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Aims: The argument that therapeutic practice affirms a reductionist paradigm of distress and overlooks socio-environmental understandings of suffering suggests that Psychology may collude with systems of power, privilege, and oppression. As key proponents of social justice it is critical that Counselling Psychologists add to the literature exploring this. This thesis employed a scenario depicting a couple's distress over divisions of parental labour, to explore the dominant discourses that therapeutic practitioners draw upon in formulating a situation of distress situated in a socio-environmental context. Methods: A combination of story completion (SC) and vignette stimuli were used to obtain qualitative data in this study, from forty-three practitioners qualified in an integrative therapeutic approach. Using a constructionist thematic analysis three themes were identified: 1) the recreation of gender roles, 2) the motherhood penalty and 3) reformulating distress. Findings: Therapeutic practitioners drew on two overarching discourses across their stories: heteronormative and biomedical. The dominant story type across the dataset reaffirmed these dominant regulatory, whilst a 'secondary' or less common story type simultaneously challenged the dominant rhetoric. Implications: The thesis provides evidence that therapists reaffirm and challenge reductionist paradigms of distress, thus engaging in a complex reproduction/subversion of dominant cultural discourses. Importantly, the results highlight that therapists are influenced by the same stereotypes as everyone else and remind us that psychology as a profession rest upon a set of social practices with implications beyond those which we are immediately aware of. The discussion inquires into the discipline's current stance on the intersection between models of human suffering and social justice. Furthermore, this work highlights opportunities posed by transposing the locus of change from the individual to wider contexts, aiding a more realistic assessment of therapeutic change and nudging the discipline into greater alignment and coherence with the social justice narrative (Woodger, 2020). Clinical implications, limitations and avenues for future research are also discussed.

Background and research aims: Little is known about single adult women's experiences of homelessness due to a concentration of literature on male homelessness. Furthermore, the empirical and statistical nature of much homelessness research, including that on skills and educational training needs, does not allow for in depth exploration of homeless women's perceptions and experiences. This study seeks to address these knowledge gaps and add to the limited existing literature on single women's homelessness, drawing on social justice and critical feminist frameworks to explore this underrepresented phenomenon. Method and methodology: This study is informed by a transformative research paradigm, adopting both social justice and critical feminist frameworks, and a qualitative methodology, to explore the lived experiences of single, homeless women. Seven semi-structured interviews were conducted, and the data were analysed using reflexive thematic analysis to produce three key themes. Analysis: The analysis produced three themes, the third of which was divided into two sub-themes. The themes are as follows: 1) "I have the fear. Now the fear starts". Experiences of threat and perceptions of vulnerability; 2) "She's still stuck by me, and I love that about her". Attachment bonds between the women and the staff as a precursor to healing and growth; 3) The importance of choice and freedom; 3.1) "Because there was nothing…nowhere else you could turn to". Loss of choice and freedoms during homelessness is damaging to women's emotional, psychological, and physical wellbeing; 3.2) "Now I have my own goals, I want to do something in the future". Fostering a sense of choice and freedom within skills and education pathways has positive outcomes for self-development and self-efficacy. Discussion: The findings of this thesis were able to elucidate the experiences of single, homeless women across seven key areas: 1) Loss of home as a gendered issue; 2) Rough sleeping; 3) Perceptions and conceptualisations of vulnerability; 4) Relational disintegration and redevelopment: the power of the relationship; 5) Economic marginalisation during homelessness and restricted access to the labour market; 6) Learning environments, engagement, and traumainformed care; 7) Limitation of liberties. Limitations, reflexive considerations, implications for CP, directions for future research, and implications for frontline practitioners are offered.

Background: School exclusionary policies, whilst a way of managing behaviour in schools, often perpetuate wider social injustices (Department for Education [DfE], 2020). Statistics related to school exclusion indicate negative disproportionalities based on race and gender. This is critical as it is shown that there are longer term impacts on the individual that go beyond studying at school. It is this perceived social injustice that engages my interest from the perspective of counselling psychology. Rationale and aim: The aims of this research are to explore young people's discourses on race and gender in the context of school exclusion based on analysis of the construction of two imaginary identities by young people of colour within a Pupil Referral Unit (PRU). It aims to raise awareness that the disproportionality relating to race and gender within school exclusion cannot be explained credibly by the individual deficit model which pathologises behaviour and it therefore aims to identify the apparent issues of social injustice (Commission on Young Lives, 2022). Methodology: The research analysed secondary data generated from an arts project, contained within a documentary called 'Beneath the Hood' (Lee, 2004). Specifically, the study offers a discourse analysis of six poems that were written and performed as raps by young people who were excluded from mainstream school and are now studying in a PRU. Analysis: The four main discourses identified were: Racism - colonialism, construction of structural injustice and the subversion of power; Masculinities and Femininities - the construction of gender; Familial relationships; and Containment - discourses of space and place. Discussion and Conclusion: Within institutions there is an enactment of control through policies and pedagogy that are embedded with Whiteness, power and oppression. This is invested in education at an institutional and societal level which only serves to hinder and impact the individual far longer than their exclusion and education. In relation to education and counselling psychology there is a reflection on social justice informed practice and policy interventions.

Background: Calls for the meaningful enactment of counselling psychology's social justice agenda have emphasised educational settings as a feasible site for social justice work, emphasising transdisciplinary considerations of relational inequality and power as vital within this. It has been argued that existing attempts to redress pervasive educational inequalities, both within educational policy and teacher education, have lacked emphasis on vital relational elements. Further, the perspectives and experiences of student-teachers (STs) and teacher- educators (TEs) have been largely absent from explorations and conceptualisations of relational (in)equality. Aims: This study aimed to explore STs' and TEs' understandings, experiences and enactments of relational (in)equality across two settings: the secondary school classroom and the PGCE tutor group. Further, this study aimed to identify factors participants perceive to be helping and hindering relational equality. Methodology: A qualitative case study design was adopted to explore this phenomenon. Data were generated across two phases using a range of methods, including semi-structured interviews, a focus group and observations. Data were analysed using a reflexive thematic analysis. Findings: 8 main themes were generated: (1) The function of relational inequality in the teacher-student relationship, (2) Relational equality is about community, (3) Role modelling an ethos of relational equality, (4) Reflexivity is key to enacting relational equality, (5) What the 'other' is bringing to the dynamic: the reciprocal nature of relational (in)equality, (6) Identity, privilege and personal power, (7) The role of time in relational (in)equality and (8) Navigating the structures of educational contexts Conclusions: This study sheds light on the complex, nuanced and contextual nature of relational (in)equality within secondary teacher education in England. The findings bring a new perspective and in doing so provide a starting point for a conversation about the applicability and enactment of relational (in)equality within teacher education. Specifically, these findings encourage a transdisciplinary conversation across teacher education and counselling psychology around the points at which unequal power relations are helpful or harmful. Further, this study provides insight into the perceived intrapersonal, interpersonal and systemic barriers to enacting relational equality and potential means by which this may be mitigated. This study offers a transdisciplinary exploration of relational (in)equality, highlighting the relational nature of such endeavours and emphasising the reciprocal learning opportunities for both teacher education and counselling psychology.

