Background: A variety of factors impact on the outcome of therapy including the therapeutic relationship, the therapist, the family background and co-morbid problems of clients. The Personal Constructs of clients, particularly their concept of ideal self and presenting problem, have been found to affect outcome in therapy. However the impact of a client’s wider pattern of construing is an area that has been neglected. In particular, this study investigated whether clients’ constructs of factors influencing personality development were associated with outcome in cognitive behaviour therapy (CBT) groups. Method: Clients were recruited from CBT groups for a range of different clinical presentations. The study was in three stages. In stage one participant’s constructs around factors influencing personality development were found using dyadic elicitation. In stage two, a participant group categorised the constructs, and all participants then ranked the constructs using a modified resistance to change methodology. In the third stage, the ranking of constructs was compared between participants with good or poor therapeutic outcomes using a Mann-Whitney analysis. Results: A total of 26 participants were recruited, of whom 22 were involved in the comparison of good and poor outcome. Participants identified sixteen constructs of influences on personality development. A particularly sophisticated hierarchical model was developed spontaneously by participants, providing methodological validation. In comparing groups, it was found that constructs about education being ranked low were associated with poor outcome, and dropping out of therapy. Conclusions: CBT groups have many parallels to educational settings. Therefore it was hypothesised that if individuals ranked education constructs low they would find it more difficult to gain benefit from a CBT group. It was suggested that rather than assigning clients to treatment based on diagnosis, more attention should be given to what they construe as ‘helpful’.

Part One: Literature Review - Background: People who experience an intensive care unit admission may also experience post-traumatic stress and other forms of psychological distress. Such phenomena are only partly explained by the reason for admission. This distress can impede physical recovery and full participation in everyday life. Method: Using specified criteria, several databases were systematically searched and 279 abstracts highlighted; 215 articles were subsequently screened with a total of 104 articles being retained for specified quality criteria screening and critique. Results: Following critique, a total of 19 articles were retained for their relevance to the research question. Conclusions: The literature presented sufficient information to enable the investigator to propose a model describing the mechanism for PTSD development in ICU. Despite the extensive selection and screening process, most articles contained methodological flaws, however the investigator advocates that the information provided by the literature should not be dismissed and that future research might be directed towards replication of such research to RCT standards. Part Two: Research Report - Introduction: Despite the literature indicating that PTSD and other forms of psychological distress are significant problems for intensive care unit patients, the mechanisms involved in the development of PTSD remain largely unexplained. The investigator hypothesised that PTSD may occur as a result of implicit learning/classical conditioning/pairing of auditory stimuli to emotional distress experienced in the intensive care unit. Aim: To test the hypothesis that classical conditioning (pairing) of ICU environment sounds to patient distress or anxiety in the ICU which can then be detected after discharge as an emotional conditioned response to the presentation of a range of sounds (Train/Rain and ICU) sounds whilst monitoring skin conductance. Method: Thirty-three patients were recruited into the study and twenty participants were able to provide data to permit testing relating to the main hypothesis at 4-5 weeks post-ICU discharge. Results: A non-significant trend was noted in the relationship between presentation of ICU sounds and increased skin conductance responses, but the investigator was unable to find significant evidence of any relationship between skin conductance responses to ICU sounds and measures of psychological distress. There was significant evidence to suggest that the presence of memories as measured by the ICU Memory Tool at one-to-two weeks post-discharged from ICU were related to PTSD development. Conclusion: Patients demonstrating increased memories of feelings at one-to-two weeks, should be monitored carefully for any subsequent signs of PTSD and other forms of psychological distress. Future research should perhaps attempt to replicate the ICU sounds findings in a larger sample size with comprehensive recording of ICU sedation and memory phenomena details. Any attempts to find evidence of implicit memory using prompted recall questions should plan to capture this within 24 hours of stimuli presentation. Part Three: Critical Appraisal - Reflections regarding the research process and content are discussed.

Literature Review: A qualitative literature review was conducted investigating the training experiences of minority ethnic students pursuing health careers. The review identified that various challenges can be experienced by the minority ethnic student. The following themes were consistently found across the studies: a fear of challenging culturally insensitive practice or ethnocentric theories; being considered the cultural expert; a lack of cultural competency by peers and faculty tutors; difficulties in balancing academic priorities and family obligations; loss of confidence and motivation due to internalisation of negative stereotyping. Recommendations include provision of a culturally sensitive pedagogy and mentoring as supportive interventions. Research Report: Semi-structured interviews were used to explore the career trajectories of nine South Asian clinical psychologists and analysed using Interpretive Phenomenological Analysis. All of the participants in this study were the only South Asian in their cohort on the DClinPsy training course; eight were the only minority ethnic student. Participants described unique classroom experiences relating to their cultural identity including feelings of isolation and being perceived by staff and peers as the ‘cultural expert,’ consistent with the literature. Furthermore, gendered pressures included balancing academic and cultural responsibilities for the female participants. Socio-cultural factors such as family expectations and a value for traditional careers within the individual’s community posed challenges for choosing clinical psychology as a career. Participants’ descriptions of ‘being different’ to their South Asian peers suggest issues of self-identity related to career choice. Once qualified, being a South Asian clinical psychologist created subtle tensions when professional roles and responsibilities challenged cultural roles within the participant’s own community. Critical Appraisal: Reflections in this paper consider the research process and the impact of the participants’ narratives on the researcher and of her personal and professional development. Considerations are also given to the researchers’ impact on the project.

