Background: International students (IS) are arguably a population facing both educational and migratory challenges. These are understood within Culture Shock (CS, Oberg, 1960), a process of culture learning. Available literature on IS seems to focus mainly on the phases of CS between the arrival in the host country until adaptation, or at the later stage of returning home. The last part of the IS journey in the host country, before the possible return home, appears neglected. Research suggests that in this period, named the ‘crossroad’ in this study, important decisions could be made, such as whether to stay in or leave the host country. Rationale: Internal struggles, dilemmas and uncertainty can arise due to the possible changes to self that IS can develop while abroad, and could be exacerbated by immigration laws. Thus, the crossroad can be a phase of psychological struggle, which can be of interest to mental health professionals. There is limited qualitative evidence on this sub-phase of CS on IS and this research attempts to address this gap by looking holistically at the subjective experiences of these students and letting their specific psychological needs arise. Methodology and main findings: An interpretative phenomenological analysis (IPA) was chosen for this research, using semi-structured interviews. Three superordinate themes emerged from the analysis of the transcripts: a) Changes to self and identity; b) Uncertainty, temporariness and emotional responses; c) Dilemmas at the crossroad. The crossroad emerged from the results as a phase dominated by uncertainty towards the future, leading to experiencing difficult emotions such as worry, anxiety and low mood. From the participants’ accounts, it seemed that the limitations imposed by the UK immigration law were the main trigger for such uncertainty, and that IS perceived their circumstances as largely out of their control. The IS’ psychological and emotional responses seemed connected with having developed a sense of belongingness to the UK, resulting from a process of changes to self and identity experienced during their time abroad.

Research in the field of HIV acknowledges the existence of social constructs, including the incongruity between HIV, motherhood and sexuality, which may add to the psychosocial burden of an HIV diagnosis (Blystad and Moland, 2009; Long, 2006; Stinon & Myer, 2012). However the research is fragmented, and addresses the concepts of motherhood and sexuality in the presence of HIV independently. There has been little consideration of how the opposing constructs may be simultaneously experienced and negotiated by positive woman. Additionally existing research focuses on pregnant women or mothers, it does not explore the impact of an HIV diagnosis before entering into motherhood. Despite adopting a philosophy of holism and valuing the creation of environments that sustain mental well-being, Counselling Psychology literature is relatively silent on women’s adaptation to HIV. This qualitative study explores how European, childless women who have been historically underrepresented in the literature experience sexuality, and feelings of motherhood following an HIV-diagnosis. Interpretative phenomenological analysis of five women’s experiences produced superordinate themes of, ‘The even worse than undateable woman’, ‘Nothing can spark my sexuality’ and ‘You have to adapt…I owe it something’. The women speak of experiencing a continued psychological impact of an HIV-diagnosis, despite the advances in medication, which precipitates multiple psychosocial crises related to sexuality, identity, femininity and concepts of motherhood. There is a dominant experience of distress, confirming previous research on HIV-trauma. However there are also experiences of resistance, successful negotiation, and personal growth. Clinical implications are discussed in light of counselling psychology’s multidisciplinary approach, including therapeutic recommendations to explore and challenge women’s definitions of sexuality, femininity and motherhood.

