Intensive care unit (ICU) staff are exposed to a broad range of professional, ethical and clinical practice issues such as when to offer and withdraw potentially life-saving care, which are most apparent when working with hyper-advanced technologies such as extracorporeal membrane oxygenation (ECMO). Despite the rapid increase in use of ECMO to support adults with critical heart and lung conditions, few studies have documented staff experiences of working with this technology. This study aimed to explore ICU doctors and nurses conceptualisations of key professional, ethical and clinical practice issues relating to ECMO, and the psychological impact of managing them. A qualitative design was utilised, in which semi-structured interviews were conducted with 10 ICU staff (five doctors and five nurses), working in a specialist ECMO centre in the United Kingdom (UK). Data were analysed using thematic analysis, underpinned by a critical realist epistemological stance. Three key themes were identified. 1) Embodying the ECMO Specialist: Staff experienced a sense of mastery when managing technical aspects of the work, but felt inept when dealing with abstract ethical issues. Specialists sought to drive forward clinical practice, and learning was considered important for developing clinical abilities. 2) Team dynamics: Staff came together as a team to address the technical, professional and ethical challenges associated with their work with ECMO, however ECMO was also described as a divisive force in the ICU. 3) Riding the Emotional Rollercoaster: Life or death outcomes were associated with intense emotions and staff reported various ways of managing them. These findings add a new dimension to the professional and ethical discussions in the academic literature and have several implications for clinical practice, which are discussed. Further research may wish to focus on more specific aspects of ECMO care, such as the processes involved in decision-making.

Background: Staff burnout and lack of compassionate care in the NHS have been frequently highlighted in the press, in part due to the current emphasis in NHS policy on improving compassionate care and staff wellbeing. However, despite this media attention, the relationships between compassion, burnout and self-care remain under researched. Aim: Specifically, this study aimed to investigate the associations between burnout, compassion for others, self-compassion and self-care. This study also aimed to explore the ways in which staff practise self-care. Method: 205 NHS staff who deliver psychological interventions completed an online survey. Associations between burnout, compassion for others, self-compassion and self-care satisfaction were measured quantitatively, through the use of three questionnaires: 1) the Maslach Burnout Inventory Human Services Survey, 2) the Compassion for Others Scale and 3) the Self-Compassion Scale, and a rating of satisfaction with their current level of self-care. Qualitative content analysis of open-ended responses was used to explore the ways in which the staff practised self-care. Results: This study found a negative relationship between burnout and self-compassion, compassion for others and self-care satisfaction. Positive relationships between compassion for others, self-compassion and self-care satisfaction were also found. Participants cited a wide range of physical, psychological, social and professional self-care activities. Two-thirds of participants reported being satisfied with their self-care. Conclusions: This study provides preliminary support for theories suggesting that self-compassion and self-care may reduce staff burnout and improve compassion for others. The compassionate mind approach was presented as a useful framework for formulating and addressing compassion, burnout and self-care in NHS staff. Implications: Compassionate mind training (Gilbert, 2009) may be a suitable intervention and a form of staff self-care that could potentially reduce burnout and increase compassion for oneself and others.