In many western nations, immigration policies place significant restrictions upon individuals seeking asylum, such as denying them access to employment. The literature review set out to explore whether factors related to the post-migratory environment have implications for forced migrants’ identity and psychological well-being, via the loss of social roles. Systematic literature searches were conducted, resulting in a total of 27 relevant papers to be reviewed. It was tentatively concluded that both unemployment and social isolation contribute to the high levels of psychological distress observed amongst forced migrant populations, and that this relationship is mediated by social role loss. However, the synthesis of findings across studies was limited by methodological weaknesses and the range of nationalities studied. It was suggested that further research is required. The research study employed a qualitative, semi-structured interview design to explore identity issues and psychological well-being in a sample of seven Zimbabwean males seeking asylum in the UK. The data was analysed using Interpretative Phenomenological Analysis. Participants described negative consequences for their identities as a result of the economic and political downturn in Zimbabwe and revealed that their identities were further threatened upon arrival in the UK due to the many losses they had incurred by migrating. The legislative restrictions imposed upon them and the negative social representations they were exposed to as asylum seekers also served to threaten their identities and to undermine attempts to rebuild a positive sense of themselves. However, all participants described having regained some positive aspects of their identities and many talked about personal growth as a result of the adversity they had experienced. The findings were interpreted with reference to previous research and relevant psychological theory. Implications for clinical practice and suggestions for future research were discussed. The critical appraisal provides the researchers’ personal reflections on the research process.

Pain is both a medical problem and also an everyday experience for chronic pain patients. Attending to the biomedical aspects is important, but the emphasis on this can result in a failure to consider how the patients perceive and live with their chronic pain. The management of sensation over understanding emotion in traditional medical and psychological approaches has resulted in the lack of attention to the lived experience of chronic pain therefore neglecting broader issues of how culture and social factors influence pain. The UK is becoming more culturally diverse therefore there is a growing necessity to understand any influences of culture and ethnicity in pain management. The aims of this study were to address what is the patient’s experience of living with chronic pain followed by an appraisal of how or if ethnicity (White British or South Asian) influences the experience of living with chronic pain. The empirical work undertaken comprised of qualitative analysis of thirty-seven semi-structured interviews with patients attending a pain clinic in a culturally diverse city. The qualitative methodology used was Grounded Theory therefore a review of the literature was conducted after the initial empirical work. The literature itself was subjected to qualitative analysis and a narrative review was produced. The final element involved generating a synthesis of the narrative review and a theoretical model was produced from the empirical work. Important constructs of living with chronic pain were identified as affect, participants‟ expectations of the consultation, the reality of living with chronic pain and legitimization of chronic pain, and relationships between them were discussed. This thesis explored patients’ narratives with a view to uncovering differences between the pain experience for different demographic groups (e.g. age, gender and ethnicity). However, the data suggest that there are more similarities than differences between groups; this may be partly explained by acculturation. Research into newly arrived ethnic groups in the UK might reveal more differences in their perception of health, illness and pain.

Aims and Method: Surgical intervention as a treatment for Gender Identity Disorder is a procedure increasingly well examined from a medical perspective, yet relatively poorly in terms of psychological outcomes. Further to a systematic review of the literature evidencing post-operative outcomes from a psychological perspective, a qualitative study was designed with a view to exploring this comparatively rare and under-examined phenomenon. Interpretative Phenomenological Analysis was selected as the method of data analysis, for the purpose of capturing the relative novelty of the subject matter and due to its emphasis on process and meaning. Eight participants who had completed male to female surgery were recruited and interviewed by the researcher. Results: Emergent themes in the interview data were clustered into five super-ordinate themes, where participants had communicated the following issues of significance to them: the importance of contextualising surgery; the social dimension of the procedure; the need to distinguish between gender and sex; the notion of having made a difficult but necessary choice; and the sense of living between genders post-operatively. Conclusions: The findings of the current study suggest that from a psychological perspective, surgical gender reassignment has complex implications for both the patient and those around them, such that it is perceived as both life-changing yet ultimately limited as an intervention. Further research is needed to build on these findings, for example through examining the experiences of partners and family members whose are themselves integral to the experience of constructing gender in this way.

