This portfolio brings together my personal and professional development over the course of training to become a counselling psychologist. It presents three dossiers concerned with the academic work, therapeutic practice and research I have completed over the last three years. The academic dossier consists of three selected essays. The first is a review of an empirical paper about whether a therapist's conscious identification with a client affects their ability to sense and convey unconditional positive regard. The second essay uses clinical material to argue a case for how I would understand and work with a client diagnosed with borderline personality disorder when practising psychodynamically. The third essay argues that the value base of counselling psychology is compatible with adopting a cognitive behavioural approach to working with clients who have been diagnosed with anorexia nervosa. The therapeutic dossier provides an account of the context of practice and the experience I gained in each of the three Clinical placements I completed. It also includes my final clinical paper, which reflects on my personal and professional development over the course of my training. Finally, the research dossier consists of a literature review and two pieces of empirical research. The review evaluates empirical literature in order to determine whether there is reason to believe that racism affects the process and outcome of therapy. The first empirical piece is an interpretative , phenomenological analysis of minority racial group clients' experiences of therapy with their white therapists. The second piece is a quantitative study that aimed to develop a measure of minority racial group clients' perceptions of subtle racism in therapy with their white therapists. Pseudonyms have been used throughout the portfolio and any information that could identify clients, research participants or placements has been removed or altered in order to protect anonymity and ensure confidentiality.

Objective: The phenomena of visions (visual hallucinations) are poorly understood due to limited research in this area. This study tested a cognitive model of visions. This proposes that it is the appraisals of the vision and not the presence of a vision itself that leads to distress. The aim of this study was to see whether the appraisals given to visions are a predictor of distress, when controlling for the characteristics and activity of the vision. This study was the first, to our knowledge to explore a wide range of appraisals that might be associated with visions. Design and Analyses: The study adopted a quantitative, cross-sectional design. The hypotheses were tested using multiple regression analysis. Setting: 109 participants were recruited anonymously through international charity networks that support people who experience visions. 66% (n= 72) of the participants were female and 34% (n=37) were male. Measures: The Brief Core Schema Scales, Beliefs About Visions Questionnaire (adapted from the Beliefs About Voices Questionnaires- Revised), Vision Activity and Impact Scale (adapted from the Hamilton Program for Schizophrenia Voices Questionnaire) and the short form Metacognitions Questionnaire were used. Participants also completed the Patient Health Questionnaire, Generalised Anxiety Disorder Assessment and the Satisfaction with Life Scale. Results: Positive beliefs about self, metacognitive beliefs about uncontrollability and danger and malevolent beliefs were all predictors of distress in people with visions when the characteristics and activity of the vision was controlled for. The study also found that the characteristics and activity of the vision also predicted 40% of the variance in distress associated with visions. Conclusions: The study shows some support for a cognitive model of visions as a number of the appraisals of visions predicted distress when the characteristics and activity of the vision were controlled for. In contrast to the voices literature, characteristics and activity of the vision also accounted for a large proportion of distress from visions. This suggests that the vision characteristics and activity may also play a pivotal role in the distress, associated with visions. Therapeutic interventions targeted at both characteristics, activity and appraisals may reduce distress in people experiencing visions. Keywords: Visual Hallucinations, Hallucinations, Visions, Appraisals, Beliefs, Impact, Distress, Cross- sectional design. This empirical paper is planned for the submission to the British Journal of Clinical Psychology. This is the first journal to publish a study on the appraisals of visions.

Primary, secondary and tertiary prevention of mental ill-health among UK military personnel was evaluated pre-, during and post-operational deployment. Primary prevention studies examined whether rest and recuperation taken during deployment promoted better mental health (n=536). R&R was highly satisfying but did not promote better mental health. Psychological benefits occurred only when R&R was used to mentally disengage from operations and to access social support. Mental health outcomes were compared in a sample of personnel attending a brief structured post-deployment rest period (Third Location Decompression or TLD) (n=1407) and non-attendees (n=1664). TLD attendance benefited mental and physical health, reduced alcohol misuse following deployment, but had no demonstrable effect upon transition from operations to the peacetime environment. Psychological effects were related to levels of combat where greater combat exposure was associated with reduced TLD benefits. Primary and secondary prevention activity was assessed during deployment (n=2794). Receipt of predeployment psycho-education, experiencing good leadership and satisfactory support for families were associated with substantially better deployment mental health. Medical consultation for a physical condition was associated with poorer mental health, suggesting that mental ill-health detection might take place during medical consultations. Secondary prevention was assessed pre-deployment (n=484) and post-deployment (n=1636). Greater mental health stigmatisation was associated with reduced help-seeking. Changes in psychological symptom levels were associated with synchronous fluctuations in stigma levels. New mental disorder caseness and remission from caseness were both associated with significant increases and decreases in stigmatisation respectively. For tertiary prevention, mental healthcare delivered during operations (n=611) returned around 75% of personnel to full operational duties. Over a four year follow-up period, around a third of study participants were consistently unfit for deployment. Pre-deployment clinical care (n=2979) returned around 75% of personnel to full duties; during prolonged follow-up, around 33% of personnel experienced reduced occupational fitness. Recommendations for improving current mental ill-health prevention practices and avenues for future research are described.