Background: High levels of shame are considered a transdiagnostic experience, and have been associated with early shame memories that contain traumatic features and become central to one’s self-concept. Compassion Focused Therapy aims to reduce shame via compassionate exercises. Difficulties, however, can be experienced when these are attempted, and identifying fears around developing compassion might not be helpful for all individuals. Consequently, there is a clinical need to consider alternative constructs. Structural aspects of self-concept are considered to be significant in the experience of psychological distress and wellbeing, but have been largely overlooked in clinical psychology, and have yet to be considered in the experience of shame. Aim: To explore the relationships between shame memories containing traumatic and centrality features, current experiences of shame, a structural component of self-concept in the form of self-concept clarity, and psychological distress and wellbeing. Method: Participants (n = 220), ranging from 18-63 years (M = 32.03, SD = 10.82) completed questionnaires online pertaining to the characteristics of a shame memory they recalled, current experiences of external and internal shame, self- concept clarity, self-esteem, psychological distress, and wellbeing. One hundred and five participants (46.47%) had received a range of psychiatric diagnoses, and a further thirty-two (14.54%) experienced self-reported psychological distress. Results: Shame memories containing traumatic and centrality features were significantly associated with shame and distress. Shame memories containing traumatic features was a significant predictor of psychological distress and wellbeing. Participants who recalled a shame memory involving an attachment figure reported significantly more traumatic and centrality features, higher external and internal shame, and lower self-esteem and wellbeing, compared to those who recalled a shame memory involving a non-attachment figure. Significant and moderate associations were found between self-concept clarity, shame memories, and shame. Self-concept clarity, however, was not a significant predictor of psychological distress and wellbeing, whilst self-esteem was. Conclusions: The findings suggested that self-esteem could be more useful to consider than self-concept clarity in the experience of shame. However, this could have been influenced by the measures used. A number of tentative clinical implications can be drawn from the study including the importance of assessing the key details of shame memories (e.g., who the individual felt shamed by), and actively attending to wellbeing and distress within assessments and interventions for high levels of shame. The importance of preventative interventions in reducing shaming experiences within public health initiatives and educational settings was also demonstrated.

Concept formation is a complex cognitive process which allows us to identify, categorise, and determine rules from sets of experiences alongside developing cognitive representations for complex thoughts, behaviours, and events. Concept formation abilities are highly important for children’s performances in school, socially, and therefore throughout their lives. Yet, most of the tests that are used to measure concept formation in children were developed for use with adults; very few have been specifically designed for children. This study is the first phase of test development. It addressed whether a new game of concept formation, the Alien Game, could capture executive functions in a group of 18 typically developing children. The game was based on the 20-Questions task and a game-like structure was adopted in order to engage participants. Codes were generated from a two-phase content analysis carried out using previous research and the children’s responses within this study. The task was also interpreted using an Abstraction Score, a Learning Slope, an Initial Abstraction Score, a Weighted Achievement Score, and a Time to First Question measure. The content analysis indicated that similar patterns were found among the children’s responses, with the children using a majority of ‘Constraint seeking’ questions. The Abstraction Score, Initial Abstraction Score, and Weighted Achievement Score addressed separate aspects of the questions asked, and were each designed to assess the quality of questions asked. These results indicate that this task could potentially be used as a formal cognitive test. This needs to be further developed through future research on norms, reliability, and validity. Clinically, the Alien Game shows potential of being used as a neuropsychological tool which could be used to capture deficits in children’s concept formation early, in order for appropriate interventions and support to be put in place at a younger age.

The literature on providing an evidence base for clinicians to deliver culturally appropriate services appears to be responding to the changing demographics in the United Kingdom (UK) but appears slow to respond to the gradually changing demographic of the profession. The research on ethnic minority status is largely focused on clients with the assumption that the therapist is White (Iwamasa, 1996). Literature exploring the experiences and issues of ethnic minority therapists emerged in the United States of America (US) before being explored in the UK. Even today, a large chunk of the literature is produced in the US and more so from the counselling and psychotherapy disciplines. This qualitative study explores the practice of clinical psychologists who identify as British Asian, when working with ethnically similar and different clients. Ten clinical psychologists were interviewed about therapeutic interactions where they encountered ethnicity and culture. Thematic analysis was used to analyse the interviews of the participants who self-identified as British Asian. Three dominant themes emerged from the analysis: Addressing culture and ethnicity in therapy, challenges in the room and dilemmas in the profession. Findings revealed that culture and ethnicity were not central to all therapeutic interactions. However, when ethnic and cultural differences were present, participants responded in various ways to the issues they faced in the therapy room and dilemmas they encountered in the profession. There were varying levels of comfort in having conversations about culture and ethnic differences in therapy as well as with colleagues, indicating a need for appropriate training of all clinical psychologists in working with culture and ethnicity. The role of supervision was also highlighted in helping clinical psychologists to enable reflecting on the impact of their own culture and ethnicity on practice.

