This research investigates the experiences of people with Down syndrome who have a congenital heart condition (CHC). While people with Down syndrome are at greater risk of CHC, little is known about their views on hospital treatment and healthcare. A review of the literature indicates the incidence and implications of CHCs for people with Down syndrome including barriers accessing health care and higher mortality for this group. The research considered ethical issues pertinent to conducting research with people with a learning disability including the choice of research method, participant recruitment, data collection and analysis. A qualitative approach was adopted and involved semi-structured interviews with five individuals with Down syndrome and a CHC. The interview covered topics including in the impact of Down syndrome, the impact of a CHC, and involvement in healthcare decisions. Three themes resulted from a thematic analysis: Who is the Patient; Self-Care, Care from Others and Gaps in Care and Health and Fitness. The major implications of this research for people with Down syndrome, their families and healthcare professionals include the need for clarity regarding supported decision making and supporting those with Down syndrome who may not have family members to aid decisions. This research involved a small relatively homogenous group of individuals and the area could benefit from further research, for example those without parent carers to support healthcare decisions and medical procedures. The research highlighted difficulties inherent to carrying out research with vulnerable groups, such as those with a learning disability. Future research should consider the process of including vulnerable groups in research, such as how to balance the research agendas of the researchers and the researched.

This research thesis explored the concept of empathy. The specific purpose was to further understand the idea of empathy in relation to the experience of male support workers who provide residential care to adults with intellectual disabilities (ID) and challenging behaviour. The thesis aimed to provide some insights into how support workers develop and extract meaning from their experiences of relationships with clients and the impact of this on their own self-care, namely, self-compassion. Since personal accounts of experience were required, a qualitative methodology was employed, Interpretative Phenomenological Analysis (IPA) (Smith, 2004). This methodology was selected as it allows for the exploration and interpretation of idiographic lived experience and meaning making. 8 experienced support workers were interviewed using a semi structured interview. Four superordinate themes emerged from the data. These included: 1. Making sense of the others inner world; 2. Processes that enhance empathic practice; 3. Tensions and conflicts, and 4. Management of distressing feelings. Differing accounts of interpreting the needs of clients were identified which helped participants understand, make sense of their interpersonal experience and participate in their role. These included utilising academic knowledge and senses, particularly sight and hearing, which were seemingly complemented by a level of reflective practice. Additionally, to make sense of the experience of a client, they appeared to put themselves in their position, suggesting a form of empathy. Participants appeared to engage in a process of reflection on their relationships with clients, which helped them think about what they had learned about the person’s needs, moreover, this process enabled them to identify some of their own responses and feelings. However, participants seemed to struggle to recognise the occurrence or impact of distressing emotional experience and to express their feelings, possibly in response to a deep sense of responsibility and fear of transferring emotional distress to others. This dilemma of holding two potentially conflicting views of experience seemed to inhibit self-compassion. Although not specifically testing theories of empathy, from the overall findings, it could be suggested that empathy may be a dynamic, transient process that is influenced by reflexivity, values and context. The context in which participants discussed their practice, and situated within their accounts, suggested a sense of confusion and uncertainty. Consequently, it is suggested this impacted on how participants understood and related to clients, and to themselves. There were some specific implications for Counselling Psychology practice, mostly concerning training and supervision. These included recommendations for staff training and supervision, systemic organisational intervention, policy development, recommendations for revisions to models of specialist care frameworks and clinical training.

Objectives: The existing literature demonstrates a need for more effective treatments and support for people diagnosed with “eating disorders”. The limited research available demonstrates the potential for yoga to be helpful as a treatment for “eating disorders”. However, only one study investigated people’s experiences of yoga and “eating disorders”, and none looked at the aspects of yoga that people may find more or less helpful. This study aimed to explore women’s experiences of yoga practice in relation to their experiences of “eating disorders”, with the hope of identifying such aspects. Methods: 12 semi-structured interviews were conducted with women with a history and current experience of “eating disorders” (Anorexia or Bulimia Nervosa), 6 of whom were trained as yoga teachers, and 6 were practicing yoga regularly during their journey to recovery. Average age of participants was 27 years. Duration of yoga practice ranged from 1 to 21 years. The transcripts were analysed using inductive thematic analysis. Results: Two superordinate themes were identified, with participants describing a joint journey between their ED and yoga practice, ways through which yoga may be helpful for achieving a better mind-body connection, such as through mindfulness, spirituality and related principles; as well as noting ways through which yoga may potentially be unhelpful to those experiencing EDs, such as when ED manifests in the practice, or if yoga becomes another manifestation of ED in the form of excessive exercise, or when yoga industry and the current presentation of yoga negatively influences individual’s practice. Conclusions: This study provides insights about potential mechanisms through which yoga could be helpful or detrimental for those experiencing “eating disorders”. The clinical and research implications are discussed. It is hoped that the findings will contribute to the development of more effective and client-accepted ways of supporting people with “eating disorders”.

