TY - BOOK

T1 - The psychological processes underpinning trauma therapy

T2 - exploring client journeys and therapist perspectives on healing

AU - D'Ambra, Rhiannon

PY - 2025

Y1 - 2025

N2 - This thesis comprises a systematic literature review, empirical research paper and critical appraisal of the research process, with the overall focus on exploring psychotherapeutic interventions for psychological trauma. Chapter one presents a systematic review and meta-ethnography which explored the experiences of accessing psychotherapy among adults with Complex Post-Traumatic Stress Disorder. A synthesis of 15 qualitative studies was conducted, identifying three interrelated processes which highlight the foundational role of relationships and trust in therapy engagement, facilitating trauma processing and psychological adaptation, all of which supports client’s empowerment and growth. Recovery was found to be non-linear, with individuals often revisiting stages. While psychotherapy was generally beneficial, barriers included difficulties in building trust and intensity of trauma work. The review underscores the importance of flexible, trauma-informed approaches, which must be tailored to individual needs. Chapter two explored psychotherapists’ experiences of using Internal Family Systems (IFS) therapy with trauma survivors. A constructivist grounded theory approach was employed to analyse semi-structured interviews with 17 UK-based IFS psychotherapists. Findings include a theoretical model which illustrates how therapists experience trauma recovery as cyclical and iterative in nature. The theory suggests that IFS fosters a nonpathologising, client-led approach, supported by three interrelated domains: Core Mechanisms, Key Processes and Developmental Patterns, which together enable deep selfexploration while maintaining psychological safety and healing. Finally, chapter three offers a critical appraisal of the research process, which integrates findings from both chapters to discuss shared therapeutic mechanisms, methodological considerations and implications for clinical practice. Reflexivity is also explored, with attention to researcher positioning, challenges in trauma research and future directions. Conclusively, this thesis contributes novel understandings of psychotherapy for people with difficulties related to unprocessed trauma; it offers unique insights into client experiences of therapy engagement and therapists’ perspectives on delivering IFS, emphasising relational safety, therapist adaptability and trauma-informed care.

AB - This thesis comprises a systematic literature review, empirical research paper and critical appraisal of the research process, with the overall focus on exploring psychotherapeutic interventions for psychological trauma. Chapter one presents a systematic review and meta-ethnography which explored the experiences of accessing psychotherapy among adults with Complex Post-Traumatic Stress Disorder. A synthesis of 15 qualitative studies was conducted, identifying three interrelated processes which highlight the foundational role of relationships and trust in therapy engagement, facilitating trauma processing and psychological adaptation, all of which supports client’s empowerment and growth. Recovery was found to be non-linear, with individuals often revisiting stages. While psychotherapy was generally beneficial, barriers included difficulties in building trust and intensity of trauma work. The review underscores the importance of flexible, trauma-informed approaches, which must be tailored to individual needs. Chapter two explored psychotherapists’ experiences of using Internal Family Systems (IFS) therapy with trauma survivors. A constructivist grounded theory approach was employed to analyse semi-structured interviews with 17 UK-based IFS psychotherapists. Findings include a theoretical model which illustrates how therapists experience trauma recovery as cyclical and iterative in nature. The theory suggests that IFS fosters a nonpathologising, client-led approach, supported by three interrelated domains: Core Mechanisms, Key Processes and Developmental Patterns, which together enable deep selfexploration while maintaining psychological safety and healing. Finally, chapter three offers a critical appraisal of the research process, which integrates findings from both chapters to discuss shared therapeutic mechanisms, methodological considerations and implications for clinical practice. Reflexivity is also explored, with attention to researcher positioning, challenges in trauma research and future directions. Conclusively, this thesis contributes novel understandings of psychotherapy for people with difficulties related to unprocessed trauma; it offers unique insights into client experiences of therapy engagement and therapists’ perspectives on delivering IFS, emphasising relational safety, therapist adaptability and trauma-informed care.

U2 - 10.17635/lancaster/thesis/2877

DO - 10.17635/lancaster/thesis/2877

M3 - Doctoral Thesis

PB - Lancaster University

ER -