Existing research has continued to demonstrate that experiences of paranoia are best understood as lying on a continuum, across both clinical and non-clinical populations. Within the non-clinical population, experiences of paranoia have been associated with gender, with the predominant pattern being a higher prevalence rate amongst males. The aim of this study was to further investigate this relationship, utilising a qualitative and discursive approach to data collection and analysis. This approach was chosen in order to address concerns with the predominantly reductive methodologies commonly utilised in investigations of both gender and paranoia. The culturally available discourses of ‘paranoia’ and ‘gender’ were investigated through conducting semi-structured interviews with nine interviewees, recruited from a non-clinical, student population. Transcripts of interviews were subsequently analysed using Foucauldian Discourse Analysis (FDA). The findings of the study demonstrated gendered aspects of discursive constructions of paranoia, as well as ways in which men and women are positioned differently within discourse, and the resultant potential consequences for individual subjective experience. Common constructions of paranoia in men were of an experience related to external and physical threats, expressed through an unpredictable and aggressive manner; whilst paranoia in women was constructed as more normalised and based in social and intimate relationships, expressed in an open manner, and shared with others. Implications of these findings suggest that considerations of gender should be brought more to the fore in both research and clinical practice, to provide a more nuanced understanding of the experience of paranoia.

Background: The rising rates of Type 2 diabetes (T2DM) around the world have serious economic and health implications, often related to the complications of the condition. One such problem is the impact of diabetes on cognitive function. In older adults with T2DM, there is an established relationship between diabetes and cognitive impairment in people with and without dementia. Emerging evidence suggests this may also be the case for younger adults, as the occurrence of cognitive deficits in people with T2DM is related to the severity and duration of the condition. In some parts of the world, T2DM has become the most common diabetes phenotype in children. Therefore, exploring the cognitive function of younger adults with T2DM is important, to understand the pathogenesis and sequelae of the condition across the lifespan. Aims: To investigate if younger adults with T2DM show signs of cognitive impairment, and how this relates to diabetes-related health indicators. Method: Ten people with T2DM were recruited from a diabetes clinic in London, and completed a battery of cognitive tests assessing processing speed, attention, executive function, learning and memory. Estimates of optimal (premorbid) ability were also derived. Clinically relevant markers for diabetes were recorded, including Hba1c and lipid profiles. Results: Scores on cognitive tests suggested deficits in attention and processing speed, but executive function was a relative strength. Scores were not declined relative to one measure of optimal ability across the group. Health markers related to diabetes were correlated with several cognitive domains, although not consistently: total cholesterol levels showed the strongest associations, and not always in the direction anticipated. Conclusions: Due to the small sample size, any profiles and associations should be treated cautiously. Further research in this area is needed, and cognitive impairment in people with T2DM should be attended to routinely in clinical services.

In seeking to gain a greater understanding around group therapy for Anorexia Nervosa (anorexia), this study explored what psychologists perceive to be useful and not so useful about working in this complex setting. Qualitative research studies, with a focus on process, are limited in this field. Existing literature predominates its exploration of clients’ experiences, and neglects to consider the perspective of the therapist. This research study aimed to address this gap in the literature. Interviews with eight participants were conducted and transcribed verbatim. They were then subject to analysis, using Interpretative Phenomenological Analysis (IPA) approaches. Researcher reflexivity was carried out throughout the various phases of the research, and are highlighted in the text. Three superordinate themes were created from the findings produced in the analysis. These were titled; Connecting with others, Them against us, and Addressing the elephant in the room. These themes aimed to encapsulate findings of participants’ perceptions of what is useful and not so useful about running therapeutic groups for those experiencing anorexia. Likewise, the themes shared participants’ observations of how psychologists’ experience facilitating group therapy for those suffering from anorexia. The participants offered recommendations as to how to manage the perceived challenges in the group setting. From the perspective of the participants’, the group was seen as a unique and powerful tool in encouraging a plethora of positive therapeutic factors, and had many positive implications for clients meeting others who shared similar difficulties. The participants considered the group process to be capable of alleviating individuals’ social isolation, commonly attributed to those suffering from anorexia, and aid in establishing a support network and building interpersonal relationships. Limitations of group therapy in this context were highlighted, and the role of the group in the development of ambivalence and the exacerbation of symptoms, was discussed. The findings and their relationship to Labelling Theory were explored, alongside their implications for future clinical practice. Such implications included a focus on the use of stigmatising language, the overall structure of the group, specific interventions, and the use of the relational approach to therapeutic work. The relevance of the findings to Counselling Psychology practice were highlighted, and evaluation of the strengths and limitations of the study were addressed, alongside recommendations for future research.

