Background: Eating difficulties manifest at differing levels of severity. As such, they may be considered dimensional rather than categorical. Research into eating difficulties is therefore legitimately undertaken in both diagnosed and undiagnosed individuals experiencing these difficulties. The topic of disclosure by such individuals has been of importance for clinicians and researchers. The aim of the present study was to explore factors considered likely to influence the decision to disclose during psychological therapy by people who experience eating difficulties. Method: Participants were recruited through the eating disorder charity Beat. Thirty-seven participants took part in the study and completed a Q-sort which required them to place 47 statements onto a grid reflecting what would make them more or less likely to disclose in therapy. PQ method was utilised to analyse the data. Findings: Three factors were extracted from the data, with thirty- four Q sorts loading onto one of the factors significantly. One of the factors deemed elements connected to the eating disorder as the most influential in their decision of whether to disclose. Another considered factors connected to the therapeutic relationship as the most influential and the last one considered readiness and sense of security with the therapist as the most influential. Conclusions: The findings of the study suggest that there are different factors that influence the decision for an individual experiencing eating difficulties to disclose in therapy. Future research could investigate developing a measure to assess this with individuals for it then to be implemented into clinical practice.

Despite studies identifying the challenges looked after children (LAC) may experience in their peer relationships, there has been no research addressing school-aged children’s understandings of LAC. The current research aimed to increase our knowledge of children’s social understanding of LAC, and to recognise how this understanding informs children’s behaviour towards LAC. Forty participants, aged between eleven and twelve years of age, took part in focus groups exploring these two questions. The resulting data was analysed using the qualitative methodology of Inductive Thematic Analysis. The results identified one overarching superordinate theme, ‘looked after children are different’, reflecting participants’ overall understanding that LAC are different to themselves and that LAC are treated differently by their peers. This superordinate theme had two main sub-themes ‘why LAC are different’ and ‘LAC should be treated the same but ...’. Participants’ understanding of why LAC are different fell into three further sub-themes; ‘there is something wrong with LAC’; ‘LAC have problematic behaviour’ and; ‘LAC have a hard, sad life’. These understandings seemed to inform how participants would treat LAC, as well as, how they thought others would treat them. The sub-theme ‘LAC should be treated the same but...’ demonstrated participants’ views that LAC should be treated the same, despite participants describing the ways in which they, and others, would treat them differently. This sub-theme was separated into three further sub-themes; ‘LAC need extra care, love and attention’; ‘walking on eggshells with LAC’ and; ‘LAC are treated badly by other children’. These results are discussed in detail, and in relation to current research around LAC children’s peer relationships.

Background: The supervisory relationship (SR) is central to psychotherapist development and client outcomes. A review of the literature on attachment theory (AT) and supervision failed to clarify whether the supervisor’s or supervisee’s attachment was more significant for the relationship and whether a distinct supervision-specific attachment exists. This suggested that the relevance of AT to supervision is not fully understood. Objectives: To explore in-depth how supervisors experience and make sense of the SR and whether AT can assist in the understanding of it. Method: An Interpretative Phenomenological Analysis (IPA) approach was used to interview and analyse data from seven Clinical Psychologists working in the National Health Service (NHS) with experience of supervising Trainee Clinical Psychologists. Results: Three superordinate themes were identified: The SR is important to me; we both contribute to the SR and attachment underpins my understanding of the relationship. Conclusion: The findings suggest that AT has some relevance to the way in which Clinical Psychologists understand the SR. However, it is possible that this is a product of the dominance of AT within Clinical Psychology rather than the nature of the supervisory relationship. Nevertheless, the findings do clarify Clinical Psychologist’s understanding of good quality supervision, suggesting that the SR is improved when both supervisor and supervisee are open and when the supervisor takes on a caregiving role providing a secure base.

Introduction: Research indicates detrimental implications for conforming to masculine norms on psychological well-being, mental health and psychological help seeking in men. However, research predominately focuses on measuring levels of adherence and non-adherence to these norms. This implies a passive process of men’s gender socialisation, which is inconsistent with the social constructivist position which dominates masculinity theory. Less is known about men’s active role in their socialisation and how active resistance to masculine norms might impact well-being. This research explored the question: How do adult men experience and respond to norms of masculinity and what part (if any) does resistance play in their well-being? Method: In depth semi-structured interviews were conducted with eight White British males between the ages of 25-40 to explore their understanding of societal conceptualisations of masculinity, their own relationship to masculinity, and their experience of resistance to traditional masculinity and implications this may have for their well-being. Results: Five themes emerged from the data: Traditional Masculinity is Understood by All; Relationship with Traditional Masculinity is Not Universally Shared; Societal change creates pressure for change on masculinity; There are costs and benefits to specific masculine norms; and The Gap between the Authentic self and The Masculine Mask. Conclusions: Participants linked Traditional Masculinity (TM) with detrimental impacts for emotional and social well-being. They discussed wanting to resist elements of TM but felt pressure from male peers to conform to TM. Participants discussed this disparity as a gap between their authentic self and outward behaviour when in male dominated environments. Clinical implications include: how restrictive emotionality can be recognised and addressed during interventions; use of humanistic approaches to address self-alienation and increase authentic self-identity; and taking a Positive Psychology Positive Masculinity approach.

Gender Role Conflict (GRC) correlated with different measures of psychological distress. However, there has been little research investigating the mechanism underpinning these relationships. Shame may be an important mechanism due to conceptual relevance to GRC, and previous research had shown that shame correlated with GRC and different measures of psychological distress. This study aimed to investigate whether shame mediates the relationship between GRC and psychological distress. A quantitative cross-sectional design was used to gather questionnaires relating to the study variables from 204 male participants with a mean age of 29.22 (SD=7.68). Using the causal step approach (Baron & Kenny, 1986) and bootstrapping, the analysis found that shame mediates the relationship between GRC and psychological distress. This finding has treatment implications for treating men’s psychological distress, including targeting shame and deconstructing dominant masculine norms. However, further research would help to establish support for the causal inferences of the study’s findings.

