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This portfolio represents the research component of four years’ training towards qualification as a psychotherapeutic and counselling psychologist (PsychD) at the University of Surrey (UK). A brief introduction outlines my interest in and approach to the chosen topic area; namely, music performance anxiety (MPA). This is followed by a research development dossier consisting of three separate projects: Year 1: a critical literature review exploring how MPA has been examined in extant research; Year 2: a quantitative, cross-sectional enquiry which draws on attachment theory to examine associations between attachment patterns and MPA, and the extent to which any such relationship is mediated by perfectionistic behaviours, and Year 3: a critical discourse analysis (CDA) exploring the ways that performing musicians construct their experiences of MPA.

This portfolio consists of a research dossier undertaken as part of the Practitioner Doctorate in Psychotherapeutic and Counselling Psychology training. The research dossier consists of three pieces of research: the literature review and two qualitative studies. The literature review provides an overview of mindfulness practice and identifies areas for future research investigation. In the second year of training the main research focus was on participants’ first experience of mindfulness practice by employing interpretive phenomenological analysis. In the final year a constructivist version of grounded theory was utilised to develop an understanding of participants’ disengagement from mindfulness practice. Both of these empirical studies aimed to develop a greater understanding of the lived experience of participants who embarked on the journey of mindfulness practice.

Alexithymia and experiential avoidance have both been shown to share substantial relationships with poor mental health outcomes. Both constructs may have heightened importance for men, as male gender is associated with higher rates of alexithymia as well as the increased use of harmful experientially-avoidant coping strategies. Recent research has turned its attention towards the hypothesis that the relationship between alexithymia and negative psychological wellbeing may be as a result of the inflexible application of broader belief systems endorsing the benefits of experientially avoidant coping. This may be particularly relevant for men, who are arguably socialised into suppressing emotional states viewed as unacceptable within dominant masculinity scripts. This thesis aimed to explore the impact of experiential avoidance on the relationship between alexithymia and psychological wellbeing. Specifically, Part One of this portfolio contains a systematic literature review exploring the current evidence base pertaining to the question: how are alexithymia and experiential avoidance related? The findings of the review suggest that studies consistently report positive, significant relationships between alexithymia and experiential avoidance. Additionally, although there have been some mixed findings from mediation analyses, the weight of evidence currently appears in support of experiential avoidance being a critical mediator in the relationship between alexithymia and poorer psychological wellbeing. Part Two presents an empirical paper that investigated the mediating role of experiential avoidance in the relationship between alexithymia and experiential avoidance in men. Findings supported experiential avoidance having a mediating role in this relationship, consistent across depression, anxiety and stress. Findings support the conceptualisation of alexithymia as a learned coping response, which develops alongside preferences for avoidant coping more generally i.e. psychological inflexibility. Parts Three and Four of this portfolio contain details of the clinical experience and academic assignments also completed as part of this clinical doctorate programme.

This is a portfolio of research work that was completed during my three years of training on the PsychD in Psychotherapeutic and Counselling Psychology at the University of Surrey. It includes a literature review and two qualitative research studies. The literature review offers a critical perspective on the available literature on social skills training for individuals living with psychosis. The first research study uses interpretative phenomenological analysis (IPA) as a methodology to understand client experiences within group social skills training. The second study employs thematic analysis (TA) to explore therapist perspectives on their role in social skills training for individuals with psychosis.

Background: There is an established association between parental Expressed Emotion (EE) and mental health disorders in children and adults. Most research has focussed on parental EE regarding under 12s or adult offspring, with very little attention devoted in the literature to the impact of parental EE regarding adolescent offspring. Furthermore, most studies have used methods of coding EE that were designed for use in relation to adult offspring, raising questions about the validity of their findings. The aim of this study was to compare level of parental EE regarding adolescent offspring (12-18 years) referred for treatment for depression and/or anxiety with parental EE regarding adolescent offspring recruited from the community. Design: A cross-sectional, between-subjects’ design was used. A clinical group of adolescents and one of their parents were recruited from a Child and Adolescent Mental Health (CAMH) service. A community group of adolescents and a parent were recruited as a comparison group. EE was assessed using the Five Minute Speech Sample (FMSS) with a coding scheme adapted for use with adolescent offspring. Parents completed the FMSS and a measure of psychopathology. Adolescents completed a questionnaire measure of their own anxiety and depression. Results: Level of parental EE, Criticism and Emotional Over-Involvement was non-significant between the two groups. Level of Warmth and number of positive comments was significantly lower in the clinical group. Parental EE was significantly associated with higher adolescent self-reported symptoms of depression. Parental psychopathology was not associated with parental EE. Conclusions: EE may be more normative in relation to adolescents compared to other studies. Lack of positive elements of EE may be more of a risk factor for adolescents. However, the cross-sectional design of this study means that causality cannot be inferred. Key words: Expressed Emotion, Parents, Adolescents, Internalising disorders.

Aim: Self-concept and identity are impacted by the experience of an acquired brain injury (ABI), often negatively. These changes have been shown to impact on other domains including mood and vocational outcomes. The study aimed to provide practice-based evidence for the effectiveness and acceptability of ‘RE-ID’, a novel vocational rehabilitation group intervention exploring identity after an ABI using an acceptance and commitment therapy (ACT) approach. Method: The study employed an idiographic case series approach, using a mixed methods single case design. Reliable change index and clinically significant change analyses were used to assess changes in self-report measures of self-concept, mood, quality of life, self-esteem, general self-efficacy, and occupational self-efficacy pre to post intervention and at one-month follow-up. Semi-structured follow-up interview data were analysed using deductive thematic analysis. Results: Quantitative outcome measures showed limited change across the intervention. Qualitative data provided preliminary evidence for the potential effectiveness of ‘RE-ID’, with participants reporting change and attributing this change to a combination of ACT therapeutic factors and group process factors. Discussion: The current study provides initial data suggesting that ‘RE-ID’ may be an effective vocational rehabilitation intervention following ABI, and that both the ACT model and the delivery of the intervention in a group format likely contribute to its effectiveness.

