Search

Centuries after it was first described, dissociation is one of the most poorly understood constructs in clinical psychology. Used interchangeably to signify either a symptom or an aetiological process, the term 'dissociation' has attracted multiple definitions incorporating a diverse range of experiences. The confusion conceptualising dissociation, as well as longstanding debates arising from significant theoretical and socio-historical challenges in the field, have contributed to the under-recognition of dissociative phenomena across clinical settings, and to difficulties researching the topic. As a result, the psychological mechanisms underpinning dissociation remain unknown. More precisely, to date, there are no cognitive models explaining the development or maintenance of dissociation that have been developed through extensive causal testing of proposed factors, and accordingly, there are no translational psychological treatments specifically targeting this construct. Furthermore, due to its importance in the field of trauma, dissociation has rarely been explored as a transdiagnostic experience in its own right, nor has there been full consideration of its influence across the spectrum of psychological distress. This omission may be particularly important in the field of psychosis, where there is increasing evidence that dissociation has robust links with positive psychotic symptoms, such as paranoia, delusions, and hallucinations. Dissociative experiences have even been implicated as a possible cause of such difficulties, as they create conditions ripe for uncertainty, misinterpretation, and distress. In the same way, dissociation has been suggested to sustain psychotic symptoms. Therefore, under-recognised in its own right, dissociation has until recently also been under-recognised in terms of its importance in psychosis, and is only now being explored as a potential novel treatment target. In order to overcome the legacy of decades of entrenched debates and confusion, new approaches to exploring dissociation are needed. Network analyses are based on network theory, which proposes that mental health problems can be understood in terms of patterns of activation between symptom 'nodes' connected in a network of conditional dependencies. Such analyses are gaining increasing popularity in mental health research and may be well-suited to providing fresh insights into dissociation as they allow the estimation and visualisation of inter-correlations between multiple variables at once. Some forms of network analysis may also benefit the field through the generation of novel testable hypotheses: directed acyclic graphs estimate the probable direction of effect between correlated variables using statistical probability and may therefore be particularly valuable in early-stage research. Aims The aims of this thesis are to clearly define the phenomenon of dissociation, demonstrate its importance in psychosis, and begin a scientifically robust interrogation of the construct which will inform the future development of a cognitive model. In order to achieve this, the first half of the thesis develops tools required for valid research from a cognitive perspective: a precise definition of the construct, and two self-report measures with which to assess dissociation and cognitive appraisals of dissociative experiences. In the second half of the thesis, state-of-the-art network analyses are used to locate dissociation within the wider context of mental health (including in relation to both common affective and psychotic experiences), and to begin determining the psychological factors underlying dissociation. Finally, key findings of the thesis are tested in the context of psychosis. Methods Data were collected from four participant cohorts: a small psychosis patient group (n=12, Chapter Two), two large online general population samples ('Mapping Dissociation in Mental Health': n > 8000, Chapters Three and Five; and 'Understanding Dissociative Experiences': n > 8000, Chapters Four and Six), and a large psychosis patient group ('Exploring Unusual Feelings', n=1038, Chapters Three, Four and Seven). Chapter Two uses a qualitative study of twelve NHS patients with psychosis diagnoses to better understand the lived experience, and hence describe the construct of, dissociation in psychosis. In Chapter Three, a systematic review of dissociative measures is carried out and triangulated with the results of Chapter Two in order to propose a novel theoretical framework which describes dissociation as it will be conceptualised for the purposes of this thesis. The theoretical framework is empirically tested via factor analysis of data from the Mapping Dissociation survey, generating a novel self-report measure of the new conceptualisation of dissociation. This measure is then validated using data from the clinical study Exploring Unusual Feelings. Chapter Four introduces a second psychometric tool: a measure of cognitive appraisals of dissociation developed with data from the Understanding Dissociative Experiences survey and validated using data from Exploring Unusual Feelings. Chapter Five explores the relationship of dissociation to other mental health presentations, including psychotic and affective symptoms. Data from Mapping Dissociation are modelled in two network analyses - a Gaussian graphical model and a Bayesian inference with directed acyclic graphs (DAGs) model. Chapter Six uses the same analytical methods to explore the relationships between dissociation and specific psychological factors in data from Understanding Dissociative Experiences. Psychological factors explored in this study include affect intolerance, perseverative thinking, anxiety sensitivity, alexithymia, and body vigilance. Finally, Chapter Seven tests the key findings from the previous two chapters in a large clinical patient sample (Exploring Unusual Feelings). Results Within the context of non-affective psychosis, dissociation is described by patients as having a negative impact on their relationships with other people, and on their existing mental health difficulties, mood, cognition, daily functioning, and sense of self (Chapter Two). As well as highlighting the significant difficulty inherent in describing their highly subjective nature, the results also reveal that a common denominator of participants' dissociative experiences is a felt sense of anomaly (FSA) where this is conceptualised as a subjective feeling of oddness or strangeness. Triangulation of these results with a systematic review carried out in Chapter Three leads to the proposition that FSA may take a number of 'forms' (e.g. unreality, unfamiliarity, detachment) and affect any of a range of 'domains' (e.g. perception of the external environment, experience of one's emotions). Empirically testing the proposed theoretical framework using factor analysis reveals seven key factors of FSA-dissociation: anomalous experiences of the self, body, and emotion, and altered senses of familiarity, connection, agency, and reality. The self-report scale developed in this chapter was found to be psychometrically robust in general population and clinical groups, and is therefore used as the primary measure of dissociation throughout the thesis. Chapter Four develops and validates a new measure of cognitive appraisals of dissociation and demonstrates its additional explanatory power above that of FSA-dissociation alone when predicting hallucinations and paranoia scores in a clinical group using regression analyses. These results, as well as the results of Chapter Five, support the hypothesis that dissociation has a causal influence on positive psychotic symptoms. In Chapter Five, network analyses find that dissociation is a probable cause of paranoia, grandiosity, and cognitive disorganisation. Dissociation is also found to have a robust relationship with hallucinations, but as with its relationship to depression and anxiety, the direction of influence is unclear. Network analyses in Chapter Six find direct relationships between dissociation and cognitive appraisals, safety behaviours, perseverative thinking, low general self-efficacy, and low alexithymia. Testing these candidates for potential maintenance mechanisms of FSA-dissociation in a clinical group (Chapter Seven) reveals direct relationships between dissociation and cognitive appraisals, safety behaviours, perseverative thinking, affect intolerance, and low alexithymia. The results of these network analyses also support the hypothesis that dissociation is related to lower wellbeing, and may cause psychotic symptoms: both paranoia and hallucinations had direct relationships with dissociation. Conclusions This thesis defines the construct of dissociation (as it is experienced in the context of non-affective psychosis) as having a core phenomenological experience of a felt sense of anomaly (FSA). Dissociative experiences of this kind are experienced as distressing, disruptive, and appear to be a probable cause of cognitive disorganisation, paranoia, and hallucinations. They may be experienced in relation to a range of 'domains' (e.g. one's body or emotions) and involve different 'types' of anomaly (such as unfamiliarity or detachment). Appraisals of such experiences typically include fears about social, biological, or psychological ill effects, as well as concerns about lack of control or agency. Such appraisals are important in the development and maintenance of dissociative experiences and may partially explain the effect of dissociation on psychotic symptoms.

