Many counsellors have shared trauma experience with their clients. However, there seemed to be mixed views on how this shared experience might impact on the client and therapist. Some researchers propose that shared experience offers symbiotic healing for the client and therapist, whilst other authors propose the shared wounds are detrimental to therapy process. Despite these conflicts little seems to be known about how the counsellor experiences and views the shared relationship with the client (Doukas & Cullen, 2011; Rowan & Jacobs, 2003; Wosket, 1999). This qualitative grounded theory study investigated the views and experiences of 10 Recovering Alcoholic Counsellors (RAC) who work with alcoholic clients. The findings of the current study suggested that therapy with the alcoholic client related to the therapist managing their own recovery from alcoholism, which involved processes of building a self-identity, identifying with the client and fearing relapse. The alcoholic identity was maintained and actively used in the therapy work with the client, despite the RAC claiming long term recovery. Identifying with the client appeared to activate shame and increase a fear of relapse for the RAC. These processes appeared to affect a potential dependency on the client work. These factors were reflected to be influenced by AA philosophies, which also affected a bias towards certain therapy interventions. Potential over-identification appeared evident in protective empathic enmeshment and hostile countertransference reactions. This included a possible and concerning coercive interpretation of affording tough-love to clients, potentially causing abuse to the alcoholic client. Positive reflexive practice, self-awareness and compassionate practice were also evident. Feeling deep empathy in the shared experience was suggestive of empathic enmeshment and possible symbiotic healing processes taking place. Other benefits and issues of the shared experience are explored and discussed further. Recommendations are suggested to increase safe therapy practice for counsellors working with alcoholic clients and future research direction has been proposed.

This research is a step towards creating an existential phenomenological model of family therapy when working with alcohol abuse. The research method was constructivist grounded theory and involved interviews with twelve experienced family therapists. From an initial one hundred and twenty-five provisional categories the data was analysed to form eight main concepts. Each of the concepts contains a family therapy and an existential phenomenological perspective. The model can be considered in three formats; a review of family therapy when addressing alcohol problems, an existential phenomenological approach to that situation and an integrated version. The model is described and shown in diagram form and can be used by practitioners in part or whole to assist in their work with families.

The objective of this thesis is to provide an analysis of the contribution that the European Union (EU) could make to the prevention of addiction. The EU is empowered to support its Member States in the public health field through the adoption of legal acts, and has the power to regulate the internal market with public health goals in mind. Recent Treaty revisions has also recognised the EU’s role in the prevention of harm arising from tobacco and excess alcohol consumption. Yet, the EU has no addiction prevention strategy of its own, and the public health and social problems caused by addiction are barely mentioned in public health policy discourse at EU level. This thesis will argue that a renewed and more intense strategic approach to addiction prevention is needed across Europe, and especially at EU level, if the currently high prevalence of addiction is to be reduced. Addiction, it will be argued, is a complex problem, but one which is ultimately caused by the influence of the social environment. The right legal intervention can reshape this environment to weaken its influence upon individuals who are vulnerable to developing addictions. The thesis will argue that the EU has both the mandate and the legal capacity to contribute to such intervention, and will offer suggestions as to how such a contribution might be designed and defended.

No description available.

Background: Community-based rehabilitation (CBR) is a promising intervention to address the complex needs of people with schizophrenia in low-income countries, in particular the high levels of disability, problems accessing treatment and stigma experienced by this group. There have been few randomised controlled trials of communitybased psychosocial interventions for schizophrenia using non-specialist workers, and none which have utilised a community mobilisation approach or that are set in low-income countries. This thesis presents the intervention development, piloting and evaluation plans of a CBR intervention for people with schizophrenia in Ethiopia. Methods: A theory of change approach was used. Intervention development work, including a situational analysis, qualitative interviews and participatory workshops, was conducted to design the CBR intervention. The intervention was manualised and ten non-specialists were trained to deliver CBR. Ten people with schizophrenia and their caregivers received CBR in a 12 month pilot study. Qualitative, process and quantitative data were collected. The protocol for a cluster randomised trial to evaluate CBR, refined on the basis of the pilot findings, was produced. Results: CBR delivered by non-specialists is an acceptable approach for people with schizophrenia in rural Ethiopia. This CBR intervention is likely to be feasible but this requires evaluation on a larger scale. CBR may improve functioning in people with schizophrenia through maximising family and community support, supporting income-generating activities, facilitating access to medication, and increasing hope. However, contextual factors, including poverty and inaccessible anti-psychotic medication, may be beyond the capacity of CBR to overcome. Conclusion: A community-based intervention such as CBR should be provided for people with schizophrenia in low-income countries, alongside accessible anti-psychotic medication. There are indications that CBR can impact on functioning but a randomised controlled trial remains essential. The trial analysis will help to determine the ‘active ingredients’ of CBR that should be prioritised in scaling up.

