Forensic Doctorate Trainee Views on an Expert by Experience (EbE)-Led Workshop: A Qualitative Exploration of Trainee Reflections

ABSTRACT

There is a growing recognition of the value of Expert by Experience (EbE) input into the training of forensic psychologists. This study aimed to gain insight into the experiences of doctoral trainees of an EbE led workshop. Sixteen trainees wrote reflective pieces of work following attending an EbE designed and led workshop. Four main themes were found: What I took from the workshop; Workshop delivery; What will I do differently?; and What needs to change? The findings point to the EbE led workshop having a positive impact on trainee current and future work practices.

KEYWORDS:

• Service user involvement
• expert by experience
• forensic doctorate training
• co-production

Introduction

There are multiple routes to being a registered Forensic Psychologist in the UK. One such route is through completing a forensic doctorate program, which combines Stage 1 (an MSc in Forensic Psychology) and Stage 2 (3 years of structured supervised practice across various forensic settings) (British Psychological Society [BPS], 2015). In addition, doctorate programs involve trainees completing a thesis and going through the viva voce examination. Forensic doctorate programs in the UK are accredited by the British Psychological Society (BPS) and the Health and Care Professions Council (HCPC). Successfully completing the program means an individual can work as a registered Forensic Psychologist in a wide range of forensic settings in the UK and abroad.

The overarching aim of forensic doctorate programs is to “equip the psychologists to practice professionally” (BPS, 2015, p. 16). The curriculum covers a wide range of academic components as well as training regarding the ethical principles in working with individuals who come into contact with the criminal justice system (CJS). There is a focus “on helping students to notice the relevance of specific principles to particular areas of practice, and encouraging generalisation by helping students to consider how to apply the code in a manner that unpacks its underlying intent and purpose” (BPS, 2015, pp. 16–17). The primary function of the code of ethics is to protect the rights and well-being of service users (SUs); in short, it sets the standards for the treatment of SUs. Furthermore, the curriculum encompasses teaching and supervision regarding the HCPC generic and profession-specific standards (HCPC, 2023).

Despite the rigorous training required to register as a forensic psychologist in the UK, research indicates that work needs to be done to improve relationships between psychologists and the people within the criminal justice system (CJS). For example, in the UK, Shingler et al. (2020) noted deteriorating relationships between prisoners and psychologists, and Maruna (2011) found that psychologists were viewed as untrustworthy and hostile and generally held in low regard by prisoners and ex-prisoners. To improve such relationships, it is important that current forensic psychologists and those training in the field are equipped with insight into SU views and experiences; “Understanding prisoners’ experiences is the first step in resolving some of the long-reported difficulties in working relationships between psychologists and prisoners as well as making the process more procedurally just” (Shingler et al., 2020, p. 571).

Furthermore, the importance of the therapeutic relationship between professionals and SUs in forensic inpatient services is also widely recognized (Bressington et al., 2011; Cartwright et al., 2021). Cartwright et al. (2021) further note the importance of gaining insight into the perspectives and experiences of SUs in forensic mental health services.

To improve relationships between psychologists and SUs, there is now a widely held recognition of the value of input from Experts by Experience (EbE; also known as individuals with “lived experience”) across the wide-ranging practices within the criminal justice system (Drennan, 2021; Lambert et al., 2021). The BPS practice guidelines (2017) note the importance of working collaboratively with clients and EbE in developing and delivering all aspects of psychological services. In addition, HCPC standards (2023) specify that psychologists must work in partnership with SUs. In mental health, the Government is committed to shared decision-making and the principle “no decision about me without me’” (p. 23). However, Drennan and Aldred (2012, as cited in Drennan, 2021), note that the involvement of individuals with lived experience is “arguably significantly more difficult when the dual vulnerabilities of forensic mental health services users are considered” (p. S24).

In recognizing the importance of EbE input, there has been a move toward co-production of training/teaching in mental health and forensic services. It is evident that EbE involvement in teaching varies across settings (Happell et al., 2014). In some institutions, there may be academics who are themselves, experts by experience; other types of involvement may be EbE contributing to discussions in lectures or co-production and co-delivery of teaching material. Co-production has been described as “an equitable partnership between experts by experience and professionals/academics … [its] theoretical framework requires active collaboration and constructive dialogue which challenges traditional assumptions about the nature of knowledge” (Horgan et al., 2018, p. 1284).