Constructions of 'mental health recovery' derive from varying discourses and differing philosophical assumptions. 'Biomedical' and 'rehabilitative' constructs appear to dominate the current literature, practice, and policy. Nonetheless, a critical discourse has emerged which challenges these constructions, their use in policy and their wider implications for understanding psychological distress. This research aimed to explore how 'mental health recovery' is being constructed in mental health services by those with a significant responsibility concerning the development and provision of care. The purpose was to gain an understanding of how these different ways of talking about 'recovery' are indicative of wider social and political struggles and to enable the exploration of possible ideological ramifications on service provision. Seven mental health practitioners, holding Band 7 positions and above, were interviewed. A Foucauldian discourse analysis, aligned with a critical realist social constructionist position, was used to analyse the transcripts. Analysis identified four main discursive constructions of 'mental health recovery': (1) recovery as being well (2) recovery as an ongoing process (3) recovery as being achieved through pluralism (4) recovery as taking place in the interaction with others. The first two constructions were considered to uphold and privilege dominant understandings of psychological distress and 'recovery', with the second two interpreted as a resistance to prevailing power structures. Overall, 'recovery's' use in neoliberal policy and practice is argued as problematic considering participant's constructions of a subjective, relational, and pluralistic process.

Background: Research suggests that 75% of people who develop a mental health illness are more likely to do so between 16 and 25 years of age. Higher Education (HE) digital native students are at greater risk of experiencing psychological distress due to this transitional life stage but have the potential for greater targeted social and emotional support. Kooth Student was developed in 2017 offering online counselling to HE students between 18 and 25 years. The use of online counselling is growing particularly with HE digital native students however, further research is needed to understand how online counselling is experienced by this population and how services may be improved. Aim: The aim of this research was to further understanding of what HE digital native students find helpful/unhelpful in this type of support, why online counselling may be a preferred medium of therapeutic communication to in-person counselling and how the therapeutic relationship is subjectively experienced. Methodology: The design of the study is a qualitative reflexive thematic analysis based on Braun and Clarke's (2019) six stages of analysis. Eight participants, recruited through the Kooth service, engaged in semi-structured, online (text-based) interviews via the Kooth platform. Interview transcripts were then analysed to develop themes. Findings: The analysis generated five themes: 1) the context of seeking online counselling; 2) Assumptions and expectations; 3) safe and familiar context to facilitate the shaping of identity; 4) development of self in relationship; and 5) support and information at the touch of a button. Discussion: The study highlights assumptions made about HE digital native students and their technical and communication skill ability. Accordingly, there is a lack of understanding of the online counselling structure, process and therapeutic communication. Despite this, HE digital native students experience safety, control and freedom in online counselling that offers an escape and relief from reality and a space to develop a sense of self and interpersonal skills with others whilst also facilitating the avoidance of social anxiety experienced in in-person counselling. Online counselling offers several unique factors which meet students' needs. Potential implications and recommendations for Kooth, other online counselling services and counselling psychology are considered.

Background: Despite growing media interest into the effects of organised sport on children and young people's mental health, there remains a dearth of research in this area. The study therefore aimed to explore sport professionals' views of how football academies support the mental health and wellbeing of academy footballers. Methods: A qualitative design was utilised to generate a rich dataset to gain insights into the views of sport professionals. Eleven individuals who worked at football academies were interviewed for this study. Reflexive thematic analysis was engaged with in order to identify key themes within the interviews. Findings: The analysis led to the creation of three major themes related to the experience of sports professionals in football academes. These were: (i) understanding the uniqueness of the culture and experience; (ii) the therapist's role; and (iii) integrating the role (finding a place for therapy). Conclusion: The findings support existing literature and government initiatives with a collective agreement of aiming to improve the facility of mental health support within football academies. Reflecting upon the findings and existing literature, a unique approach to integrate therapy within academy football is proposed. This emphasises a need for therapeutic support across the whole academy system. A collective term was coined within this research as 'The Three Ps' (the players, their support network (parents), and the professionals). This requires applied psychologists to offer support in ways that do not alienate them from the football academy community. Suggestions and implications are discussed, including the provision of flexible holistic support, tailored athlete-centred therapeutic practice, and counselling acting as a platform to connect the whole academy community. Further research is required to assess bi-directional communication between counselling and psychotherapy and football academies to ensure that therapy is adaptable throughout the environment.

Background: Despite numerous benefits to being online, a digital inequality exists; where those with intellectual disabilities often have their internet access and use restricted, as a result of barriers, such as gatekeeping (Chadwick et al., 2013, 2017). Large gaps in the literature exist, in relation to the online risks which people with intellectual disabilities may encounter and how experiencing online risks may impact people with intellectual disabilities. In better understanding the online risks experienced, and how they impacted people with intellectual disabilities, we can better support people with intellectual disabilities to manage these threats as part of a positive risk-taking approach to internet membership, thus closing the digital inequality divide (Seale, 2014; Seale & Chadwick, 2017). This thesis addresses these gaps and seeks to contribute to counselling psychology's social justice agenda by improving digital inclusion, through better understanding online risks for adults with intellectual disabilities. Method: Fifteen adults with intellectual disabilities were interviewed remotely using semi-structured interviews. Findings: The data from the interviews were analysed using Template Analysis, which evidenced four main themes: 1) The Types of Online Risk; 2) The Psychological Impact of Online Risk; 3) The Management of Online Risk and 4) The Support for Online Risk. The study findings offer novel insights, where all participants had knowledge of online risks, and those who had experienced victimisation reported experiencing a wide range of negative emotions immediately following the event, but in some instances, there was also personal growth, and the majority of participants were able to delineate different coping strategies which they use to manage online risks. The implications and recommendations based on the findings for practitioners including counselling psychologists are outlined. The researcher provided an original contribution to knowledge in the form of phenomenological experiences of adults with intellectual disabilities of online risks, including online negative comments and/or messages.