This portfolio thesis consists of: a systematic literature review, an empirical paper and appendices. The thesis considers the influence of early psychosis on relationships within families. Part one is a systematic literature review exploring how family relationships are influenced by first episode psychosis (FEP). The review utilised the NICE quality checklist to evaluate research papers, determining the final included papers which were ultimately subjected to a narrative synthesis. Findings demonstrated the influence of psychosis and identified themes of progressive changes as well as the difficulties encountered within family relationships. Potential future research and clinical implications of findings are discussed. Part two is an empirical study of care coordinators' perceptions of family growth associated with a FEP. Eleven care-coordinators participated in semi-structured interviews and transcripts were analysed using social constructivist grounded theory. Findings described key aspects of growth and how it may be inhibited within some families. The findings are discussed thoroughly alongside previous literature and implications and avenues for future studies are described. Part three contains appendices that are relevant to both the systematic literature review and empirical paper. It includes a reflective statement of the process of completing the research and review, and an epistemological statement that describes the position of the researcher.

This portfolio thesis has three parts: a Systematic Literature Review followed by an empirical research study and finally, a set of appendices. This thesis explored the potential uses of wearable technology in the treatment of mental health difficulties and in the management of chronic pain. The systematic literature review explored recent mental health care research that utilised wearable technology. From this body of literature, three potential areas of use for wearable technology in mental health care were synthesised. Consideration is given to the clinical implications and limitations of the research. Potential areas of future research are also discussed. The empirical section describes a study aimed to investigate the utility of incorporating activity tracking technology into a pain management programme (PMP). This pilot study employed mixed methodology in order to investigate both whether being provided with an activity tracker is beneficial to individuals experiencing chronic pain. No significant improvements on outcome measures for various domains (including sleep, pain levels and mental wellbeing) were found for a group with trackers compared to a group without. However those in the tracker group provided positive feedback about benefits of the trackers. The implications for the findings of this study and avenues for future research are discussed. The appendices section contains a set of appendices for both the preceding sections. It also contains an epistemological statement and reflective statement in order to provide context about the researcher's experience of conducting the research and the philosophical position from which the design of the research was approached.

This portfolio comprises of three parts: Part One: A systematic literature review in which the literature relating to dyadic parental wellbeing during the post-adoptive period is reviewed. Ten studies were identified for inclusion following a systematic search of electronic databases. A narrative synthesis of findings discussed presentations, and protective and risk factors of post-adoptive parental wellbeing. Suggested clinical implications were also reviewed and conclusions were drawn in relation to the wider literature. Part Two: A qualitative empirical research study using thematic analysis to explore adoptive parents' experiences of attachment in the context of their child's underdeveloped sensory systems following early trauma. Nine participants completed semi-structured interviews and thematic analysis was used to analyse the data, from which two overarching themes and six sub-themes were generated. These themes were discussed in the context of previous literature and implications for clinical practice were made. Part Three: Appendices including all relevant documents relating to the systematic literature review and the empirical research study. A reflective statement on the process of completing the portfolio and an epistemological statement are also included.

Background Psychoanalytic approaches have decreased in use as a therapy in the UK. After an initial growth in Britain post World War One, the subsequent emphasis on using empirically supported treatments resulted in cognitive and behavioural approaches being prioritized. Neoliberalism and austerity measures have led to an emphasis on short-term, low cost treatments, and the further marginalization of psychoanalytic approaches. There is no research exploring its use within clinical psychology in the NHS, despite increased research supporting its utility and a policy emphasis on patient choice. Aims This research will aim to explore how clinical psychologists use the psychoanalytic approach within the NHS and their experience of the approach. Methods A mixed methods approach was used. A quantitative online survey of clinical psychologists working within the NHS in the UK (N=189) collected demographic data as well as information about modalities used and their services, clients and training characteristics. An interview was used to explore the experiences of clinical psychologists of using the psychoanalytic approach within the NHS. Results It was found that a higher percentage of participants (18%) used the psychoanalytic approach than expected from previous research. A greater majority used CBT and third wave approaches. Most participants using psychoanalytic approaches worked with adults with severe and enduring difficulties in secondary care settings. From the interviews, participants spoke about having little space and practical time to use psychoanalytic approaches within services. Participants spoke about how the approach was useful to provide space for clinicians and clients to reflect and build a therapeutic relationship. However, some participants expressed concern that it could be regarded as elitist and inaccessible to some client groups. There was debate about the future of psychoanalytic approaches within the NHS. Conclusions Some clinical psychologists use psychoanalytic approaches in practice and find it useful, although there are service barriers that constrain its use within the NHS that should be addressed. Strengths and limitations of the study are discussed and recommendations made for future research.

Background: The scientist-practitioner (S-P) model is in the heart of the identity of clinical and counselling psychology. The framework was developed to facilitate the integration between science and clinical practice, as well as competence in both. However, the research that has focused on the scientist-practitioner identity of qualified psychologists is minimal, since the S-P has been treated as a model of training. Objective: The purpose of this study was to explore how experienced clinical and counselling psychologists relate to the scientist-practitioner model in their career. This topic was narrowed down to professionals working with psychological trauma. This professional area was selected as a substantial amount of research has contributed to its evidence base and development of clinical guidelines, making discussions about the implementation of research more transparent in the research interviews. Method: A single method qualitative design was employed. Thematic Analysis was used to analyse the 14 research interviews of 7 counselling psychologists and 7 clinical psychologists. Participants had a minimum of 2 years of work experience post-qualification and a collective average of 4.9 years of employment as qualified psychologists. Findings: The findings were conceptualised as a spectrum of epistemological and professional identities through which five superordinate themes emerged: The Scientist, the Aspiring Scientist, the Artist-Scientist, the Aspiring Artist, and the Artist. The study findings suggest that all participants identified as S-Ps, but their interpretations of the model and what constitutes science varied. Qualitative characteristics were identified to describe each theme. Professional issues and socio-political barriers to fully actualising the S-P were identified and discussed. Discussion: Patterns of more similar responses were observed when the participants shared a work setting, such as academia. The findings of this study lead to the further conceptualisation of the data portraying a philosopher-practitioner, instead of a scientist-practitioner. The stance of a philosopher-practitioner would be better at acknowledging and addressing the individual differences. If the artist-scientist spectrum is thought of as a critical realist-naïve realist spectrum, then the ontological and epistemological positioning of the participants would probably reflect their current role, worldview, and activities, as well as their interpretation of science.

This portfolio thesis is comprised of three parts, a systematic literature review, an empirical report and supporting appendices. Part one is a systematic literature review which quantifies the relationship between self-compassion and burnout in a range of professionals. The review additionally aimed to analyse the moderating effect of age and gender on this relationship. A systematic search identified seventeen papers for inclusion and a meta-analysis determined an overall effect size for the relationship between self-compassion and burnout. Three random effect meta-regressions were also carried out to test moderating effects. A review of methodological quality is also provided. Findings are discussed within the context of implications for the field of research and for clinical practice, with consideration of areas for further research. Part two is an empirical report, which uses quantitative methodology to explore the role of self-compassion, compassion to others and compassion from others in predicting levels of well-being and burnout in teachers. The research also aimed to determine if the fear of receiving compassion from others had a moderating effect on the relationship between compassion from others, burnout and well-being. The findings of the study are also outlined and discussed in relation to relevant theory, implications in the context of future research and interventions aimed at reducing burnout and increasing well-being in teachers and in educational settings. Part three consists of appendices relating to the systematic literature review and the empirical report. It additionally includes epistemological and reflective statements.

This portfolio thesis comprises of three parts: a systematic literature review, an empirical paper, and the corresponding appendices. Part one consists of a systematic literature review tasked with examining the evidence for the use of peer support groups within acquired brain injury. The studies included varied considerably across a range of factors including: type of acquired brain injury, group setting, structure, and duration. As such, whilst the findings were generally in support of the use of peer support groups, it is difficult to make reliable conclusions about how these can most effectively function and be used. Part two is comprised of an empirical paper which investigated the relationship between shame and self-discrepancies as predictors of adjustment following an acquired brain injury, using quantitative methodology to interpret participants' responses on a range of self-report measures. The results suggested that shame and the pre-injury vs post-injury self-discrepancy predict adjustment following an acquired brain injury. Additionally, the paper provides further evidence for the presence of both shame, and self-discrepancies between the pre-injury self and post-injury self, and post-injury self and ideal self, after an acquired brain injury. Part three contains the accompanying appendices for the previous two sections.

