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This thesis is a psychoanalytic engagement with fashion. It follows from established work in literature, film and visual art, and deploys psychoanalysis, particularly the work of Jacques Lacan, as a critical theory in order to interpret a particular cultural form. It departs from other psychoanalytic cultural criticism in that it takes fashion as the object of study. Although fashion is not art there are moments where it can be discussed in the same terms as art, and it is with these moments that this thesis is concerned. The instances of fashion under discussion are selected from the unusual, innovative, avant garde fashions that are seen in galleries and museums, in the bi-annual, international Fashion Week shows, and in photography editorials in fashion magazines. Kristeva’s notion of the avant garde as a mechanism by which intractable gender conventions can be critiqued is central to my definition of the feminine in fashion as pertaining to feminine subjects, usually but not exclusively women, as pertaining to and contingent upon the body, in particular the female body, and, in a specifically Lacanian idiom, as following an impossible and contradictory logic. These three definitions of femininity allow for a reading of fashion that will anchor fashion to the category of the feminine, while also rejecting any notion of that category as in any way either biologically or anatomically determined, or reliant on social structures for its resonances and its meaning. If psychoanalysis is concerned with what cannot be said, then so is fashion, but despite the best efforts of both, the unsayable remains precisely that. Fashion is predicated on leaving contradictions intact, and a psychoanalytic reading of fashion demonstrates what these contradictions are and how they operate not just as instances of avant garde creative forms but also, and more importantly, as instances of the unspeakable impossibility of human subjectivity, writ large on the human body itself.

Formal treatment (such as inpatient detoxification) often plays an important role in an individual’s addiction journey, but it is important to recognise that recovery from substance use disorder does not stop with formal treatment (Drug Strategy, 2017). This thesis investigated the attentional bias processes that can be used to predict treatment outcome after detoxification, and the experiences of individuals recovering from substance use disorders who were involved in a wide range of mutual aid groups. Previous research suggests that individuals with a substance dependency transition from identifying as an ‘addict’ to a ‘recovered’ individual, and that mutual aid groups play a significant role in this identity shift (Frings & Albery, 2015). The research in this thesis explored whether this identity shift could be detected through measuring individuals’ attentional bias processes towards identity-related words, and explored the beneficial nature of mutual aid groups and their role in maintaining recovery. Using the Stroop task, Study One assessed the relationships between clients’ attentional bias for alcohol and recovery-related stimuli, and their treatment outcomes. The results showed that an attentional bias for positive recovery-related words was the best predictor of treatment outcome after detoxification, with successful individuals having less attentional bias for these words than for the other word categories. Study Two aimed to qualitatively depict individuals’ experiences within social-based recovery groups. Four themes emerged from the semi-structured interviews with 10 group members: (a) the group’s role in their recovery, (b) personal choices and flexibility in the recovery experience, (c) group as an inclusive family unit, and (d) active involvement in the group. These themes provided an in-depth insight and highlighted the importance of socialbased groups for some individuals in recovery. The objective of Study Three (Part A) was to validate the Recovery Strengths Questionnaire (RSQ) as a new measure of recovery capital. The questionnaire was found to be psychometrically sound, with high internal consistency and concurrent validity with similar measures. RSQ scores were positively correlated with length of time both in recovery and in recovery groups. Factor analysis of the RSQ revealed a two-factor structure of recovery capital (‘internally generated recovery strengths’ and ‘externally generated recovery strengths’). Only internal strengths developed within recovery groups could predict length of time in recovery, and this finding emphasises the important role groups can play in developing recovery capital and helping sustain recovery. Study Three (Part B) used a survey to gain a first-hand perspective of the components that are offered and are considered important in recovery groups. Triangulation of the qualitative and quantitative data collected supported the presence and importance of the group components that have been suggested in previous literature (Moos, 2008). The qualitative results highlighted other important components of groups that were not identified in the previous literature, such as the presence of like-minded individuals, and an updated list of recovery group components was created. This updated list could be used to help develop new mutual aid groups, and evaluate the groups that are already established. Collectively, the findings from this thesis provide insight into the processes and experiences associated with the recovery pathway, and the identity transition from ‘addict’ to ‘recovering’ individual. The findings theoretically contribute towards the addiction literature, and have important clinical implications that can be used to help improve both substance misuse services and mutual aid groups.