Background A positive supervisory relationship is considered essential in ensuring a psychotherapist’s safe and effective practice. Attachment Theory (AT) has been used to investigate factors that may impact upon the quality of the supervisory relationship, for trainee psychotherapists. A literature review revealed inconsistent findings as to whether attachment styles of supervisors and supervisees were associated with the quality of the alliance, suggesting an incomplete understanding the attachment-supervision construct. Objectives To improve our understanding of the attachment-supervision construct, this study aimed to explore, in-depth, how supervisees experienced and understood the supervisory relationship and to explore what within this may be relevant to AT. Method Interpretative Phenomenological Analysis (IPA) was used to interview and analyse data from seven trainee clinical psychologists (supervisees). Results Several participant experiences resonated with AT, including the supervisor demonstrating secure attachment figure qualities, which help the supervisee feel worthwhile. Rather than the supervisory relationship merely being influenced by past infant-caregiver attachment, it appears that there is the potential for a new attachment to form, similar to the freshness of an infant-caregiver attachment. However, unlike an infant, the supervisee has more influence over the attachment, in a collaborative effort with the supervisor, where the relationship seems to benefit from a goodness-of-fit between both relational styles. Non-attachment factors such as reciprocal disclosure were also important in the supervisory relationship. Conclusion Overall, AT appears a useful way to think about the supervisory relationship, particularly for inexperienced trainees. However, as trainee clinical psychologists are trained to think in attachment terms, it remains unclear whether the supervisory relationship is truly a “full-blown” attachment relationship (rather than one consisting of attachment dynamics), or whether this is just the way that trainees approach it. Regardless, the findings suggest that the supervisory alliance may be improved via supervisor attunement to supervisee needs.

Objective: To explore the impact social class biases may have on the treatment of clients by psychological and psychotherapeutic professionals in Britain. Design: A cross-sectional on-line study among 156 psychological and psychotherapeutic professionals working in the NHS incorporating a comparison between two groups - video vignettes representing ‘lower’ and ‘upper’ class clients. Methods: The video vignette depicted a psychological assessment session of a client who had been referred by his general practitioner after incidences involving deliberate self-harm. The accent and dress of the client were varied. Study participants completed measures of clinical reasoning relating to diagnosis, risk and treatment, measures of their awareness of the influence of social class on their work and a social class brief implicit association test. Results: Within the context of this study participants tended not to discriminate against clients in relation to their class. However, they believed that a ‘lower-class’ client was more likely to receive an ‘alcohol or substance misuse’ diagnosis (p= .002; d=0.40). They also scored the ‘lower-class’ client as more motivated to make changes (p=.032; d=.29). Seeing a ‘lower-class’ client resulted in significantly higher scores indicating participants reflection on personal conflicts relating to their own social class and the impact such biases may have on their work. Conclusions: There was no general pattern of discrimination against clients in relation to their social class. This may be due to client class cues priming the psychologist to reflect on their position. Practitioner Points: •Training and professional development for Psychological and Psychotherapeutic Professionals in ways to raise awareness of their personal beliefs about social class may help reduce class bias. •Working with clients such professionals perceive to be a ‘lower’ class allows them to reflect on these personal beliefs.

Background: Co-rumination is the process of problem discussion within a dyadic relationship that is repetitive and unproductive with a focus on negative affect. Co-rumination has been found to have adaptive and maladaptive facets, which result in it being positively correlated with both negative affect and friendship quality. To date research has focused upon relationships between co-rumination and depression within children and adolescents using cross-sectional designs. Aim: To assess the relationship between co-rumination, depression and anxiety in adults using a prospective design. Methodology: This study used a two-wave prospective design where adult participants were asked to complete an online survey (comprising measures of rumination, co-rumination, depression, generalized anxiety and social anxiety) at two time points three months apart. Participants rated co-rumination in relation to the confidant they most often discuss problems with (e.g. same-sex best friend) Findings: Positive correlations were found between the affects depression and generalised anxiety, and co-rumination at Time 1 which became non-significant when controlling for rumination. At Time 2, generalised anxiety exhibited this trend; however relationships between depression and co-rumination remained significant when controlling for rumination. No relationship was found between social anxiety and co-rumination at either time point. When results were split by confidant type, positive correlations were found between same-sex friend co-rumination and depression and generalised anxiety. However, significant positive correlations between these variables were only found at Time 2 for Romantic partner dyads. Hierarchical linear regression found that co-rumination at Time 1 predicted generalised and social anxiety at Time 2 but it was not found to be predictive for depression. Conclusions: Cross-sectional correlational analysis supports prior findings in the field. However prospective analysis indicated that co-rumination predicts generalised and social anxiety but not depression. Differences in the relationship between co-rumination and affect are observed between different confidant types. Implications of these findings are discussed.

Background: Given their highly unacceptable nature, negative intrusions are likely to promote the experience of negative affect such as fear, shame and guilt. Moreover, moral thought-action fusion (believing that negative thinking is the equivalent of acting immorally) is likely to inflate the occurrence of negative affect when intrusions are experienced. In turn, negative affect is likely related to disclosure. The current study investigated whether thought-action fusion beliefs predict anticipated disclosure of hypothetical negative intrusions, and whether this was mediated by anticipated negative affect. Method: An online survey was completed by a sample from the general population (n=175). The survey assessed anticipated negative affect and anticipated disclosure of hypothetical negative intrusions, guilt and shame proneness, frequency of negative intrusions, thought-action-fusion beliefs, and general self-concealment. Results: A strong positive relationship was found between TAF-Moral beliefs and anticipated negative affect from experiencing negative intrusions. The analysis indicated evidence of co-operative suppression: when both TAF-moral beliefs and negative affect were entered into a model predicting anticipated disclosure, the effect of both predictors increased. Whereas TAF-Moral beliefs predicted lower likelihood of disclosure, negative affect predicted increased likelihood of disclosure. Conclusion: The current findings add to the literature in that they suggest that individuals may be less inclined to disclose unacceptable intrusions. Further work is needed to understand the conditions under which negative intrusions are more or less likely to be disclosed. Limitations and recommendations are discussed.

The present study aimed to develop a theory of perceptions of how mindfulness influenced colleague relationships. Abbreviated Grounded Theory methodology was used to collect and analyse data from eight participants. The participants were from a diverse range of occupations and geographical locations. 45 to 90 minute interviews were conducted, and participants contacted after to expand on the discussion. Participants perceived mindfulness practice to influence colleague relationships through changes in internal experience, which led to changes in interpersonal behaviour. The actions of mindfulness practitioners were seemingly influenced by values they held about their workplace relationships. Reactions of colleagues were difficult for participants to predict, and both positive and negative reactions were commonly described by practitioners. Results of the study provided the beginnings of an explanation for previous contradictory findings. Considerations for future research are discussed, and include further investigation of proposed mediating factors, and possible future interventions to improve workplace relationships; such as ACT and modified mindfulness training.