This portfolio thesis consists of three parts: a systematic literature review, an empirical paper and appendices. The thesis considers the factors influencing the understanding of parents in early psychosis. Part one is a systematic literature review exploring the factors that influence the experience of stigma of parents of a child with psychosis. The review critically evaluated and synthesised the findings of twelve qualitative papers. The NICE quality checklist was used to evaluate the quality of each paper and Narrative Synthesis was used to synthesise the data. The results demonstrated the wide-reaching effects of stigma. They also highlighted a need to provide caregivers with support, as those with more support had a reduced experience of stigma. The clinical implications of the findings and potential avenues for future research are explored. Part two is an empirical study of parents' experience of making sense of ARMS through family interventions. Seven parents were recruited and shared their experiences through semi-structured interviews. The data gathered were analysed using Interpretative Phenomenological Analysis. Three superordinate and seven subordinate themes emerged from the data. The findings demonstrated that parents appeared to share a similar experience of sense-making, which continued following their involvement with services. The findings of the study are discussed in the context of previous literature and the implications and recommendations for future research are considered. Part three consists of appendices relating to both the systematic literature review and empirical paper. This includes a reflective account of the research process and a statement regarding the epistemological position of the researcher.

This portfolio thesis is comprised of three parts: 1) a systematic literature review, 2) an empirical report and, 3) supporting appendices. Part one is a systematic literature review which aimed to explore the effectiveness of compassion-based group interventions. A systematic search of three key databases identified 13 empirical papers for review. A meta-analysis of ten of these papers was conducted to explore the effectiveness of the compassion-based group interventions administered in these studies. Four meta-analyses were conducted with regards to the following outcomes; anxiety, depression, self-compassion, self-criticism. A narrative synthesis of the evidence for the effectiveness of compassion-based group interventions provided by the three remaining papers is also included in the review. A review of methodological quality and standard of reporting of the reviewed studies is provided. Implications for research and clinical practice are discussed. Part two is an empirical report of an original piece of research aiming to identify the agents of change within a compassionate mind training group for staff. This is a feasibility study which pilots the reported methodology and evaluates its suitability for identifying agents of change. Quantitative analysis aimed to investigate both the effectiveness of the compassionate mind training group and the agents of change within the training. Qualitative analysis was used to explore participants' experiences of the group and any changes they had observed. The findings of the study are reported and the clinical implications are discussed. Part three contains the appendices relating to the systematic literature review and the empirical report. In addition there is a reflective statement focused on the research process, followed by an epistemological statement.

This research aimed to develop understanding of ethical competence in clinical psychology by exploring responses to hypothetical ethical dilemmas presented in vignettes, developed for the present research. It investigated what psychologists considered to be appropriate justifications for ethical decisions; and how the ethical decision-making process occurred. A mixed-methods Delphi survey was employed using qualitative justifications for quantitative scores, in an iterative process. Ethical competence in clinical psychology is arguably socially constructed, largely within the discipline. Ethical decision-making was therefore assessed by exploring responses and consensuses to ethical dilemmas, from an opportunistic sample of experienced clinical psychologists, working in the UK (n = 31). Quantitative analyses indicated that the vignettes developed for this research were rated as realistic (72-79%) and relevant (75-85%) to UK clinical practice. Thematic analysis identified five themes within ethical decision-making: assessing, formulating, responding, influencing factors, and guiding principles. A model describing this process of ethical decision-making is presented; the first of its kind in clinical psychology to be empirically derived. Future research should assess whether this is seen by the wider profession as a competent way of making ethical decisions. It is argued that this research has important implications for clinical psychology, including for ethical instruction (as the vignettes and model can be used for research or teaching), and for those using clinical psychology services.

Reflective practice groups are increasingly common in clinical services and training programmes in health and social care. They are seen as a method of learning from experience and thus as a way of supporting continued professional development and improving practice. Despite the growing popularity of reflective practice groups, the relevant research remains disparate, spread across multiple fields of practice and academia. Moreover, a large section of the current literature is focused on the impact of reflective practice and staff wellbeing, as opposed to the clinical value of attending a reflective practice group. Literature Review: The literature review aims to highlight the experiences of those taking part in reflective processes within health and social care environments. Five themes were generated from twelve empirical studies exploring methods of reflective practice within professional training or practice. Key themes were: facilitator qualities; security in the setting and relational security; ambiguous experiences of written reflection; self-reflection and time and developing reflective skills. Research Report: Semi-structured interviews were conducted with five Trainee Clinical Psychologists who had attended monthly reflective practice seminars as part of their training. Audio excerpts from previously recorded reflective practice seminars were played within the participant interviews; it was felt that the excerpts would support participants' recall of the seminars and facilitate the collection of rich and meaningful interview data. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). The analysis highlighted how presenting clinical material and hearing multiple perspectives from group colleagues impacted on how participants' thought about their clients. Moreover, participants were able to appreciate the view point of their client, following discussing the case in reflective practice, and acquire an increased sense of compassion.

Mental health outcome measures are being increasingly used to monitor the efficacy of interventions put in place to support children. For Looked After Children (LAC), mental health outcome measures are of further importance for placement planning. It is important that the measures used for these purposes are psychometrically robust. Literature Review: The psychometric properties of 25 informant rated mental health outcome measures for young people were systematically reviewed. A novel quality appraisal tool was developed to evaluate evidence pertaining to internal consistency, test-retest and interrater reliability (IRR), construct validity and responsiveness. No measure provided evidence of acceptable rigour in all assessed domains. Generally, this was a result of an absence of evidence. A need for further research pertaining to the psychometric properties of these measures, particularly with respect to their responsiveness to change, test-retest and inter-rater reliability was identified. Research Report: This study aimed to explore the psychometric properties of the BERRI in its current form for use with LAC in residential care and to explore whether these properties might be enhanced through the extraction of factors. Evidence of good internal consistency and construct validity was found for all original scales. Inter-rater reliability was 'poormoderate' for three of the five scales and 'moderate-good' for the remaining two and the BERRI total score. An exploration of the structure of the BERRI using principal components analysis revealed a five component structure. The psychometric properties of the BERRI were not improved through the empirical extraction of components. Suggestions were made with regards to the item content of the BEERI. Consideration was given to the clinical implications arising from the exploration of the measure's IRR and subsequently how IRR might be improved. Overall, the BERRI was felt to show promise as a targeted outcome measure for use with LAC in residential care.

This portfolio thesis is comprised of three parts; Part one is a systematic literature review of the empirical research on school-based positive psychology interventions for adolescents. In total eight studies were included in the review. The quality of these studies was critically evaluated and a narrative synthesis of the collective findings is presented. The narrative synthesis also involves a critique of the implementation of the interventions and the methodological quality and strengths and limitations of these approaches. Findings are discussed with reference to existing literature on positive psychology interventions and in terms of clinical implications and future research. Part two is an empirical study which explored the experiences of school staff who work with adolescents who self-harm and their families. An interpretive Phenomenological Analysis (IPA) approach was employed to explore the experiences of six members of school staff in five secondary schools England. Three superordinate and nine subordinate themes were identify which describe participants' experiences of communicated with parents. The themes are discussed in relation to existing literature on self-harm and in the context of the current political shift which advocates integrating mental health support in schools. Part three comprises appendices of parts one and two. An epistemological statement and a reflective statement are included to provide additional context (appendices R & S).

