Resilience literature has recently seen an important shift in focus from the identification of individual characteristics that seem to contribute to positive adaptation to a focus on how these characteristics appear to work together cumulatively to result in such adaptation. There is a paucity of research though that conceptualises post-trauma resilience as an interactional and transactional process or adopts a culturally-sensitive perspective. This study therefore sets out to consider some of these gaps by qualitatively investigating the processes underlying resilience from an ecological, developmental and culturally-sensitive perspective in an adult population that have endured high levels of psychological trauma. Refugees were the population of choice given the proportionally high levels of exposure to traumatic events present within this population. Moreover, the study of the resilience process within the experience of refugees hailing from certain cultural backgrounds such as Eritrean is remarkably scarce. Six in-depth interviews were conducted with Eritrean refugees who have sought asylum in Malta. Subsequently, in the theoretical sampling stage, an additional seventh interview was conducted with one of the original participants. Themes garnered from a constructivist grounded theory data analysis high light the role in resilience of a variety of psychological processes including responding to external messages critically and analytically and striving to maintain existential well-being. Additionally, analysis pointed towards the role of contextual factors such as religious practices and cu ltural norms and indicated the presence of a set of transactional processes between these two aspects. Finally. a theoretical model was developed attempting to capture how these processes operate in conj unction to lead to post-trauma resilience in Eritrean refugees. Following a discussion of this study's limitations, suggestions detailing how future research can help enlighten areas that were only partially examined by this research, were provided. Finally, implications for theory and practice were discussed in view of providing suggestions for resilience-based interventions for refugees exposed to traumatic events. ;

Individuals who suffer a traumatic medical event, such as diagnosis of life-threatening illness or invasive treatment, are now recognised as at significant risk of posttraumatic stress disorder (PTSD) and PTSD symptomology (DSM-IV, (American Psychiatric Association, 1994)). Yet, these individuals also have the opportunity to transform their negative experience into a positive, life-changing experience; a process known as posttraumatic growth (PTG) (Tedeschi & Calhoun, 1996). Given this apparent dichotomy, this review attempts to integrate the literature on these phenomena, to identify the common variables involved in producing these outcomes. Published studies were included if they focused on adult medical populations (of 18 years and above) and assessed predictor variables of either PTSD or PTG. Exclusion criteria applied to studies were; articles where samples included family and carers, studies that implemented interventions, qualitative studies and studies without objective, standardised psychometric measures. A total of 27 studies were included in this review (18 PTSD; 9 PTG). Similarities and dichotomies in the literature were found, indicating that both phenomena may be inextricably linked. In general, sociodemographic and medical variables showed inconclusive patterns of prediction. Instead psychological and interpersonal factors, namely personality and coping styles, were found to have a consistent influence on outcomes. Methodological limitations and recommended future directions in the research are discussed, as are the implications for clinical practice.

Interpersonal violence in adulthood adversely affects large numbers of people around the world; its deleterious physical and psychological consequences are well documented. Over the past 18 years, research has broadened its focus to the full range of potential sequelae including posttraumatic growth (PTG). The first paper presents a systematic review of the literature addressing PTG in survivors of interpersonal violence in adulthood. The evidence reviewed suggests that growth is experienced by around 70% of survivors, and is by no means a universal phenomenon. Findings point to the therapeutic relevance of cognitive-behavioural therapy and developing individuals' social support networks. Implications for future research are discussed with an emphasis on factors associated with PTG. The second paper presents an empirical study of factors related to PTG and posttraumatic stress disorder (PTSD) in female survivors of intimate-partner violence (IPV). The internet-based questionnaire study employed an international sample of 200 women. While there may be some overlap in PTG and PTSD, the current finding suggest that the two trauma outcomes may be separate constructs. Although cross-sectional, findings draw attention to the importance of positive, post-trauma variables such as coping self-efficacy and social support in facilitating PTG and protecting against PTSD. Future longitudinal research is required to investigate the pattern of PTG development over time and the clinical utility of PTO for this population.