Despite a definite move toward EbE involvement in teaching/training in applied psychology (whether this be co-production or other means), there is currently a paucity of literature to provide the field of forensic psychology, with an evidence base regarding the impact of EbE involvement and recommendations for best practice.

In the field of forensic psychology, Lamph et al. (2022) describe the evaluation of three co-produced modules designed and delivered by those with lived experience, academics, and expert clinicians. The modules were on the topic of offender personality disorder (OPD) at a higher education level in the UK. Findings suggested that student confidence in working with people with personality disorder increased as a result of the modules; however, it is unknown as to whether confidence would translate to improved practice in working with those with personality disorder and whether the modules increased compassion for such individuals. Further research would need to be done to draw such conclusions.

BPS guidelines on teaching and assessment (2015) suggest that teaching and learning should be an active process, have real-life relevance, and involve “wide-ranging discussions and stimulate students to debate and appreciate the contested and situated nature of ethical dilemmas and problems.” (p. 11). In addition, as mentioned above, BPS guidelines for doctorate programs have more recently specified that there is a necessity for EbE involvement in programs within all areas (e.g., teaching, research, curriculum development). However, as yet, there is a lack of clarity regarding the forms that such involvement may take and how these may be evaluated. It is imperative that such work is evaluated from both a student and EbE perspective to further the knowledge base and share examples of good practice.

As such, the main aim of the study was to identify what trainees thought were the important outcomes of the workshop. More specifically, to gain insights from trainees regarding what was useful about the session, what key learning they took away with them, and what impact it may have on their work as a practitioner.

Method

Procedure

The workshop was delivered as part of a module on the doctorate program. The workshop involved 4 h of contact time with an EbE, an advocate, and a Recovery Lead for a local Trust. Immediately following the workshop, Forensic and Forensic Clinical Doctorate trainees (N = 20) were required to write a 500-word formative reflective report on their views on the workshop. Trainees were informed of the study via e-mail and given the option to opt out of their anonymized assignments being analyzed. The timing of the request (i.e., immediately following the workshop) was chosen to increase the likelihood that trainees would recall the workshop content and associated feelings.

Participants

Trainees were mostly female (n = 15) with one male, and between the ages of 22–35. Sixteen trainees (out of the total sample of 20) consented to their assignments being analyzed for the study. Consideration was given to ethical issues around trainees being participants in the research. Ethical approval was granted by the University Science, Technology, Engineering, and Mathematics ethics committee in February 2020.

Materials

The EbE-led workshop

During a curriculum development course meeting, a discussion took place regarding the training needs of psychologists’ and, more specifically, the issues of power in therapeutic relationships, and trainee preparedness to reflect upon certain professional issues. From this discussion emerged an agreement on the benefit of an EbE-led additional workshop for trainees on clinical, forensic clinical, and forensic programs. An EbE member of the course meeting then led in the development and delivery of a four-hour workshop for forensic and forensic-clinical trainees.

The workshop day was entitled “Are we in this together? Building a better relationship.” It combined a range of areas of good practice in teaching for practice doctorate programs (see above, BPS, 2015) and teaching in higher education in general (e.g., Morton, 2008) and was produced and delivered by an EbE with experience as a SU in both clinical and forensic sectors.

The topics covered included relationships (i.e., between SU and psychologists); SU experience of the forensic/clinical environment; supporting the SU voice; and the psychologists’ role. The delivery style was based on discussions of views and experiences, and examples of real-life situations. There was a hope that the workshop would be thought provoking and allow trainees a safe space to reflect on their practice with the benefit of insights from an EbE. A further hope was that their learning and reflections on learning would be applicable to practice and ultimately, make them more effective and compassionate in their roles.

The workshop involved discussions where trainees were presented with a question (e.g., “other than getting and keeping well, what other challenges do SUs face in a clinical setting?”; “who is responsible for upholding SU rights?”; “What are some of the inequalities and differential outcomes people face?”; “Do you feel people engage differently with psychology in ways that might depend on their race/ethnicity?”) which they discussed in pairs and then discussed with the whole group. In addition, video footage and written scenarios/case studies were used as a basis for further discussion.