War-reporting journalists have a higher prevalence of Post Traumatic Stress Disorder (PTSD) than the general population (Feinstein, Owen & Blair, 2002). However, no psychopathological gender differences have been identified (Sinyor & Feinstein, 2012). This is in stark contrast to evidence from the general population, which indicates women experience double the rate of PTSD than men (Kessler, Sonnega, Bromet, Hughes & Nelson, 1995). This study qualitatively analysed female journalists’ experiences of covering potentially traumatic news stories, with a view to exploring the lived experience behind the statistics. Interviews with four UK-based journalists, with extensive experience of covering potentially traumatic news stories, were analysed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes were identified; psychological responses to covering traumatic news stories, perception of support related to traumatic coverage and attitudes towards counselling. None of the participants’ psychometric screening surveys indicated significant post-traumatic stress responses, yet all qualitatively reported multiple symptoms, indicating a tendency to under-report and a lack of psychological mindedness. Conversely, post-traumatic growth (PTG) was evident indicating that perceived rewards mitigated adverse psychological outcomes. Support from management and colleagues were largely perceived as practical rather than emotional by the participants, if at all, with indications of a macho work culture which did not support motherhood but propagated inter-journalist romance. Dissatisfaction, ambivalence and misconceptions related to counselling emerged, alongside a preference for a non-stigmatised professional encounter, such as debriefing, indicating a need for psycho-education and specialised training for both media professionals and mental health practitioners.

Vitiligo is a chronic skin disorder, which de-pigments parts or all of the skin. This disfiguring condition presents individual sufferers with many challenges. Studies have shown an adverse psychological impact of living with such a skin condition. However, no studies to date have explored the experience of vitiligo from a purely male perspective. This study sought to provide some preliminary understanding of and insight into men’s experience of vitiligo. A qualitative design was employed and the study was conducted using semi-structured interviews with six participants from a white British background who were all members of the Vitiligo Society UK. Three arching themes were found: processing the vitiligo diagnosis, focus on self and managing relationships. These findings are relevant to the theoretical understanding of the psychological impact that skin disorders can have on men. The applicability of these findings for Counselling Psychology practice in the management of vitiligo is discussed and future areas for research are suggested.

Personal and professional development activities are a central component of Counselling Psychology training due to regulatory requirements and the high value Counselling Psychology places on the therapist’s "self". Most research on the facilitation of personal and professional development focuses on specific training activities such as personal therapy and personal development groups. However, it is widely acknowledged that personal and professional development are also facilitated by aspects of training and life that are not designed for their facilitation. This research explores the relationship between trainee Counselling Psychologists’ personal and professional development and their client work. Interpretive Phenomenological Analysis (IPA) was used to analyse semi-structured interviews with six final year trainee Counselling Psychologists. Two main findings were identified: firstly, participants were unable to discuss their personal and professional development in relation to client work specifically; personal and professional development were facilitated by the relevance of specific experiences to individuals’ needs and preferences rather than activities having a direct facilitative effect themselves. Secondly, participants did not engage in active personal development work, and this was not explicitly discussed or structured in training. These findings imply that trainees may not develop optimally: as personal and professional development are highly individualised and complex processes, research and training that focuses on specific training activities may fail to interrogate the complexity of why and how personal and professional development are facilitated. Regulatory and ethical implications are discussed alongside existing literature to suggest the beginnings of a personal development curriculum for Counselling Psychology training.

The effectiveness of Sexual Offending Treatment programmes has generally been measured through evaluating intervention content and reoffending rates. In response to the growing call to explore the role of therapeutic process in facilitating meaningful change on these programmes, this thesis considers how interpersonal dynamics may influence programme effectiveness from the perspective of the group member. This offers the opportunity to consider the impact of how we work, rather than what we do. The critical literature review uses a pluralistic framework to present relevant existing research and identify gaps in practice-based knowledge in the field of sexual offending intervention from a Counselling Psychology perspective. While the literature suggests interpersonal ingredients important to this process, it offers little information regarding where, when and how these qualities are effective. Furthermore, little is understood about the impact of relational dynamics between the facilitators and group members in creating a facilitative environment. This reveals broad gaps in research relating to a neglect of the client’s experience of these interactions and how they are conceptualised in their change process. This research therefore uses a social constructivist grounded theory method to generate data exploring these process issues. The results highlight the value of facilitators fostering a dynamic and balanced core interpersonal process that is sensitive to the unique context of these group interventions. This offers a foundation for group member engagement and effective group functioning relevant to subjective change. The implications for theory and practice are discussed, highlighting how a Counselling Psychology presence in this field has the potential to enhance practice. The study is concluded with reflections of the study’s limitations and areas in need of further research.