Despite the long-standing interest of psychological research and practice in group dream sharing and group dream work, to date no research has been conducted examining group dream experience (GDE) of psychotherapists. Furthermore, GDE has not been considered in the context of Counselling Psychology. In this thesis GDE as a term is used to refer to a generic expression of psychotherapists' complex experiences of participation in, and facilitation of, dream sharing and dream work in groups. It was assumed that GDE can be noted during a collaborative effort within a group to explore and share transpersonal meaning outside individual understanding of a dream recalled from sleep, for the purpose of gaining insight and awareness. The range of group techniques from different modalities for working with dreams may evoke GDE. This study explored psychotherapists' GDE from the psychoanalytic, Gestalt and Social Dreaming groups. The qualitative method of Thematic Analysis was used to process the data from individual interviews conducted via Skype with seven participants, and one face-to-face focus group interview conducted with a group of five psychotherapists. Three overarching themes were identified: In-action GDE, On-action GDE and GDE as a whole. These three aspects of GDE were distinguished as a result of overseeing the whole data set. This differentiation considered subtle differences in the experiences, depending on where they were situated in time and space in the participants' lives, with the acknowledgement of the potential 'superposition' of all three aspects. The findings were contextualised through the integration of theoretical literature and useful analogies from different disciplines, including psychology, anthropology, sociology, physics, and computer science. This thesis argued that GDE is a complex nebulous experience which is hard to articulate. It involves the processes of construction, deconstruction, and reconstruction of meaning, facilitated by dreams shared in a group. Based on the findings from this research, GDE is viewed as an opportunity to approach and cross a certain threshold of awareness that expands past everyday reality, thereby playing a part in promoting Professional Maturation.

There is growing recognition of parental alienation [PA] amongst family courts and social workers within the United Kingdom [UK]. PA primarily occurs in family custody disputes, where there is manipulation of a child by one parent against the other. This study was developed to address the complexity of the phenomenon by exploring how aware psychological practitioners are of PA, how they meaningfully construct PA, and the implications this may have for clinical practice. A qualitative approach was utilised using a social constructionist grounded theory [SCGT]. Data were collected through semi-structured interviews in two stages, with eight psychological practitioners (including one negative case analysis). Data gathering and analysis followed the grounded theory [GT] methodology. The analysis of data reflects how psychological practitioners utilised 'Conceptual Manoeuvring' to develop an emerging interpretation of the meaning of PA. Three key sub-processes were identified: (1) using pre-existing knowledge to open a new interpretative space; (2) co-constructing parental alienation; and (3) becoming aware. The analysis found that there are multiple ways in which participants co-constructed the meaning of PA, which had multiple implications for the consideration of psychological interventions and practice. As part of conceptually manoeuvring PA, all participants were able to recall possible cases of PA in their clinical work with individuals. However, for seven participants, their understanding of PA was initially based on assumption, due to an identified lack of self and others' awareness. This appeared to raise uncertainty when considering relevant psychological theory and intervention for PA; but despite this, counselling approaches appeared more favourable. It was indicated by seven participants that due to the relational aspect to understanding PA, counselling approaches (such as Humanistic and Psychodynamic) appeared more favourable in comparison to Cognitive Behavioural Therapy [CBT] approaches. However, some CBT interventions (such as cognitive restructuring) were considered helpful. A negative case analysis was purposefully sought to strengthen the GT following interviews with seven participants. The negative case analysis reflected similar conceptual manoeuvring to construct PA; however, their construction of PA and consideration of therapeutic interventions provided richer insight into the phenomenon and appropriate interventions. The implications of the research appear to highlight the gap in awareness of PA among psychological practitioners within the UK, a need for defining terminology, the construct of PA, and identification of evidence-based treatment. This research has contributed towards developing awareness of PA and provides recommendations for future research.

This qualitative study explores the lived experience of previous self-harm in the context of school bullying. Based on semi-structured interviews conducted with a purposive sample of seven young adults, the study uses Interpretative Phenomenological Analysis to investigate the specific meaning attributed by participants to their own experiences. Four superordinate themes emerge from the data: dealing with rejection; expressing self-hatred; screaming alone and in silence; and taking back the pain. Participants in this study give meaning to their self-harm in the context of bullying as a way of physically expressing both negative interpersonal and intrapersonal dynamics. Lack of belongingness; perceptions of unsupportiveness and invalidation from others; strong tendencies to withdraw and keep struggles hidden; intense self-hatred and desire to punish the self; and a need to escape and seek distraction, characterise participants' understandings of their experience. This study adds support to the affect regulation theory of the relationship between bullying and self-harm; raises awareness that loneliness is a central mediator in this relationship; and strengthens the understanding that unsettling school environments are critical in adolescents' bullying and self-harming. As the first qualitative study the author has come across on the subject, it reveals participants' accounts that self-harm, whilst in many ways hurtful, is a way of escaping from the bullying-related pain, and that no theory can, by itself, explain the complex functions of self-harm within this context. The findings of this study can be useful for future research and can hopefully have beneficial implications for the practice of Counselling Psychology.

Background: Research specific to Muslim minority perspectives on social media representations of Islam remains limited and literature pertaining to Pakistani Muslim students' experiences of the phenomenon almost non-existent. This study makes an original contribution by examining social media depictions of Muslims and Islam from the perspective of Pakistani Muslim HE students. Given its commitment to issues of difference and diversity (in the context of wellbeing), it is important for counselling psychology to examine this subject. Methodology: A qualitative design was adopted to explore the perceptions and experiences of six Pakistani Muslim students attending university education in Britain. Semi structured interviews were conducted and an IPA approach was used to analyse the transcripts. Findings: Four key super-ordinate themes were identified: 'The self and the (perceived) other', 'Understanding exposure and influence', 'Making sense of intersecting identities' and 'Processing and coping'. Conclusions: Negative social media constructions of Pakistani Muslims (and Muslims in general) were found to be relevant to participants' experiences of perceived discrimination, microaggressions and racist abuse (in both online and offline contexts). Participants' subjective processes of rationalisation and normalisation allowed them to make sense of and cope with hateful expressions towards their ethnic and religious identities. Also imperative to their processes of coping, were participants' positive experiences within British HE institutions. These findings taken together are aimed at offering an understanding of the discursive power of the social media particularly in forming perceptions pertaining to racialised identities. The potential implications, limitations and recommendations for future research are discussed.

Animal Assisted Therapy (AAT) is a psychotherapeutic approach that uses animals in a therapeutic capacity and can be used as an adjunct with a range of practices such as different psychotherapeutic modalities. Despite its relatively long history, more robust research is needed to increase AAT's evidence-base. There is a relative lack of research in AAT practice from a practitioners' perspectives. The aim of this qualitative study was to explore how practitioners use AAT in their clinical practice. Ten participants were interviewed about their experiences of using AAT in their clinical practice. Thematic analysis was used to analyse the data. Three main themes emerged from the analysis: The Psychotherapeutic Encounter, Multi-Faceted Relational Process, and Challenges and Opportunities in AAT. The findings revealed that practitioners who used AAT utilised features of the therapy animal, with elements of nature and incorporated it into working in the moment. In addition, the findings revealed the relational dynamics between the client-animal, practitioner-animal, and that AAT is more than a dual therapeutic relationship. The findings also revealed the challenges and opportunities of using AAT within psychotherapy. The study has implications in the areas of better understanding and enhancing the therapeutic relationship in AAT, integrating AAT into counselling psychology practice and identifying potential areas for future research.