This dossier comprises of three pieces of research that was undertaken per each year of the PsychD course; namely, a literature review and two qualitative research projects. The literature review examined the literature on morality within the context of psychotherapeutic practice. Leading on from this, the first research project sought clients’ subjective experiences of morality within their respective psychotherapeutic relationships. The second research project explored whether therapists’ moral values play a role in their practising lives.

Objective: Both financial strain and socio-economic status (SES) or class have been found to be negatively associated with mental health for students. In the context of national changes to higher education funding, male students from low SES backgrounds may be at particular risk of developing untreated mental health difficulties because of the way such distress tends to manifest in men, and because of their lack of help-seeking. The first year of university study is a period of significant transition for young people, which can increase their vulnerability to psychological distress. This study aims to look at the association between financial disadvantage and psychological wellbeing in male first year undergraduate students, and to examine whether this is mediated by perceived financial strain and subsequent stress. Design: A quantitative cross-sectional design was used. Method: Data was collected from 164 male students using an online questionnaire. This contained measures of financial strain, stress, depression, anxiety and family affluence. Pearson’s correlation coefficients were calculated to examine associations between the study variables. Bootstrapping analyses was conducted to test for the indirect effects of financial strain and stress. Main Findings: Lower family affluence scores were not directly associated with increased scores for depression, anxiety or stress symptoms; however, they were indirectly associated with increased scores for depression symptoms, through increased financial strain. Greater financial strain was associated with increased scores for anxiety and depression symptoms, through increased stress. Serial mediation of family affluence scores to mental health symptoms through both financial strain and then stress was not found. Conclusions: The findings support the broader idea that perceptions of financial circumstances are related to psychological wellbeing in the male student population. The study also supports the idea that male students have a stress-vulnerability that may lead those with higher perceived financial strain to experience psychological distress.

The research dossier contains a literature review and two research reports. The literature review provides an overview of the development of Equine Assisted Psychotherapy (EAP) and explores the research literature to date. This is followed by two qualitative research reports. The first is an exploration of clients’ experiences of Equine Assisted Psychotherapy. The second investigates how practitioners experience offering Equine Assisted Psychotherapy.

Objective: Previous research suggests that female partners have a key role in encouraging men to seek help from a mental health professional. Men are most likely to talk to a female partner if either are concerned for the men’s mental health. This study investigated the communications female partners use to successfully encourage their male partners to seek help for a mental health problem. Participants/Design: Fifteen women aged 28 to 71 years (M = 38) participated in a 30-50 minute semi-structured interview about their experiences of discussing mental health with their partners. The interviews reached saturation, and were analysed using Thematic Analysis to identify processes used by participants. Results: Five main themes were identified, which took the form of stages in help-seeking. Initially women took “Role Adaption”, and changed their behaviours and roles to reduce the stress on their male partners. Second, the women made “attempts to activate engagement” by having conversations about mental health and the benefits of help-seeking with their male partners, however the men did not always engage in this conversation. Third, men responded with “men’s management”, where they considered their coping mechanisms, managed stigma and thought about the cause of their mental health issues. In the fourth stage, the majority of couples entered “resolution” where they had two-way conversations which resulted in the men either seeking help, carrying on without change or considering and attempting suicide. The fifth theme captured the “dynamics of control” where the women usually assumed responsibility for the man’s safety, but would offer him control to help-seek. Conclusions: Female partners have a key role in supporting men to seek help from a professional and in maintaining their safety. Women strive to make this communication adaptive and useful, and these strategies could be utilised by others to encourage men to seek help from professionals.

This qualitative study explored seven adults’ experiences of recovery from an episode of psychosis, with a particular focus on the self-identified factors they believed had supported, and impeded, their recovery. Thematic Analysis was used to analyse the data. This resulted in a thematic map consisting of three superordinate themes: ‘Getting through psychosis’, ‘Barriers that got in the way’ and ‘Life after psychosis’; each with a cluster of subordinate themes. The narratives of the participants demonstrated a complex relationship between subordinate themes such as perseverance and self-belief, positive experiences of being helped, the timing of recovery, support from others, and stigma. Analysis also highlighted the strength of character and courage of individuals who experience psychosis, and reinforced the need to foster personal resources, and service users’ awareness of these resources. The results showed the need for clinical policy and interventions to continue to be informed by service user perspectives, because analysis highlighted some valuable insights into how services are experienced. Of note was the impact of the communication style, personal qualities and timing of clinical interventions upon positive or negative experiences of recovery.

Objective: Mental contamination is a term used to describe a psychological state in which one feels a sense of contamination or dirtiness in response to cognitive processes such as intrusive thoughts or memories. This gives rise to negative emotions and an urge to wash. Research has begun to identify predictors that might explain individual differences in sensitivity to feelings of mental contamination. The current study aimed to add to this evidence base, exploring perfectionism, tendency to the cognitive bias moral thought-action fusion and shame-proneness as possible predictors. Design: An online survey was designed to assess whether individual differences in these factors were associated with sensitivity to mental contamination. The survey measured the above variables, and included an induction task which asked participants to recall a time they committed a moral transgression toward another person. Feelings of mental contamination (anxiety, sense of internal and external dirtiness and urge to wash) were measured before and after the induction, with changes indicative of sensitivity to mental contamination. Participants: Participants (N = 131; 71.8% female) were recruited from the general public via social media advertisement and snowball sampling. Results: Shame-proneness and subscales of perfectionism (high standards and discrepancy) were found to correlate positively with indices of mental contamination (anxiety and feelings of internal and external dirtiness). Shame-proneness emerged as a significant predictor of these indices. Furthermore, the relationship between shame-proneness and mental contamination indices was found to be moderated by duration spent thinking about the moral transgression. Conclusions: Results of this study point to the potential importance of targeting shame-proneness and rumination in the treatment of mental contamination based difficulties. Participants varied in their response to the induction procedure which may point to the importance of idiosyncratic induction procedures in future research.

This is a portfolio of research work completed during my three years of training on the PsychD in Psychotherapeutic and Counselling Psychology at the University of Surrey. It comprises a literature review and two research reports. The literature review explores some of the conceptual and empirical links between mindfulness and attachment. The first research report is a qualitative enquiry into how therapists and clients experience joint mindfulness practice within therapy sessions, and identifies themes and superordinate themes relating to this experience. The second research report employs a qualitative methodology to understand how therapists bring mindfulness to the therapeutic relationship, and presents a theory of the processes through which this is achieved.