Research on secondary traumatisation suggests that there is a certain overlap in terminologies used in the literature that are related to the concept of secondary traumatic stress. These interchangeable concepts include vicarious trauma, compassion fatigue, burnout and countertransference. The main aims of the current study are to investigate the differences between various terms associated with post-traumatic stress disorder (PTSD) including secondary traumatic stress, compassion fatigue and burnout. The present research also aims to investigate the impact (direct and indirect influences) of secondary trauma on professionals working with victims and survived traumatized individuals. It was predicted that health workers who are exposed to psychological or physical traumas would experience secondary traumatic stress. In addition, it was also hypothesized that there would be gender differences in the intensity of secondary traumatic stress reactions. Longer years of employment were predicted to relate to lower levels of secondary traumatic stress. Furthermore, the profession would moderate the relationship between years of employment and secondary traumatic stress. A sample of 210 professional staff, working in several hospitals and private clinics, and representing health and social care councils in London, United Kingdom completed four self-reported questionnaires measuring secondary traumatic stress. Several hypotheses were postulated and tested using correlation and hierarchical regression analyses. The results showed that a majority of professionals working with traumatized patients displayed symptoms related to secondary traumatic stress, in particular those professionals new to the field. However, a greater reduction in symptoms was observed the longer an individual had spent in the profession. This finding has suggested years of experience may help professionals employ resiliency against severe traumatic events. Other interesting findings reported in this study suggested that females are inclined to experience higher secondary traumatic stress symptoms than males, regardless of years of experience. The reported findings seem to be consistent with previously undertaken research (Figley 1995; Miller and McGowen 2000; Robinson 2003; Sonneck and Wagner 1996; Stamm 2000). It should be emphasized here that extra care, attention and support are essential to new healthcare providers, especially during their first year of work. Researchers also need to develop intervention programmes that will assist healthcare providers in their vital work in trauma care settings – recognizing and dealing with the early stages of secondary stress symptoms and reactions is of the utmost importance.

There has been a significant increase in the number of people using club drugs and entering treatment for problematic club drug use in the United Kingdom. It has been suggested, based on socio-demographics, that the treatment needs of such users are different from those of users of traditional drugs, and consequently specialist club drug clinics were introduced. However, to date no research has explored the subjective experience of problematic club drug use to substantiate an understanding of users’ psychological treatment needs or the subjective psychological motivations to use club drugs, or how such users self-identify rather than being categorised in terms of socio-demographics. This research aims to answer these questions, with a focus on mephedrone, one of the most newly identified and popularly used club drugs in the United Kingdom. Semi-structured interviews with six male users of mephedrone were analysed using interpretative phenomenological analysis. Findings suggested that the subjective experience of mephedrone use is like that of traditional drug use, and consequently that corresponding users’ psychological treatment needs are similar. The subjective motivation to use mephedrone was primarily concerned with a want to appease identity distress, a common precursor to substance misuse. Users of mephedrone appeared to make sense of their problematic use by progressing through the stages of change. Moreover, findings implied that stigmatising beliefs operated within the drug-using community, which facilitated the social construction of mephedrone as harmless in comparison to traditional drugs. This perception was found to be further propagated by terminology such as “club drugs” that are used within the professional arena and represent mephedrone as “fun”. Not only did the socially constructed image of mephedrone as harmless and fun encourage its use, it appeared to prevent users self-identifying with the stereotypical identity of problematic substance misuse commonly associated with traditional drug use. This potentially acted as a barrier against users of club drugs seeking treatment from generalised services based on the needs of traditional drug use, thus highlighting the necessity for specialised club drug clinics. Implications of this research include introducing the under-represented area of problematic substance misuse to counselling psychology to promote the applicability of counselling psychologists to work in this field. This research fills the imperative training gap experienced by healthcare professionals based in the United Kingdom in relation to the understanding of problematic club drug use, and does so by providing subjective knowledge of the experience of problematic mephedrone use in order to develop the psychological treatments delivered. Furthermore, this research advocates the introduction of policies that would reduce the harm caused by mephedrone and demystify its socially constructed image. One such policy would be to suggest interventions to distribute information concerning the harms associated with mephedrone. Another would be to reframe the professional language used to describe club drugs. Lastly, this study highlights the need for further investigation into the stigmatising beliefs operating within the drug-using community that potentially act as a barrier preventing users of mephedrone from seeking treatment.