This portfolio thesis consists of three parts: a systematic literature review, an empirical paper and a set of appendices. The thesis as a whole considers the meaning and experience of hope for clinicians and clients in psychological therapy, with emphasis on the context of waiting times. The first section is a systematic literature review that explores the role, experience and effect of client hope in psychological therapy. The review also considers the methodological quality of the evidence in this area. Thirteen papers were included and synthesised using a narrative approach. The findings are discussed within the context of the wider literature, including existing theoretical models of hope. The clinical and research implications for these findings are also considered. The second section is an empirical study that explores the meaning and experience of hopeful therapeutic relationships for clinical and counselling psychologists, in relation to long waiting times for therapy. The research used a qualitative method, gathering data using semi structured interviews, and analysed the data using interpretive phenomenological analysis. Four superordinate and twelve subordinate themes emerged from the data. The results of this analysis are linked to literature relating to client hope and systemic models. The clinical and research implications for these findings are also discussed. The third section consists of a set of appendices which relate to both the systematic literature review and empirical paper. Included in these appendices are a reflective and epistemological statement, describing the primary researcher’s reflections on the research journey, and the philosophical position and underlying assumptions of the research.

This portfolio thesis has three parts: a systematic literature review, an empirical paper, and appendices. Part one is a systematic literature review in which the empirical literature relating to interventions to improve psychological wellbeing in teenage mothers is reviewed. A systematic search identified sixteen papers that matched the inclusion and exclusion criteria and methodological quality was assessed. Narrative synthesis was used to analyse the findings and the clinical implications are discussed. Part two is an empirical paper which explores professionals' experiences of resilience in teenage mothers from a positive psychology stance. Inductive thematic analysis was used to analyse interviews conducted with staff working with teenage mothers to explore their experiences of resilience in this population. Part three comprises the appendices of parts one and two. This includes guidelines for publication for both parts and documentation used in the empirical research. A reflective statement regarding the process of the empirical research and an epistemological statement are also included.

Little research has been completed on the experiences of newly-qualified mental health professionals within children's services in the NHS. Consequently, there exists a gap in the literature of how such a population may experience their work environments, how they cope with challenges, and what helps them to thrive or survive in their new roles. This study therefore proposed the research question: What are the experiences of newly-qualified Clinical Psychologists (NQCPs) in CAMHS? Specifically, this research aimed to explore three particular aspects of NQCPs' experiences; their transition and development; the MDT and wider organisational contexts; and support and coping in the role. A qualitative design was utilised to explore these topics, with seven participants engaging in one semi-structured interview each. Interpretative Phenomenological Analysis was the chosen method of analysis. This analysis of participants' accounts led to the emergence of three super-ordinate themes; 'A big jump: the transition from TCP to NQCP'; 'The support of home comforts, old and new'; and 'Acknowledging and desiring ongoing development'. These consisted of ten sub-ordinate themes. These themes illustrated the difficulties in NQCPs' initial transitions, their support-seeking strategies, and their growing confidence and desire to develop further as clinicians. There were wide-ranging implications resulting from the outcomes of the analysis, and recommendations made to both Clinical Psychology training programmes and NQCPs' employers. These included: increasing caseloads and the opportunity for further exposure to leadership and management processes throughout training; staggering NQCPs' workloads after joining CAMHS; and improved communication between CAMHS' management and clinical teams. A critique of this research, and suggestions for further investigation, are also outlined.

This thesis is split into three parts; a systematic literature review, an empirical research paper and a set of appendices. Part one contains a systematic literature review of the factors which help or hinder military personnel adjusting to civilian life. Fifteen Articles published in the UK, USA and Canada were reviewed. The results are discussed in relation to one another and the psychological understanding of adjustment. The implications of the findings on clinical practice and future research are then discussed. Part two is a piece of original qualitative research exploring the experiences of ex-military amputees. It aims to consider the social and personal perspectives which influenced their adjustment and identity. Five individuals were interviewed and their transcripts were analysed using narrative analysis. The clinical implications of the findings and suggestions for future research are then discussed. Ways to build more positive societal perspectives of ex-military amputees are also considered. Part three contains a complete set of appendices, referenced throughout the previous two parts.

This portfolio thesis has three parts. Part one comprises a systematic literature review, wherein the effectiveness of psychological interventions that integrate religion or spirituality are considered. Part two is an empirical research paper, wherein the role of spirituality is explored when individuals are making sense of hearing voices. Part three collates the appendices, containing supporting documentation and information for the systematic literature review and empirical research paper, as well as epistemological and reflective statements.

This portfolio has three parts. Part One: A systematic literature review, in which the available research regarding the interaction of traditional healers and formal mental health professionals, from the perspective of both types of practitioners, is reviewed. Part Two: A qualitative exploration of how clinical psychologists, trained in the United Kingdom, construct their work in countries classified as low to middle income. Taking the form of a social constructionist thematic analysis, informed by Foucauldian Discourse Analysis. Part Three: Appendices for both part one and two. The appendices also include a reflective statement and epistemological statement.

Rationale and Aims: Research into the lived experience of parenting children with muscular dystrophy has typically addressed key transitions along the disease trajectory, such as diagnosis or end-of-life care. Families reportedly face continuous challenges as their child's health deteriorates. No research has considered accounts of parenting across the lifespan that look at adaptation following their child's death. This research was conducted in the context of a wish-fulfilment charity that offer experiences for children to be supported in activities that are usually deemed inaccessible. In this context, the study asked how do parents who have lost a child to muscular dystrophy story their experiences of parenting. Methods: This research used a qualitative approach that explored the accounts of eight parents interviewed in couples, all of who had experienced the death of their child to muscular dystrophy. The study used a semi-structured interview, lasting from 100-150 minutes each. Interviews were video-recorded, transcribed, and analysed using narrative analysis to explore what and how the parents narrated their experiences. Consideration was given to the social and cultural contexts that shaped these. Analysis: Multiple readings of the transcripts allowed me to develop individual summaries and then construct an analysis across all of the accounts. Three main stories of change, survival and creating change emerged through my analysis. These three stories represented six sub-stories in total: waking up to different futures; being so close, you don't see the deterioration; humour through the struggle; storytelling together; creating a legacy; and living the dream. Findings: Couples narrated the loss of parental dreams, leading to the need for identity (re)formation. Humour and storytelling together were often used to regulate emotions during the storying telling, and a means of surviving their loss. Parents shared narratives of building legacies and the memories created through 'living the dream', which alluded to an impact that surpassed death itself. Implications: These findings suggest the need for greater consideration of sense-making, changing identities, and benefit-finding in clinical consultations, at key transitions during the parenting journey and particularly following the death of a child to muscular dystrophy. Accounts suggest that wish-fulfilment events can sustain hope for parents, a proposition that will need further investigation in the future.

Positive Clinical Psychology (PCP) argues that positive and negative psychological constructs are jointly important for explaining psychological problems. “Positive” constructs have been explicitly focused on by positive psychology researchers and “negative” constructs have been explicitly focused on by mental health researchers. This thesis examines the relationship between positive and negative constructs in relation to four psychological problems: depressive symptoms (Chapter 2), anxiety-problems (Chapter 3), suicide attempts (SAs) (Chapter 4 and 5), and nonsuicidal self-injury (NSSI) (Chapter 4 and 5). Clarifying how psychological problems are most appropriately conceptualised has implications for definitions, diagnostic criteria, measurement, and clinical interventions. This thesis provides evidence that some constructs form bipolar continua, having a positive pole and a negative pole, whilst other constructs do not. Chapters 2 and 3 demonstrate that well-being and calmness respectively form continua with depressive and anxiety symptoms. In contrast, Chapters 4 and 5 demonstrate that SA and NSSI cognitions do not form a continuum with another construct. Results indicate that positive and negative constructs appear to have different relationships to one-another depending on the construct under investigation. Constructs that are common in the general population – such as depressive symptoms, anxiety symptoms, well-being symptoms, and calmness symptoms – appear to be bipolar, having a positive and a negative pole. Psychological constructs that are rare in the general population and which specifically characterise psychological problems (rather than being an extreme manifestation of a common psychological experience) – such as SA and NSSI cognitions – appear to be unipolar. The replication of scientific findings also features strongly throughout this thesis. Each chapter may therefore have a timely bearing on the emerging “replication crisis” literature.