No description available.

Aims: Drinking behaviours are regulated by motivational tendencies – fast and automatic responses to alcohol related cues - and by a reflective system which can inhibit impulsive actions. While heavy drinkers tend to display an approach tendency, an avoidance tendency has been promoted by the Cognitive Bias Modification, a training that has reduced relapse rate in individuals treated for alcohol dependence. This study investigates motivational tendencies in a group of young heavy drinkers and matched controls. Methods: Participants were selected on the basis of their scores on the Alcohol Use Disorders Identification Test (AUDIT) and 23 heavy drinkers were compared with 20 social drinkers on a Relevant-Stimulus Response Compatibility (R-SRC) task. The R-SRC is a measure of automatic motivational tendencies and it requires to move a manikin away or towards alcohol related and neutral pictures on a computer screen. Neuropsychological tests and the Attentional Control Scale (ACS) were also administered. Results: Heavy drinkers and controls differed in their responses on the R-SRC task, with heavy drinkers being faster in approaching alcohol related images. There were minimal differences in working memory and attention between the two groups, while heavy drinkers reported lower scores than social drinkers on the ACS. Conclusions: Heavy drinkers showed an approach tendency towards alcohol-related cues. This might reflect motivational tendencies towards alcohol although these could have also been influenced by social desirability effects. Group differences in ACS scores might reflect heavy drinkers’ awareness of alcohol-related cognitive decline. Motivational tendencies and drinking patterns might increase the risk of alcohol dependence.

Young people’s very visible and public performances of drunkenness have become a matter of popular and political concern. English alcohol policy, frames this type of harmful alcohol consumption as a problem of individual behaviour, which is underpinned by conceptualisations of risk and rationality. Thus positioning the individual as a rational, risk adverse, decision maker. Consequently, interventions focus on risk factors and individual harm reduction models, despite there being little evidence to suggest that these type of interventions are effective. This thesis moves away from this focus by using a social practice theoretical framework, to explore the contemporary drinking practices of young people from socio-economically deprived areas and to reconceptualise risk in relation to these practices. This study draws on data from three mixed gender friendship groups of twenty-three young people from deprived communities in the North West of England during a 14-month period. This study focuses on the alcohol consumption of young people from deprived communities in northern England because they are the group whose drinking has frequently been the most problematised in English alcohol policy. In addition, people living in disadvantaged communities have been shown to suffer from more alcohol attributable harms than those living in more affluent communities. During the study period, data was collected from three to four in-depth group interviews with each group and from the social media content of each young person. The study draws on the theoretical frame of the three element model of social practice together with ‘doing gender’ and conceptualisations of Bourdieu’s capital, to undertake an empirical enquiry of alcohol consumption, that explores the unequal and varying performance(s) of the practice. This study illustrates how a specific material arrangement of alcohol, the corporeal, spaces, finance and mobile phones; combines and interconnects with social and symbolic meanings of social recognition, sociability, caring and group belonging and with competences relating to the consumption of alcohol and staying safe. By doing so, a recognizable practice-as-entity is identified, which is framed as a proper night out. The study re-conceptualises risk as routine, ordinary and normalised within young people’s intoxicated drinking practices. Thus, risk is viewed as being complex, multi-layered and fluid and knowledge about moderating and navigating hazards and uncertainties is part of the (un)conscious, embodied know-how of the practice.

No description available.

This thesis is divided into two main sections: a systematic review and an empirical paper. Supporting documents and supplementary information can be found in the appendices. Thesis sections and how they are linked will be outlined in this chapter. Chapter 1 (Systematic Literature Review) The aim of this chapter is to systematically review the role of thought suppression in alcohol use. Many alcohol-dependent patients undergoing treatment report using cognitive strategies such as suppression in their attempts to suppress thoughts or cravings about alcohol. However, the evidence on thought suppression suggests that this strategy can have paradoxical effects in that it makes the to-be-avoided thoughts more accessible (Wenzlaff & Wegner, 2000). Klein (2007) found that attempts to suppress alcohol-related thoughts made them hyper-accessible during an alcohol Stroop task in an abstinent alcohol-dependent group but not in a control group of social drinkers. Attempts have been made to counteract thought suppression using mindfulness-based practices (Bowen et al., 2007) as mindfulness encourages acceptance of thoughts rather than suppressing them (Kabat-Zinn, 1990). The findings are discussed in terms of their strengths, limitations, clinical implications and future research. Given the evidence from the review, it was hypothesised that thought suppression was linked to attentional avoidance of alcohol-related cues as seen on measures such as the visual probe task i.e. when alcohol-dependent individuals make a deliberate effort to look away from the alcohol pictures presented for 500ms or longer. The empirical paper aimed to investigate this prediction.