The aim of this thesis is to explore how clinicians construct their practice with women experiencing difficulty with orgasm, by adopting a Foucauldian Discourse Analysis (FDA). In the first part, a critical review of the literature is presented, which illustrates the socio-historical constructions of female orgasm in relation to three distinct temporal periods; classical, modern and contemporary. The discursive constructions of orgasm within these epochs are considered in relation to research and treatment development. The thesis then presents the analysis which used semi-structured interviews to explore how six clinical psychologists and two psychosexual therapists make sense of the work they do with women experiencing difficulty with orgasm. The transcripts were analysed using a FDA. A critical realist social constructionist epistemological position was adopted in this research to facilitate the exploration of the constructed nature of orgasm, both at the local level of the text and the wider institutional level, to explore contextual and social factors and their implications for subjectivity. The analysis identified that clinicians construct their understanding of therapy with women experiencing difficulty with orgasm in three main ways. They constructed their practice in terms of pursuing expert knowledge to secure professional power. They constructed the women with whom they work as ‘problematic’ yet ‘untreatable’ in the context of dominant biomedical discourses. Finally, they constructed the broader service context as regulating the ways in which they are able to conceptualise and ‘treat’ this presentation, thus perpetuating a pathologising construction. This thesis recommends that clinicians should focus on interventions that promote a strength-based and systemic approach, which adopt a preventative stance towards addressing this phenomenon, involving social action and community development. Finally, supervision and reflective practice is recommended to increase awareness of the impact of social discourses on the subjectivity of the women who present for ‘treatment’.

The Mental Capacity Act (2005) is a legislative framework designed to promote autonomy and support those who may struggle to make decisions for themselves. Previous research suggests that the implementation of the Mental Capacity Act raises a number of challenges for professionals (McVey, 2013; Walji, Fletcher & Weatherhead, 2014) and that applying the Act in learning disability settings may be particularly complex (Brown & Marchant, 2013). The concepts of ‘capacity’ and ‘learning disability’ draw on knowledge across legal, philosophical and psychiatric discourses, which may imply different practices for professionals. Semi-structured interviews were completed with eight professionals working in adult community learning disability services. A Foucauldian approach to discourse analysis was used to examine how capacity was constructed in professionals’ accounts of their experiences implementing the Mental Capacity Act. The discourses and subject positions available to professionals and people with learning disabilities were considered. Analysis of professionals’ accounts suggested that ‘legal’ and ‘rights’ discourses of capacity were oriented to. Knowledge of capacity was constructed as being limited to professionals, with families and service users often in need of further information on the Mental Capacity Act. ‘Legal’ and ‘rights’ discourses enabled multiple subject positions for professionals and people with learning disabilities. These positions allowed for both restrictive and empowering practices. Promoting subject positions of ‘personhood’ appeared to allow for alternative understandings of capacity, in which decision-making is an interdependent rather than independent process. This study suggests that capacity assessments are sites of tension between multiple discourses. Co-constructing meanings of capacity within services and across disciplines may allow for the development of best practice, and facilitate supported decision-making practices with people with learning disabilities.

Major Issues A tendency for individuals with depression to exhibit overgeneral autobiographical memory (OGM) has been consistently observed in the literature for almost thirty years, yet evidence for the specific mechanisms behind this link is lacking. Less established is the link between OGM and post-traumatic stress disorder (PTSD), which has gained inconsistent support in the research literature. Methods A literature review was conducted to investigate the association between OGM and PTSD, employing a systematic search strategy and meta-analysis techniques. Online recruitment and data collection methods were implemented as part of a research study to gather information on OGM, experiential avoidance (and sub-types thereof) and depressive symptoms in 399 participants. Data was analysed using a multiple mediational model employing bootstrapping. Findings The literature review and meta-analysis revealed a large and significant association between OGM and PTSD, however evidence for a correlational or causal relationship was inconclusive. Limitations of reviewed research evidence were noted and it appears that wide variation in approaches taken towards experimental design and analysis significantly weakens research quality in the area. The research paper suggests that experiential avoidance partially mediates the relationship between OGM and depression, and that there is a specific mediating role for a sub-type of experiential avoidance; Repression and Denial. These findings are discussed in relation to previous research, theory and implications for clinical practice. Conclusion The findings of the literature review and research paper indicate that there is an association between OGM and both depression and PTSD. More specifically there is evidence for a mediational role for experiential avoidance in the form repr~ssion and denial in the relationship between OGM and depression. More robust longitudinal research is required to establish any causal relationship between OGM and PTSD.

Literature Review: A systematic review was conducted that evaluated the impact of religious coping on levels of depression among adults. The findings of the review supported a dichotomous view of the impact of religious coping on depression, and suggested that individuals who make use of positive religious coping methods experience significantly different levels of depression than those who use negative religious coping methods. Future research is needed to examine long-term effects of using positive and negative religious coping, to better understand how religious coping is used in non-Christian communities around the world. Research Project: The current study investigated religious coping and depressive symptoms in the context of the Ismaili Muslim religious community in Nairobi, Kenya. Six participants were interviewed using semi-structured interviews and the data was analysed using Interpretive Phenomenological Analysis (IPA). Four super-ordinate themes and twelve sub-ordinate themes emerged from the interviews. Overall, the findings indicated that religion appears to have both positive and negative influences on depressive symptoms, a finding that is generally supported by the wider literature on religious coping. Clinical implications for practice, limitations and areas for future research are discussed in relation to these findings. Service Evaluation: The current study examined professional development within the context of the Community Counselling Services (CCS), local, community-based institution which provides voluntary counselling services for the Ismaili Muslim community. In the current study, counsellors’ perspectives of the professional development trainings and the extent that these trainings improve their therapeutic practice and skills were explored. The findings indicated that while the counsellors experienced a broader scope of knowledge and positive client outcomes and service delivery, the trainings were often too theoretically-orientated and lacked sufficient practical components. These findings, together with recommendations for improvement are reported with consideration of the existing literature.