Stroke is one of the major causes of death and disability worldwide. The area that surrounds the infarcted core is the location of the continuing damage that takes place hours and days following an insult, and is referred to as the penumbra. By creating an oxygen deprived environment in the neuronal-like PC12 and NT2 cells and an in vivo photothrombotic model of stroke (PTS) in mice, two different strategies were created to replicate the conditions of an ischaemic brain. In differentiated PC12 and NT2 cells, following hypoxia, preferential activation of HIF-2α transcription and protein expression was detected. Increased expression of the neural progenitor stem cell-like markers, thought to be transcriptionally regulated by HIF-2α, were also observed. Furthermore, hypoxia caused loss of neuronal characteristics in differentiated cells. This is highly significant as it shows neuronal cells possess molecular mechanisms which could trigger recovery following ischaemic insult. The expression of the chloride co-transporters, NKCC1 and KCC2, mediators of the GABAergic response, was assessed following hypoxia in differentiated PC12 and NT2 cells and PTS. In PC12 and NT2 cells exposed to hypoxia, the expression of KCC2 was significantly decreased at both the transcript and protein level whereas NKCC1 expression remained unmodified. In the in vivo model, the development of the penumbra in the days following injury was assessed with specific markers allowing the identification of the penumbra up to 200 ❍m from the ischaemic core and a progressive neuronal loss was observed within. Our results show an increase in the number of neurons expressing NKCC1 in the penumbra up to 5 days following the insult when compared to the contralateral hemisphere. On the contrary, KCC2 positive cells were dramatically decreased in this area. In mice treated with bumetanide, an NKCC1 antagonist, a significant reduction in neuronal loss was observed. Our results show a reversal on the chloride co-transporters expression in vitro and in vivo and how treatments targeting these channels might represent a novel strategy to reduce the damage associated with stroke.

Aims: To describe the health behaviours and health of those described as health workers; explore the possible effect of work on their health and early exit from the workforce; and make comparisons to other occupational groups. Study design and methods: The aims were addressed through 5 studies incorporating both a literature review and secondary analyses of existing data sets using both cross-sectional and longitudinal approaches. Data was collected on demographic data, health, health behaviours, impact of health on work, and workforce exit. Descriptive analysis was used to summarise the comparisons and binary logistic regression and Cox proportional Hazard models were applied to give more in depth analysis. Results: A disability was reported by 11.1% of nursing and midwifery professionals compared to 7.1% of health professionals and 16.8% of caring personal service workers. One in four nursing and midwifery professionals reported a health problem that affected the amount and type of work they could undertake compared to one in two workers categorised in other occupations. Predictors of poor health included demographics, occupation and health behaviours. Age appeared to be the only significant predictor of workforce exit in the study. Compared to nursing and midwifery professionals, those identifying themselves as nursing auxiliaries, care assistants, and home carers were significantly more likely to leave the workforce before retirement age (p ˂ 0.001).Conclusion: The findings suggest that nurses' health is poorer than some other health professionals and that they engage in a number of health behaviours known to lead to health problems. Occupation plays a direct or indirect role on health and early exit from the labour market; however, the inter-relationship appears complex. Further research is needed to understand, address and improve the health of nurses and care workers. Factors that explain auxiliaries', care assistants' and carers' workforce exit also require further examination.