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This thesis comprises a literature review, a research report, and a critical appraisal. Section one: A review of the literature on the psychological consequences of falling among older people. This includes a consideration of the psychological consequences of falling, detailing prevalence and correlates. Evidence was found for the development of fear of falls, depression, anxiety, post-fall syndrome and post-traumatic stress disorder (PTSD) after falls, and these difficulties have been correlated with increasing age of the individual, personality, health and fall-related factors. Little research has investigated the incidence of PTSD in this population, and no research to date has examined the role of shame with regard to falling. Section two: A prospective, repeated measures design (n=49) was employed, in which older people attending falls programmes completed questionnaires examining the attributions, anxiety, depression, post-traumatic symptomology and shame, before, and at the end of the falls group. Clinically significant levels of PTSD and other psychological symptoms are present after falls, which change over time, and are related to external shame, affective disorders and the presence of negative internal, global attributions for their fall. Section three: The critical appraisal considers the research process for this study, based upon information from the research diary. The origins of the project, supervision, data collection, facilitators and barriers to the process are considered. Learning outcomes, methodological limitations and clinical implications are discussed.

Contextual influences on memory retrieval are of theoretical and e~pirical importance in infant memory research. Early in infancy, memory is strongly constrained by contextual congruency at encoding and retrieval. Contextual constraints appear to progressively loosen over the infancy period (Hayne, 2004), but little is known about the nature and extent of this change. The present studies revealed that age-related decreases in contextual constraints on memory retrieval extend to both physical and social context, and to recall and recognition memory (Experiments 1-4). Specifically, for 9-month-olds both recognition and recall memory were less affected by a change of social context than for 6-month- . olds, and for 12-month-olds, recognition memory was less influenced by a change of global physical context than for 6-month-olds. At 12-months, memory retrieval appeared to be particularly constrained by intrinsic contextual details, a constraint that was robust across procedural variations that alleviate context-shift effects in other age-groups (Experiment 5). Nonetheless, providing infants with a unique environment for learning and retrieval helped them to retrieve memory across an intrinsic contextual change, indicating that extrinsic context may perform a disambiguating function later in infancy (Experiment 6). Finally, Experiments 7 to 9 used an EEG study to explore the processes underlying contextual influences on memory retrieval with adults. A change ofioom selectively impaired the purported neural correlates ofrecollective-based recognition memory, indicating that investigating the development ofrecollection in infancy may be an important step towards understanding contextual influences on memory in development. Taken together, these studies show that sirililar contextual features are encoded in memory from infancy to adulthood. Contextual details exert progressively less influence over memory retrieval over the first year of life, likely through a combination ofboth the maturation ofbrain regions involved in memory, and experience oflearning and remembering in a variety of settings.

Several authors claim that deaf children with hearing parents do not' develop theory of mind (ToM) until adolescence, but this is largely based on false-belief studies. Peterson & Siegal's (2000) review of false-belief studies is updated and the section also reviews research using a wider range of methodologies with deaf children and adults. Deaf children have difficulties in false-belief, perspective-taking and emotional responses/reactions, but these skills may develop later. In contrast, deaf children do not appear to have deficits in mental-state attribution or emotional recognition. More research with deaf adults is needed. Section II: Research Report This study explores whether Deaf adults have impairments in ToM and empathy compared to hearing adults, and if Deaf forensic patients have further impairments. Tests were adapted and translated for the purpose of the study. The Deaf community scored lower than the hearing community on the Reading the Mind in the Eyes test and produced fewer mental states. The Deaf forensic group was too small for reliable statistical analysis. Deafpeople may continue to have ToM impairments into adulthood, but the results could be due to methodological, linguistic and social factors. Assessments must be developed specifically for use with Deaf populations rather than relying on interpreted measures. Section III: Critical Appraisal This section gives a commentary, and personal reflections, on the project. The challenges faced during the progression through the thesis and of researching within the Deaf culture are explored. Methodological problems, clinical implications and areas for further research are discussed and key learning points are identified.

Background: Total hip replacement (THR) and total knee replacement (TKR) are increasingly common procedures to treat the pain and disability associated with osteoarthritis. There is a large variability in time to achieve functional milestones following these procedures and of success of surgery measured by pain and functional ability. Factors which affect outcome are poorly understood, but research in health psychology suggests psychological variables may play an important role. Objectives: To explore the relationships between selected psychological variables with pain and function pre-operatively in patients awaiting THR and TKR, on achievement of key functional milestones as an inpatient post-operatively, and of pain and function three-months post-operatively. Design: A correlational study of patients undergoing primary unilateral THR and TKR as a result of osteoarthritis. Subjects: 105 THR, 70 TKR. Psychological Measures: NEO-Five Factor Inventory, Multi-dimensional Health Locus of Control Questionnaire, Coping Strategies Questionnaire. Outcome Measures: Oxford Hip Score, Harris Hip Score, Oxford Knee Score, Knee Society Knee Score, key functional physiotherapy milestones. Results: Hip Study: Catastrophizing was a significant predictor of greater pain and worse function both pre-and post-operatively. Pain control efficacy was predictive of less pain and better function pre- and post-operatively. In addition, conscientiousness was a predictor of worse pre-operative function. Few psychological variables were predictive of physiotherapy outcome measures. Knee Study: Neuroticism was found to be a predictor of worse pain both pre- and post- operatively. Pre-operatively openness to experience was predictive of less pain and better function. Post-operatively, a chance locus of control was predictive of worse functioning. Few psychological variables were predictive of physiotherapy outcome measures. Conclusions: Psychological variables influence pain and function both pre- and post- operatively in THR and TKR. The psychological variables may exert their actions through pain control efficacy. There is scope to develop an intervention targeting negative psychological variables and improve outcome.

