The way in which family members are supported by staff from the mental services after the suicide of a relative is an important, though not well researched area. This research aims to explore two main areas; firstly to explore from the family members perspectives how they were supported by staff after the suicide of their relative and whether this was what they would have wanted as a means of support. Secondly mental health staff were asked about what and how they provided support to families after the suicide of a relative and how they felt about what was provided by them and the service. This research project presents a qualitative study using grounded theory analysis of data collected from family members and mental health staff members about their experiences after the death from suicide of a family member or patient receiving care from the mental health services. The study sample comprised six staff and five family members who were interviewed face to face about what they experienced. The interviews were audiotaped and transcribed verbatim, then analysed in keeping with grounded theory, by using constant comparison of data, paying particular attention to reflexivity and researcher influence upon the data and on-going analysis. The core categories arising out of the analysis from the staff interviews showed that staff feel ill equipped to inform family members or provide support after their relative has died by suicide. More specifically the core categories presented the following key areas for staff as follows; 1. Training and awareness raising about suicide, including broadening understanding about the context within which suicide occurs. 2. The emotions involved with and related to the impact of suicide. 3. Skills and competence in breaking bad news to others including family members after suicide. 4. Including families in the care of people receiving mental health services. 5. Awareness and support with the formal processes that ensue following suicide. 6. Staff support after suicide, including managers, colleagues as well as staff in general in the organisation. The core categories from the analysis of family members interviews showed, that; 1. Family members felt excluded and unheard by staff following the suicide of a relative. 2. Family members spoke about their fear for the future and the legacy of suicide. 3. The formal processes that take place after suicide were unclear and inconsistent for family members. 4. The emotional aftermath of suicide was significant however as core category 5 indicated, the family members experienced a mismatch between what they wanted and what they received from mental health staff and the organisation. Consequently core category 6. Showed how their experience motivated the family members to speak out and join the research into this subject. Conclusions are therefore set out with recommendations that promote guidance and training to mental health staff and services about ways to work with patients and families, incorporating current NHS policy, to improve staff skills and confidence; to ‘attune’ with patients and families, by including families in mental health care and afterwards if suicide happens, to which Family Therapy/systemic psychotherapy theory and practice could contribute in a variety of ways.

This study explores the role of church communities in the everyday lives of refugees in London. It is concerned with how refugees’ interactions with church communities contribute to their strategies to establish community and home in new geographical locations. Such a study makes an important contribution to understanding how refugees, as social agents, actively seek solutions for their lives and how civil society responds to refugees at a time when states are failing to fulfil their obligations to them. This research adopts a lived religion approach which recognises the importance of the agency of individuals and collectivities such as church communities, as well as the power of organisational actors such as religious institutions. The idea of religion as lived experience allows for consideration of the way religion can cross boundaries through the everyday strategies of individuals. Consequently, in-depth interviews with refugees, clergy and laity were a very important source of data for this study. Data was also collected and recorded during ethnographic fieldwork which took place in 2013 in churches and refugee centres across the city of London. The evidence from this study showed that finding a place of belonging is the most important objective in refugees’ choice of church communities even if it means crossing the boundaries of Christian denominations or of religious faith to achieve this. The evidence also revealed that church communities go beyond filling the gap in state welfare provision by providing refugees with access to social networks and to advocates who can represent them in acts of solidarity. The first of two main conclusions drawn from this study is that the opportunity for refugees to choose and act in the social context of church communities counteracts the disenfranchisement that is often experienced by them in other areas of life. Secondly, when solidarity with refugees is based on notions of common humanity then hospitality is given to the Other as an equal thus reducing the risk of a dominant group merely accommodating and tolerating the stranger.