Reflective assignment instructions

Trainees were given a purposely broad instruction to describe their thoughts about the workshop. Prompts were used to facilitate reflections: “Do you think it is useful to have a session led by an expert by experience?”; “How did the session make you feel?”; “What insights, if any, do you feel you have gained?”; “Do you feel that the session will have any impact on your current work as a trainee forensic psychologist and/or in your future careers?.” They were also asked for any additional thoughts.

Analysis

Template Analysis was used to analyze the reflective assignments. Template Analysis involves identifying and analyzing patterns within the data, whilst also incorporating existing knowledge relevant to a topic. This method was considered appropriate given that there were both a priori themes and themes derived from the data, and as such, the analysis takes an inductive and deductive approach (King, 2004). As a first step, a priori themes were identified: impact on practice; insights gained; usefulness of the workshop. Further codes were developed whilst reading through the text in the first three documents (randomly selected). The codes were analyzed and integrated to form key themes and lower-level sub-themes within these. These themes and sub-themes formed the first template which was used as a basis for the analyses of the subsequent 13 documents. An iterative process of reading, re-reading, and checking new data against the template followed, and amendments were made to the template as a result of additional data which was not apparent in the first three documents. A total of five versions of the template were created. The final template of themes and subthemes is presented in Table 1.

Table 1. Themes and sub-themes occurring from template analysis of the reflective assignments.

Theme	1. What I took from the workshop	2. Workshop delivery	3. What will I do differently?	4. What needs to change?
Sub-theme	1.1 Gaining insight	2.1 Teaching style	3.1 Advocating	4.1 Systemic and cultural change
	1.2 Reflecting on SU experiences	2.2 The importance of speaking from lived experience	3.2 Promoting a person-centered, collaborative approach	4.2 EbE led workshops for all staff
	1.3 Being challenged		3.3 Patient notes
	1.4 Pride in my profession		3.4 Reflecting
	1.5 How it changed me

Results

Four broad themes were identified, and these are described below along with example quotes. The first two themes link directly to the experience and outcomes of the workshop, namely, what trainees thought they had learned from the workshop and recognition of the importance of how the workshop was delivered. The second two themes relate to the wider impact of the workshop through changes that trainees intended to make to their practice and the recognition of the need for social change.

Theme 1 - What I took from the workshop

Trainees described having gained insight into what services are like for SUs and, relatedly, they mentioned specific experiences of SUs which they reflected on in terms of trying to understand how that must feel.

Gaining insight

All trainees made reference to having gained insights into what it feels like to be a SU in a forensic secure setting. Over half were explicit as to the value they placed on gaining such insights. For example, “The expert by experience session was extremely valuable due to the unique insight it provides; a perspective that we rarely get to explore at such a depth.” (P1).

P4 went further to explain why these insights are necessary:

It was useful because it allowed us to hear the other side of the story in terms of how it feels to go through the services in which we work in as Psychologists. I think that we try as best as we can to empathise with our service users, but we can never really know how it feels to be an inpatient without that experience and so having a SU talk about this and provide an alternative perspective was really eye opening.

Reflecting on service user experiences

Some trainees expanded on their thoughts about insight by providing examples of specific experiences that SUs had had. They spoke of how being able to, to an extent, put themselves in the shoes of a SU. For example, P3 described this as being able “ … to connect to these experiences of losing your freedom, choice, control and, in some cases, your voice and views when entering such environments.”

Many trainees commented on what they had learnt about the SU experience of a restricted environment, for example:

… the most profound thing I heard today was [name]’s experience of secure services and the unintended consequences of the restricted environment … I reflected on times in which seemingly trivial things have led to incidents of self-harm and violence on the ward. (P6).

Similarly, P11 stated: “The workshop also enabled us to reflect on the impact of the ward environment – something that we are privileged enough to be able to remove ourselves from when necessary.” P11 went further to explain that, through listening to the EbE, they were able to reflect on what it may feel like to have psychologists label behavior as being maladaptive when, from their perspective, it is a logical response to an unnatural, restricted environment and a lack of power. In addition, P11 noted that the workshop highlighted the need to consider covert racism as this is a neglected concept in some forensic settings.

