me thinking. What is it about receiving teaching from people with lived experience of mental health difficulties that makes it so different? A couple of models already existed to help me think about this. Rush (2008) had interviewed nurses about their experiences of being taught by people with mental health difficulties. She highlighted the transformational nature of the teaching, partly due to role reversals and also due to it prompting reflection. Schreur with colleagues (Schreur et al., 2015) interviewed clinical psychologists to explore their experiences of being taught by people with lived experience. Their model also highlighted reflection as central, with processes such as hearing new information, occupying different roles and connecting with the emotion of the speaker facilitating this reflective space.
These models still didn’t quite get to the core of the experience for me. Why was this learning was different to other learning? In other teaching there is emotional content, there is reflection, and there is new information, so apart from role reversal what is different?
I set about answering this by interviewing our own trainees and recent graduates about their experiences of being taught by people with lived experience. I used Braun and Clarke’s reflexive thematic analysis (Braun & Clarke, 2019) to analyse the data and as I deepened my analysis I found something that felt like it answered my question.
As well as reflecting some of the other findings in the two studies I had been influenced by, I became very interested in why the emotion was so important. For my participants it wasn’t just the connection with the emotion that was important, it was that the emotion both created stronger memories and also created mild discomfort that prompted reflection. Participants mentioned that they knew the teaching meant a lot to them, but they couldn’t put their finger on why – exactly my own experience.
I started to wonder whether this kind of teaching evoked a new kind of meta-cognitive experience. Meta-cognition is widely discussed in teaching and learning, but the focus is often on meta-cognitive knowledge (knowing about cognitive states) and meta-cognitive skills (being able to manipulate cognition). Efklides (2006) identified that our metacognitive experiences, or the feeling of learning, can influence our motivation and attitudes towards learning and therefore can influence the learning itself.
In my analysis of the data I started to hypothesise about a new metacognitive learning experience; feeling that you have learned something, but not being sure about what it is that you have learned. For me, this described the uncertainty and low-level arousal that trainees reported, and also accounted for their verbal descriptions of feeling sure they had learned something, but finding it difficult to put into words.
This felt like an important finding. This metacognitive experience seemed to be the thing that prompted further reflection; a kind of searching for additional meaning. It prompted some participants to actively seek out additional experiences where they could be taught by service users and it prompted others to be more curious about the service users they were working with in services.
Service user teaching research has moved on since I completed this research and it is increasingly important to recognise the preparation that goes into successful teaching, that this needs to be supported by institutions and suitably recompensed and that the experience and expertise that people with lived experience have needs to be properly recognised. However, recognising that this kind of teaching might have a unique role to play in professional learning is hopefully helped by recognising some of the factors that make it unique.
Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806
Efklides, A. (2006). Metacognition and affect: What can metacognitive experiences tell us about the learning process? Educational Research Review, 1(1), 3–14. https://doi.org/10.1016/j.edurev.2005.11.001
Rush, B. (2008). Mental health service user involvement in nurse education: A catalyst for transformative learning. Journal of Mental Health, 17(5), 531–542. https://doi.org/10.1080/09638230802053383
Schreur, K., Lea, L., & Goodbody, L. (2015). Learning from service user and carer involvement in clinical psychology training. Journal of Mental Health Training, Education and Practice, 10(3), 137–149. https://www.emerald.com/insight/content/doi/10.1108/JMHTEP-02-2015-0009/full/html
Charlotte Wilson is also the author of the following article: Wilson, C. (2019), "The experience of learning from mental health service users and carers", The Journal of Mental Health Training, Education and Practice, Vol. 14 No. 2, pp. 119-130. https://doi.org/10.1108/JMHTEP-06-2018-0036
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