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At some point in our lives, we will probably find ourselves visiting someone whom we love, who may be frail and elderly, and is now living in a care home. This happened to me when I visited my grandparents and, while it’s not always the case, I can still remember witnessing what seemed to be a particularly stressful and unpredictable working environment for staff. 

It was, however, by no means my only experience of spending time in a care home. I have also worked in research at the University of Birmingham and Aston University, focusing on the psychological wellbeing of residents in care homes following a stroke or experiencing frailty. I made regular visits to care homes to collect data, and so I became aware of the difficult conditions for staff whose professional lives are spent working in these settings. 

Of course, Íø±¬ÃÅ Workplace readers recognise the importance of staff support to promote wellbeing – yet, care home staff are typically on a low income, and exposed to multiple factors that contribute to workplace stress. Their work is generally undervalued in society, despite the extremely challenging conditions care workers experienced during the COVID-19 pandemic, such as the difficulties obtaining personal protective equipment (PPE) and the high number of resident deaths. Even without a pandemic, the close bonds that staff often form with residents, and the subsequent grief that can occur when residents die, make the work incredibly demanding. For all these reasons, I thought that the psychological needs of this workforce would be an interesting and important area to research. 

About my research 

In 2022, I was given the go-ahead and Íø±¬ÃÅ funding to start a piece of PhD research that contributes to Íø±¬ÃÅ strategy. My PhD is being conducted through the University of Leicester, and focuses on whether counselling and psychotherapy for staff in nursing and residential care homes is an acceptable and useful service. Currently, the research into counselling and psychotherapy for this group is limited, so this project will contribute substantially to the evidence base. 

My PhD will involve carrying out interviews with care home staff and managers as part of the data collection process. The interviews will explore staff and managerial views and awareness of counselling provision in their workplace setting; current perceptions of the mental health needs of staff; barriers and facilitators for delivery and access of this type of intervention; and, preferred therapy formats such as in-person, online or telephone therapy. 

About the workforce 

Care home residents tend to have multiple health care needs such as frailty, sight or hearing loss, approximately 70% have dementia or severe memory problems, and 60% have a mental health problem.¹ Care home staff also often encounter challenging working conditions every day, characterised by long hours, shift work, high workloads, insecure and zero hours contracts, relatively low pay, and tasks that can be physically as well as emotionally demanding due to residents’ healthcare needs.²

It’s not unusual for care workers to encounter unpredictable events during the working day which can include resident falls, hospitalisations, potentially sensitive situations when interacting with the families of residents, and resident deaths. Residents with certain issues such as dementia can also exhibit behaviours that present challenges for staff to work with. A wealth of evidence suggests that care home work can have various negative effects on staff emotional health, such as stress and burnout, as well as from developing close bonds with residents and experiencing a sense of bereavement when they die.^3,4,5Ìý

Timetable for research 

My PhD research is being completed on a part-time basis over a seven-year period, from 2022 until 2029. The first two years have involved a literature review of counselling and psychotherapy research for care home staff. This has also included reviewing the literature on workplace stressors experienced by care home staff, counselling and psychotherapy in other occupational settings, and for occupations who experience similar stressors to care home staff. I have also looked at previous research into other types of mental health interventions for care home staff, such as peer support, and carried out a scoping review into peer support interventions for care home staff. 

The third year involved finalising the details and data collection processes for two of the research studies I am conducting, and applying for ethical approval. I received ethical approval in late-2024, and have begun my interviews with care home staff and managers. The rest of the PhD will involve finalising decisions about another study for the PhD, data analysis and writing up the PhD thesis. 

Why research matters 

In conversation with therapists, I often hear that there can be a perception that research in the field of counselling and psychotherapy is not relevant or applicable in the real world. Unsurprisingly, it’s not a view I share. Back in 2019, I joined Íø±¬ÃÅ as a research fellow within the Research team. Our remit is to undertake and support research that is intended to bring about changes in practice or standards development, influence policy and commissioning of services, support the development of greater research capacity within the field, and contribute to improved research literacy among practitioners. I have collaborated with universities and charities on various research projects, focused on counselling and psychotherapy for different groups such as care home staff, people with dementia, older adults, school children and university students. 

I honestly believe that research into counselling and psychotherapy is really important because it helps to contribute to the evidence base for the profession. This is essential as it helps our Policy team at Íø±¬ÃÅ promote the profession and campaign for more paid jobs for members. 

I’ve spoken with Íø±¬ÃÅ members who’ve completed their degree, a master’s dissertation or are now researching a special area of interest, and have surprised themselves as they initially thought they did not like doing research. If you are reading this and are involved in some research of your own,

Funding and support 

It’s certainly true that securing funding for research can make all the difference to whether the research is possible. Íø±¬ÃÅ is funding my PhD research because it is aligned with Íø±¬ÃÅ’s strategy, and I am provided protected time to work on it. In addition, I receive support from my line manager and other members of the Research team, as well as a very supportive supervisory team at the University of Leicester. 

Alongside my research, I am also involved in helping to provide products and services to support member research needs, such as contributing to the research pages of Therapy Today, as well as the Postgraduate Research Forum, the Annual International Íø±¬ÃÅ Research Conference, and producing surveys for members and staff as part of Íø±¬ÃÅ’s Data and Surveys Working Group. I am the special interest lead (SIL) for the Workplace division – a voluntary role where the SIL acts as a bridge in communication between Íø±¬ÃÅ and the division. 

Early insights 

To date, one of the things I’ve found of most interest is how the care home sector is under-researched compared to the wider healthcare sector such as hospital and primary care settings. This appears to be the case both for research into service users, such as patients or residents, and research into staff. Staff-centred research in both healthcare and the care home sector, is also far more likely to focus on the quality of care and training, rather than focusing on the emotional wellbeing of staff.

We simply don’t have sufficient research into the emotional and psychological health of staff in the sector, and this is a problem, especially given the current vacancies in the care workforce. The research that does exist into counselling and psychotherapy field for staff is limited, and tends to be based around a handful of studies on acceptance and commitment therapy (ACT) and eye movement desensitisation and reprocessing (EMDR), which have been shown to be useful for stressful incidents. 

Next steps 

I am currently interviewing staff and managers in nursing and residential care homes as part of this research. I’d welcome hearing from any Íø±¬ÃÅ Workplace readers if you are aware of care home providers that might be interested in taking part in this research project. I will be interviewing both care homes that currently have a counselling service, for example, those that use an employee assistance programme (EAP) or an independent counsellor, and care homes that currently do not have a counselling service or support for staff 

Ultimately, I hope when my research is complete that it will highlight the potential impact that working in a care home environment can have on staff wellbeing, show the current lack of research into mental health and counselling and psychotherapy interventions for this group of staff, and demonstrate how we are trying to address this gap in the research at Íø±¬ÃÅ. 

You can contact Jenny at: Âá±ð²Ô²Ô¾±´Ú±ð°ù.´Ç»å´Ç²Ô²Ô±ð±ô±ô°ª²ú²¹³¦±è.³¦´Ç.³Ü°ìÌý