Objectives: Mental contamination is the psychological sense of dirtiness that arises in the absence of physical contact with a perceived contaminant. Research suggests mental contamination can be evoked through recalling or imagining perpetrating a moral transgression. This study experimentally evoked mental contamination by asking men to imagine perpetrating a moral transgression. It explored whether reducing one's sense of personal responsibility for the transgression moderated the mental contamination effect. Method: Male students (N=60) imagined perpetrating either a consensual or non-consensual kiss. Personal responsibility for the act was manipulated in one of two non-consensual kiss conditions through the provision of social influence information. Feelings of mental contamination were assessed by self-report and through a behavioural index (choice of a free gift) of mental contamination. Results: Mental contamination was successfully induced in the two non-consensual kiss conditions. Results provide some evidence to support the hypothesis that reducing personal responsibility would moderate the mental contamination effect in imagined perpetrators of a forced non-consensual kiss. However, findings suggest that there was no significant difference between non-consensual conditions when mental contamination was assessed behaviourally through choice of free gift. Overall, more men who imagined perpetrating a moral transgression (irrespective of personal responsibility), chose a cleanse based free gift compared to men who imagined having a consensual kiss. Conclusion: It is possible to experimentally induce mental contamination in a non-clinical sample. The study shows some evidence that personal responsibility may moderate the mental contamination effect. Implications for research, theory and practice are discussed.

Mental contamination refers to the feeling of being contaminated in the absence of physical contact and can be triggered by immoral behaviour. Differences have been found between victims and perpetrators of immoral behaviour in how much mental contamination they experience. This study aimed to investigate this variability by assessing whether feelings of responsibility could explain the differences found between groups. An online experimental paradigm was conducted where participants (N=121) were asked to recall an autobiographical memory of being either a victim or a perpetrator of immoral behaviour. Mental contamination was measured through participants’ ratings of negative emotions pre and post manipulation. It was found that responsibility was related to mental contamination through ratings of disgust and contamination, but there was no effect of responsibility on group differences when a between groups ANCOVA was conducted. A between groups ANOVA found that victims reported more mental contamination through ratings of anger and the behavioural measure (intention to neutralise). Conversely, perpetrators reported more shame and guilt than victims. These differences suggest that experience of mental contamination is different between groups, with victims having an external negative response and perpetrators reporting more internal negative emotions. These findings are discussed along with potential implications.

Background and objectives: Mental contamination (MC) refers to feelings of internal dirtiness that can arise without direct physical contact with a contaminant. MC is also associated with a variety of negative emotions including disgust, fear, anger, shame, guilt and revulsion. Previous research has shown that MC can be evoked by recalling an autobiographical memory of being the victim of a moral transgression. This study sought to extend these findings to explore further the MC reaction using autobiographical memories. In addition, previous research has found that washing related tasks are ineffective in reducing feelings of MC. This study explored whether brief writing interventions could help to reduce the MC reaction. Method: The current study used a non-clinical adult sample and induced MC through asking participants to recall a time they were the victim of a moral transgression (N=93). Participants were then randomised into three groups to complete a writing task (N=74). The writing tasks included: writing about a normal day (control), a self-compassion writing task and a self-esteem writing task. The study examined first whether MC would be induced, and second whether writing tasks were effective in reducing MC. Results: The autobiographical victim memory recall task induced feelings of MC (feelings of internal dirtiness, anxiety, shame, guilt, fear, sadness and humiliation). The largest effect sizes were seen for humiliation, shame and sadness. Feelings of MC significantly reduced after the writing tasks in the whole sample; no writing task intervention showed a superior effect. Conclusions: MC reactions can be induced by the memory of being victim of ‘everyday’ transgressions. The main impact of these is on humiliation, shame and sadness. The current study supports other literature suggesting that the MC reaction decays in the absence of active interventions. However, future studies are required with larger sample sizes and examining other interventions. Abbreviations: MC=Mental Contamination, MP=Mental Pollution, INE=Internal negative emotions (such as shame and guilt), ENE=External negative emotions (such as anger and anxiety).

The purpose of this study is to explore the relationship between self-esteem, narcissism, psychopathy and aggression to aid our understanding of personality factors that precipitate aggression. Further research into factors associated with aggression is urgently required due to the huge economic and personal costs of this behaviour. This is the first time these relationships have been explored in a unique and hard to treat population who are at high risk of harming others. Fifty inpatients of a high secure psychiatric hospital completed self-report measures of personality traits and completed a computerised task measuring implicit self-esteem. Information regarding previous and institutional aggression was obtained from patients’ medical files. Self-esteem fragility did not predict high levels of physically aggressive behaviour. However the findings suggest that narcissism and explicit self-esteem may play a role in institutional aggression. A profile of high explicit and high implicit self-esteem was found for Factor 1 psychopathy, and high explicit self-esteem was associated with adaptive narcissism. These findings suggest that narcissism and psychopathy have different self-esteem profiles. Alternative measures of implicit self-esteem in high secure populations are required to further test hypotheses relating to self-esteem fragility and aggression.

This portfolio comprises a culmination of research work spanning three years of full-time training on the Practitioner Doctorate course in Psychotherapeutic and Counselling Psychology (PsychD) at the University of Surrey. My research comprises three research reports: a literature review, and two qualitative studies. The literature review explored how the phenomenon of uncertainty translates to the field of counselling psychology, specifically the identity of counselling psychologists and its application within therapeutic practice. The first empirical study used Interpretative Phenomenological Analysis to analyse counselling psychologists’ experiences of uncertainty in therapeutic practice. The analysis revealed four major themes: ‘The Ethereal Nature of Uncertainty in Life’ ii) ‘Uncertainty is Core to Therapeutic Practice’ iii) ‘A Process of Negotiation: Engaging with the Tensions’ iv) ‘Facilitating the Art of Improvisation: A Dance between Being-With and Doing-To’. The second empirical study used Constructivist Grounded Theory to analyse the actions, processes and implicit subjective meanings implicated in how practitioners engage with uncertainty in therapeutic practice. Analysis revealed three interrelated core-categories: ‘Expressing an Attitude’, ‘Cultivating Different Ways of Being’, and ‘Engaging in a Constantly Unfolding Process of Negotiation’. Clinical implications for both empirical studies are discussed in light of their findings.