Internet usage across the globe has grown exponentially over the past sixteen years from 361 million users in 2000 to 3.68 billion users in 2016, constituting an increase of over 918% (Miniwatts Marketing Group, 2016a). The increase in utilization and advancement of communication technologies has led to an increase in the prevalence of cyberstalking (Parsons-Pollard & Moriarty, 2009). Consequently, cyberstalking has become a global epidemic (Maple, Short & Brown, 2011). However, in contrast to the ubiquitous nature of cyberstalking, there is relatively little research examining the impact of cyberstalking on victims (Dressing, Bailer, Anders, Wagner & Gallas, 2014; Parsons-Pollard & Moriarty, 2009). The current study aimed to address this paucity in research and explore and understand more about the lived experience of being cyberstalked. Interviews were carried out with five people who had been cyberstalked and transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes emerged including ‘feeling powerless’, ‘loss’ and ‘trying to make sense of the perpetrator’. The findings illuminate the devastating impact of cyberstalking upon victim’s wellbeing with many experiencing suicide ideation to end the torment. Organisations such as advocacy services, anti-stalking organisations, the police force and employers were found to provide inadequate support and exacerbate feelings of powerlessness. In coping, participants employed various strategies, but far from alleviating their suffering, such strategies appeared to compound their distress. The findings highlight the role for Counselling Psychology in providing support to those who have been targeted by a phenomenon that is likely to become more prolific (Parsons-Pollard & Moriarty, 2009).

In line with public health discourses, current literature indicates that walking can improve mental wellbeing. Much of this research draws on bio-cognitive models to suggest that walking, especially in natural environments, reduces distress. The individualist focus in these studies means that service-users’ holistic experiences of environments and walking are overlooked. There is also little qualitative research that considers service-users’ subjective meaning-making processes. Alternatively, this qualitative study explores service-users’ perspectives of an urban-based ‘Walk and Talk’ (WnT) group and how being part of it has intersected with their experiences of other contexts. An ecological ontology that drew on the work of Tim Ingold (2011; 2015) and Kurt Lewin (1936/2015) and critical realist epistemology underpinned the study. Multi-modal methods were employed. Participants took photographs that formed the basis of a semi-structured interview and also participated in individual walk-along interviews. Transcripts were analysed using thematic analysis. This framework aimed to increase nuanced understandings of participants’ ongoing experiences of their environments and walking. An analysis of the data identified several, interconnected themes that are situated within two overarching sections: ‘Everyday Landscapes’ and ‘Wider Worlds’. It is argued that participants inhabited complex environments which contained malleable micro-spaces and oppressive boundaries shaped by macro forces. Furthermore, WnT is argued to be a relational space that fluidly accommodated participants’ subjectivities and helped expand their personal territories. The findings suggest that urban walking groups, which are not time-limited and focus on shared interests, can form a therapeutic space for service-users. Moreover, the findings highlight the need for clinical psychologists to develop clinical and theoretical frameworks that engage more fully and dynamically with service-users’ experiences of environments. It is also recommended that further research should highlight the complex and multifarious ways that structural inequalities enfold the fluid contexts’ that service-users negotiate.