Literature Review: A systematic review was conducted examining factors that positively influenced post-traumatic growth (PTG) following direct exposure to a terrorist attack. A systematic search was carried out across 10 databases and eleven studies were selected for inclusion. Eight studies used quantitative methodology and three used qualitative methodology. The findings revealed six themes that emerged from the eleven studies covering the specific factors that positively influenced PTG. Further research is needed to understand better how these factors interact with terrorism exposure to experience PTG and how actual growth differentiates from perceived growth. Research Project: The current study explored the experiences of recovery for adult, Ismaili Muslim survivors of the Westgate Mall terrorist attack which took place in September 2013, in Nairobi, Kenya. The study also sought to understand how the Ismailis made meaning of their experiences following the attack. Six participants were interviewed using a semi-structured interview topic guide and the data was analyzed using the Interpretive Phenomenological Analysis (IPA) approach. The findings suggested that Ismaili adults can largely experience positive changes following an attack but are also able to experience negative changes. Based on these findings, clinical implications, suggestions for further research and limitations are discussed. Service Evaluation: The current study was conducted in the context of the Ismaili community in Nairobi, and within the Community Counselling Services (CCS). CCS is an Ismaili service that provides voluntary counselling for Ismailis and carries out frequent psycho-social interventions for Ismaili adults with physical disabilities. The current study explored the experiences of Ismaili adults with physical disabilities and of CCS members of partaking in the psycho-social interventions, and evaluated the extent to which the interventions met their objectives. The findings indicated that only two out of the three CCS objectives were being met. These findings were reviewed in light of existing literature.

This research investigates the way that males who identify with the diagnostic label ‘conversion disorder/functional neurological disorder (CD/FND)’ experience agency in their lives. The historical developments, controversies and complexities around ‘CD/FND’ form the backdrop of this exploration into the lived experience of agency. A sample of eight participants were recruited via social networking sites and charities, and the data was collected through Skype-based interviews and analysed using the qualitative Interpretative Phenomenological Analysis (IPA) approach. The analysis showed the following five main themes: ‘paradox of control’, ‘living within a dualistic framework’, ‘disconnection from self and others’, ‘engaged in a battle or fight’ and ‘meaning and reality as dependent on other people’. These master themes and their related subordinate themes are presented in light of existing research. The findings highlight the difficulty experienced by participants who identify with a diagnostic label that is at odds with a medicalised approach to understanding and treating illness. The limitations of this study and the potential avenues for future research are also discussed.

Background – People with aphasia (PWA) have been shown to present with aberrant use of pronominal words in the form of abnormal noun-to-pronoun ratios (e.g. over- or under-production), omissions, inappropriate or incorrect substitutions, and inappropriate reidentification of contextual antecedents. These error patterns have been identified in sentence and discourse comprehension and production. Although different processing accounts have been put forward to explain these variations and difficulties, it continues to remain unclear what specific contributing factors underlie the aberrant patterns of pronoun use observed. Aim – This thesis investigates how fluent and nonfluent PWA process pronouns and reflexives at different levels of communication. The primary research questions in this thesis focus on whether pronominal processing is impaired in PWA; and, if so, why are pronominal words difficult to process? Particular attention is drawn to how differential complexity factors in terms of increased syntactic, thematic, and structural (e.g. pronoun competition, reversibility, passive) complexity may influence pronominal processing in the aphasic linguistic system. Furthermore, this thesis aimed to expose whether or not different pronominal feature markers may be differentially processed or selectively impaired. Method – A series of language experiments were conducted using a study group of fluent and nonfluent people with aphasia and normal controls. The experiments investigated the following: 1) single-word pronominal comprehension, 2) pronominal comprehension in sentences, 3) pronoun comprehension in discourse, and 4) pronominal production in sentences. Further, a descriptive analysis was conducted to characterize patterns of pronoun use and cohesion in aphasic connected speech. The results of pronominal processing at single-word, sentence, and discourse levels from people with aphasia were compared to normal controls, and then between aphasia type. Results – The findings from the single-word experiment have shown that gender and number pronominal feature markers are differentially processed to person and case feature markers. The findings from the sentence and discourse experiments have exposed that people with aphasia interpret pronouns similarly to normal controls when processing pronouns as non-discourse-linked elements, and with significantly more difficulty than normal controls when processed as discourse-linked elements. These novel findings have advanced our understanding of pronominal processing in that the difficulty does not occur as a global impairment; rather, the difficulty is relevant to specific syntactic computations required for explicitly discourse-linked pronominal resolution.