According to previous literature, trainees, in general, experience significant self-development during their training. In particular, individuals entering higher education, may develop many skills associated with self and experience identity development (Cast & Burke, 1999), which may impact on their romantic relationships. The present study investigated trainee and qualified counselling psychologists' self-development during their doctoral journey and, specifically, set out to investigate, how romantic relationships can be impacted by the doctorate training or related self-development. A constructivist-subjectivist standpoint was chosen, and qualitative semi-structured interviews were conducted with 4 trainees and 5 qualified counselling psychologists from four UK universities. The data was analysed according to the categorical-content interpretive narrative model of Lieblich et al. (1998). Overall, the study found that participants reported experiencing self-development which enhanced their reflexivity, self-awareness, personal attributes, values and goals. Elements of the doctoral programme also influenced participants' romantic relationships positively and negatively, some in more direct ways including separation from partners as a direct result of self-development and the doctoral training. Analysis generated three main categories. Firstly, Developing academic and clinical practice experiences as the foundation for self-development. The second category was: The doctorate's negative and positive impacts on the romantic relationship. The third category was: Self-development and its impacts on the romantic relationship. This research enriches existing literature, and it also informs understandings of the need to create a supportive higher educational culture, to develop support groups in order to protect students and to promote the experience of a joyful personal relationship as also relevant to a fruitful doctoral journey. This study, therefore, increases awareness of issues that occur for professionals to work in clinical settings and also contributes to the theoretical understandings of love and romance within the higher education setting, that still maintain an important component of trainees' experiences. Related future research could investigate trainees' potential vicarious trauma during their clinical practice and its impact on their romantic relationships.

Gelotophobes have a negative attribution bias skewing appraisal of laughter meaning expressions of joy negatively affect interpersonal interactions and could be a barrier to positive outcomes in therapy. This study investigated participants' perceptions of gelotophobes and non-gelotophobes responding to expressions of joy and examined whether the empathic underpinnings of counselling psychology afforded greater empathy and was a predictive factor in correctly identifying facial affect. This study was a quasi-experimental design employing a quantitative method. Participants (N = 144) consisted of counselling psychologists (CP) (n = 44), non-psychologists (NP) (n = 54), and psychology other (PO) (n = 46). Participants were shown emotional stimuli, pre-coded using Facial Action Coding System (FACS), depicting gelotophobes and non-gelotophobes responding to expressions of joy and asked to identify the emotion from a choice of seven basic emotions. Participants also completed the Interpersonal Reactivity Index (IRI) and the Empathy Quotient (EQ) questionnaires to discern affective and cognitive empathy levels. Results found significant differences in the correct identification, and perception, of non-gelotophobes' and gelotophobes' facial affect. CP had significantly higher levels of cognitive empathy and identified significantly more gelotophobe emotional states than NP, but differences with the PO were non-significant. There was also a positive correlation between cognitive empathy and number of emotions correctly identified. Cognitive empathy, however, did not mediate between participant group and correctly identifying gelotophobes' facial affect; as such, further research is needed to understand these findings. There were also no significant differences in affective empathy. Research highlights factors contributing to gelotophobes' interpersonal difficulties, a factor in the development of gelotophobia, as well as factors that will facilitate positive therapeutic outcomes.

Research has established that a constitutive theory of language and the interrelations between knowledge, power, and subjectivity have provided a useful framework for understanding how social and cultural forces come to form subjectivity, identities towards certain possibilities. Richards (1997) has looked at the emergence and establishment of racism as a social construction. This thesis has been inspired by the work of various feminist, postcolonial and antiracist theorists including Foucault and Fanon. Given the limited studies of how racism can be addressed by counselling psychology, the first aim of this research was to understand counselling psychologists' accounts of encountering racism towards other groups of people in the therapy practice. The second aim was to explore what a discursive perspective brings to our understanding of the (de)construction of racism in therapy. Implications for the profession of counselling psychology in promoting an anti-racist practice have been provided. This is a qualitative study adhering to a social constructionist epistemology and a relativist ontology. Six counselling psychologists were recruited to the study. The accounts were generated via semi-structured interviews and they transcribed and analysed by Foucauldian Discourse Analysis (FDA). The analysis suggested that potential reasons for reinforcing racism appeared to be linked with the White supremacy and with Colonialism. Dominant discourses of power appeared to be aligned with other systems of classification including class, education and status. Therapists' strategies included deconstructing Otherness and promoting awareness and dialogue around issues of oppression and racism. This study claims to make its contribution to knowledge in three main areas; conceptual, methodological and practice-related interventions.

Background and aims: Time to PhD completion is a pressing concern for universities in the United Kingdom and internationally, including the United States and Australia. It impacts students, universities and economies through resource use and students' psychological wellbeing. Therefore, this study aims to identify, and determine the interaction between, the psychological influences on timely PhD completion by building a conceptual model of the process. Method: 10 current or former PhD students from a Russell Group university in the United Kingdom participated in one hour unstructured interviews about their PhD journeys. Interviews were audio-recorded, transcribed verbatim and analysed in CAQDAS (computer-assisted qualitative data analysis software) using a grounded theory approach. Findings: All students reported intending to complete on time, yet more than half either had not completed or expected to complete in the time specified by their programmes. A core category, making progress towards goals was identified as a central concern to participants. Four sub-core categories of the core category were generated: goals and expectations, motivation, engagement and managing wellbeing. Goals set direction, yet may shift over time and are influenced by students' expectations of timely completion through departmental normalisation of longer completion. From the structural conditions around the student, the most significant category identified as influencing timely completion was effectively meeting the needs of the student through a supportive supervisory relationship. Across the model, affective connections to the PhD experiences impact on students' wellbeing and timely PhD completion. Conclusions and implications: The research indicated the degree of internalisation of the institutional goal of timely PhD completion varies, not just for the student but also in the departmental culture around the student, including the supervisory relationship. Encouraging timely completion may be achieved through autonomous motivation support, particularly in the supervisory relationship, to encourage passion for the research project, minimise students' negative affective associations with PhD completion and promote wellbeing. Counselling psychology is well-positioned to contribute to the development of autonomy support interventions in universities through coaching programmes, supervisor training and psychological interventions for doctoral students. Suggestions for future research are to explore in greater depth connections between areas of the model through qualitative and quantitative research, using data from students and other university actors, in the UK and other PhD systems.