No description available.

No description available.

This thesis concentrates on factors influencing the trainee psychologist’s information-sharing in supervision sessions as growing evidence indicated that as many as 97.2% of trainees consciously withhold information from their supervisors. This thesis is divided into two sections. The first section contains a journal paper that is ready for submission. The second section, an extended paper, is to be read in conjunction with the journal paper and details information relevant to the research area that could not be presented within the journal paper. The journal paper concentrates on the main literature about non-disclosure in supervision and highlights the gap which this thesis aims to fill. In order to build a theory about information-sharing in supervision Grounded theory embedded within a theory-building case study research design was used to analyse the video-recordings of supervision sessions. The results of analyses showed that factors underpinning information-sharing could be grouped into those attributable to the supervisor and those attributable to the supervisee and could also be divided between those that promote information-sharing, hinder information sharing and those that have a dynamic role in information-sharing. Owing to limited space, however, the results section of the journal paper focuses mostly on factors that were found to have a dynamic role in information-sharing and these results are discussed in connection with the main literature. The extended paper sets the aim of this research project against a wider literature background about supervision in general and non-disclosure specifically. It offers additional information about the methodology and the process of analyses, and also includes discussion about the choice of methodology, more detailed reflections and a description of memo-writing. The results section concentrates on factors that were found to promote and hinder information-sharing attributable to both supervisor and supervisee. Also presented is the first draft of more generic and abstract theory about intentions and information-sharing that was extrapolated from the data and needs to be further elaborated and tested in further research. In addition, the information gained from the analyses of supervision logs is presented. The results section also contains details about a residual category that was formed from three codes not used in final analyses. The discussion therefore relates to the data presented within the extended paper only.

Guinea pig vocalizations were investigated. The behaviour of the guinea pig was observed in a wide variety of situations, and from these samples of vocalizations were recorded, analysed on a sonagraph and classified on the basis of their physical structure. Eleven basic calls were isolated, these were the chut, chutter, whine, low whistle, whistle, squeal, tweet, scream, chirrup, purr and drrr. A series of playback experiments was conducted; from this, general observations and a detailed study of mother-infant interactions, five functional categories of calls were suggested. These were: calls increasing physical proximity, greeting and proximity-maintaining calls, proximity-regaining calls, distress calls and alarm calls. Within the context of maternal behaviour it was found that lactating females, unlike virgin females, responded vocally to proximity-regaining calls of infants and showed searching behaviour. Females did not appear to respond preferentially to the calls of their own young but the possibility that females recognized their own young, entirely by voice, could not be excluded. An exmaination of the ways in which vocalizations are used in mother-infant interactions indicated that the incidence of most calls made by both mothers and infants changed over the post-partum period, and in this situation specific calls were found to be associated with particular forms of behaviour. In general, vocal responsiveness of the female towards her young declined as the suckling period waned, and this paralleled a decline in other forms of maternal responsiveness. Infant animals showed no similar decrease in vocal responsiveness to the mother during the observation period. The part played by exteroceptive stimuli in controlling maternal behaviour in the guinea pig was considered and discussed in relation to other rodents.