Objective: To examine the discourses used by trainee and qualified clinical psychologists from the South West of England to manage discussions of spirituality and religion as they relate to clinical practice. Methods: Four focus groups were carried out with a total of 25 qualified and trainee clinical psychologists. Transcripts were analysed using discourse analysis. Results: Three key discourses were identified, giving insight into how cohorts of qualified and trainee clinical psychologists manage discussions of these difficult topics. These were: balancing medical and therapeutic discourses, particularly when discussing psychosis and religious or spiritual beliefs; positioning and the Other, including religion and spirituality as a proxy for talking about race; and negotiating what can or cannot be said, principally when sharing personal views. Conclusion: Ensuring that clinical psychologists have an awareness of the different discourses in use within the profession and how these may impact practice is important. Explicit discussion of the medical and therapeutic discourses likely to arise across different settings should be encouraged, including how these can constrain discussions around difficult topics such as spirituality and religion, race, and sexuality. Training should equip psychologists to have an awareness of othering, particularly in relation to religion or spirituality and race, and the potential effects this could have on power and engagement in therapy and broader work.

Both teamwork and giving compassionate care have been shown to be beneficial for the mental health and wellbeing of healthcare professionals (Veale et al., 2014, Fernando & Consedine 2014a, Crawford et al., 2014, Borrill,et al. 2000a). However, barriers to compassionate care (paperwork, high caseloads, complex presentations etcetera) have been demonstrated to relate to poorer mental health and wellbeing in healthcare staff (Owen & Wanzer 2014, Maben et al., 2012b, Reid et al., 1999, Wood et al., 2011). Elsewhere in the literature, self-compassion has been proposed as a means by which resilience to anxiety, stress and depression is enhanced (Neff & McGehee, 2010). The current study investigated the relationships of team climate and barriers to compassionate care with mental health and wellbeing in healthcare staff. The study also proposed that self-compassion moderates the relationships between team climate and barriers to compassion on distress and wellbeing, and an exploration of this formed the third aim of this study. The study followed a cross sectional, correlational design using self-report data from online questionnaires. Ninety-six clinical staff working across two Mental Health trusts in the greater London area completed five questionnaires; the Barriers to Physician Compassion Questionnaire, the Self- Compassion scale short form, the Team Climate Inventory short form, Depression Anxiety Stress Scale short form and the Warwick-Edinburgh Mental Well-being Scale. The results revealed that there was no significant relationship between team climate and distress or wellbeing, but that barriers to compassionate care correlated positively with distress, and the burnout/overload subscale correlated negatively with wellbeing. Self-compassion was found to moderate these relationships at low levels of self-compassion, at the mean and below for distress, and more than one standard deviation below the mean for wellbeing. The results indicated that healthcare professionals could benefit from a brief intervention aimed at increasing self-compassion.

Despite many Clinical Psychology training programmes utilizing reflective practice groups as part of clinical training, there remains little research examining the experiences of such groups from a trainee perspective. However, it remains the preferred method of developing reflective practice skills during training. This research used interviews and Interpretative Phenomenological Analysis to explore the experiences of attending reflective practice groups as part of doctoral Clinical Psychology training. A purposive sample of eight participants were recruited for a single, semi-structured interview. The interviews were audio-recoded, transcribed and analysed by the researcher. Five superordinate themes were constructed: 'the process: there were so many layers', 'the impact: an ongoing process', 'the facilitator: a presence who was not always present', 'commitment: I hated it, but I still went' and 'getting through it: finding ways to cope'. Nineteen corresponding subordinate themes were constructed from the data. The research findings illustrate the varied and complex experiences of the participants. Whilst the experience was often difficult, participants appeared committed to attending and sought out ways in which to navigate the experience. The results are conceptualised in terms of existing psychological theory and literature. A critique of the research and suggestions for future studies are offered, which include exploring the views of the facilitators of such groups and comparing how groups are utilized within different training institutions. Recommendations are made related to the development of future reflective practice groups, which include recommendations related to the style of facilitation and the frequency and size of the group.

Research suggests hearing and seeing things that others do not is universally experienced by many humans; yet, there is a dominant discourse that hallucinations are a negative and debilitating phenomenon. This portfolio examines the differences between those who seek help for their hallucinatory experiences and those who do not, and explores a more positive narrative of experiencing hallucinations as a medium in which a person can develop and personally grow. The portfolio is comprised of three parts. Part one is a systematic literature review, in which existing empirical literature relating to mental health service-use and distress for individuals experiencing hallucinations is reviewed. A total of sixteen studies are first critically evaluated and assessed for quality, then the findings are collated and synthesised to examine the psychological and social factors which may contribute to a rise in hallucinatory distress and/or help-seeking. Part two is an empirical paper, which explores experiences of personal growth with auditory and visual hallucinations. The qualitative study interviewed seven individuals to better understand the experience of personal growth, individuals’ expectations of positive change, and highlight any facilitating or hindering factors in the development of personal growth. Part three comprises the appendices. The supporting information for the systematic literature review and the empirical study are presented, in addition to epistemological and reflective statements to provide further context for the untaken research.

This Portfolio Thesis comprises three parts. Parts one and two are conceptually linked by their focus on the effect of anxiety on cognitive processes in psychosis. Part one is a systematic literature review. Biological views of psychoses such schizophrenia still dominate, but more recently research into the psychological aspects of psychosis has burgeoned. Literature in the field suggests that anxiety interacts with cognitive processes and increases the likelihood of cognitive biases associated with psychosis. The systematic literature review investigates how anxiety affects the cognitive processes associated with the onset and maintenance of psychosis. Part two is an empirical paper. Understanding the interactions between social, emotional and cognitive processes in psychosis holds promise in terms of improving psychosocial interventions. Current research suggests a link between childhood trauma, dissociation and psychosis. Studies of dissociative populations suggest cognitive inhibition, which is implicated in hallucinations, may be adversely affected by threat in psychotic populations. The empirical paper investigates the effect of anxiety on cognitive inhibition in participants with various levels of hallucination-proneness, and the associations between childhood trauma, dissociation and hallucination-proneness. It was hoped that the findings would contribute to the understanding of psychotic experiences and assist in the formulation and treatment of psychosis. Part three comprises the appendices.

This portfolio comprises three parts. Part one is a systematic meta-analytic review of the relationship between cognition, including social cognition, and the pragmatic aspects of language comprehension and production following traumatic brain injury. Part two is an empirical paper which presents novel data pertaining to the characterisation of moral judgement disturbance following traumatic brain injury, and the relationship of these disturbances to social cognition. Part three comprises the appendices, which contain information supplementary to parts one and two, in addition to an epistemological and reflective statement.

This thesis portfolio is comprised of three parts: a systematic literature review, an empirical study and a set of appendices. Part one is a systematic literature review in which existing empirical literature relating to fathers’ representations of their unborn children during pregnancy is reviewed. A total of 15 studies is critically evaluated and assessed for quality. Their findings are then collated to examine the manner in which fathers represent their unborn children and the factors which influence the development of these representations. These findings are discussed in relation to clinical implications and directions for future research. Part two is an empirical paper which explores fathers’ experiences of the perinatal period in the context of maternal mental health problems. The study employed a narrative approach in the exploration of forty fathers’ stories of this time. Both elicited and pre-existing online stories were included. The holistic form and content of the stories was examined in an attempt to gain insight into the factors and processes that contribute to differential outcomes for families within this period. The findings are discussed in reference to the Developmental Systems Framework of Family Resilience (Walsh, 2016) and clinical implications are presented. Part three is a complete set of appendices of parts one and two. The supporting information for the systematic literature review and empirical study are presented, in addition to epistemological and reflective statements to provide further context for the undertaken research.