Background: Primary Care Psychological Therapy services (PCPT) face pressure to deliver effective services due to the increasing prevalence, complexity and societal costs of Common Mental Health Disorders (CMHDs). Furthermore, commissioners and managers deliver services within a complex system of evolving policy and healthcare practice where successive policy changes, such as Improving Access to Psychological Therapies (IAPT), have significantly shaped PCPT design. Any Qualified Provider (AQP) represents one policy aimed at addressing financial pressures, extending patient choice and stimulating quality-assured competition. AQP shares features with several NHS developments which will arguably impact Counselling Psychology going forward, such as partnership working in 'Sustainability and Transformation Partnerships', and the increased use of 'Payment by Results'. However, to date, there has been little significant discourse within Counselling Psychology around AQP, service design and the practical implications of policy changes. Aims: This research investigated the impacts of AQP on existing IAPT services and considered implications for Counselling Psychology in the context of policy change and new models of care for effective PCPT. It aims to inform and support clinical leaders with an awareness of the wider impacts of policy to improve the real-world effectiveness of services to address the rising problems with mental health. Method and analysis: Semi-structured interviews with a cross section of commissioners and managers in different regions and organisations generated leadership perspectives on AQP. Thematic Analysis offered a broad overview of the impacts of AQP in IAPT. Results: Four superordinate themes were identified: Resources and AQP delivery; Partnership working in AQP; Bureaucracy in AQP; and Patient experience in AQP.Conclusions: AQP offers insights into the partnership working of clinical leaders in a local IAPT service, and their adaptations to financial and bureaucratic pressures. To address increasing CMHDs, PCPT needs adequate funding to provide quality patient-centred care. Clinical leaders are willing and able to work within new quasi-market structures, but they prioritise clinical and relational values. Policy makers should embed these values in policies impacting PCPT to ensure the quality of services. This is an area where Counselling Psychology could - and should - engage more effectively with service design and policy.

Schizophrenia has long been a contested and controversial psychiatric diagnosis. Over the last six decades, research has consistently demonstrated that Black, Asian and Minority Ethnic (BAME), specifically people of Black African and/or Black Caribbean descent in the United Kingdom (UK) are more likely to face mental health inequalities and be diagnosed with schizophrenia in comparison to other ethnic groups (Fernando, 2002; 2008; 2010; Read & Dillon, 2013b; Nazroo, 2020). However there has been a paucity in research into the lived experience of receiving a diagnosis of schizophrenia. This research seeks to contribute to the field of counselling psychology and allied professions by exploring the lived experience of receiving a diagnosis of schizophrenia amongst this specific population. The phenomenon was investigated by adopting Interpretative Phenomenological Analysis (IPA) (Smith, Flowers & Larkin, 2009). Semi-structured interviews were conducted with eight participants and subsequently analysed using IPA. The Six-Stages of Analysis was used (Smith et al., 2009) as a process of interacting with the data within an inductive and iterative cycle (Smith, 2007). The consisted of close interaction between the researcher and the text, using line-by-line analysis of each participant’s transcribed interview (Smith et al., 2009). The findings revealed that participants were engaged in a range of meaning-making processes regarding their experiences relating to the diagnosis. Four super-ordinate themes emerged from the data: ‘Schizophrenia is a form of social control’, ‘Living with schizophrenia is a dynamic sentence’, “A spiritual dimension to this experience” and ‘Being Black in the mental health system’. The findings highlighted that receiving a psychiatric diagnosis is not a static event located at one point in time. Rather it is a multifaceted process that is engaged with by the recipient on multiple levels beyond the diagnosis. The implications for Counselling Psychology and allied fields are reviewed, as well as limitations and suggestions for future research were discussed.

This study aimed to develop a constructivist grounded theory (CGT) of how counselling and clinical psychologists understand and sustain resilience in the context of their work within the National Health Service (NHS). Recent surveys have highlighted that NHS mental health practitioners report high levels of professional burnout and low levels of job satisfaction due to increasing demands, with workers required to meet ever higher targets. Resilience, conceptualised as the ability to sustain professional effectiveness, fostering psychological wellbeing, is suggested to be a protective factor against burnout. Despite its relevance, there is no research that explores the mechanisms of resilience in the NHS. Therefore, the current study recruited nine counselling and clinical psychologists who identified as resilient, and, as part of a negative case analysis, a cognitive-behavioural therapist and a clinical psychologist who didn’t identify as resilient. Participants were interviewed about their experience of resilience in the NHS. The interview data were subjected to a grounded theory analysis. The theory developed proposes that values, and in particular the extent to which a practitioner’s personal and professional values align with the values of their organisation, appear to play a central role in the way resilience is experienced and negotiated. The overarching aim of this study was to develop insights that may enhance the provision of support for the NHS psychology staff. Recommendations include suggesting that employers take a more active role in supporting psychology staff wellbeing, the need for more effective communication between practitioners and management, as well as potential implications for training. Suggestions for future research include exploring a male perspective and non-psychologists, using discursive approaches to investigate resilience within this context, as well as investigating further the possible link between alignment of values and resilience in the NHS.

Background and objective: Homelessness is a growing issue in the United Kingdom (UK). Counselling psychology in the United States of America (US) has made working for social justice a part of its professional identity and recognises that engaging with individuals experiencing homelessness is part of this work. There have been calls for the discipline in the UK to follow suit in making social justice work a part of its identity and recognising homelessness as an issue of social justice. Homelessness is largely absent from UK counselling psychology literature and it is important for training programmes to consider how they can support and prepare trainees to engage with individuals experiencing homelessness. The purpose was to explore the experiences of individuals who had engaged in psychological therapy while homeless to learn what they found helpful or unhelpful in the therapeutic process. As well as this, perspectives were sought from psychological therapists who had worked with individuals who were homeless to learn what aspects of their training were helpful or unhelpful in preparing them for this work. The aim was to identify ways that therapeutic training programmes can prepare trainees to engage with people who are homeless. Method: Data was collected from two participant groups. Individual interviews were completed with eight psychological therapists who were recruited from organisations throughout the UK, and a focus group focus group with the seven individuals who were homeless and recruited through a hostel. An inductive thematic analysis was carried out on the interview data to find out what would be helpful in therapeutic training, and on the focus group data to find out what was helpful in the therapeutic process. A template analysis was then carried out on both data sets to identify recommendations for how therapeutic training programmes could support trainees to engage with individuals who are homeless. Findings: The themes identified from the inductive analysis of the interviews were: Preparedness to work therapeutically with individuals experiencing homelessness, Awareness of homelessness as a context, The therapeutic process: Approaches & Challenges, and The therapeutic relationship (Therapist's perspective). The one theme identified from the inductive analysis of the focus group was: The therapeutic relationship (Client's perspective). The codes identified from a template analysis of both data sets were: Specific input on homelessness, Issues of social justice, and Wider Influence of Psychology. Conclusions: This research highlights differences in therapists' feelings that their therapeutic training was helpful in preparing them to work with individuals experiencing homeless, suggesting a further disparity in the extent to which trainees are being taught about homelessness and social justice across therapeutic training programmes in the UK. Individuals who received therapy while homeless consider power to be a key consideration in the maintenance of the therapeutic relationship. This research provides several recommendations about how therapeutic training programmes can support trainees to engage with individuals who are homeless through the provision of designated training, research, and practice opportunities. The wider implications of this research for other professions is also discussed.