The first paper is a review of Imaginal Exposure treatment for Post-Traumatic Stress Disorder (PTSD). There are still questions around the effectiveness and acceptability of exposure treatments for PTSD, and whether different forms of exposure such as Imaginal Exposure (lE) are equally as effective as other psychological treatments for this presentation. Such knowledge may prove useful for services and clinicians who want to utilise an effective and acceptable treatment. This review summarises and evaluates empirical literature on lE treatment for PTSD. Numerous methodological limitations were raised , however evidence suggests that lE treatments are effective in the treatment of PTSD, including some co-morbid difficulties such as depression and anxiety. Nonetheless, lE is not always as effective when compared to other PTSD treatments or 'combination' treatments, and cannot yet be recommended by itself for more complex PTSD presentations or Type-II trauma. Acceptability of lE was not determined in any of the studies, although dropout rates (a potential marker 0 acceptability) were similar to other PTSD treatment studies. The findings also support the Emotional Processing Model as a potential mechanism in exposure treatment. Clinical, service and research implications are discussed. The second paper aimed to produce a shorter version of the Supervisory Relationship Questionnaire (the Short-Supervisory Relationship Questionnaire: S-SRQ) that retained its reliability and psychometric validity. Two hundred and three UK trainee clinical psychologists completed a series of on line questionnaire including the developed S-SRQ. A Principal Component Analysis identified three components of the S-SRQ: 'Safe Base', 'Reflective Education' and 'Structure'. The S-SRQ (three subscales, 18 items) has high internal reliability, adequate test-retest reliability and good convergent, divergent, and predictive validity. Certain supervisor and supervisee characteristics were associated with higher supervisory relationship (SR) scores. Findings also support aspects of existing S models. The S-SRQ is a promising measure for use in clinical, training and research settings.

Early clinical observations and more recent clinical studies have identified that individuals with Posttraumatic Stress Disorder (PTSD) commonly experience difficulties with anger and anger expression. However, no exploration of this relationship has been undertaken in samples of mentally disordered offenders (MDOs), despite the high levels of PTSD and anger-related difficulties identified within this population. The current study explored the relationship between PTSD and anger in a sample of 44 mentally disordered male and female offenders. Participants completed self-report measures that examined posttraumatic symptomology, trait anger, anger expression and alexithymia. Results indicated that PTSD was prevalent within this sample although no participants had received a formal diagnosis. PTSD was tentatively related to trait anger, although this was no longer the case when the effect of gender was taken into account. PTSD and anger expression were also related, although PTSD did not predict anger expression when trait anger was controlled. Alexithymia was found to be predictive of trait anger. The findings indicate that a diagnosis of PTSD should be considered in samples of MDOs. Furthermore, interventions aimed at addressing anger and anger expression in the context of PTSD might be effective. Treatments for anger might also be effectively supplemented by addressing emotion regulation skills.

There is significant research into childhood bullying and associated psychosocial difficulties in childhood. In contrast, research into the impact of childhood bullying in adulthood is sparse and predominantly quantitative. This study addresses this gap by exploring the lived experience of adults who were bullied as children. Semi-structured interviews were conducted and the data was analysed using Interpretative Phenomenological Analysis (IPA). Participants were six women and two men, aged between 27 and 57 years of age, who experienced bullying during their childhood and adolescent years. Four superordinate themes emerged from the interviews: "The impact on the self', "Interpersonal relationships", "The struggle for control, power and autonomy" and "Making sense of childhood bullying experiences in adulthood". This study's findings have been placed in wider context to existing literature. This study has also adopted an integrative theoretical framework for the interpretation of the findings in order to understand the mechanisms and processes involved in the experiences reported by participants. Therefore, suggestions can be made for psychological interventions and therapeutic exploration in clinical work with adult clients who experienced childhood bullying. The theoretical approaches used were developmental life span, humanistic, psychodynamic and cognitive-behavioural. Clinical implications, such as control relating to coping strategies and the potential for post-traumatic stress in adults who experienced childhood bullying, are also explored. Limitations of the study and recommendations for future research are discussed.