The focus of this study was to explore how Clinical Psychologists narrate their experience of relatedness within a multi-disciplinary team. Mental health services in the UK are facing increased financial pressure and a necessity for all professionals to justify their role. In this context value often appears to be placed on the cheapest way of providing individual, independent care for clients rather than on the relational value of job satisfaction, joint working and therapeutic relationships. The aim of this study was to explore the experience of Clinical Psychologists and through this contribute to thinking around collaborative and interdisciplinary working. This study was guided by eight individual semi-structured interviews which were conducted with Clinical Psychologists who work in Multi-Disciplinary working age adult Community Mental Health Teams and explored using Narrative Analysis. The participants consisted of seven females and one male who had been qualified between three and fifteen years and were working at various pay bands between 7 and 8c. Four relational narratives were found. These were connections to the self of the psychologist, connections to clients, connections with colleagues and connections with the system. The first relational aspect was how the Clinical Psychologists in this study storied their ability to remain connected to their own humanity and their personal values within the context of their Multi-Disciplinary Teams. The second level involved the stories about relationships and connections with clients, particularly thinking about the perceived impact and consequences of the other relational levels for the clients and their safety. The third relational aspect was the stories that Clinical Psychologists told about their sense of relatedness to their colleagues within their teams and the importance of having time available for this. Finally, the fourth level, which was evident within all the other relationships, was of the impact of the wider system and context. These stories emerged from the analysis process with the understanding that the interviews were co-constructed and represented multiple voices. This study confirmed that despite a history of both research and legislation highlighting the benefits and values of inter-professional working and compassion the reality remains elusive. To achieve these aims there needs to be a shift in focus from short-term planning evaluating efficiency in relation only to perceived financial value, to thinking more widely and long-term about relational value. There is a need for investment and recognition of the aspects of team working that are less easy to quantify financially. Further research could explore the experience of other professional groups within CMHTs, and other MDTs, and of clients. This would give a voice to individuals who did not have an explicit voice in this research.

Background: Both Freud (1921) and Skinner (1971) were regarded as 'hard determinists' who saw human thought and action as determined by prior events, and the idea of free will as simply an illusion. While this belief system clearly impacted on the models of therapy they developed, whether such beliefs also had an impact on their ability to develop qualities of effective therapy, such as empathic and genuine therapeutic relationships, is not known. Furthermore, whether there is something about holding this belief system that could affect therapists' abilities to attain and nurture such qualities, remains unclear. Research Question: The research study reported here sought to gain some insight into the above question, and into what it is like to deliver therapy from a hard determinist philosophical frame, by asking how clinical psychologists who hold a hard determinist philosophy, experience delivering therapy. Method: The study made use of a qualitative design methodology. Semi-structured interviews were conducted with seven hard determinist clinical psychologists, and interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Results: Four super-ordinate themes emerged from the analysis: 'From Hell to Utopia: How it feels to be a hard determinist therapist', 'Hating the sin, loving the sinner: Enhancing the therapeutic relationship', 'Free will: A felt vs reflective understanding', and 'Therapist as thinker'. Implications: The themes to emerge from the data gave rise to a number of implications and recommendations for practice and further research. In particular, it was recommended that the link between hard determinist beliefs and a perceived enhancement of the therapeutic relationship warrants further research. Furthermore, since the philosophy was linked to ideas about power, self-control, therapeutic models, science, and research, discussions of the philosophy may add valuable contributions to clinical psychology's understanding of these issues. In addition, a replication or development of this study with a broader range of therapists is recommended, to establish whether the findings reported here can be generalised to therapists from fields outside clinical psychology.

This portfolio has three parts. I. Part one is a systematic literature review entitled ‘What are the psychological factors associated with psychogenic syncope or psychogenic non-epileptic seizures? Psychological factors that appear to be commonly linked to syncopal events of unknown medical origin are explored in relation to psychogenic syncope. Studies have widely acknowledged psychological distress in this patient group. The prevalence of psychological factors and their impact on people remains uncertain. A systematic search of four databases identified eleven studies. The findings are summarised and discussed from various perspectives. Clinical implications and areas of future research are highlighted. II. Part two is an empirical paper, utilising Interpretative Phenomenological Analysis (IPA) entitled: ‘What are the experiences of people diagnosed with psychogenic syncope?’ The study explores peoples’ perspective of living with psychogenic syncope. A total of six people chose to participate in the study, which employed a semi-structured interview based on the self-regulation model (Leventhal, Nerenz & Steele, 1984). Five superordinate and seven subordinate themes emerged from the data. Peoples’ experience of psychogenic syncope was conceptualised by drawing on various theories in order to highlight a need for holistic healthcare practice. Wider psychosocial influences on people diagnosed with psychogenic syncope were also considered. III. Part three comprises appendices relating to part one and part two. Included in this is an epistemological statement of the stance of the researcher, and a reflective statement on the process of conducting the research, and its challenges.

The portfolio thesis has three parts: Part one is a systematic literature review reviewing the literature on the relationship between parenting style and diabetes management in children and young people with type 1 diabetes. Seven papers were systematically reviewed and the findings and clinical implications are discussed. Part two is an empirical paper, which explores adolescents with type 1 diabetes perceptions of control. Six adolescents who perceived themselves to have low personal and/or treatment control were interviewed about their experiences. The interviews were analysed using Interpretative Phenomenological Analysis. The findings of the study are discussed along with the clinical implications of the study and areas of future research. Part three comprises the appendices, which compliment parts one and two of the portfolio. The appendices also includes a reflective statement.

This portfolio thesis consists of four parts, a systematic literature review; a mixed methods empirical paper; a qualitative empirical paper; and supporting appendices. Part One is a systematic review of the literature regarding how body awareness can affect well‐being. This review stems from ideas of embodiment and reciprocal influences and connections between mind and body. The concept of embodiment also informed the development of an empirical investigation into the impact of compassionate imagery on affect and self‐compassion in a non‐clinical sample. This empirical study is divided into two papers, presented in Parts Two and Three. Part Two uses mixed methods to quantify the extent to which psychoeducation and meditative exercises can alter affect and self‐compassion. Additionally, participants’ interview responses to this experience are presented to add depth to the understanding of the clinical relevance of this practice. Part Three offers a qualitative study to explore reactions to the concept of self-compassion in a non‐clinical sample. Participants emphasised the role of culture and systemic influences on their perceptions of their capacity to be self‐compassionate and the paper presents a brief exploration into possible reasons for this and methods by which these barriers could be overcome in order to promote well‐being. Part Four comprises of appendices, including reflective and epistemological statements.

This portfolio thesis is comprised of three parts: a systematic literature review, an empirical paper and a set of supporting appendices. Part one is a systematic literature review that summarises and critically appraises eleven studies exploring the relationship between self-blame for the onset of a chronic physical health condition and emotional distress. As inconsistent perspectives have been noted regarding the relationship between self-blame and psychological adjustment to illness, with some suggesting self-blame to be beneficial and others suggesting a detrimental impact, the aim of this review was to clarify the nature of this relationship when self-blame for illness onset is measured appropriately. It is important for professionals to recognise the factors that may be associated with increased distress for people with chronic physical health conditions so that appropriate support can be offered to maintain and improve their quality of life and long-term physical health. Part two presents an empirical study that explores the relationship between feelings of personal responsibility for illness onset, self-compassion and symptoms of anxiety and depression, as self-reported by people with a diagnosis of cancer. A wealth of research supports the association between self-compassion and psychological well-being, particularly when people are self-critical or self-blaming. However, few studies have explored these benefits for people with chronic physical health conditions who can feel personally responsible for causing their condition and may therefore be more vulnerable to experiencing self-blame and emotional distress. This study was the first to investigate the potential for self-compassion to buffer against the negative emotions associated with feeling responsible for cancer onset. This investigation therefore aimed to support the potential for self-compassion enhancing psychological interventions to benefit people with cancer who may feel responsible for their diagnosis and who may be experiencing symptoms of anxiety and depression. Recognising appropriate psychological interventions for this population of people is essential for promoting well-being, quality of life and long-term physical health. Part three contains appendices that support both sections one and two.

