"I too matter" : the experience and impact of a brief online self-compassion intervention for informal carers of those with a life-limiting or terminal illness : a mixed methods study

Aims: Being an informal carer of someone with a life-limiting or terminal illness ('Carer') often results in marked levels of depression, anxiety and stress. Yet, Carers have little available free time to devote to lengthy, well-being interventions offered outside the home. Carers also struggle to prioitorise their self-care, a factor which may help buffer some of the negative impacts of being a Carer. The aim of this research was to gain insight into Carers' views and perceptions of the impact of a brief, four module, online self-compassion intervention for Carers which was created to improve wellbeing, increase self-compassion and develop self-care among Carers. In so doing, the research addresses gaps in the literature relating to self-compassion interventions for Carers and targeted self-care initiatives for Carers. Design: This predominantly qualitative study was undertaken in two phases. In Phase One semi-structured interviews with nine participants of a four module, one to one self-compassion intervention (iCare), delivered in person, were conducted and data subjected to a reflexive thematic analysis within a critical realist framework. Additionally, descriptive statistics were collected. The findings from Phase One provided a theoretical basis for the design and content of the online version of iCare, the intervention studied in Phase Two. Seven Carers completed the four module online self-compassion programme. Data were collected through individual module feedback, post-intervention online qualitative questionnaires and descriptive statistics. Findings: The reflexive thematic analysis of the data generated four overarching themes: The Myth of SuperCarer; Get with the programme!; 'Being kinder to myself'; and Everyone's a winner. These explored how participants approached iCareonline, the impact engaging with it had on their well-being and highlighted how participants developed self-care through gaining permission to recognise their own needs. Improvements in psychological well-being and increases in self-compassion were reflected in the quantitative findings. In line with critical realist methodology, a causal mechanism was proposed explaining the development of self-compassion and conscious self-care among participants based on a cyclical model of Carer self-compassion. Implications: This study has relevance for: healthcare practitioners as the findings suggest that these professionals have a key role in legitimising Carer needs and fostering permission in Carers to practise self-care; counselling and psychotherapy professionals who work with Carers who are well-placed to challenge barriers Carer-clients may erect in the face of encouragement to practise self-care and self-compassion. Some of the content of iCare may prove useful to those therapists adopting a pluralistic approach when working with clients who are carers. Finally, teachers of mindful self-compassion could note the importance of the permission-giving aspects of a self-compassion intervention and the role it plays in developing conscious self-care in participants.