Background: Despite the dominance of psychiatric diagnosis within mental healthcare systems, there is no validated measure of diagnosis impact on those who receive them. Consequently, there is also a paucity of statistically generalisable research on the experience of receiving and living with a diagnosis. Aims: To develop a valid and reliable measure of the effect of psychiatric diagnosis on recipients, the Diagnosis Impact Scale (DIS), for clinical and research use. Method: Measure development protocols used included the generation of an item pool, expert rating of items, and Three Step Test Interviews. Psychometric properties of the DIS were investigated, including internal consistency, convergent validity, discriminant validity, and criterion validity. A principal components analysis was carried out on a sample of 248 people with psychiatric diagnoses, followed by a two-parameter IRT analysis. Findings: The principal components analysis suggested that the 19-item DIS had two discrete subscales: Helpfulness of Diagnosis and Diagnosis-Related Self-Stigma. Each displayed excellent reliability in this sample, with Cronbach’s alphas of 0.93 (n=256) and 0.81 (n=263) for Helpfulness of Diagnosis and Diagnosis-Related Self-Stigma respectively. They were also found to have acceptable content and construct validity. Significant associations were found between both subscales and diagnosis type, perceived correct diagnosis, receipt of treatment due to diagnosis, and helpfulness of said treatment. Helpfulness of Diagnosis was significantly associated with age and time since diagnosis. Diagnosis-Related Self-Stigma was significantly associated with having multiple diagnoses, the number of these, and the type of healthcare professional who gave the diagnosis (e.g. GP or psychiatrist). The two-parameter IRT analysis showed that both subscales were within acceptable ranges for discrimination and differentiationbetween strength of attitude.

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.

The potential psychological phenomena of a client's subjective experiences are commonly overlooked by clinicians as it is common practice to jump into a diagnosis and a biological explanation (Kaplan,1964). The area of interest was to appreciate and elucidate people's experiences of psychosis and the meaning of these experiences constructed in their published story. The subjective and meaningful experiences of people who experienced psychosis are explored to understand their sense making experiences. I have chosen an inductive explorative qualitative design through the Narrative Analysis approach, and used from the Lieblich holistic-content interpretive model (Lieblich et al., 1998) two different dimensions (content and holistic). Through narrators' stories, I explored the sense making experiences constructed, and the emergent global holistic themes from the four stories. Findings suggest that sense making involves narrators' understandings of distinctive aspects of their lives that eventually lead to meaningful experiences. It was also an ongoing process of increased awareness of searching for the truth. This 'quest' resulted to sense making associated with early adverse experiences (such as developmental trauma), Christian faith (human suffering and love being the key source of meaning) and of spiritual dialogues and growth. Narrators' experience of psychosis was also considered as spiritually hopeful, life changing and enriching in a lot of ways. It also facilitated growth and healing through existential and meaningful awareness of the world around them. The holistic global themes emanated from the analysis of each story, showed the following four themes: 1st Story - Formation and progressive growth of self-identity; 2nd Story - Growth and healing from reconnecting to Jewish cultural and spiritual heritage; 3rd Story - Experiencing madness across a tormenting emotional passageway of altered self, existential and meaningful awareness; 4th Story - Spiritual explanation of human suffering, through faith, proved to be nurturing. I further considered the Counselling Psychology clinical implications, how my findings inform clinical practice with people who experience psychosis and how this new knowledge may be applied to enhance our research and clinical practice to enable professionals offer a meaningful support to restore the human aspect of the experience and provide hope for a positive change and well-being.

The need for professionals to develop multicultural awareness, knowledge and skills has been recognised in literature and mental health practitioner programmes since the early 1970s. Despite the professional growth of the Doctorate in Counselling Psychology (DCoP), recent research still suggests that cultural competency skills must be further emphasised and developed in training courses. Following an integrative philosophical model, this study adopts a mixed methods approach including interviews and cross-sectional surveys to explore how cultural competency skills are facilitated in DCoP training or acquired by professionals compared to biomedical trainees and professionals. Interviews were conducted with the DCoP course directors, while the Lie scale (Eysenck, 1976) measuring social desirability and the Healthcare Provider Cultural Competence Instrument (HPCCI) (Schwarz, Witte, Sellers, Luzadis, Weiner, Domingo-Snyder, 2015) measuring level of cultural competency skills, were administered to the DCoP and biomedical groups. I hypothesised that the DCoP trainees will score significantly higher on cultural competency compared to trainees from other training programmes and this proved not significant. The results have implications for further developments of cultural competencies in counselling psychology and biomedical training courses.

Background: Developmental and psychoanalytic research findings suggest that early face to face interactions with caregivers play a significant role in the construction of an individual’s sense of self and that disruptions to these interactions can have negative consequences for social and emotional development. However, there is currently a significant gap in the research literature regarding how the sense of self is constructed in individuals who have limited or no facial expression due to conditions such as congenital facial palsy. Consequently, little is known about how the sense of self develops in these individuals. The aims of this study were twofold: to explore the construction of ‘self’ in individuals living with this condition and to construct a grounded theory of this process. It is hoped that these findings will add to the limited literature in this area and be used to develop specialist psychotherapeutic interventions for those living with this condition. Method: A constructivist Grounded Theory methodology was adopted, and a purposive sampling strategy used to recruit the initial sample. Semi structured interviews were conducted with fourteen adults (8 male and 6 female) with a diagnosis of congenital facial palsy; eight interviews were conducted face to face with participants in the USA and six via Skype with participants in the UK. In the final stages of the analysis theoretical sampling was used to recruit two parents of children with congenital facial palsy. Participants were asked about their experiences across the lifespan of living with congenital facial palsy and their constructions of self were explored. Findings: Participants’ retrospective accounts suggest that living with congenital facial palsy negatively influences communications with caregivers and others across the lifespan. Participants’ accounts suggest that two separate self-states were constructed through their interactions with others; a ‘“defective me”’ and a “validated me”. Participants described how the ‘“defective me”’ self-state was constructed through the following relational processes; ‘struggling to make connections’, ‘experiencing invalidation,’ and ‘struggling with affect regulation’. Conversely, several participants described how the construction of a “validated me’’ self-state occurred through; ‘making validating connections’. Those participants who described the ability to move more fluidly between self-states described better psychosocial outcomes as they recovered more quickly from negative interactions with others. Conclusion: The findings of this study highlight the central role that the face occupies in the construction of the ‘self’ and the unique challenges those with congenital facial palsy are likely to experience in constructing a validated self-state. It is suggested that psychotherapies which focus on healing the non-verbal sense of self may be one effective approach to working clinically with this population.