Objective: To identify whether racial differences between mother and child in interracial families produce a perceived lack of resemblance, and whether this affects the claiming and relationship formation processes. Design: Data was collected through semi structured interviews and analysed using thematic analysis. Participants: Nine white European women, in an interracial relationship with at least one child under the age of four. Results: Four themes were generated: 1) anticipated lack of resemblance 2) the reality of having a mixed-race baby 3) challenges faced by the family 4) creating a multifaceted identity. Conclusions: The women anticipated a lack of resemblance between themselves and their baby. This could have served to affect the claiming and relationship formation processes. However, the women actively searched for similarities between themselves and their baby which aided the claiming process. This, in combination with other factors, helped the women begin to form a relationship with their baby.

Background: Psychopaths represent a large cost to society due to their high criminality, antisociality, the costs of incarceration and the notion of therapeutic nihilism that dominates the literature. Subtypes of psychopathy seem to exist that map onto Karpman’s constructs of primary and secondary psychopathy. Cultural differences exist in the phenotypic structure of psychopathy and so further research is needed to ascertain whether similar subtypes emerge among psychopaths in the United Kingdom and what implications this may have for effective treatment and risk reduction Method: Data was collected as part of standard assessment and follow up procedures at 4 Dangerous and Severe Personality Disorder Units over a 10 year period. Standardised psychometrics were used to assess for psychopathy, personality disorders and risk. Cluster analysis was employed to determine if subtypes of psychopathy emerged from the data and subsequent ANOVAs were used to externally validate and differentiate the emerging clusters. Finally, regression equations were used to determine whether cluster membership could predict change in risk over treatment. Results: Two subtypes of psychopathy emerge in the data resembling primary and secondary psychopathy. These subtypes differ in regard to symptomatology, personality profiles, exposure to childhood trauma, recidivism rates and risk. It was hypothesised that subtype membership would affect outcome. The best predictor of future risk is previous risk. Conclusion: Psychopathy should not be viewed as a unitary, nosological construct. Clear subtypes emerge in the data that can be differentiated by a range of variables. This has implications for more person centered treatment planning and potential future risk reduction.

Introduction: Prevalence studies show that fewer girls are diagnosed with Autism Spectrum Conditions (ASCs) than boys. This difference is particularly marked where there is no cognitive impairment. Some suggest that ASCs present differently between males and females, perhaps leading to delayed diagnosis in girls. A review of the literature exploring sex/gender differences found that many studies have measured the severity of ASC symptoms rather than the quality of difference. Limited research has considered the perspectives of parents on the signs noticed in their daughters and the context in which difference is noticed. Objective: This study sought to explore how parents make sense of their daughters’ behaviours and the processes by which behaviours are perceived as requiring intervention or diagnosis. Participants: Five parents whose daughters (aged 9-12 years) had recently received a diagnosis of an Autism Spectrum Condition without cognitive impairment were invited to tell their stories of diagnosis. Design: Transcripts were analysed using a narrative approach, focusing on how stories were told. Findings: Narrative themes were identified across transcripts in relation to the process by which behaviours are made sense of. Themes included: daughters only showing their ‘real self’ in safety; their distress peaking; parents questioning normality; and parents feeling blamed and unheard. Conclusions: The findings are discussed in relation to existing research and theory. Implications are discussed in relation to education and health services and UK policies. Further research into parents’ experience of judgement in relation to their child’s behaviour, and exploration of interventions for masking in girls is needed.

Background: There have been significant advances in research, treatment, policy and service provision for people diagnosed with a personality disorder in England. However, diagnoses such as borderline personality disorder (BPD), continue to be controversial due to the validity of the construct itself, the ability of clinicians to diagnose reliably, and the significant impact stigma can have on those diagnosed. Aims: This study aims to provide a current service-user perspective on the diagnostic process in BPD within specialist PD outpatient services. It specifically focuses on how service-users perceive this process to influence how they understand themselves, given that past research has indicated a BPD diagnosis can influence self-concept, and understanding of their mental health, given research has highlighted a lack of clarity from professionals about the diagnosis. Method: Data were collected from six in-depth interviews with people currently accessing complex needs services, within a London NHS trust, who had experienced the diagnostic process in BPD. Transcripts were analysed using interpretative phenomenological analysis (IPA). Results: Two superordinate themes emerged from the data: “Making sense of a BPD diagnosis” which encapsulated participants’ experiences of understanding the diagnosis, in terms of whether it “fitted” from their perspective, how it made sense of traumatic and challenging past experiences and the clarity they received from professionals; “Struggling to get what I need from services” which captures participants’ experiences of needing to reach crisis point and exhaust all other treatment options before accessing specialist assessment and treatment. Conclusions: Service-users continue to experience a lack of clarity during the diagnostic process in BPD, particularly within secondary care, and feel they struggle to access the specialist support they need. The diagnostic process is an opportunity to help service-users make sense of their current difficulties and past experiences, and to help them feel fully informed about treatment choices.

This research portfolio contains three pieces of work conducted during my training as a Counselling Psychologist at the University of Surrey. Initially there is a review of literature on men and their close relationships. This is followed by two qualitative studies, with each based on a group of white British, professional mid-life men. The first of these explores experiences of relational closeness and the second focuses on developing new theory regarding how closeness is conceptualised.