The field of traumatic stress recognises that the impact of traumatic events can extend beyond those immediately exposed. However, in the past decade, research has been dominated by Post-traumatic Stress Disorder (PTSD) with less focus on how the greater majority, who do not develop PTSD, accommodate traumatic experiences into their lives. The Foreign and Commonwealth Office (FCO) has approximately 4,800 diplomat officers serving in 170 countries. Officers may be exposed to a disaster while on a short-term posting overseas, i.e. of two to four years duration. Adopting Charmaz's (1990) social constructivist approach to grounded theory, this qualitative study aims to explore how a disaster event is experienced from the perspective of the spouses of these British diplomats. Semi-structured interviews were conducted with ten participants. The analysis led to a theory, captured in an emergent model, of the temporal pathway of the lived experience of a disaster event for the spouses of British diplomats. It can be described as follows: Locating Multiple Self-Aspects at the Point of Disaster; Encountering Disaster; Immersion; Dissonance; Consequences; Disaster Endures. The core category - Incorporating Disaster into the Self-Concept- occurred in each phase of the model. The results may be helpful for both clinicians and policy makers working with this population. 23

This study aims to explore resiliency and its relation to dissociations (healthy & unhealthy) and, examine psychoanalytic work within an inter cultural framework. Four factors are identified, elaborated and contextualised as necessary for good therapeutic intervention in working with people who endured trauma: 1) the sense of self 2) the psychic space 3) the listening other 4) healthy dissociations. The literature review is organised to explore psychoanalytic concepts relevant to the research question, and provide a foundation upon which theory and practice can be coherently linked following the clinical vignettes and discussion throughout the thesis. Two case studies! are used to illustrate and discuss the central hypothesis that healthy dissociation is an indicator of resiliency, made possible through the access to and development of the four key factors. The clinical data is presented from a relational perspective, with the view that childhood trauma and patient experiences during the developmental processes is a dual narration playing a significant role in the capacity for resiliency. Three issues specifically will be addressed: 1) the characteristics commonly associated with trauma and with resilience 2) the creation of an intra-psychic and secure state of mind with reference to Freud and contemporary psychoanalytic thinking, specifically Object Relation Theory 3) the relevance between resiliency and psychological health or lack of it The effect of trauma in adult life and its relation to earlier experiences is discussed, indicating that people with good enough environment during developmental process can dissociate healthily, therefore better managing the effects of trauma, whereas those who experienced interruptions during this developmental phase may collapse psychologically. Through the course of psychoanalytic psychotherapy, however, people can be helped to develop stronger psychic space and a better sense of self through the containing provided by the listening other: the therapist.

Traumatic and life threatening events can have a profound impact on the physical and psychological wellbeing of those who experience them. Limited research has been conducted into the impact upon partners of people who have experienced trauma and subsequent Posttraumatic Stress Disorder (PTSD). This study aimed to explore such experiences. Six partners 'of service users awaiting' or undergoing treatment for PTSD at a specialist Trauma Service were interviewed. The data was analysed using Interpretative Phenomenological Analysis (Smith et aI., 2009). One final, overarching theme was developed from the data: participants experienced trauma and PTSD as an ongoing journey of loss and gain. Their journeys were characterised by striving and struggling to make sense of the trauma and its ensuing consequences, whilst also grappling with the identities of themselves, their partners and relationships shifting over time. Participants navigated their journeys in the context of external resources and support from friends, family, colleagues and professionals. The results are discussed in relation to existing literature and limitations of the study are highlighted. Further research is recommended to investigate and inform how clinical and non-NHS services can provide appropriate and culturally-sensitive support to families of people with PTSD.

Background: Some research on combat-related trauma suggests that Post Traumatic Stress Disorder (PTSD) is socially constructed and mediated by historical, social and political context. PTSD continues to attract controversy, but is often used as a way of understanding combat-related trauma in both military and civilian cultural contexts. However, recent literature suggests that the PTSD label might not be appropriate to represent the variability of expressions of distress in serving and discharged combat personnel. Furthermore, reluctance to seek help amongst this group makes it more difficult to appreciate potential variability in distress responses. Current study: The current study attempts to build on previous work to understand how trauma is constructed according to context and what this enables and disenables amongst a veteran population. Methods: Discourse analysis was carried out on the transcripts of two focus groups comprising four male officer veterans and four male non-officer veterans. Discourse analysis was also carried out on a purposive selection of 8 newspaper articles from the Mail, the Telegraph and the Sun from 2000-2012.