The majority of clothing-related research has concentrated on anthropology and social psychology, suggesting that clothing can impact the wearers behaviours, mood and cognitions and that first impressions are formed rapidly with great accuracy. In light of this knowledge, a gap in literature on professional attire within therapy orientated research was identified. Whilst clothing oneself is an everyday practice, its ubiquity has rendered it almost invisible as a focus of psychotherapy research. Clients’ preferences regarding therapists’ clothing have been researched quantitatively with highly inconclusive results. Additionally, some advice on self-presentation exists in the form of blogs, with few connections to research. The main aim of this research was to explore the views around the professional attire of counselling psychologists and to answer the question “How do counselling psychologists view and make sense of their attire in clinical work?”. Additionally, whether counselling psychologists can regard attire as an added source of information about the self. A variety of sampling strategies were used to recruit participants. Inductive thematic analysis was chosen to engage closely with data in an under-researched subject and additional research questions were developed during the analysis. Eleven semi-structured interviews were conducted with qualified counselling psychologists in the UK; four males and seven females participated. The interviewees’ ages ranged from 33 to 91, with their experience of private practice ranging from 1 to 13 years. Three themes were identified. ‘Shall We Talk About Attire?’ illustrated the ambivalence surrounding the importance of discussions about attire. The second theme: ‘You need to look the part; became an echo of clothing practices beyond specific garments and was explored within three further sub-themes that grapple with what this part might actually look like. The last theme, ‘Underneath our clothes’, pointed to attire being used beyond simply being dressed, but as a way to enhance the therapeutic relationship, reflect congruence and acknowledge that clients notice us. The results highlight that counselling psychologists consider attire and their visual self-presentations to be an important aspect of clinical work, even if rarely discussed. This study is unique in empirically investigating the issue of counselling psychologists’ attire and its findings are transferable to other helping professions. Further implications for counselling psychology and avenues for additional research are discussed.

This study is concerned with exploring the lived experiences of six mothers who have experienced anorexia while raising their children. This group of women are currently under-represented in the eating disorder and anorexia literature. Much of the current literature on anorexia focuses on younger people; particularly young women. The limited literature that does exist on mothers with anorexia is often pathologising, where the women are represented as being needy, defiant and oppositional to treatment, or are signified as failing as mothers in important respects. The six women participated in telephone interviews that focused on how they made sense of their experiences of mothering and in seeking and receiving psychotherapeutic interventions for anorexia. Interpretative phenomenological analysis was used to analyse the data. Three super-ordinate themes captured the ways in which these women made sense of their experiences. The first theme ‘We live in an Alice in Wonderland world’ illuminated the women’s feelings of ‘otherness’ through experiences of (in)visibility, shame and engaging with an anorexic identity. The second theme: ‘The windowsill syndrome’ highlighted the competing demands of motherhood and anorexia that were described by the women through the course of their narratives. The final theme: ‘Fuck you, don’t give up on me’ explored the diverse experiences of support and recovery, expressed through the stories the women told. The findings are examined in the context of dominant and feminist discourses on motherhood and anorexia. The utility of these findings for an increased psychological understanding of, and improved interventions for, mothers experiencing anorexia is also discussed. I argue that a focus on formulation, rather than diagnosis, would allow for a holistic perspective from which to inform help and support. Therapeutic interventions that acknowledge the life-world of the client offers a whole person focus that has often been lacking in therapy for the experience of anorexia. (The use of the word ‘treatment’ is part of a medicalised discourse and has been used sparingly in this research, primarily when discussing research that uses this term).

This qualitative study aimed to hear the subjective lived experiences of adults who experienced parental death during adolescence in order to gain insight into how their experience has impacted them from adolescence to adulthood. The findings from this research endeavour to contribute to a theoretical understanding of this experience and highlight the clinical implications for Counselling Psychologists working with individuals who have experienced parental death during adolescence. An Interpretative Phenomenological Analysis was the methodological design used to facilitate an understanding of how participants make sense of their experience. Seven participants were recruited via a purposive snowball sampling method. Participants spoke about their experiences of parental death from adolescence to adulthood in 45-50-minute semi-structured telephone interviews which were then transcribed and analysed. The Findings illuminated the following four superordinate themes, Managing Emotions, Interpersonal Changes, Complex Grief and Positive Changes. Participants appeared to have an impaired ability to manage and regulate their emotions relying instead on maladaptive coping and defence mechanisms to attenuate their emotions. This could be attributed to their difficulties with grief expression, lack of support in both aiding their grief and helping the development of these regulatory skills. Emotional regulatory difficulties could also be symptomatic of their unique developmental period. Participants appear to exhibit an array of symptoms pertaining to the diagnosis of Persistent Complex Bereavement Disorder (DSM-5, 2013) and Prolonged Grief Disorder (ICD-11r, 2018). Participants reported experiencing vast interpersonal changes and experienced subsequent attachment difficulties which were influenced by a range of developmental, psychological and psychosocial factors and stressors post parental death. Although indicators of growth were also apparent, the findings support the potential association of parental death in adolescence to ongoing developmental, psychological and psychosocial effects, from adolescence to adulthood. Implications for Counselling Psychologists’ clinical practice, training and consultancy have been addressed. How the humanistic and psychodynamic counselling framework addresses the needs of the individual parentally bereaved in adolescence are illuminated. Furthermore, a range of directive and non-directive therapeutic interventions and clinical suggestions have been recommended as Counselling Psychologists work in an integrative manner in line with the nuanced need of the individual client. Early intervention inclusive of a comprehensive complex grief assessment and a developmentally informed formulation is suggested. Psychological therapy to aid the development of emotional regulation skills is also suggested. Parent-child/Family therapy and a range of treatment and preventative initiatives and interventions across the education, health and community sector is recommended with both the bereaved individual and existing family.

Background: Sexual abuse is a highly distressing traumatic experience that negatively affects the lives of sexual abuse survivors. The number of individuals who reported sexual abuse has increased, which makes it a public and global concern. As a result, survivors of sexual abuse turn to counselling to cope with the traumatic impacts. Counsellors, psychotherapists, and psychologists engage in deep and meaningful explorations of the sexual abuse in order to support survivors. However, very little is known about the impacts and coping strategies involved in this type of work. Objectives: The objective of this study, therefore, was to explore the experiences of UK-based counselling professionals who counsel survivors of sexual abuse. The research questions were as follows: 1. What is the impact of counselling survivors of sexual abuse? and 2. What self-care strategies and coping techniques have been beneficial when counselling survivors of sexual abuse? Method: An inductive qualitative design was used for the purposes of this study. Semi-structured interviews were conducted with twelve UK-based counselling professionals who provided counselling to individuals who had experienced sexual abuse. The collected data were then analysed using thematic analysis. Findings: The themes developed from the first research question revealed a number of ways in which counselling survivors of sexual abuse affected counselling professionals. Three main themes emerged from the data analysis: work-related impacts, impacts on personal wellbeing and relationship impacts. These themes encompassed a total of fourteen sub-themes. Another two main themes were developed when exploring participants' self-care techniques and coping strategies: holistic self-care and work environment selfcare. Both of these main themes incorporated twelve more sub-themes. These are introduced and outlined in depth in turn. Conclusions: This research has provided a unique insight into the impacts and coping strategies of UK-based counselling professionals working with survivors of sexual abuse. The findings suggest that the counsellors experienced a number of negative impacts, some of which were perceived as traumatic in nature. Further, the impacts were not limited to the counsellors themselves; partners, children, extended family, and friends were also affected by the work. Such far-reaching impacts of sexual trauma have not been sufficiently explored previously. Contrary to the negative tendencies expressed in the research literature, some of the findings indicate positive aspects, such as high job satisfaction and evolved personal growth. The findings of this study provide a rare insight into the useful self-care techniques and copings strategies specific for counselling survivors of sexual abuse. Although the strategies are similar to those used in other areas of counselling, they emphasize organisational and educational responsibilities to support counsellors' wellbeing. Suggestions are proposed for research, educational, organisational, and ethical developments.

