An Exploration of Trauma-Focused Psychological Therapies From Client and Older Adult Clinician Perspectives

Abstract

This thesis aimed to qualitatively explore the barriers and facilitators to trauma-focused therapy from both client and clinician perspectives, with a particular focus on Eye Movement Desensitisation and Reprocessing (EMDR) in older adults. It comprises three papers: a meta-synthesis, an empirical qualitative study, and a critical appraisal of the research papers. Paper 1- a meta-synthesis of 16 qualitative studies exploring client perspectives on trauma-focused therapies involving exposure. Thematic synthesis was used to analyse the findings, generating five overarching themes. These highlighted key facilitators such as therapeutic alliance, preparation for exposure, and pacing, alongside barriers, including emotional overwhelm, disempowerment, and ruptures in the therapeutic relationship. The findings underscore the importance of collaborative, culturally sensitive, and well-paced trauma therapy. Paper 2 - a qualitative study that sought to explore clinicians’ experiences of delivering EMDR to older adults. Twelve clinicians from two NHS trusts took part in the study. Verbatim semi-structured interview transcriptions were analysed using applied thematic analysis. Four main themes were developed which focused on clinicians’ perspectives on tailoring EMDR to meet the needs of older adults and the systemic context in which they work: (1) Adapting EMDR to meet the emotional, cognitive, and physical needs of older adults; (2) Agency and emotional safety as foundations for effective EMDR; (3) EMDR as a distinctively valuable intervention in later life; and (4) Service-level and cultural barriers to equitable EMDR access for older adults. The clinical implications for age-inclusive, trauma-focused psychological practice are discussed, as are recommendations for service delivery and future research. Paper 3 - offers a critical reflection on the research process and personal journey of the researcher. It explores methodological decisions, ethical considerations, and the influence of reflexivity. The authors’ lived experience of EMDR and bereavement during the doctorate shaped both the research and the interpretation of findings. This paper reflects on how positionality and clinical training informed the approach to each study. Together, the three papers offer a rich and reflexive exploration of trauma-focused therapy and EMDR from multiple perspectives. The findings have clinical implications for improving access, delivery, and acceptability of trauma-focused interventions, particularly for older adults. They also contribute to the evidence base around EMDR and highlight the importance of relational, contextual, and systemic factors in shaping therapeutic experiences.

Date of Award	24 Nov 2025
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Lydia Morris (Main Supervisor) & Filippo Varese (Co Supervisor)