Aims: The main purpose of this study is to explore the effects of labelling on the general public's reactions to people with schizophrenia and intellectual disability. Method: A total of 1233 adult members of the UK general population were randomly presented with either diagnostically labelled or unlabelled case vignettes depicting someone with schizophrenia and intellectual disability. Causal beliefs, emotional reactions and social distance were assessed in response to each vignette. Results: Labelling increased beliefs that the causes of schizophrenia and intellectual disability are biomedical. It also had a positive, but small, direct effect on emotional reactions and willingness for social contact. However, examination of links between causal beliefs and emotional reactions revealed additional undesirable effects of labelling. Conclusions: Labelling has complex effects on stigma toward people with schizophrenia and intellectual disability. It is important to attend to the cognitive, emotional and behavioural components of stigma.

The aim of this thesis is to determine whether exposure to low levels of organophosphate pesticides (OPs) causes neuropsychological or psychiatric impairment. The thesis is arranged in three parts. Part 1 provides an introduction to neurotoxicology, the role of the psychologist, and the toxicity of OPs; Part 2 provides a historical review of the existing scientific evidence regarding the impact on human health of low level exposure to organophosphate pesticides. A major unresolved issue in the toxicity literature is whether repeated, low level exposure to OPs, in the absence of a history of acute toxicity, is harmful to human health. Part 3 presents the findings of a four year empirical study designed to address this issue. A cross-sectional study was undertaken in which the performance on neuropsychological tests of 127 sheep farmers with a history of low level exposure to organophosphate pesticides was compared with 78 nonexposed healthy volunteers (rural police workers) matched for age, gender, years in education and level of intelligence. Methodological weaknesses of earlier studies were addressed in the study design, such as inclusion of study participants who had retired on ill health grounds to take account of the ‘healthy worker effect’; exclusion of study participants with a history of acute poisoning and those with a psychiatric or medical history that might otherwise account for ill health; and exploration of factors that may render some individuals more vulnerable to the effects of OPs than others (e.g. genetic differences in the capacity to metabolise and detoxify OPs). In the final chapter the findings are summarised and discussed, the study design is critically appraised and the implications of the findings are listed along with recommendations for future research.

Many couple therapists prefer an integrative approach to working with couples. They also have shown more interest in the humanistic approach in recent times than they used to do in the past. However there has been almost no discussion in the literature of how the focusing-oriented approach can be used in couple therapy, probably because most focusing-oriented therapists remain individual counsellors. The present research is a contribution to bringing the focusing-oriented approach into couple therapy, but is also a contribution to the integrative approach to working with couples. The aims of this research are: 1. To examine how couple therapists usually work with couples. 2. To investigate how widespread the use of the focusing-oriented approach is as a therapeutic approach when working with couples. 3. To explore what are seen as the common factors of therapeutic change in standard couple therapy and in focusing-oriented psychotherapy. 4. To examine what elements of focusing-oriented therapy can be brought into couple therapy. 5. To ascertain whether there is any evidence for the focusing-oriented approach being effective in working with couples. 6. To discover how using the focusing-oriented approach can make a difference to couple therapy. This research aims to demonstrate how the focusing-oriented approach can apply to couple therapy. With this end in view, the research for the thesis was conducted in three parts. Part One collected quantitative data about the extent to which focusing-oriented therapists are involved in working with couples and how couple therapists normally work with couples. Part Two observed and recorded focusing sessions with the Diploma students in focusing-oriented and experiential psychotherapy at the University of East Anglia for two years. The aim of this part of the research was to understand the focusing process and to find what elements of Focusing might apply to working with couples. Part Three involved interviews with fourteen counsellors. Seven counsellors worked with couples as couple therapists and the other seven counsellors were trained in the focusing-oriented approach and had experience of working with couples. The interviews and analysis revealed how they worked with couples, and what the possibilities are for integrating the focusing-oriented approach into couple therapy.

No description available.

No description available.

Art therapy with the blind has received little attention in terms of practice and research. This study investigates for the first time the psychodynamics of the gaze in the triangular relationship between congenitally blind clients, their artwork, and their sighted art psychotherapist. Analysing case material from a cohort of four blind clients in long-term art psychotherapy, this research explores how blindness and sight engender gazes that are specific to the sensory differences between the clients and the therapist. The nature of the interpersonal gazes between blind client and sighted art therapist are investigated in terms of transference, power and surveillance. The research shows that the client’s ‘blind gaze’ and the therapist’s ‘sighted gaze’ are subject to unconscious dynamics that mirror the continued historic, cultural and psychological misunderstandings between the blind and the sighted and powerfully determine the individual therapeutic situation. Through a multimodal qualitative research design, including the in-depth visual analysis of the clients’ artwork, three types of images are discerned by their characteristic form and content; these are described as protomorphous, allomorphous and automorphous sculptures. It is argued that the reciprocal relationship between these three forms of imagery and the clients engenders distinct gazes which gradually enhance the clients’ ability for the conscious reflection of ‘other’ in relation to ‘self’, arriving at a dynamic, changed and loveable self-image towards the end of therapy. The investigation further explores how the clients’ and the therapist’s joint beholder’s gaze likewise evolves in relation to the three forms of artwork and to the gaze of the artwork back to its maker and the therapist. The main findings of the study are described as a congruent and progressive anamorphosis of artwork and gazes; it is suggested that these specific forms of artwork and gazes do not only challenge the sighted therapist’s visual paradigm, but also eventually engender a changed sensory culture that reconciles the perceptual divide between blind client and sighted art therapist. This shared culture is discussed in terms of a tactile joint attention and a ‘tactile gaze’. The case material and the findings are examined and reflected against diverse theories on the gaze with particular reference to psychoanalysis and art psychotherapy. The entire process of the study, its methodologies and its impact on current practice are discussed and evaluated, and potential areas of further research are outlined.