This recognition of the frustration felt by SUs when they do not feel they have a voice was echoed by over half of the trainees. For example, P16 noted:

… it made me think about what is was actually like for the person that has to live in a restricted environment and a life that is far from normal. It made me reflect on what that would feel like for me, how I would feel if people were making choices about me, for me, and writing clinical notes using terms such as “maladaptive” behaviours.

P10 noted that SUs’ experiences may differ, so they were mindful that the experiences described in the workshop may not be generalizable. However, they further note that, “the workshop has stimulated a reminder that we should and must ask clients about their experiences and listen to complaints. Not just consider it ‘best practice’ to include clients, but essential practice.”

Being challenged

Many trainees stated that the workshop challenged them in some way; that they had a realization of some sort which had run contrary to previously held views or experiences.

P2 described a chain of thought during the workshop, whereby, at first, they were praising themselves for building good relationships with SUs and striving for collaborative working. However, they realized that everyone in the room seemed to be thinking and recounting similar positive perceptions of their work. They then reflected that it was unlikely that they were all excellent:

We can’t all be above average surely? So some of us are mistaken?…this challenged me to push aside any feelings of comfort and reassurance, and to instead spend the rest of the day considering the times I got it wrong, or didn’t speak up, and couldn’t build a relationship. I really needed to think about why those situations occurred.

Many trainees commented that they felt challenged as to why they had not stood up for SUs in meetings when they felt that opposing views were being voiced. It was evident that the workshop discussions raised the issue of the power dynamics and that this included power dynamics within staff teams whereby trainees do not feel confident to challenge those who are higher in the hierarchy. For example:

Discussing the power dynamics that often occur between the RC [Responsible Clinician – generally a psychiatrist] and the rest of the MDT [Multi-disciplinary Team] in terms of not challenging the decisions made by the RC, made me consider the times in which I have fallen into that trap myself … listening to EbE talk about the experience in which his psychologist did not advocate for [their] best interests provoked an uncomfortable feeling in myself as I am aware that I have not advocated for my patient in the best way I can. (P6).

P12 reflected that they “ … found myself openly reflecting to [EbE] about times where I had not spoken up when I disagreed with a decision made regarding SU care.

Pride in my profession … but

A few trainees mentioned that they agreed with the need for person-centered practice and that this was consistent with their experiences of working as a trainee forensic psychologist.

P10 stated that: A psychologist is by definition person-centred and is different from other professionals due to their developed skills of formulation … we all completely agreed with everything “negative” the SU stated about services and shared [their] opinions. They went further to state that they believed that the workshop would be more appropriate for, for example, psychiatrists and others who subscribe more to a more medical approach.

Other positive reflections included: “I appreciated feeling like I was doing the right thing, and engaging with SUs as I should be.” (P2) and “It made me feel confident and happy that we are using a person-centred approach in our interactions with our clients” (P16)

P12 went further to state that “ … overall, this session had given me a huge sense of pride in my profession and the SUs I work with.” However, P12 and all other trainees within this sub-theme further reflected that, although they and their services strive to be person-centered, that there is more to be done both by themselves as individuals and by the wider system to achieve a truly person-centered practice.

How it changed me

The vast majority of trainees reflected on the ways in which they felt they had changed within the space of the day, i.e., their views, attitudes, and general feelings about their roles.

Many trainees reflected that, following gaining insights from the EbE and discussions within the group, they felt more passionate about their work in terms of doing their best to make a difference in the lives of SUs. For example “The session made me feel more positive and hopeful.” (P14); “The workshop has made me think harder about my responsibilities, and my duty to those I work with.” (P2). P6 felt that the workshop would “continue to influence the way I view situations from the perspective of the SUs moving forward.”

For some, they also noted that the day highlighted certain things to them which they want to bear in mind in their practice. For example, “ … this workshop has reinforced the enthusiasm to change opinions and enthusiastically stimulate person-centred and formulation-based treatment.” (P10). In addition, some trainees noted that the workshop highlighted the need for a trauma informed approach and a strengths based approach.

