"Psychologists aren't just fluffy and compassionate" - Discursive legitimacy, role conflict, and the therapeutic relationship. Psychologists as Professional Witnesses in First-Tier Tribunals (UK)

<p dir="ltr">First-Tier Tribunals (FTTs) form part of the essential safeguards to protect the rights of those sectioned and detained under the Mental Health Act in the UK. Almost 29,000 applications to overturn sections were submitted to FTTs between 2021 and 2022; of those that made it to an FTT hearing, around ten per cent were overturned. Whilst FTTs are employed to protect patients, a paradox emerges in the literature, which outlines that FTTs are biased in their risk assessments, have an overreliance on medical opinion, and disempower patients who participate within them.  </p><p dir="ltr">Concerns also persist regarding the dual role dilemma clinicians enact when engaging in FTTs, reflecting a wider dual role dilemma for psychologists who have increasingly moved into positions which include assessment of risk and mental health, which contribute to decisions around care and detainment. The dual role dilemma is widely considered to impact the therapeutic relationship negatively. It is particularly pertinent in forensic settings where demands placed on therapists between patient-centred care and ensuring public protection are considered to conflict with one another.  Given these concerns, current research must explore how psychologists engage with and navigate the professional witness role in FTTs, in particular how dual roles are experienced and enacted, and how these impact on the therapeutic relationship,  </p><p dir="ltr">This study employed semi-structured interviews with seven qualified psychologists to examine the experience of forensic and clinical psychologists who have assumed the role of a professional witness in an FTT. There was an emphasis on understanding role dilemmas and their impact on the therapeutic relationship, as well as exploring broader themes previously uncaptured within the literature. Reflexive thematic analysis was utilised in the context of a critical realist and experiential position. Two overarching themes were constructed; It is fundamentally important; the power of discursive legitimacy; and Pulls and duty; role code-switching, alongside associated subthemes; sit around the edges of it: the power of formal authority; Disrupting the hierarchy; The motivational role of trust; and Psychologists aren’t just fluffy and compassionate: Integrative scripts. Additional subthemes of The relationship between accountability and decision-making and Collaboration over conflict are considered, as well as a conceptualisation of all data sitting within the context of a professional conflict.  </p><p dir="ltr">Findings were discussed in line with organisational models of power and role conflict, and considerations were made regarding the idealised position of collaboration in healthcare. Findings are also used to strengthen current models of therapeutic relationships in forensic practice. A model of the proposed interaction between themes is also presented but considered in the context of the need for further research to strengthen links between organisational models of power and influence and mental health team working, including the role of psychologists. Future research should consider broadening out the investigation of these themes to other critical stakeholders within FTTs and understanding how these findings sit and change within the context of shifting practice in FTTs.  </p>