Purpose: To gain a better understanding of clinical psychologists’ experiences of embedding team formulation meetings in multidisciplinary (MDT) settings and make recommendations for how best to conduct this work. Design: Thematic analysis of semi-structured interviews with 11 clinical psychologists working in NHS adult mental health settings including community mental health teams (7), rehabilitation and recovery units (2) and outreach and recovery teams (2). One participant worked in a privately owned rehab and recovery unit. Findings: Two main themes were identified ‘Implementing team formulation can be challenging’ and ‘Team formulation creates space to broaden thinking’. Participants reported difficulties embedding team formulation in services and developing it as a shared practice, and made suggestions for how to overcome these. Facilitating was a complex task, which required training and supervision. The value of team formulation to teams included creating space to reflect and discuss different perspectives, as well as increasing the role of psychosocial perspectives within teams. These were thought to increase understanding and empathy, as well as spread psychological knowledge and improve care. Research limitations: Themes were based on a small sample and may not apply to other settings. Participants were self-selected and the author had an interest in this topic, which may have impacted on results. Practical implications: A number of recommendations were highlighted, many of which reinforce suggestions from theoretical literature and practice examples, as well as providing further points to consider. Value: Recommendations are offered based on clinical psychologists’ experiences of implementing team formulation meetings.

Objective: Existing research suggests that men are less likely to be diagnosed with common mental illnesses, but are more likely to drink to hazardous levels and attempt and complete suicide, suggesting that mental illness is prevalent among men, but how they express their distress can be externalised. The need to attend to men’s help-seeking behaviour has been recognised and is extensively researched; but, the role of the medical system in supporting this access is less researched. However, the role of General Practitioners (GPs) in supporting men’s access is recognised. This study explored how GPs encourage their patients to disclose symptoms of psychological distress, and how they make decisions regarding treatment. The results with a specific focus on men were highlighted. Design: A qualitative inductive Thematic Analysis was undertaken to identify themes emerging from the data. Method: Nine GPs (mean age = 35) were recruited. Data was collected using semi-structured interviews about their consultations with patients presenting with psychological distress. Results: Three themes emerged; 1) “Facilitating Techniques” which captured factors assisting consultations, encompassing five subthemes; Interpersonal Skills, Masking and Unmasking, Specific methods used to Gather Information, Mental Health Awareness and Organisational Influences; 2) “Recognition of the Patient’s Treatment Preferences”, which captured how GPs are guided by their patient’s preferences, men’s preference of medication, and the immediate availability of medication; and 3) “Cultural Prism”, which captured cultural factors through which help-seeking is governed from the GPs’ perspectives. Conclusions: This research has improved the understanding of how GPs elicit men’s disclosure of psychological distress, and their decision-making processes about treatment. It also highlights the benefits of inviting men to attend regular health checks, which has important implications in reducing some of the barriers of help-seeking in men. However, the clinical implications and conclusions are drawn tentatively given the perceived limitations of the study.

This portfolio represents the completed works towards the fulfilment of the Practioner Doctorate in Counselling and Psychotherapeutic Psychology (PsychD). The research dossier includes three research reports: a literature review, and two qualitative studies: one interpretative phenomenological analysis (IPA) and one critical discourse analysis (CDA). The literature review explored the use of dialectical behavioural therapy and mentalization-based treatment within inpatient settings for individuals given the label of Borderline Personality Disorder (BPD). The first empirical study, which utilised an IPA methodology, analysed the experience of mentalization-based treatment for individuals given the diagnosis of BPD. The second empirical study, which employed a CDA methodology, analysed how individuals who identified with the label BPD constructed the label of BPD on Twitter.

Objective : The primary aim of this study is to investigate the prevalence of anxiety, depression and PTSD disorders for people with cardiac devices, and compare differences between patients with pacemakers and ICDs. The secondary aim is to understand other factors involved in illness-related distress following device implantation including appearance related concerns and illness perception. Finally, the study will explore whether anxiety, depression, appearance related distress, symptoms of PTSD and illness representations have a relationship with one another. Design: A cross sectional questionnaire design compared differences between people with ICDs and pacemakers. Participants: Sixty nine patients with ICDs and 71 with pacemakers were recruited from an outpatient clinic (total n=140). Results: For both groups, measures for anxiety, depression and PTSD were within the normal range. No differences were found between people with pacemakers and ICDs foranxiety or depression. However, for both groups, elevated anxiety or depression was associated with higher appearance dissatisfaction, ICD patients having significantly more concerns with the appearance of their device. People with ICDs experienced significantly more symptoms of PTSD. In terms of illness concern, people with ICDs had a significantly higher overall illness threat, consequences, concern and emotional representation compared to those with pacemakers. Conclusions: The study showed that on the whole people adjusted well to having a device and scores for anxiety, depression and PTSD were within the normal range for both groups. A small proportion of people did experience anxiety and depression which was associated with other areas of psychological distress, including PTSD symptoms, appearance concerns and illness perceptions. Patients who do experience distress in these groups may require psychological treatment and support.

Background. Research has shown spontaneous imagery to be a common form of cognition in a chronic pain population. Imagery rescripting was found to be an easy and effective intervention in improving the pain experience, but similar to the immediate effects of distraction. The current study aimed to test the effects of imagery rescripting against an imagery distraction task through an online questionnaire. Method. Adults (n=126) were recruited through Internet pain support forums. An experimental design compared the immediate effects of intervention (imagery rescripting) vs. control (imagining a dream house) using Visual Analogue Scales of pain intensity, distress, physical threat and emotional threat (pain experience variables). A 4-6 week follow-up questionnaire used a repeated measures design to compare changes against baseline for pain experience variables and a measure of fear-avoidance beliefs. 106 participants met criteria for statistical analysis. Results. Both imagery rescripting and imagery distraction resulted in immediate and statistically significant improvements across all pain experience variables, to a clinically significant level. Further significant reductions were observed at follow up in fear-avoidance beliefs and levels of pain, distress and emotional threat (n=40). Conclusions. Imagery techniques are an effective way to improve the experience of chronic pain in the short term. The reductions observed at follow-up were small and may not have been due to the effects of imagery rescripting, as some participants also performed the imagery-distraction task. However, wider theoretical considerations point towards imagery rescripting as a useful therapeutic tool in chronic pain management.

Previous research has shown low rates of seeking professional help for mental distress in the UK. Explanatory Model (EM) theory (Kleinman, 1977) can be used to understand this. The media influences EMs in the general population, while at the same time it is likely that EMs presented in the media reflect those held by the general population. Thematic analysis of 10 UK newspapers was undertaken. Eight types of portrayal of mental distress and help-seeking were distinguished as themes. EMs presented were relatively crude reflections of medical models; except for one theme which used more holistic EMs. Female journalists appeared to be writing about distress in a more sympathetic way than their male counterparts. Of concern was the stigmatising content of several themes. Areas for possible future research and intervention are discussed.