Some trainees reflected on the balance of their duty of care to the community (with reference to their role to assess risk). One trainee went further in this train of thought by stating “ … but at some point SUs were, and will once more be part of that community; they are just temporarily displaced from their community. Therefore, we have a duty to them, too.”

Two participants made reference to changes in their thoughts on communication with SUs. For example,

… recognise that sometimes, the value of asking a simple question to our clients about what they need, rather than what we think they need, can in some cases, answer a lot of the questions we speculate over. (P7).

One participant did not feel their views had changed but recognized that it had an impact on their level of understanding and recognition of the importance of the SU voice: it has added a layer to my understanding from someone who has been on the receiving end of forensic care. It has brought his experiences to the forefront of my mind and reminded me of the importance of the SUs voice when it comes to practice and positive change. (P15)

Theme 2 – Workshop delivery

Approximately half the trainees made direct reference to the delivery style of the workshop. In addition, many trainees made comments about the EbE with reference being made to the importance of hearing from someone with lived experience.

Teaching style

All Trainees commented that discussion was used well in the workshop alongside reflection with the EbE. In the context of noting the impossibility of psychologists being able to fully empathize with SUs, P13 stated “ … the next best thing, in my view, is to have frank and open discussions with individuals who have and see things from their side.” Other examples of comments on this topic were as follows: “I appreciated the informal discussion led style which meant I felt fully engaged throughout, despite other things competing for space in my mind.” (P2); “The workshop was presented to us in a very open and interactive style, allowing ongoing and informative discussion.” (P10).

P1 reflected on the use of narratives to facilitate discussions in the workshop, commenting: whilst there were elements of sharing narratives from a SU perspective, this did not appear to be the main focus. These narratives were instead used as a vehicle to reflect on our clinical practice and psychology as a profession.

The importance of speaking from lived experience

All Trainees reflected that having an EbE lead the session was the key to the gains from the workshop; highlighting that this workshop was unique in that regard.

For example:

Learning from the experts themselves is something I believe is crucial in our roles as psychologists as our SUs are the experts in knowing the most about themselves as well as what works best for them … The session made me feel moved and amazed by the insight and strength that the SU brought forward within the discussions that were held. (P8).

P4 spoke of the realization that if the EbE could progress in recovery despite the challenges faced, then so can others, “I felt inspired to hear about the challenges faced by the SU, how they overcame them … It gave me hope that any one of the SUs we work with could also achieve this.”

Theme 3 – What will I do differently?

Following on from trainees reflecting on how they felt they had been impacted by the workshop (i.e., challenged and changed – see Theme 1), the vast majority of trainees reflected on how they feel the day could lead to changes in their role as practitioners.

Advocating

The majority of trainees spoke about how they were more likely to (or already had) spoken up for SUs where they, in the past, would have kept quiet. Advocating was mentioned in the context of speaking on behalf of SUs to ensure the best care/intervention for them. To advocate for SUs in their care, they spoke of the need to challenge other professionals. The majority of trainees who spoke about advocating for their SUs also made reference to how challenging this is, and how, for example, doing so will involve “being braver” (P2). Similarly, P12 wrote “It has enthused me to speak up for what I think is in the best interests of my clients, no matter how intimidating this may be at times.”

Trainees also noted that they were prepared to advocate for SUs even where they thought there was little chance that their views would be noted by those with more power than them. They felt that it was still necessary to speak up even if it just serves the purpose of ensuring that the SU in their care knows that they are trying.

I’m now thinking about how to be bolder, and how to advocate on behalf of my SUs, even when it feels pointless and I feel certain that my views will be disregarded … I may feel quite powerless at times, but often I have more power than they [SUs] do, so I owe it to them to speak up more often, more loudly, and with the courage of my convictions. (P2).

P12 went further to note their recognition of the position they are in and the role they are playing for the SUs in their care: “Today’s session helped me put into perspective my role to protect clients’ rights and to speak up when I feel their needs are not being considered.”