Five separate studies are reported on two groups of chronically ill children: children with end-stage renal failure who had received renal transplants and children with insulin dependent diabetes mellitus (IDDM). Assessment studies of both these groups investigated psychosocial factors influencing children's anxiety, pain and distress during venipunctures. Behavioural, cognitive and physiological measures of pain were used as well as standardized and structured interview questionnaires. The assessment studies involved 21 renal transplant children and 62 chidren with IDDM. The results found a revised version of the Observation Scale of Behavioural Distress to be a valid and reliable measure of children's distress during venipuncture. The predictor variables for children's distress in the transplant sample were the child's self-concept for social acceptance and the child's usual anxiety over injections. In the diabetic sample, the presence of emotional/conduct disorder, the child's usual anxiety over bloodtests and parent's rating of the child's usual anxiety over bloodtests were the three predictor variables for children's distress. Other significant psychosocial variables are discussed. Bloodtests were reported to be the most stressful aspect of the medical treatment by parents of children with renal transplants and by diabetic children. A pilot study is reported of cognitive-behavioural and hypnotic intervention with children in the transplant clinic. Cogntive-behavioural intervention was found to be effective in reducing distress during venipuncture in children aged four to seven years, following renal transplantation. With older children aged 6-16 years, both cognitive-behavioural and hypnotic intervention were effective in reducing diabetic children's distress. However, control groups appeared to improve following baseline observations, possibly as a result of non-specific factors such as attention and therapist presence. The results are discussed in relation to the literature on acute pain in children.

The study investigated aspects of emotional behaviour in two piebald and two non-piebald genotypes of hamster, to confirm anecdotal reports that piebald hamsters were more fearful than other types. Behavioural differences were hypothesized to relate to psychological functions and to be associated with the recessive piebald gene, thereby representing a major gene effect which could merit further investigation by a behavioural geneticist. Limitations on uses of the terms 'fear' and 'emotionality' were acknowledged, and evidence that they were unlikely to refer to unitary states was discussed. Genetic, maternal and sibling effects were controlled for, so that a single cross could produce the four genotypes in any litter. The hamsters were bred by a geneticist, Roy Robinson. On arrival at four weeks of age they were housed solitarily or in small groups for about three weeks when they were all isolated; experiments began at eight weeks of age. Behavioural and nonbehavioural tests, designed to measure emotionality, were based on previous work and a priori reasoning. They included reaction to handling, the open field, novel situation, activity, aggressive encounter, passive avoidance learning, and measures of body weight, food intake, adrenal gland weight, gastric ulceration and mortality. The results from the experiments were subjected to analyses of variance tests; significant genotype, sex and housing differences were discussed. It was concluded that hamsters carrying the piebald gene could be described as more emotional than golden or brown hamsters. although there was no consistent pattern shown by either sex or differentially housed hamster in terms of emotionality. The piebald hamster may thus provide a starting point for investigations into a gene-behaviour pathway. The data were compared with other rodent studies on emotionality and how findings contributed information as to whether fear was a unitary condition assessed. One type of organization responsible for emotionality could be studied in the piebald hamster and this may contribute more generally to literature on physiological and behavioural expressions of fear.

Literature Review: Qualitative research was reviewed to better understand how people cope with burns. Eleven articles were identified for inclusion with a total of 107 participants. A thematic synthesis was undertaken which resulted in two superordinate themes. These provided an account of how patients managed the burn (e.g. by maintaining a positive perspective and utilising pragmatic strategies), and how they distanced themselves from distress and pain (e.g. by using distraction). The findings reinforced the benefits of social support, which facilitated the use of coping strategies. Reviewing support and interventions during the process of recovery from burns is important, as patients’ needs may change over time. More research is needed to understand the use and effectiveness of avoidant coping at different times, and to understand what people need at different stages of recovery. Research Report: The experiences of using scar management interventions for burns were explored using Interpretative Phenomenological Analysis. Eight participants were recruited and data was collected using semi-structured interviews. Three superordinate themes were identified: ‘identity’, ‘functions of the pressure garment’ and ‘coping’. ‘Identity’ described the role of scar management in the developing identities of burn patients. ‘Functions of the pressure garment’ indicated the various personal and social functions of the garments. ‘Coping’ described the main strategies used to manage associated difficulties. Implications for healthcare professionals were discussed, which included appropriate assessment of trauma, providing information on managing social responses, and the facilitation of containment through their support. Recommendations for further research were to explore prior hospital experiences, and investigate the experiences of different demographic groups. Critical Appraisal: The process of conducting the research was reflected upon. This focused on developing good quality research in the face of dynamic challenges, formalising processes of reflexivity, and developing skills in utilising qualitative methodology.