Dual Diagnosis (co-occurring mental health and substance use issues) is a pressing issue in health services. Despite its prevalence, research has demonstrated problematic practitioner-client relations; including stigmatisation and service-exclusion of clients, and confusion and fear among practitioners about working with this client group. There is also a referential ambiguity about the term dual diagnosis, and an absence of consensus among services about its definition. Dual diagnosis may therefore be considered a problematic discursive phenomenon, which is constructed in diverse and discontinuous ways. Practitioners’ experiences of working with dual diagnosis clients is an under-researched area, to date. Moreover, there is a dearth of research on dual diagnosis in general within the discipline of counselling psychology. To address these shortcomings this research aimed to investigate practitioners’ accounts of working therapeutically with dual diagnosis clients, to make visible these constructions and their power effects. Ten psychological practitioners (counsellors, psychologists and psychotherapists) were individually interviewed, and a Foucauldian Discourse Analysis was performed. The analysis identified several contradictory circulating contemporary dual diagnosis discourses, which circumscribed dual diagnosis practice. These discourses were deployed to resource five power-laden therapeutic subject positions. Four subject positions perpetuated asymmetric practitioner-client power relations, while one seemed to afford a more egalitarian practice. Overall, these findings are argued to contribute to the dual diagnosis literature by raising practitioners’ awareness of the power relations in their talk about working with clients. They may therefore offer practitioners a resource to develop a critical reflexivity in their practice, which may mitigate its harmful power effects. This is argued to be of particular relevance to counselling psychology, given its commitment to reflexivity and engagement with issues of power.

In the UK, proportionally fewer men attend counselling and psychotherapy services (British Association of Counselling and Psychotherapy, 2014; NHS Digital, 2018). Suggesting externalising expressions of distress, authors cite the increased rates amongst Western men of: completed suicide (Scourfield, Fincham, Langer, & Shiner, 2012), violence (Evans & Wallace, 2008), homelessness (Inckle, 2014) and substance misuse (Kiselica, Benton-Wright, & Englar-Carlson, 2016). Positioning masculinity as affecting the counselling process, this thesis addresses the question of how young men’s masculine identities interact with the counselling process and contextualises the impact of counselling on these identities. A qualitative, psychosocial narrative methodology (Hollway & Jefferson, 2013) and photographic elicitation was chosen to investigate the intrapsychic, interpersonal and wider social components of identity and gender (Evans, 2010). Eight men who attended at least 12 sessions of counselling or psychotherapy were twice interviewed. Categories emerging related to: needs and concerns around being in counselling whilst maintaining masculine identity; showing and acknowledging distress; negotiating counsellors’ subjectivity and professional authority; personal authenticity; and the effect of the researcher. Results suggest anticipated or actual power differentials between counsellors and clients can be addressed before and during counselling. Relational factors inside and outside of the counselling relationship, and the opportunity to express emotions seems to hold greater significance for masculine identities rather than practical or action-focussed elements. The specific demographics of participants are discussed along with wider implications regarding the barriers in accessing psychological support, how counselling services are represented and promoted, the training of counsellors and future research within the complex and dynamic topics of masculinity and help-seeking.

Despite constituting a sizeable minority ethic group and having been present for some considerable time, there is dearth of research on the lives of Chinese communities in the United Kingdom (UK), particularly those who identify as non-heterosexual. Using an intersectional framework and a constructivist grounded theory methodology, the present study aimed to produce a mid-range theory to clarify the main concerns of Chinese gay men who have migrated to the UK, and to understand and explain their responses to those experiences. Eight participants who self-identified as Chinese gay males took part in semi-structured interviews that were analysed using methods consistent with a constructivist grounded theory approach (Charmaz, 2014). The findings propose that participants' two biggest concerns relate to (1) disclosing their sexual identities to their families and at work, (2) and feeling rejected by other gay men due to a combination of sexual racism and sexual objectification. In response to these challenges, Chinese gay men utilise a range of coping strategies that include the use of psychological therapies. A core category, "making the best of both worlds" reflects the continual process by which men integrate the benefits of the two (or more) seemingly opposed alternatives, whilst navigating a whole host of psychological obstacles within a complex power structure, in order to be successful in their personal and professional lives. The findings are discussed in relation to their relevance to their profession of counselling psychology. Recommendations for practice and policy are considered.

Background. Counselling and psychotherapy services are under pressure to evidence clinical effectiveness. However, many of the outcome measures in use are based on the ‘disease model’: a paradigm that is at odds with several key psychotherapy approaches, including the humanistic approach. This has led to calls for psychometrically sound outcome measures that emphasise growth and well-being. One such measure is the Authenticity Scale (AS), based on the Rogerian concept of congruence. Authenticity is a core construct within humanistic psychology and the person-centred model of psychotherapy, and the measure has been developed specifically for use as an outcome tool for counselling and psychotherapy. Despite this, no research to date has assessed the validity of the AS in this way. Aims. The aim of this thesis is to investigate the psychometric properties of the AS, and how it functions as an outcome measure, specifically looking at its reliability, validity, acceptability, and sensitivity to change in a clinical sample. Methods. The thesis consists of two studies. Study 1 is a systematic review of the literature regarding the AS in general populations, collating psychometric data from 60 publications into a narrative synthesis and meta-analysis. In Study 2, a total of 67 clients receiving psychotherapy completed the AS and the CORE-10 periodically over the course of their therapy. Sensitivity to change was assessed using pre- and post-therapy comparisons, and multilevel modelling. Results. In Study 1, the AS showed excellent psychometric properties in the majority of samples, confirming its potential as a psychotherapy outcome measure. In Study 2, the AS was internally reliable in the clinical sample, and showed convergent validity with the CORE-10 measure of psychological distress. Multilevel modelling indicated that the AS was sensitive to change, with participants’ scores increasing significantly over the course of therapy. These findings indicate that the AS may be a psychometrically valid and reliable outcome measure for use in the psychological therapies.