Phenomenological similarities between spiritual crisis and psychosis have proved problematic for clinicians. Difficulties in discerning between the two are particularly challenging as is knowing how and when to intervene. Research has suggested these experiences hold potential for growth and transformation and has recommended that Early Intervention for Psychosis (EIP) clinicians facilitate these conversations with clients. Little has been published about how EIP clinicians might respond to a client presenting with a spiritual crisis and how this might be understood from a team or individual perspective, which this study aimed to address. Twenty-seven clinicians from four EIP teams were recruited using a purposive sampling strategy. Focus groups were conducted with each team using a vignette of a possible spiritual crisis to stimulate discussion. Thematic analysis was used to analyse data, which produced four main themes: 'Tentative exploration of client belief system', 'Discerning the spiritual and/or psychotic nature of the experience', 'Managing limited resources' and 'Religion as taboo'. Results suggest that clinicians struggle to meet competing demands from the client, team, profession and society. Although they attempt to categorise the experience, some spoke of tolerating ambiguity and holding a not-knowing position. Discussing spirituality and drawing on their own beliefs was discussed as something potentially helpful and potentially damaging. Fear of reprisals in terms of serious case reviews was particularly salient and often formed a barrier to engaging with spirituality. Lack of training and clear guidelines regarding how to ethically and appropriately engage with spirituality was discussed. Provision of training and formal guidance is recommended. Once clinicians feel more comfortable with this, suggestions from other research about reframing the experience as transformative with potential for growth can be evaluated empirically. However, implementation is unlikely to succeed currently given clinicians reservations about engaging with spirituality.

This portfolio was submitted to The University of Surrey for the completion of the Practitioner Doctorate (PsychD) in Psychotherapeutic and Counselling Psychology. It aims to demonstrate my personal and professional development throughout my four years of training. It comprises three dossiers which reflect the academic, clinical and research work undertaken as part of this degree. The academic dossier contains three essays written on topics of personal interest against the backdrop of theoretical subjects and philosophical contexts that were covered during my training. The first essay deals with the high rate of suicidality amongst individuals with bipolar disorder and considers psychodynamic theories on suicide and on manic-depressive disorder in the search for answers. The second essay looks at the role of the therapeutic relationship in cognitive-behavioural therapy using the example of the treatment of borderline personality disorder through Young’s Schema Therapy. The third and final essay explores the individual dimensions of clinical presentations and, using the example of shame, highlights the necessity to engage with the underlying personal meaning of any expression of human distress. The therapeutic practice dossier introduces the three placements I attended during my training and gives an overview of the kind of work I conducted there. It concludes with my Final Clinical Paper ‘Early Days’ which gives an account of my personal and professional development over the course of my training and of how I engaged with the different therapeutic modalities. Finally, the research dossier contains a literature review and two pieces of qualitative research all concerned with the experience of suicidality in the context of bipolar disorder (BD). The literature review undertaken in the first year highlighted that BD has largely been studied from a positivistic perspective leading to a simplistic view of the condition and a lack of understanding of the idiosyncratic meaning of suicidality. The first study investigates individuals’ experience of their own suicidality. It appeared that participants were experiencing a gradual loss of identity which led to an erosion of their sense of self and ultimately to the experience of suicidal feelings. The second study is a complementary project to the first one and investigated practitioners’ perspective of the nature of bipolar suicidality. The role of empathy and openness to clients’ idiosyncrasies are emphasised throughout the whole of the research.

This portfolio constitutes the culmination of the Practitioner Doctorate in Psychotherapeutic and Counselling Psychology at the University of Surrey and consists of three dossiers containing a selection of work pertaining to the training. The three dossiers relate to academic, therapeutic practice and research engagement respectively, each reflective of particular areas of interest as well as skills and competencies gained, offering, I hope, an overall sense of my professional and personal development throughout the course. The academic dossier contains three essays. The first essay examines the way in which psychoanalysis may inform therapeutic practice with clients who display narcissistic tendencies, with particular attention paid towards enlisting techniques aimed to facilitate exposure and integration of the ‘real’ self. The second essay explores the presence of client resistance and / or ambivalence within therapy, from the perspective of cognitive behavioural therapy, and focuses on bridging gaps identified within the model that limit effective response to this therapeutic barrier. The third essay examines the way in which attachment theory offers a useful rich framework from which to better understand and therapeutically work with individuals suffering from symptoms of depression. The therapeutic dossier contains a description of clinical placements undertaken throughout the course. A reflective account of my development as a counselling psychologist is also included, summarised within the final clinical paper. The research dossier comprises three pieces of research, namely a literature review and two empirical studies, and also contains copies of a published journal article and conference paper. The research focuses on women and men in leadership roles, examining the way in which the social construction of gender and leadership, governing expectations pertaining to the attributes and behaviours of men, women and leaders, may influence firstly, the behaviour of current and aspiring leaders, secondly, the recruitment of leaders, and thirdly, the framework from which policy aimed at promoting diverse leadership is addressed. The literature review examines and identifies gaps within extant research pertaining to these points. Employing a constructivist version of grounded theory, the first empirical study explores the concept of leadership from the perspective of female leaders. The second empirical study utilises interpretative phenomenological analysis to examine the concept of leadership from the perspective of male leaders. Both empirical studies seek to gain a sense of the lived experience of leaders and, in so doing, identify the usefulness and/or problematic nature of the prevailing view of leadership.

IPT was originally derived from what were considered to be appropriate clinical techniques, in order to mimic ‘good supportive therapy’ in clinical trials. IPT was not developed from a theoretical model and consequently it does not have a specific theoretical foundation for practitioners to draw on. Existing IPT research has focused on outcomes, but little is known about how or why IPT works. Literature pertaining to the epistemology of professional knowledge suggests that professionals make use of espoused and implicit theories to guide their work. Those wishing to train in IPT are required to have completed training in a relevant field and therefore may approach IPT with an existing repertoire of theories. This study aimed to explore how IPT practitioners account for theory and evidence in their practice. Interviews were conducted with eight IPT practitioners, and analysed using interpretative phenomenological analysis (IPA). The practitioners made use of a repertoire of implicit and espoused theories, applied during practice and retrospectively. The way practitioners drew on theory and evidence was influenced by their professional context, perceived level of experience, and their individual experiences and values. This study highlights differences in the way practitioners currently make sense of IPT, and the potential implications of appending theory in a post-hoc fashion. Future research might focus specifically on examining the range of espoused and implicit theories IPT practitioners employ, and their implications for practice.