Part One: Literature Review - Background: Women may experience birth-related PTSD and research has begun to examine the potential effects of this disorder on infant development. This article aimed to review that evidence. Method: Three databases were systematically searched. Results: 8 articles met inclusion criteria. The variables examined were categorised into mother-infant attachment, children’s temperament and parenting behaviour. Conclusions: The review highlighted a dearth of rigorously conducted research in this area. However, the articles provided limited evidence to support the claim that aversive birth experiences/PTSD can lead to less optimal parent-infant bonding and difficulties with infant temperament. Although tentative, these conclusions suggest professionals working with families postpartum should be alert for the possible impact of aversive birth experiences on their parent-infant bond and the infant’s temperament. Part Two: Research Report - Background: The traumagenic potential of childbirth is well-documented but no research has examined the way in which professionals understand birth-related trauma. Given the potential impact of these understandings for women’s care, this research aimed to explore the knowledge, attitudes and beliefs of health visitors regarding birth-related PTSD. Method: Three focus groups and three interviews were conducted with health visitors and their managers. Verbatim transcripts were analysed using template analysis. Results: Analysis highlighted two routes by which participants perceived birth could result in distress. The first emphasised qualitative aspects of a birth as traumagenic, whereas the second began with a ‘normal’ birth but was experienced as traumatic due to other circumstances. Discussion: Although much of the phenomenology described by participants was commensurate with that in the literature, a notable discomfort with the term ‘PTSD’ and a lack of emphasis on the role of meaning suggested participants may have lacked theoretical understanding of PTSD. Clinical implications of these findings are described. Part Three: Critical Appraisal - Reflections on the overall research process are provided.

Part One: Literature Review Background: Children and young people who are looked-after by social services are at increased risk of mental health problems. This and their experiences of care may contribute to difficulties accessing friends and social support. The aim was to review the state of the literature on the friendships and social relationships of children and young people looked-after by social services. Method: Five databases were systematically searched. Results: Thirty seven articles were retained as relevant to the question. Conclusions: The articles reviewed demonstrated some evidence of peer relationship difficulties for the looked-after population and identified contributing factors. However, the articles demonstrated areas of poor quality such as small sample sizes and highlighted areas for future research. Part Two: Research Report Introduction: Children and young people who are looked-after by their local authority are more likely to experience difficulties in forming and maintaining friendships but how they make sense of their experiences is not understood. Aim: To understand the meanings young people who are looked-after construct from their experiences of friends, friendship and peer relationships. Method: Seven young people looked-after by their local authority took part in semi-structured interviews. The co-construction of narrative in the interviews were analysed using Critical Narrative Analysis (Emerson & Frosh, 2004). Results: The young people were all able to construct meaning from their experiences of friends, friendship and peer relationships and all had some experience of close and supportive friends that they valued. Some barriers to friendship were understood by the young people to be caused by having to move a lot and by individual characteristics within themselves. Conclusion: Friendships were positive contributions to the lives of LAC and provided them with a source of emotional support. Part Three: Critical Appraisal Reflections regarding the overall research process are provided.

The literature review synthesises and critiques the research literature pertaining to the efficacy of clinical supervision within the psychology profession. Five electronic publication databases and two journals were examined in a systematic literature search according to particular inclusion and exclusion criteria. The search revealed studies examining the supervisory relationship, supervisee characteristics and supervisor confidence and competence. A notable omission from the review was empirical research investigating the effectiveness and outcomes of clinical supervision. It is posited that research exploring this area would represent a significant contribution to the literature on clinical supervision. The research study attempted to gain an understanding of the experiences of staff and patients on an acute adult inpatient ward through the use of a psychodynamically-orientated observation methodology. The influence of supervision group meetings on observational learning was also explored. Six planned observation sessions took place and qualitative data was collected through the audio-recording and transcription of supervision group meetings. The data was thematically analysed according to the procedure of Braun and Clarke (2006). The suggested findings of the analysis appeared to illustrate a complex system which impacted upon ward atmosphere, relationships, behaviour and perception of job role and responsibility. The research process also appeared to highlight important considerations relating to the role of affect and the process of learning in qualitative research. The suggested findings are considered in terms of previous research and relevant theory. Clinical implications are discussed. The critical appraisal provides an exploration of the research journey and presents the research process as a challenging yet rewarding learning experience.

Purpose: The needs of young people within forensic mental health settings are starting to become more recognised and services are beginning to reflect this. However there is little research into how staff in forensic child and adolescent mental health settings experience the task of working with this group of young people with complex difficulties. The purpose of this study is to explore how these staff experience their work. This is intended to expand research in this area and identify how the findings can inform clinical practice and future research. Method: A systematic literature search identified some research in relation to the needs of adolescents with mental health and forensic difficulties and literature in relation to working with children. Very little was found in relation to staff experiences working with children in forensic mental health settings but some research relating to adult forensic and mental health settings was found. A qualitative study was carried out in order to bridge this gap in the research. Interpretative Phenomenological Analysis was selected as the method of analysis for the study, which involved interviews with nine participants who were currently working in secure child and adolescent forensic mental health services. Results: Four themes emerged from the first level of analysis: powerful internal experiences, impact of the environment, negotiating complex staff relationships and managing complex client dynamics. A second level of analysis focusing on the researcher's impressions of the research overall identified another theme: difficulty thinking about and articulating experiences. Conclusion: This study is an important first step in identifying some of the issues faced by staff working in a challenging area. It has highlighted clinical implications and where further research might be useful.