This thesis offers a critical consideration of the recovery approach to severe and enduring mental-health problems (Roberts & Boardman, 2013; Anthony, 1993), with the primary-research element focused on recovery after forensic secure care. A systematic review of qualitative research into recovery processes was conducted, using best-fit framework synthesis as a method of analysis (chapter 2). An expansion of the CHIME recovery model (Leamy et al., 2011) is proposed, in which the difficulties experienced by service users are more prominently considered. Chapters 3 and 4 report an investigation of the barriers to recovery perceived by people discharged from forensic secure care, using interpretative phenomenological analysis as a method (Smith et al., 2009). Eight participants were interviewed, and five superordinate themes are proposed: living in the shadow of the past, power imbalances, security and care, reconfigured relationships, and ‘recovery’ as a barrier to recovery. The final chapter of the portfolio is a shorter reflective paper considering the wider context of the work.

Background: There is some evidence to suggest that computerised Cognitive Behavioural Therapy (cCBT) is effective for reducing adolescent anxiety and depression. However, most studies have used samples of young people in the general population or those who are 'at risk' of anxiety or depression, and so less is known about the usefulness of cCBT for adolescents with clinically significant levels of distress and impairment. Aims: This study aimed to investigate the feasibility of using a novel computerised cCBT intervention, 'Pesky gNATs,' with adolescents aged between 13 and 18 years old who had clinically significant symptoms of anxiety and/or depression. Method: Eleven participants were recruited from a Tier 3 Child and Adolescent Mental Health service (CAMHS). Six participants were allocated to the intervention group and received the intervention immediately, and five were allocated to the control group and received the intervention after a delay. Outcome measures were completed pre- and post- intervention. Qualitative data were also obtained during the final session. Results: A high participation and retention rate was found for the intervention and the majority of participants described the programme as helpful and identified several benefits of completing the programme. No differences in overall self-reported symptoms of anxiety and depression, self-concept and functioning were found when comparing the intervention and control group on pre- and post- intervention scores. However, decreases in parent-reported symptoms of anxiety and depression and the impact of symptoms on functioning were found across both groups. Conclusion: This study demonstrates the acceptability of using a cCBT programme in a Tier 3 CAMHS setting, but shows limited evidence that this intervention is effective at reducing self-reported symptoms of anxiety and depression. Therefore, 'Pesky gNATs' may not be appropriate as a standalone treatment for young people with more severe clinical presentations.

Resilience, as a trait, process or outcome, is the negation of an undesirable outcome or of an expected maladjustment in the context of an adversity. Young people represent a developmental stage in which there is a vulnerability to experience deleterious outcomes during adversity. The literature on risk and promotive factors for resilience in youth is compounded by narrative reviews which have not applied a rigorous search methodology and which have failed to operationalise resilience. To date, the majority of research in resilience for emotional distress has focussed on data collected in high income countries. The first paper presents a systematic review of the literature on risk and promotive factors for trait resilience in youth. The findings indicate that there are differences in the magnitude of association between trait resilience and various risk and promotive factors, which were conceptualised into biological, intrapersonal, interpersonal and environmental factors. The largest body of evidence reviewed pertained to intrapersonal risk and promotive factors for trait resilience. Factors predicting trait resilience were also identified. Implications for future research include addressing the methodological and sampling limitations of the reviewed studies. The second paper presents an empirical study investigating factors within a microsystem which differentiate adolescents with resilience for emotional distress and those vulnerable to emotion distress in India (N = 967) and in Peru (N = 606). Factors which predict low emotional distress in each country and factors which differentiate between low emotional distress Indian and Peruvian adolescents were additionally investigated. A cross-sectional exploratory investigation of secondary data was employed. The findings suggest that the profile of low vulnerability for emotional distress differs between different cultural contexts and contribute to an extraordinarily limited evidence-base in low and middle income contexts. Extensive additional research is required to delineate culturally-specific profiles of resilience for emotional distress in a bid to develop culturally-sensitive treatment targets.

The thesis portfolio is divided into three parts: Part one is a systematic literature review, in which quantitative literature considering the role of relational connectedness in the recovery process for people with mental health difficulties is reviewed. A systematic search of five databases identified twelve studies in the area. A narrative synthesis of the findings is provided. Methodological quality of the area, as well as implications and directions for future research are discussed. Part two is an empirical paper which explores relational connections among care leavers. This study has an idiographic focus using semi structured interviews and employing Interpretative Phenomenological Analysis. Nine care leavers took part in the study. Five super-ordinate and eighteen subordinate themes emerged from the data. These themes are discussed in the context of relational aspects of wellbeing, self-identity, emotional coping and barriers to help-seeking. Part three comprises the appendices supporting the systematic literature review and empirical papers. It also contains a reflective statement.

The portfolio has three parts: Part one: A systematic literature review of evidence based and theoretically derived models of civic engagement development in adolescence. Part two: A qualitative research study using Interpretative Phenomenological Analysis (IPA) to explore looked after children’s ideas for the future and the factors that contribute to the formation of these aspirations. Part three: Appendices consisting of documents relating to the systematic literature review and the qualitative research study. A reflective statement and an epistemological statement are also included.

The portfolio has three parts. Parts one and two are conceptually linked by their focus on self-harm and the cessation of the practice. Part one is a systematic literature review. Each individual’s self-harm experience is unique to them but there has been research that has shown that there are similarities between each experience. The systematic literature review examines the views and experiences of those who practice the behaviour with a view to identifying any similarities and discrepancies. Part two is an empirical paper. The therapies that have been studied for their effect on self-harm behaviours have failed to yield results that show that any one approach is consistent in decreasing the frequency and/or intensity of the behaviour. The empirical paper reports a study that explored the experiences of 8 adults who had previously self-harmed but no longer did so. It was hoped that the themes and any commonalities between the experiences would provide insight into what is poignant for the individuals when stopping the behaviour and that this would contribute to the on-going work helping people to no longer use the behaviour. Part three comprises the appendices.

The portfolio has three parts: a systematic literature review, an empirical study and a set of appendices. Part one: Comprises a systematic literature review in which studies relating to the use of self-initiated pain coping strategies in adults with cancer are reviewed. Fifteen studies were included in the review, including qualitative, quantitative and mixed methods designs. The studies reviewed had to have explored pain coping strategies and have included patient characteristics such as demographic, psychological or clinical variables that would allow for the investigation of possible relationships between the two. Part two: Comprises an empirical paper which explores the experiences of older people who self-manage their cancer pain at home. Patients attended semi-structured interviews with the main researcher. These interviews were analysed using Interpretative Phenomenological Analysis (IPA). The data was analysed, emergent themes are presented and implications are discussed in regard to existing literature. Methodological limitations are discussed and potential areas for future research are identified. Part three: Comprises the appendices which support the work of the first two parts, and includes a reflective statement on the research process, an epistemological statement, and a worked example of IPA analysis.