This psychosocial study examines some processes at work when commissioners outsource to independent social worker experts (from a black and ethnic minority background social work), assessments involving black and ethnic minority children and families in cases where here are serious child protection issues. Eight participants, (three commissioners, four independent social workers and one parent). were interviewed using the Free Associative Narrative interview method (FANI). The psychosocial research method used values the subjectivity of the researcher, and the FANI method is consistent with this. (Holloway and Jefferson 2000). Data was analysed using a blend of thematic and narrative approaches, supported by reflections on the researcher's own emotional experience of the interviews. The findings of this study centre on assessments of parents from black and ethnic minority backgrounds who had experienced structural inequalities, discrimination and in some cases racism. The independent social work experts have used a particular framework to undertake the assessments and this has assisted them in formulating recommendations. Anxiety and conflict have featured heavily in the assessments. These anxieties are interwoven with the impact of racism on families, independent social work experts and commissioners working in modern social work organisations. Alongside this the importance of anti-racist social work is considered. Anti-racist social work recognises that racism exists within social work and offers a framework to tackle racism within social work. However, currently anti-racist social work appears to have slipped off the professional agenda and has been replaced by more 'neutral' discourses such as 'diversity'. This allows one not to think about race and racism. lt is a study of how anxieties are delegated to independent social work experts. My interest in this study stems from being a black, female, ethnic minority researcher and independent social work expert. The key research findings are firstly, there are conscious and unconscious processes that have influenced the independent social work expert's approach, which included being motivated and affected by their personal experiences with their own parents and families of origin. Secondly, the way an assessment was presented by the independent social work expert was influenced by unresolved issues from their background. Thirdly, the independent social work expert's biographical material is significant both in shaping their capacity to do the work sensitively and in depth, but also in creating blind spots for them. There are significant implications for social work practice. There is a need for a different model and approach to supervision in social work, which is informed by a recognition of the impact of conscious and especially unconscious influences of a practitioner's biographical material. The importance of intersectionality is considered. This is thinking about how family/emotional/biographical factors are interacting with the dynamics of race/ethnicity, and how anxieties about all these in commissioners and practitioners produce a complex psycho-social knot that has to be understood and worked with if we are to do justice to these cases. This deep and complex biographical investment in this work is both a source of strength and vulnerability. lt is evident that there is something professionally and personally reparative for the independent social work experts, and myself as the researcher, in engaging in the discussions and reflections that make up the data and the findings of this research.

There has been an increasing amount of research into mixed heritage individuals, both adults and adolescents. More recently, some research has emerged on mixed heritage families, but there is hardly any research on mixed ethnicity stepfamilies. As a systemic clinician of mixed heritage, my research interest has stemmed from my personal experience of living in a stepfamily with visible differences, where my fathers Nigerian culture was not discussed. In my clinical job, work with families from culturally mixed backgrounds and have developed a keen interest in their experiences of maintaining the different cultures. I used discourse analysis to examine the various ways in which stepfamilies talked about their differences. Five stepfamilies were recruited. The biological parents (all mothers) and their partners and children participated in the study. The study revealed considerable variation in the talking and maintenance of cultural heritages within the stepfamilies, but four main findings emerged. In some stepfamilies, there was little or no talking, whilst in others, talking about the process of becoming a stepfamily occurred. The stepfamilies had various experiences of living with their visible differences, which included ideas of not having any differences or minimising differences. The extended family's role also played an important part that changed over time. The biological fathers 'presence' was particularly significant to the children, most of whom maintained contact with their fathers. The study has revealed stepfamily life's complexities and the numerous ways in which the mixed heritage children/stepchildren navigated the different households to maintain their cultural heritages.

This study takes as its subject the clinical work with 7 older adolescents who attended for once-weekly psychoanalytic group psychotherapy, and focuses retrospectively on the first 15 months of this intervention, in which the researcher was a co-therapist. The clinical process notes formed the data set. The starting point for this thesis is our conception of an inherent, developmental relationship to groups, and to the intersubjective relating that exists in human beings. It then moves on to the psychoanalytic thinking about groups and the emotional disturbance that emerged during World War II found in the work of WR Bion and SH Foulkes. It further examines literature on adolescence as a developmental process, adolescent breakdown, and the particular psychosocial risks and challenges of later adolescence. The intrinsic complexity in the data precipitated initial conceptualisations – for example, borrowing Foulkes’ notion of figure-ground - to help apprehend the material. Then, using a form of Grounded Theory, the data set was examined methodically. This evidenced how members brought complex, changing constellations of feeling, and mental and bodily states to the group. Analysis revealed relational and developmental predicaments which would interweave inter-relationally at both conscious and unconscious levels. Using both narrative and tabular forms of presentation, it is demonstrated how this shared, multi-dimensional matrix of iv relationship and communication created the bedrock of the group therapeutic encounter. Emotional and psychological growth developed in the context of members’ capacities to bear emotional knowledge, and hold emotional states over time as individual preoccupations became less pressing within a heuristic relational encounter within the group. This conferred to the group the qualities of Bollas’ ‘transformational object’, while the matrix itself linked with Stern’s primary inter subjective matrix. It is suggested that group psychotherapy has much to offer young people whose relational and psychosocial struggles can be explored in the safety and stability of the clinical group setting.