Promoting a person-centered, collaborative approach

Following on from reflections and insight into how it may feel to be a SU (i.e., lack of power, restrictive environment, etc.), many trainees made explicit reference to taking a more person-centered approach: I feel that this [the workshop] will greatly impact on my professional development, my confidence to question other professionals who don’t align with a person-centred approach, and to ensure that care planning is collaborative with the clients we work with. (P7)

Many trainees acknowledged that a person-centered approach is generally taken in their placements (see 1.4); however, all trainees who made mention of it, reflected that they were going to try harder to be truly person-centered:“ … to talk more in depth to the clients about recovery and what this means to them, ask them who they see themselves as, and who they want to be seen as.” (P16)

One aspect of remaining person-focused mentioned by many trainees was avoiding labeling or pathologising. For example,

… often “normal,” human emotions and responses are pathologised within secure settings, and it often feels like SUs aren’t allowed to express any kind of emotional response to things … I will try to voice this to other staff members when I feel it may be happening. (P15)

P12 spoke of the value of listening to SUs:

I also hope to reflect the underlying principles of person-centred care in my work, aiming to consider SU needs and uphold the strong professional relationships we build together. The SUs we work with are our most valuable text book … The discussions that occurred today have encouraged me to continue to learn from those I work with, much like I have learnt from this SU led session. I hope to always reflect an approach whereby we are “in it together” with our SUs.

Patient notes

Linked to sub-theme 3.3 (Promoting a person-centered approach), a small number of trainees made specific mention of clinical notes. The trainees noted that, as a result of the workshop, they would ensure that the case notes form a more balanced picture (i.e., the positives as well as any negatives). This was as a result of reflecting in the workshop on what it may feel like for SUs to read purely/largely negative comments about themselves.

P14 spoke of their reflections on “the interpretative lens worn by staff,” commenting that,

… often negative matters are reported but positive events are not. The simple act of completing a life skill (doing one’s own laundry, cooking a meal for oneself) is often overlooked despite it being a massive strength, protective factor and achievement for that person.

Similarly, P16 wrote,

The discussion regarding the clinical notes made me question if we were truly using a full positive behavioural approach … it has made me be more mindful whilst at placement to make sure I note all of the positive interactions that I have through the day.

Reflecting

After noting the value of the workshop in terms of how it made them reflect on their work as a trainee forensic psychologist, some trainees went on to note the importance of continuing to reflect on their work as a practitioner throughout their careers.

For example, P1 wrote “ … it [the workshop] reminded me of the ongoing importance of reflection as a professional tool to ensure the rights and recovery of SUs. Most crucial is to reflect on ourselves and our own practice.” They went on to comment that practitioners should reflect on the fact that psychologists are fallible.

Theme 4 – What needs to change?

Across the previous themes, all trainees commented on changes that they felt needed to take place; however, many went on to say that, as individuals, there is only a certain amount they can do to implement change – there needs to be wider changes/shifts in order for practices to change. Many trainees felt that the workshop would be a good way to go about changing the views of others who work with forensic SUs.

Systemic and cultural change

Over half the trainees made reference to the need for systemic change. For example, P6 stated, “I am not personally in a position to change the management of an inpatient setting, as this is something far deeper rooted in terms of needing a cultural shift in whole organisations.”

Trainees made mention of the wider issue of the punitive element to the system and then need to change the mindsets of people working in the field. P13 spoke of this issue and their own thoughts as to the part they wish to play in the changes:

My reflection of this workshop has taken on a more systemic line of thinking, but I think that is because there is still a punitive and pathologizing culture within forensic settings (both prison and hospitals) … The workshop has inspired me to try and think of ways in which I can begin to shift this pathologizing and punitive culture within my future role as a psychologist. Maybe that is too ambitions, but I firmly believe … that if you do nothing, nothing will ever change.

Two trainees mentioned the systemic racism evident within forensic settings and more widely. P11 noted “ … as a privileged white individual we can subconsciously conform to a system or belief that neglects those of an ethnic minority.” They went on to highlight that a key issue for people to be aware of in forensic services (and beyond) is that “to disregard an individual’s race, ethnicity, culture (or any other factor) is to ignore their experience and what makes them a unique individual.”

It was also noted that systemic change will involve more than just one discipline; wider changes need to occur as well as changes within the field of psychology.