No description available.

Self-concept clarity (SCC) is defined as the “extent to which the contents of an individual's self-concept (e.g., perceived personal attributes) are clearly and confidently defined, internally consistent, and temporally stable” (Campbell et al., 1996, p.141). SCC is becoming an increasingly researched topic in relation to the onset and development of psychopathology. To date, there had been no systematic review addressing associations between SCC and psychopathology. Thus, Chapter 1 of the thesis aims to systematically identify, appraise and synthesise all available peer reviewed literature, which explored an association between SCC and psychopathology. The review includes twenty-two papers, which report on 29 individual studies, all of which explore a quantifiable relationship between SCC and psychopathology. Strong evidence was found to support an association between SCC and psychopathology in both clinical and non-clinical populations. The empirical paper is reported in Chapter 2. This explores the relationship between adverse childhood experiences, SCC and psychopathology. Participants were allocated to one of three groups: psychosis (presence of psychotic experiences), anxiety/depression (moderate-severe levels of anxiety and/or depression) or control (no psychotic experiences and mild levels of anxiety/depression). Analyses revealed that participants in the psychosis and anxiety/depression groups reported significantly higher incidences of adverse childhood experiences compared to the control. Lower levels of SCC were associated with higher levels of depressive and anxious symptoms, congruent with the findings from the literature review. Levels of SCC did not significantly differ across the three groups. The intricacy of SCC as a construct and its complex association with psychopathology was apparent throughout the process. In an attempt to conceptualise this relationship Chapter 3, the critical appraisal, discusses the similarities and differences between SCC and theoretically related concepts. Further clinical implications are discussed and identified limitations of the current research are considered citing recommendations for future research.

This thesis was designed to explore the nature of risk-taking behaviour in people diagnosed with Bipolar Disorder (BD). Research has traditionally attributed risk-taking behaviour in BD to difficulties in impulse control. Nonetheless, impulsivity remains predominantly measured using self-report questionnaires, with dubious validity. The links between impulsivity and risk-taking have also been challenged by new research in the field of decision-making suggesting a different conceptualisation of this often misunderstood set of behaviours. In particular, Fuzzy Trace Theory (FTT) offers an interesting framework to understand risk-taking as a “rational/deliberate” act, rather than an impulsive one, providing evidence for a “reasoned route” to risk-taking. This piece of research comprised of a systematic review, an empirical paper and a critical appraisal. The aim of the systematic review was to clarify whether there is consistent evidence to suggest that risk-taking behaviours are more prevalent in people diagnosed with BD compared to controls. Clinical and demographic predictors of risk-taking in BD were also explored. The research paper aimed at characterising a group of people with BD in the context of FTT and to explore whether measures of FTT were predictive of higher risk-taking tendencies after controlling for impulsivity and mood. Finally, the critical appraisal aimed at discussing the dilemma of conducting quantitative research as a trainee clinical psychologist. The review suggested that people diagnosed with BD are more likely to engage in risk-taking behaviour, but that this is dependent on mood state and mainly prevalent during states of mania. Some evidence in support of clinical and demographic predictors of risktaking in BD was also found. The empirical paper also supported the hypothesis that FTT predicts risk-taking behaviour, even after accounting for the effects of mood and impulsivity. The findings were discussed in relation to previous research on the topic.

This thesis comprises a literature review, a research paper and a critical appraisal of the research process. Qualitative literature was systematically reviewed using a meta-ethnography, with the aim of understanding how people with long-term physical health conditions (LTCs) experience psychological therapies. Thirteen articles were identified. Six themes emerged from the synthesis: i) ‘therapists’ expertise and empathic approach led to positive relationships’; ii) ‘therapy was a safe and neutral space’; iii) ‘therapy prompted change in LTC management’; iv) ‘psychological awareness reduced isolation and increased control’; v) how physical ill health interacts with being able to participate in therapy’; and vi) ‘time-limited therapy did not always match service users’ illness trajectory’. The findings were discussed in relation to the values of psychological therapy for people with LTCs and the current way services are delivered to people experiencing co-morbid mental health difficulties. The research paper comprised a qualitative study using a Discursive Action Model approach, which aimed to develop an understanding of how practitioners and service users construct resources and preferred futures within solution-focused therapy sessions. Eight participant dyads were recruited, formed by pairs of practitioners and service users. Data were collected via audio recordings. Four discourses were highlighted: i) ‘practitioners' use of assumptions drew out resources’; ii) ‘explicit commentaries construct change’; iii) ‘de-contextualising for goal construction’; and iv) ‘removing the blame, effort and failure’. The results highlighted the discursive mechanisms which enabled construction of resources and goals. The trans-theoretical applicability of the discourses, clinical implications and recommendations for future research were discussed. The critical appraisal discusses the importance of discourse in clinical psychology practice. The drivers behind conducting this thesis, strengths and weaknesses of the study, and lastly reflections on future practice in clinical psychology were offered.