Chapter One: Literature Review This chapter reviews the research surrounding the prevalence of comorbid social phobia in people diagnosed with schizophrenia. It then critically evaluates the eight studies that have specifically explored the relationships, if any, between social phobia and psychotic symptoms. The review surmises that the research findings are inconsistent, which seem to be attributable to methodological differences between all the studies in terms of participant selection, chronicity of psychotic symptoms and lack of consistent measures. Chapter Two: Research Report This study investigates attentional processing, the influence of social phobia and the ability to use Theory of Mind (ToM: the ability to infer other people's mental states and behaviour) in people diagnosed with their first episode of psychosis, when compared to healthy matched controls. The results showed that the first episode group attended towards negative evaluation, somatic sensations, physical threat, but not social situation word groups. Social phobia was highly prevalent in the first episode of psychosis cohort (37%) and this anxiety disorder was unrelated to psychotic symptoms. ToM processing was impaired in the first episode group. ToM was not related to social phobia symptoms, but was related to social functioning. Chapter Three: Critical Appraisal This section presents an overview of the experiences and personal reflections of the work that constitutes this thesis and includes the main personal learning points.

This thesis explores the field of psychotherapy with clients with learning disabilities. The work is organised into three sections: Part One: Literature Review. The review examines the available literature on psychotherapeutic contact with people with learning disabilities. The emphasis is on exploring the attitude of the profession towards such clients and charts the move from exclusion to partial inclusion. The review then explores in greater depth, the experience of providing therapy to this client group. The review notes the paucity of information on the topic and concludes that access to services has been affected by the stigmatised identity of the group. The spoiled identity associated with learning disabilities appears to be a central focus in the client-therapist relationship. Part Two: Research Report. This section describes a qualitative study exploring therapists' experience of providing therapy to this client group. Personal accounts were elicited from eleven therapists using a semi structured interview. Data were analysed using the principles ofInterpretative Phenomenological Analysis (IPA). Super ordinate themes emerged, relating to the similarities and differences with other client groups, and the experience of working with stigmatised clients. Themes were identified and theoretical links made with prior case descriptions. Part Three: Critical Appraisal. This section gives a detailed critique of the study's methodology, and explores limitations, clinical implications and directions for future research. A personal account the research process is given, including learning outcomes.

Aims: To investigate any possible relationship between the power and resilience of British psychotherapists and counsellors, and the possibility of their having been abused as children. Main research question: What elements contribute to recovery from childhood abuse? Methods: This three-part study used a mixed-methods approach. Results: (1) The Systematic Review of reliable questionnaires resulted in the design of a final instrument with eight sections including the following five measurements: the 'GHQ1?', the 'List of Threatening Experiences', the 'Ways of Coping Questionnaire-R', 'The Empowerment Scale' and the 'TSC-40'. (2) A Survey of results of 103 completed questionnaires indicated that the prevalence of childhood abuse was 57% with a higher proportion (64%) in women. The occurrence of symptoms of trauma was found to be significantly different between the abused and nonabused groups. However, the results suggested that psychotherapy was beneficial because the abused group did not reflect significant trauma. A complex interaction was discovered between coping styles, power, life events, trauma and emotional health. I Regression analysis demonstrated that Self-Esteem-Self-Efficacy was a subscale of empowerment that mediated trauma. (3) Interpretative Phenomenological Analysis of seven Interviews showed different usages of power: Dominance Power, Powerlessness/Disempowerment' Inner Power and Empowerment. It also showed that 'Imagination' in childhood and 'Active Imagination' in adulthood were faculties of In'ner Power. Psychotherapists reported that their experience of childhood abuse led to an open understanding of trauma, and of its emotional effects in clients who had suffered childhood abuse. They believed that psychotherapy was important for empowerment and recovery. Conclusions: Triangulation of results strongly suggests that imagination is a fundamental component of inner power, and that play, creativity and sports are crucial elements in the construction of empowerment. These results highlight the importance of play, arts and sports in psychotherapy methods, education programmes, and everyday life.

The aim of the current study was to examine cognitive and parenting factors involved in the development and maintenance of social anxiety in adolescents. Cognitive factors comprised interpretational biases of ambiguous social situations and mildly social scenarios. Interpretative biases are assumed to play a major role in maintaining social anxiety. Socially anxious adults interpret ambiguous social events negatively and interpret negative social events in a catastrophic fashion. However, there is little research to support the extension of this theory to adolescents. Parenting factors comprised parenting rearing styles examining dimensions of over-protection, emotional warmth and rejection and parental discipline styles examining dimensions of verbosity, laxity and overreactivity. Past research has indicated a link between child anxiety and parental styles that are characterised by control and rejection, however, these studies have largely been retrospective and few have specifically examined social anxiety. The current study was a prospective crosssectional study with a sample of 78 adolescent pupils aged 12-14years. The relationships between cognitive factors and· parenting factors in relation to social anxiety were examined individually. The planned mediation analysis regarding the role of cognitive factors in the relationship between parenting factors and social anxiety in adolescents was not undertaken due to limited significant associations between the variables. Although only a trend was found suggesting that social anxiety in adolescents was associated with a tendency to generate negative interpretations of ambiguous social situations, a strong association was found between social anxiety and a tendency to endorse catastrophic responses to mildly negative social events. The results provided provisional support for the applicability of adult cognitive theories of social anxiety to adolescents. Social anxiety was associated with negative parental rearing styles and with negative discipline styles overall. It was found to be specifically linked with a rejecting parenting style. Support for associations between parenting and cognitive factors was not found, except for a relationship between the dimension verbosity and self-responsibility for negative social situations, such that children who rated high levels of verbosity in their parents showed a tendency to indicate that they would feel responsible for mildly negative social situations.

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