Many of the trainees who mentioned the need for systemic and cultural change also mentioned that they felt frustrated with the current state of the system; stating that there were barriers to them being the practitioner they want to be. For example, “ … at times I can feel frustrated with how forensic psychology can feel so disconnected and out-of-tune with the people we work with … it can be oppressive and disempowering.” (P9), and ”we can be as knowledgeable about these issues as possible, but it doesn’t always feel that there are methods to change it single-handedly.” (P5).

EbE led workshops for all staff

One way of implementing change at a wider systemic level put forward by some trainees was to provide EbE led workshops for all staff working in forensic settings:

It would be really useful to have more workshops in this style to hear more experiences of service users. I also think it would be beneficial for other disciplines to have the opportunity to attend a service user led workshop to support a shared understanding within the multi-disciplinary team of how services could feel disempowering and confusing for service users. (P4)

P13 wrote about the importance of speaking with SUs and hypothesized about how a psychiatrist may respond to the workshop. They noted that unless professional staff have personal experience of being in the same situation (health and life experience wise) as a SU then they cannot: “fully empathise with those who have had those experiences.” They went on to note:

… the next best thing, in my view, is to have frank and open discussions with individuals who have and see things from their side. I wonder if this workshop were to be delivered to a forensic psychiatrist how they would respond? I have a strong feeling it would be met with a defence and a feeling of being blamed or being “told off.” Yet, I can’t help but feel that this is something that needs to be done.

Discussion

The main aim of the study was to identify what trainees felt were the important outcomes of the workshop and to gain insights regarding what was useful about the session, what they had learnt, and what impact it may have on their work. Trainee reflections on the EbE-led workshop were overwhelmingly positive. Firstly, as presented in Theme 1, trainees were unanimous regarding the view that they had gained important insights into what it is like to be a SU in a forensic setting. They were able to reflect on the experiences which the EbE recounted and felt challenged in terms of their work as a practitioner. Some trainees reflected on the positives of their roles in terms of the person-focused approach, however, they still felt that there was a need for improvement. These findings were concurrent with the aims of the workshop, and, as noted by Shingler et al. (2020), such insights can be seen as a first step in improving relationships between practitioners and SUs.

The findings within Theme 2 present a picture of the utility of the particular teaching approach taken by the EbE, i.e., a move away from the didactic style to a more active, discussion-based approach. The approach appears to model some of the content of the teaching, i.e., the shift toward collaboration and reflection. Trainees were encouraged to speak openly with their peers, the EBE and Advocates. It is evident from the type of information that trainees reported that they shared (i.e., instances where they felt they should have acted differently) that the EbE and Advocates were successful in their aim to make it a safe space where they would not feel judged or criticized. Indeed, it appeared that they created a space that was somewhere people could openly reflect on their actions and the actions of others. The use of case studies, the EbE’s own experiences, and the real-life experiences of the trainees could be seen to serve the purpose of making the workshop highly relevant and applicable to their work. The apparent success of the mode of teaching adopted in the workshop further supports the notions advocated by the BPS (2015) in the use of discussion and real-life experiences/scenarios.

It was encouraging from a course management perspective that the values held by the trainees were in line with those discussed in the workshop, i.e., they believe in taking a person-centered approach to their practice, appear to have a genuine desire to help SUs in their care, and are keen to do their utmost to help in the rehabilitation of SUs. The reflections outlined in Theme 3 present a narrative of the workshop having had a tangible impact on the trainees, with some reporting that they were already advocating more for SUs in their care, and many others reporting that they planned to do so moving forward. In addition, although trainees already appeared to hold person-centered values, their reflections suggested that these values had been strengthened such that they would be advocating for SUs at times when, in the past, they may have kept quiet.

Furthermore, trainee reports of making a conscious decision to focus on positive qualities of the individual rather than solely on what could be considered to be deficits or problems are reflective of a strengths-based approach to working toward the recovery of forensic SUs. This is promising given the research around the effectiveness of this approach (e.g., Quinn et al., 2022; Robertson et al., 2011; Tse et al., 2016).

Similarly, views expressed by some trainees regarding an increase in their level of hope that an SU can be rehabilitated are promising given literature which highlights the importance of a positive attitude toward SUs (Ward & Brown, 2004).