Paranoia is thought to exist on a continuum with 10-15% of the general population experiencing high levels (e.g. Freeman, 2007). Many different cognitive and affective factors have been linked to the experience of paranoia. These include theory of mind, jumping to conclusions bias, attributional bias, self-esteem, low mood, anxiety and social anxiety. However, there is mixed evidence that each of these factors is related to paranoia. One potential reason for this is that few studies have looked at the inter-relationships between these factors. Some studies have investigated the role of several factors together but most of this research has been done in the clinical population which makes it difficult to isolate paranoia from other clinical symptoms which may have a confounding effect on the findings. The aim of this study was to contribute to the current understanding of paranoia by determining which factors are uniquely related to the experience of paranoia and the direct and indirect relationships between these factors and paranoia. 151 participants aged between 18 and 70 completed an online survey consisting of measures of paranoia, cognitive and affective theory of mind, attributional bias, jumping to conclusions bias, self-esteem, low mood, generalised anxiety and social anxiety. Cognitive theory of mind, social anxiety and generalised anxiety were found to predict paranoia. Furthermore, mediation analysis indicated indirect relationships between self-esteem and paranoia, and externalising bias and paranoia, through social anxiety. The findings build upon previous studies in the clinical population and suggest that social anxiety plays a key role in the experience of paranoia.

For people experiencing psychosis, namely schizophrenia, contact with family members may provide valuable support throughout the course of illness. Some family environments, specifically those displaying high levels of expressed emotion, may have a detrimental effect on the recovery of an individual with schizophrenia. Evidence for the effectiveness of working with these families is mixed and the nature of how expressed emotion develops and is maintained is complex. In the present paper, recent clinical and theoretical research in this area is reviewed and the main themes and ambiguities discussed.

This portfolio contains work which was submitted as part of the Practitioner Doctorate (PsychD) in Psychotherapeutic and Counselling Psychology at the University of Surrey. It consists of three dossiers which reflect the academic, clinical and research work undertaken as part of this degree. The academic dossier contains three essays. The first essay explores a Winnicottian perspective on how depression can be conceptualised and worked with therapeutically. The second essay examines the variation within the CBT tradition with respect to how emotion is attended to and worked with in clinical practice. With specific reference to depression, the third essay explores the possibility of a second-wave CBT approach to practice that would be more compatible with the principles of counselling psychology than the standard CBT treatments which have adopted the medical model of distress. The therapeutic practice dossier gives an overview of my clinical practice during my training. This dossier contains descriptions of the clinical placements I have undertaken, and also includes my final clinical paper which provides a reflective account of my journey toward becoming a counselling psychologist. Finally, the research dossier contains a literature review and two empirical research studies. The review explores the historical context of contemporary theory of emotion within psychotherapy, by examining the theories of emotion within influential philosophical works from the history of Western thought. The first empirical piece is a Foucauldian discourse analysis of how emotion is constructed in contemporary CBT self-help literature. The second empirical piece is a conversation analysis of the recordings of therapy sessions conducted by A. T. Beck, seeking to illuminate how emotion is dealt with in the practice of Beckian cognitive therapy.

This portfolio encompasses a compilation of work that I submitted as part of my Doctorate in Psychotherapeutic and Counselling psychology. It is divided into three dossiers which, combined, demonstrate my varied interests, learning and understanding, and my personal and professional development as a counselling psychologist. The academic dossier contains a selection of three essays. The first explores the dangers of unconscious countertransference associated with play therapy. The second discusses whether we, as counselling psychologists, can incorporate our understanding and use of the therapeutic relationship when working with clients within a Cognitive-behavioural (CBT) framework. The third discusses the cognitive approach to working with psychosis. My therapeutic dossier includes a description of my four placements through my training as well as my final clinical paper; this portrays my journey from the naive young girl I was when I started this course, through my personal and professional development, to the counselling psychologist I have become. Finally, my research dossier comprises my literature review and two empirical research pieces. My literature review explored the effect of parental styles and parental control on adolescents’ relationship with food, alcohol and drugs; drawing from the findings of this review combined with my personal interests, research questions were established for my research. My first empirical piece is a baseline study looking at the influence of parental control, modelling and adolescent autonomy on adolescents’ diet and eating behaviour while they live at home. My second empirical piece is a longitudinal study looking at the influence of parental control, modelling and adolescent autonomy on adolescents’ diet and eating behaviour after they left home.

Borderline personality disorder (BPD) is considered to be a debilitating psychiatric condition, characterised by a cluster of symptoms and behaviours including bursts of outrage, an intolerance of being alone, persistent fear of abandonment, volatile interpersonal relationships and lack of a sense of self. Attachment theory has provided an influential framework for studying development, relationships, personality and psychopathology. There is a wealth of literature emphasising the significance of childhood experiences in the aetiology of BPD. The following literature review investigates the extent to which attachment theory and research may explain the development of BPD. Following a brief overview of Bowlby’s theory of attachment, I discuss research which suggests that the symptoms and behaviours of BPD manifest from childhood patterns of interaction with primary caregivers. I believe that while attachment appears to be the overarching mechanism underpinning the development of BPD, a complex interplay of biological, psychological and social influences play a role too. I end the review by discussing some of the broader implications for clinical practice focusing on the therapeutic relationship, the impact of stigma and service development.

Introduction: Compelling worldwide research shows a threefold risk of psychosis in people who migrate (Cantor-Graae & Selten, 2005) without increased psychosis in their homeland (Jablensky et al., 1992). The even greater risk of psychosis in the second-generation indicates that social factors inherent in being a minority contribute. Despite the evidence that gender is a determinant of the course and outcome of psychosis, no review has focused on the interaction between gender and social risk factors. Method: Papers from PsyclNFO were searched first relating to migrants with psychosis and then to gender. Results: Overall, the increased incidence of psychosis in males worldwide is also evident in migrants. However, in certain groups, women have a greater risk than men (Schrier et al. , 2001) with no clear explanations for these findings. Few studies analyze gender separately or examine the interaction between gender and social risk factors in psychosis: discrimination, neighbourhood ethnic density, socioeconomic status and anti-social behaviour all appeared to have a larger impact on men. Discussion: The social risk factors and their differential impact on men and women are discussed. This literature is then linked with the cognitive models of psychosis and implications for clinical effectiveness, training and further research are suggested.