The portfolio thesis is separated into three parts: a meta-synthesis of qualitative research, an empirical study and appendices. Part one is a meta-synthesis reviewing the published qualitative literature regarding the decision to remain childfree in women. The aim of the synthesis was to provide healthcare professionals with an in depth insight into the influences and consequences of the decision in order to inform aspects of their practice when working with childfree women, alongside infertile women and those contemplating the motherhood decision. Five broad themes were discovered from six papers eliciting that the childfree decision is multifaceted and individual. The findings are discussed in relation to clinical implications and potential future research. Part two is an empirical study that explores the experience of the motherhood decision in women diagnosed with Multiple Sclerosis. Eleven women were interviewed, and data was analysed using Interpretative Phenomenological Analysis (IPA). Though the study involved both women who had children and women who did not have children following diagnosis, several themes occurred across interviews with participants. Key implications for the aid of the decision making process within health care services are discussed. Part three consists of appendices supporting both the meta-synthesis and the empirical study. It also includes a reflective statement detailing the process of the research from beginning to end.

This portfolio thesis comprises of three parts: a systematic literature review, an empirical report and supporting appendices. Part one is a systematic literature review of empirical papers examining current literature on the psychophysiological and behavioural mechanisms by which type-D personality influences health outcomes in the cardiovascular population. The findings of the review are discussed in relation to theory and the conceptual issues surrounding the validity of individual psychophysiological and behavioural mechanisms. The review concludes with recommendations for clinical practice and future research. Part two is an empirical report of a study that used quantitative methodology to examine type-D personality as a potential predictor of quality of life in an atrial fibrillation population. In addition, the study investigates the role of illness perceptions as a mediator in the relationship between type-D personality and quality of life. The findings are discussed in relation to clinical implications. Methodological limitations and areas of future research are also identified. Part three comprises supporting appendices. These include a statement reflecting on the research process and supplementary information pertaining to the literature review and empirical study.

This portfolio thesis consists of three parts. Part one is a systematic literature review investigating existing research on the illness perceptions of men with erectile dysfunction (ED). The following five online databases were searched; PsycINFO, MEDLINE via EBSCO, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Web of Science Core Collection. With the application of relevant inclusion and exclusion criteria, 13 studies were found to be eligible for inclusion in the review. A narrative synthesis of the findings of the included studies was conducted. Findings were organised into five categories of men’s perceptions about ED. These were as follows; severity and permanence of ED, communicating about ED, causes of ED, consequences of ED and treatment for ED. A discussion of the findings is presented, with consideration of the impact of illness perceptions on communication about and treatment-seeking for ED. The limitations and the clinical implications are proposed, as well as avenues for future research. Part two is an empirical paper investigating the experiences of South Asian men with diabetes mellitus (DM) and ED, utilising exploration of their illness perceptions and the impact on quality of life. Qualitative methodology was employed. Semi-structured interviews based on the Self-Regulatory Model (Leventhal, Nerenz, & Steele, 1984) were conducted with six South Asian men with DM and ED. Interpretative phenomenological analysis (IPA) was employed. Four superordinate and ten subordinate themes were identified. The findings are discussed in consideration of clinical implications and limitations of the study. Avenues for future research are proposed. Part three consists of the appendices for the systematic literature review and the empirical paper, including an epistemological statement and a reflective statement.

This portfolio is made up of three sections: Part one is a systematic literature review, in which the empirical literature relating to family-based interventions after brain injury –delivered both face-to-face by therapists and utilising new telehealth delivery methods –is reviewed and critically contrasted. It aims to explore the effectiveness of these delivery methods. Part two is an empirical paper exploring the shared relationship of mothers and non-injured siblings of young adults who have incurred severe traumatic brain injury. This was implemented using semi-structured interviews and analysed using Interpretative Phenomenological Analysis, with consequent themes discussed in the context of established empirical and theoretical literature. Part three comprises the appendices, including further information for parts one and two, as well as reflective and epistemological statements.

This study explored newly qualified Clinical Psychologists’ (CPs) experiences of personal professional development (PPD) during doctoral training. In particular there was a focus on their experiences of their personal and professional identities. Within literature relevant to PPD in Clinical Psychology training, personal and professional development were largely conceptualised as separate processes. Yet models of reflective practice would suggest that an awareness of the personal self is necessary for effective clinical work. The research questions were ‘How do newly qualified CPs experience their personal and professional identities during doctoral training? and ‘How do they experience the boundary between their personal and professional development?’. To respond to these questions seven newly qualified CPs were interviewed regarding their experiences of their personal and professional identities during training. A qualitative research design was employed and Interpretative Phenomenological Analysis was used to analyse the data. Three superordinate themes were identified within the data: Developing self-acceptance; Enhancing awareness of self and others; Taking risks and managing uncertainty. Within these results there was a strong message of an inextricable link between personal and professional identities. It seemed that participants started from a position of being themselves, and during training negotiated the dilemmas of learning a professional role. In order to do this they would often look to others for how to negotiate this process. Yet this process could create challenges, as bringing one’s personal self into the professional arena was not always seen as acceptable. If participants were able to show personal aspects of themselves this could make them feel vulnerable and, therefore, these processes held an element of uncertainty. Where participants were able to show their personal selves and felt validated, this allowed for developing self-acceptance. The implications for clinical training and the clients with whom CPs work are discussed.

This portfolio has three parts. Part one is a systematic literature review, in which the theoretical, conceptual and empirical literature relating to the effectiveness of using Intensive Interaction with people with learning disabilities is reviewed. Part two is an empirical paper, which explores the experience of hospital staff using intensive interaction. Part three comprises the appendices.

Background: Pregnant women who are told their unborn babies require postnatal surgery following the 20 week scan are likely to be distressed. There is a small body of research in this area that suggests pregnancy experience is fundamentally changed and that pregnancy expectations may play a part in that process but it is unclear how women come to terms with their news. Objectives: This study aimed to gain a detailed understanding of what pregnant women experienced when faced with this news by applying Lazarus and Folkman's (1984) transactional model of stress and coping (TMSC) and expectancy theory against a backdrop of disruptions to the normal stages of pregnancy as identified by Raphael-Leff (2005). Method: Seven in-depth interviews were conducted with pregnant women whose unborn babies had been diagnosed with a surgical nonlethal structural abnormality following the 20 week anomaly scan. Results: Pregnant women's experiences had four super-ordinate themes: 'living with a changed pregnancy’, which represented living with the unknown and pre and post news pregnancy expectations; ‘an emotional journey’, which represented post news emotions experienced and concerns about the future; ‘coping’ which represented how women mediated their distress; ‘relationships with self, their baby and others’ which involved questioning ideas around motherhood and their baby's identity and how others influenced pregnancy experience. Discussion: Themes were discussed in relation to the TMSC and expectancy theory and explored emotions and appraisals and the interplay an uncertain prognosis had on pregnancy expectations alongside interactional influences from the environment.

The portfolio thesis is divided into three parts: Part one is a systematic literature review exploring the literature in relation to illness representations and older people living with health conditions. A systematic search of three databases identified ten studies in the area. The findings of the studies are analysed using a qualitative method to identify what has been examined in the literature to date. Three themes were extracted from this method: ‘associations between the constructs of the common sense model of illness representations’, ‘coping and health outcomes’ and ‘variables associated with illness representations’. The findings are discussed in relation to research in chronic illness management, clinical implications and directions for future research. Part two is an empirical paper that explores the experience of epilepsy in older age. The study employs an interpretative phenomenological analysis. The illness representation model is used as a framework (Leventhal, Nerenz, & Steele, 1984) for conducting semi-structured interviews. Ten older people with a diagnosis of epilepsy took part in the study. Three super-ordinate and eight subordinate themes emerged from the data. These themes are discussed in relation to clinical implications and the wider literature of epilepsy, health and ageing. Part three consists of the appendices supporting the systematic literature review and the empirical paper. It also includes a reflective statement of the research process.