Non-communicable diseases, such as coronary heart disease (CHD), are the leading cause of death globally, and their link to lifestyle behaviours has led to national and global investment in healthy-lifestyle promotion. Located within the logic of neoliberal governance, health promotion constructs healthy lifestyle as a matter of individual responsibility and choice. Critical research identifies the potential for judgement and blame through this individualistic construction, suggesting an alternative framework is needed. But there is a gap in critical health research that considers how dominant health discourses are negotiated by couples. In contrast, mainstream health psychology research identifies intimate relationships as important mediators of health benefits. But findings are inconclusive, and indicate that wider social factors may contribute to the complexity of couples’ health behaviours. Drawing these two literatures together, this thesis aimed to explore couples’ management of individualistic and pervasive healthy lifestyle advice. In developing a theoretical framework that accounted for the complexity of couples’ health behaviours, it also aimed to provide an affirmative alternative to the logic of blame. To meet these aims, people in long-term relationships were interviewed about lifestyle and lifestyle change, both in the absence of diagnosed illness (Study 1), and after a diagnosis with CHD (Study 2). Their talk was analysed using a novel poststructuralist theoretical framework that combined Foucauldian Discourse Analysis (FDA) with Deleuzian concepts of affect, assemblages, and time. Study 1 was designed to identify key issues in participants’ talk about healthy living within relationships and test the analytical framework. In individual semi-structured interviews with seven people (five women and two men), participants extended neoliberal discourses of individual health responsibility to encompass their partners. Within this joint endeavour there were three discourses: ‘weight ... is a relationship thing’, in which participants’ negotiated distinct but parallel discourses of appearance and health; ‘risky relationships’, in which they constructed healthy lifestyle as joint risk management; and ‘drift back into comfortableness’, which built an account of healthy lifestyle as fluid, effortful and short term. The salience of health led to the exploration of how couples negotiate lifestyle advice in the context of illness. Study 2 was a substantial, longitudinal qualitative project with 22 people (nine couples and four men in long-term relationships who chose to participate alone), recruited within two weeks of a partner receiving a new diagnosis of CHD, and interviewed once a month for three months, creating a total of 37 interviews. Using FDA with Deleuzian concepts, three main discourses were identified: ‘Ideal health citizens, ideal partners’, in which couples’ negotiated conflicting norms of ideal coupledom and responsible health citizenship; ‘expert patients, expert partners’, where couples managed competing knowledges and ensuing power relations; and ‘multiple temporalities of lifestyle change’, where couples referred to multiple time-frames or durations of illness, recovery, and ageing which afforded acceptance, stoicism, and the assertion of values other than the narrow pursuit of health through healthy lifestyle. The novel contributions of this thesis include the following: A reconceptualization of ‘technologies of the self’ meant that couples’ joint practices could be understood as work on both self and other to produce desired subject positions, and revealed that imperatives of health can transgress relationship norms. Far from always being in alignment, ideals of coupledom could compete and conflict with those of good health citizenship. The thesis also contributed a novel understanding of how couples’ co-construction of risk through multiple experiential and expert knowledges produced intricate power relations. Finally, this thesis developed the field with an original application of Deleuze’s notion of time to couples’ talk of multiple and fluid temporalities of illness, recovery, and health could work for or against engagement in lifestyle change. In health psychology literature, intimate relationships are assumed to be protective and supportive of health, but the thesis indicated that couples’ joint management of lifestyle increases complexity and therefore possibilities for both affirmative and negative experiences. The Foucauldian-Deleuzian approach successfully engaged with the complexity and dynamism of couples’ health negotiations, offering an affirmative and ethical perspective on couples’ management of lifestyle advice and change that has valuable implications for future research and practice.

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Abstracts Mindfulness-Based Cognitive Therapy versus self-help for students with clinical perfectionism: A pilot randomised study Objective: This pilot study compared a mindfulness-based cognitive therapy (MBCT) intervention with a self-help guide based on a cognitive behaviour therapy (CBT) approach for students with clinical perfectionism. Method: Participants were randomised to either MBCT or self-help. Questionnaires were completed at baseline, eight weeks later (the primary outcome point, corresponding to the end of MBCT) and at ten-week follow-up. Results: Post-intervention intention-to-treat (ITT) analyses identified that MBCT participants (n = 28) had significantly lower levels of unhealthy perfectionism and stress than self-help participants (n = 32). There was also significant MBCT superiority for changes in unhelpful beliefs about emotions, rumination, mindfulness, self-compassion and decentering. At ten-week follow-up, effects were maintained in the MBCT group and both ITT and completer (per-protocol) analyses showed superior MBCT outcomes for unhealthy perfectionism and daily impairment caused by perfectionism. Mediational analysis showed that pre-post changes in self-compassion mediated the group differences in pre-post changes in clinical perfectionism. Conclusions: MBCT is a promising intervention for students with clinical perfectionism, which may result in larger improvements than self-help. The findings require replication with a larger sample. Session-by-session outcome monitoring in CAMHS: Clinicians beliefs The CYP-IAPT programme emphasises the meaningful contribution session-by-session routine outcome monitoring (ROM) can make to clinical practice and its importance in highlighting services’ effectiveness. Two studies on issues related to the implementation of ROM in children’s services were conducted. Study one was qualitative; twelve CAMHS professionals participated in focus groups. Themes identified included the idea that ROM could provide objectivity, could be collaborative and empowering. Concerns included how measures may adversely influence therapeutic sessions and how the information may be used by the service. These themes were used to develop a questionnaire about professional’s experience of and views on session-by-session ROM. In study two, 59 professionals from four CAMHS teams completed the questionnaire. It was found that only 6.8% reported “almost always” utilising session-by-session ROM. Detailed analysis of questionnaire responses suggested two factors reflecting the perceived negative and positive impact of session-by-session ROM. It was found that clinicians who currently use session-by-session ROM hold stronger positive and negative beliefs than clinicians who do not. This study suggests that session-by-session ROM is not currently routine practice within CAMHS and highlights the importance of considering how this practice can be best implemented within this setting with reference to clinician attitudes. Psycho-social risk factors for Generalised Anxiety Disorder: An exploratory literature review of current knowledge Research around worry and its central role within Generalised Anxiety Disorder (GAD) has primarily focused on characteristics and treatment, with little investigation into factors involved in its development. The current paper reviews literature to explore our existing understanding of risk factors involved in the aetiology of worry and GAD and briefly reviews how well current cognitive models account for identified aetiological factors. Collectively, current cognitive models vary in their focus on, and explanation of, aetiological factors of worry and GAD and require further theoretical development. Further research within this field focused on the role of parenting and insecure attachment styles, life events and the course of symptoms across gender and the lifespan will be beneficial.

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Main Research Project: Psychosocial factors underpinning depression in Multiple Sclerosis, Service Improvement Project: Increasing access to emotional coping skills training in an acute inpatient setting: Exploring feasibility and barriers to implementation. Literature Review: The efficacy of video-feedback interventions to enhance parent-infant interaction in ‘at risk’ populations: A systematic review.