Implications for practice

It is evident that the unique EbE-led workshop which can be seen to have used evidence-based pedagogic techniques has value in the training of forensic doctoral trainees in terms of potentially leading to subsequent improvements in SU care in line with BPS codes of ethics and conduct and with HCPC standards of proficiency. Building on the success of the present workshop, further workshops that incorporate a broad spectrum of EbE’s (e.g., those who have been in prisons, diversity of crime type, diversity in demographics) could potentially provide trainees with even wider ranging insights.

Longitudinal research is needed to evaluate the effectiveness of such workshops with a larger sample with a view to determining the duration of impact. Future studies could explore how such workshops (or adapted versions) are received by other professionals working in forensic settings.

Strengths and limitations

The strengths of the study were around the rigorous analysis undertaken on the trainee reflective pieces; the principles and guidance set out by King (2004) on Template Analysis were adhered to. Sixteen of a potential 20 trainees agreed to take part, which equated to 80% of the potential sample. Trainees were aware that, although the EbE and Advocates would not have access to their reflective pieces, excerpts would be visible in any publication, and this knowledge may have led to the omission of negative comments. In addition, despite being provided with a potential structure for reflections (i.e., the option to structure reflections under certain questions), only one trainee adopted this structure. This allowed the trainees more freedom in their reflective process but also increased the heterogeneity of issues covered in the reflections. It would have been of interest to ask for further reflections from trainees after a follow-up period to allow for insights from trainees regarding whether the workshop had influenced their practice. However, this was not possible due to the course completion date of some of the trainees.

Conclusions

It is apparent that the workshop had a significant impact on the trainees. Whilst it is the responsibility of the individual psychologist to ensure they are upholding BPS and HCPC ethical standards, it is the responsibility of academic providers to equip trainees with the necessary knowledge and understanding to do so. Both the BPS and HCPC underscore the paramount importance of prioritizing the rights and welfare of SUs. The findings of this study suggest that the EbE led workshop has helped trainees to reflect upon the extent to which they, for example, promote SU interests and work collaboratively with them. As such, it is felt that the workshop was a valuable contribution the trainee learning experience on the doctorate course. Values and actions mentioned by trainees are in line with BPS ethics and conduct (2015) and also with publications recognizing the importance of the person-centered approach, i.e., tailoring therapeutic intervention to the needs of the individual (e.g., Barnao et al., 2016).

The findings of the current study are also in line with literature which highlights the importance of reflexive practice (e.g., Aurora et al., 2023), collaboration in treatment planning (Markham, 2020), and improving relationships with those in the criminal justice system (e.g., Shingler et al., 2020). These values and skills are of particular importance in forensic mental health settings, where clinicians may “encounter unique ethical challenges” (Aurora et al., 2023, p. 2).

The findings also mirror the assertions made by previous researchers that EbE content should be the foundation of sessions (Pringle & Smith, 2022), as opposed to sessions which have a small amount of EbE involvement. As identified by Byrne (2014) and the current study, such sessions have the ability to increase awareness and understanding of issues such as racism and discrimination. Trainee recognition of a need for change and of the value of SU involvement in treatment and teaching may serve to enhance the provision of forensic psychologists who are enabled to act as agents of positive and active change.

Furthermore, considering the broader context of the study in terms of SU involvement, it is hoped that the workshop highlighted the value of SU involvement (SUI) to the trainees, not only in the training of forensic psychologists but also in shaping the criminal justice system (Pike et al., 2019; Weaver & Lightowler, 2012). For example, in rehabilitation program design and delivery (Devilly et al., 2005) and having a SU presence at CJS councils and forums (Pike et al., 2019). Recent findings suggest that many staff in the criminal justice system “strongly believe in its [SUI] value” (Pike et al., 2019, p. 4). However, there are challenges to overcome and more work to be done to further develop SUI (Pike et al., 2019), as such, it is hoped that having positive, valuable experiences of SUI at the training stage will increase the likelihood that trainees will be conscious of SUI in their future careers as forensic psychologists.

Disclosure statement

No potential conflict of interest was reported by the author(s).