This portfolio contains work which was submitted as part of the practitioner Doctorate (PsychD) in psychotherapeutic and counselling psychology at the University of Surrey. It comprises of three dossiers which reflect the three aspects of the training course; academic, therapeutic and research works. The academic dossier contains two essays. The first an essay focusing on how the understanding of attachment experiences is important to the practice of psychodynamic psychotherapy, and counselling psychology. The second essay presents the implications of homework assignments for the process and therapeutic relationship within a cognitive behavioural framework. The therapeutic dossier reflects years two and three of the training course and contains brief placement descriptions of my psychodynamic and cognitive behavioural clinical placements. The dossier also contains a final clinical paper which includes reflections of my personal and professional training in counselling psychology across a period of six years. The research dossier contains three pieces of work completed over the last three years of training. The first a literature review which explores the psychological impact of hair loss on self image and identity in women who have experienced chemotherapy treatment for breast cancer. It offers a discussion on how psychotherapeutic interventions which leave out the body and touch could be incorporated with touch therapies namely massage to provide a more holistic intervention for individuals with this chronic illness which may implicate the body. The second is a research project exploring women’s experiences of hair loss as a result of treatment for breast cancer and their use of mind and body interventions. This was a qualitative project using Interpretative phenomenological analysis. The third piece of work is also a qualitative research project focusing on how psychotherapists of varying orientations and who have chronic health condition manage their own health status when working psychotherapeutically with clients.

This is a portfolio of academic, therapeutic practice and research work. The portfolio consists of three dossiers that demonstrate my personal and professional development during my three years of training. The academic dossier contains three selected essays that were compiled through the course of my studies. The first essay explores the concept of resistance within psychodynamic theory and practice. This essay describes the expressions and functions of resistance, highlighting how client and therapist resistance shapes the therapeutic relationship. The second essay draws on Cognitive Behavioural Therapy (CBT) theory and practice. This essay attempts to highlight the complexity, challenges and benefits of using CBT with older adults. In particular, this essay examines how CBT influences the therapeutic relationship when working with this specific client group. The third essay considers how a person-centred approach understands and conceptualises human distress, whilst critiquing the use of classification systems such as the DSM-IV-TR and the ICD-10. This essay also illustrates how a person-centred practitioner would engage therapeutically with a client presenting with obsessive compulsive personality disorder traits. The therapeutic practice dossier focuses on my clinical experience. It contains a description of my three clinical placements and includes my ‘Final Clinical Paper’. This paper provides a personal account of my journey towards becoming a counselling psychologist, explaining how theory and practice have shaped the practitioner and individual that I am today. Finally, the research dossier is comprised of a literature review and two qualitative research reports. The literature review addresses the psychodynamic phenomenon of countertransference within the supervisory relationship and discusses how supervisee and supervisor styles of relating colour the supervisory relationship. The first research report is an Interpretative Phenomenological Analysis (IPA) that examines how psychodynamic supervisors experience countertransference in supervision. The second research report uses Thematic Analysis (TA) to explore how trainee practitioners experience the psychodynamic supervisory relationship.

This is a portfolio containing academic, therapeutic practice and research dossiers in part fulfilment of a PsychD qualification in psychotherapeutic and counselling psychology. The academic dossier contains three papers. The first examines abuse, use, and misuse of power in the therapeutic relationship. The second examines whether collaboration in cognitive behavioural therapy is better considered in the light or in the shadow of power dynamics. The third examines the concept of narcissism and how counselling psychologists might work with narcissistic distress. The therapeutic practice dossier contains descriptions of three clinical training placements and a final clinical paper providing a richer account of my evolving identity and therapeutic approach as a counselling psychologist. The research dossier contains three pieces of research relating to the concept of retirement. The first is a review of the retirement literature, critiqued from an existential perspective, and includes an existential perspective on retirement counselling based around four themes: temporality, freedom, meaning and isolation. The second is a qualitative study examining older people’s experiences of existential therapy in their transition into retirement. Six retirees were interviewed and transcripts were analysed using interpretative phenomenological analysis. Participants identified therapy as helping with choice and decision-making around their future lives in retirement, and identifying with their therapist on a deeply personal level as particularly influential in their therapeutic experience. The third is a qualitative study examining the experiences of five people from the babyboom generation transitioning to encore careers. Participants were interviewed and transcripts were analysed using narrative analysis. Three narrative forms were identified and termed: an adventure, a calling and a reclaiming of identity. Three commonalities across the five accounts were identified and termed: pioneering, giving back, and continuity through similarity.

Currently there is no suitable measure to assess the frequency of childhood rigid behaviours. Furthermore, there is a paucity of research surrounding factors that may affect the frequency of these behaviours. The first aim of this study was therefore to create a psychometrically-sound, parent-defined measure of common childhood rigid behaviour and also to find out parental responses to these behaviours. A parent-defined measure was created and distributed to 110 parents of children aged between four and six years. This led to the development of a final 20-item measure of child rigid behaviour which was shown to have good psychometrics. The second aim of the study was to correlate frequency of rigid behaviour with other measures relating to child anxiety, parental magical ideation, parental obsessive compulsiveness and parental style. The results indicated that frequency of child rigid behaviours significantly correlated with child anxiety as well as parental obsessive compulsiveness and an Authoritarian parental style. No correlation was found between rigid behaviour and parental magical ideation. In conclusion, the study produced a new tool that assesses the frequency of child rigid behaviours in a non clinical sample. The study found that child anxiety is associated with a child’s frequency of rigid behaviour and external parental factors are also additionally associated with child rigidity.

Objectives. Little is known about how Acceptance and Commitment Therapy (ACT) facilitates change and this study aimed to establish clients’ perspectives of the mechanisms of change in ACT for anxiety and depression. Method. Semi-structured interviews were conducted with eight clients. They had attended an eight-session ACT therapy group at a Community Mental Health Team (CMHT). All had diagnoses of enduring anxiety and/or depression. The interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Results. Analysis identified three master themes: ‘Processes of Change in ACT’, ‘Aids and Hindrances to Change in ACT’ and ‘Non-Specifics of Therapy’. Hypotheses about the possible interactions between the themes were considered (e.g. some of the moderating factors identified in ‘Aids and Hindrances’ may need to be present in order to maximise the likelihood of the ‘Processes of Change in ACT’ occurring). Conclusions. This study highlights the complexity of the process of change and suggests specific (to the ACT model), moderating, and non-specific factors are responsible for facilitating change in ACT for anxiety and depression. The research was critiqued and implications for future practice and research were discussed.