Increasing technology use in the organization of human services is seen as essential to achieving greater efficiency and effectiveness. However, the promises may not be realised if technology generates processes and structures that are misaligned to the primary task of the service. How and why this occurs, and the role of unconscious and emotional factors, is insufficiently understood. There is limited guidance on how to work with technology in complex services where anxiety, and defences against it, may be a significant factor. Drawing on systems-psychodynamics, actor-network and process theory, this research addresses these gaps through a methodology in which human and technology are seen to operate symmetrically in the ongoing formation of organizations. The research studies child welfare and mental health services as an ‘extreme case’ for technology implementation as the site of significant transformation and powerful human dynamics. Data are gathered via a visual method known as the social photo-matrix in which participants, all practitioners in these services, generate and respond to images on the theme of ‘technology at work’. It is found that technology reduces an organization’s capacity for processing emotion which leaves staff with increased anxiety and fewer ways to modify it. Technology mediates organizational processes to make them fit the models of measurement and efficiency by which it operates, and transforms the reality of services both on the ground and in the minds of the people within them. It is concluded that these processes make staff less available to provide compassionate, empathic care for service users, and generate organizational processes that may not be aligned to the task of providing human services. The implication for leaders and consultants is that it is only possible to realise the promises of technology if it is engaged with thoughtfully, in an environment where anxieties can be managed.

The project was a feasibility study into the usefulness of a collaborative consideration of observational material in an early years special education provision. Children were referred, often for only two terms before returning to their mainstream schools where there was an expectation that the concerns would have been improved or resolved. A Child Psychotherapist observed the classes from behind a screen. These were filmed and then written up later in the tradition of Tavistock young child observation. This material was discussed with the teachers in an exploratory session and then a month later there was a review of this process to see if it had been helpful to the teacher’s thinking about the children. The whole process was repeated to allow for some learning from the first phase to be carried forward. A secondary aim of the study was to explore the aspects of the teacher-pupil relationship that promote learning. This study encompasses the use of observation and video along with consultation in schools to assist work with teachers in early years settings. The themes drawn from the data revealed a passive and active interaction between conscious and unconscious processes as they occurred in the classroom as well as in the discussion of the observations. These themes describe the progression of learning as it was observed. There emerged a preference among the teachers for the filmed material which yielded a rich data set. It highlighted the importance of the relationship between teacher and child and the extent of the non-verbal nature of this communication. The written observations worked as a foil to the acceptability of video and provoked discussion in post observation sessions. Whilst technically and ethically demanding the use of video here revealed an increasing desire and orientation toward visual media and its application in work with vulnerable children.

