The District Health Boards (DHBs) of the Aotearoa New Zealand (ANZ) healthcare service is the single largest employer of psychologists in the country; and psychologists operate across many diverse sections of the healthcare service. Unfortunately, in keeping with international trends, psychologists in the public healthcare system also experience high levels of stress and burnout. Consequently, recruiting and retaining clinical psychologists in a public healthcare service is challenging. It is therefore important to understand clinical psychologists’ experiences of working within the ANZ healthcare service.

The aim of this research was to explore the experiences of clinical psychologists working in the New Zealand healthcare service, and especially their experiences of providing psychological therapies within a large organisational structure. 17 psychologists working in various ANZ District Health Boards agreed to participate in open-ended interviews for this study. Using constructionist grounded theory, data were gathered and analysed until theoretical saturation was reached.

The central finding and overarching theory of this study is that clinical psychologists use alliance-building as a gambit, or strategy. They do this to manage the vulnerability they feel from working within an overburdened, and politically complex public healthcare system. The research study explored three primary institutional processes that provide context and impetus for this gambit. These categories were being productive, navigating power, and revisiting protocols. The theory is predicated on two conditions: that psychologists experience feeling vulnerable in their roles, and that they use a process of allying to address the expectations of their service.

A clearer picture emerged of how the institutional culture of the DHBs impact the delivery of therapeutic care. Additionally, the tenacity and flexibility of clinical psychologists in preserving and upholding their agenda was demonstrated. This study highlights the importance of a seeing professional activity, like therapy, as a form of dialogue with the environment. While therapy is first and foremost a clinical activity intended to facilitate healing, it also serves to communicate and co-construct a social narrative within the ANZ public healthcare service.

The research has the potential to illuminate the experiences of an important profession operating within the ANZ public healthcare service. The results may stimulate critical reflection and ongoing dialogue between the leadership and policy makers within the ANZ health care system and the psychologists they employ.