This study aims to understand and describe some of the ways in which power arises, and is managed, between clinicians who are systemic psychotherapists and the parents they are working with in a social care context. Examining their interactions in detail, particularly their talk, aims to do this. Interest in the questions arose from my own practice as a systemic psychotherapist working in children's social care, with a focus on complex neglect, where I identified challenges to effective practice that were related to that context. My initial ideas were about power being a particularly salient issue in each of these challenges in one way or another, and I wanted to examine and extend this area of interest using qualitative research methods. Conversation Analysis (CA) is used here to examine the power dynamics at the heart of therapeutic work in this social care context. The primary overall objective of the study is to understand how power dynamics are managed to enable interventions aimed at reducing risk in families to be effective, by answering the following questions: L What is happening in moment-by-moment interactions between parents and systemic psychotherapists talking together, when the talk is taking place because of issues regarding risk to children? How are power dynamics being spoken about, negotiated, or managed in this high-risk context? 2. What is happening in moment-by-moment interactions between parents and systemic psychotherapists when talk that may lead to change, and reduce the risk to children, can be identified and seems to be being mutually created, understood and agreed between them? How are power dynamics being spoken about, negotiated, or managed in this particular high risk context? I examine 3 sessions, with 3 different sets of parents and systemic psychotherapists, in detail. I argue that power can be made useful when it is arising as authority that is jointly created between parents and therapists. I contend that the findings show how systemic approaches and practice can uniquely conffibute to safeguarding work in contexts where issues of power prevail. I consider how the systemic practitioners in the study show their ability to deal with the power differentials arising, and develop relationships, that lead to effective and ethical working. I show how combining systemic and CA frameworks allow these abilities to be seen, and identified. These abilities are reflective of the systemic theoretical base, and systemic techniques enable these theories to be put to use. I show how these elements of practice enable complex processes between people to be negotiated. I argue how systemic approaches could contribute to mentalization-based approaches more than they do presently, and specifically when working with 'hard to reach' families. I argue that other therapeutic approaches such as these would benefit from dealing with the concept of power more explicitly, and benefit from understanding and utilising systemic approaches and practices in more depth to do so. I also use this understanding of what is happening in the relational systemic approach to examine the often-used concept of 'disguised compliance'. I make an argument for a more relational use of the term than is sometimes suggested. All of the above areas have implications for practice, and for the training and supervision of systemic psychotherapists, and other practitioners working in a social care context.

This thesis reports on a study of the emotional impact on sibling bone marrow donors. lt considers in particular donation that takes place during their adolescence and was prompted by the concern of medical and nursing colleagues managing the treatment of young people with cancer. The study interviewed five donors and discusses these interviews using the lens of psychoanalytic theory to offer a deeper understanding of these donors' experiences. Understood in this way, particularly using the psychoanalytic concept of projective identification, a main finding of the study is that whilst these donors would not have refused to donate, based on the love and duty of a filial relationship, the donation evoked complex emotions arising from the sense of the physiological merging of two people. The study makes some recommendations to change current practice within the hospital where I work in order to improve the psychological management and care of sibling bone marrow donors.

This research is based on ethnographic fieldwork amongst women purchasing direct sales cosmetics in Slovakia. To interpret the data I use concepts from social as well as evolutionary anthropology. In the thesis I examine the closely bonded female collectives that emerged during the purchasing of cosmetics from direct sales companies. I show that while the company sales representatives were trained in the network selling marketing to make a profit, under specified conditions women’s collectives emerged that encouraged the shared ritualized purchase of cosmetics which undermined the sales representatives’ incentives to make a gain. I identify and explain the mechanisms that intensified the relationships amongst the women who created collectives of allies. In this ritually forged environment the women created small collectives based on mutual trust, sharing, egalitarianism and cooperation that extended beyond the context of attractiveness enhancement. In the ritual mode women generated a resistance culture that opposed the individualistic and competitive practices of the cosmetic companies and favoured the leveling of beautification through ritual egalitarianism. From the energetically costly ritual performance ambivalent ritual gender emerged that incorporated both female and male characteristics and was controlled by the female collectives. Endowed with ritual power women employed their ritually created collective agency by claiming their ritual space and time. In the process of ritualization the women transformed economic relations into gift-like relationships that through a web of social obligations created bonds of solidarity and cooperation amongst them. As a result of the collective ritual practice cosmetics became a signal of commitment to the cosmetic coalition. They were invested with the meanings of morality, cooperation and equality of quasi kinship ties. Through regular participation in the collective cosmetic rituals women learnt a ritual template that enabled them to enter any such female collective across Slovakia. These collectives provided their female members with benefits beyond the ritual context. The thesis contributes to the body of work on female competition and cooperation. It shows that once women are united through collective rituals with cosmetics and beautification at their centre they create a safe environment where cooperation rather than competition through beauty prevails. Through recognizing and interpreting the mechanisms for bonding and group commitment the thesis also develops the model of female cosmetic coalitions within the setting of direct sales cosmetics in Slovakia.