Pharmacotherapy is the most common treatment approach for late life depression, however, because of fears about side effects by practitioners and recipients alike and poor compliance rates with medication there is a need for an investigation of an effective psychological treatment alternative to medication. This study provides an empirical evaluation of Cognitive Behaviour Therapy (CBT) alone versus Treatment as usual (TAU) alone (generally pharmacotherapy) for late life depression in a UK primary care setting. General Practitioners in Fife and Glasgow referred 114 Participants to the study with 44 meeting inclusion criteria and 40 participants providing data that permitted analysis. All participants had a diagnosis of Major Depressive Episode. Participants were randomly allocated to receive either TAU alone or CBT alone. Participants in both treatment conditions benefited from treatment with reduced scores on primary measure of mood at end of treatment. However, one-Way ANOVAs and repeated measures ANOVAs performed between the two treatment conditions showed no differences between each treatment at the end of treatment and at 6 months follow-up on any of the primary outcome measures. Accounting for differences due to living arrangements, ANCOVAs provided evidence that CBT may be beneficial in reducing depression scores and hopelessness at end of treatment and at 6 months follow-up. Both the CBT alone and the TAU alone treatment conditions produced significant reductions in depressive symptoms at the end of treatment and at 6 months follow-up. CBT on its own is shown to be an effective treatment procedure for mild to moderate late life depression.

The aims of this research were: 1. To examine the role of adverse life events in the response of depressed patients to treatment; 2. To examine the relative effectiveness of cognitive therapy and biological treatment when patients experience life events; and 3. To examine the mediating variables of dysfunctional attitudes, attributional style and coping style in patients receiving cognitive therapy and patients receiving biological treatment and the effects of life stress on these processes. Cognitive therapy did not lead to more effective coping than biological treatment. The main hypothesis was not supported. However, it seems that cognitive therapy and biological treatment operate in different ways as can be seen by their differing effects on dysfunctional attitudes and attributional style. The negative findings may be due to the small sample size and the fact that few patients experienced major life events. Larger numbers may have resulted in more powerful statistical effects. The results need to be replicated with larger numbers. The findings are discussed with reference to the literature. The implications of the findings are that 1) there may be no advantage in treating depressed patients who experience life events with cognitive therapy instead of medication; 2) cognitive therapy may need to be more tailored towards the social context in which depression occurs in order to increase its effectiveness; 3) patients receiving cognitive therapy appeared to cope equally with life events compared to patients receiving biological treatment which suggests that coping style may not be a mechanism through which cognitive therapy reduces depression. It is possible rather that improvements in coping occur as a result of reduced levels of depression.

Communicative Psychotherapy is characterised by its distinctive focus on the immediate therapeutic interaction. The approach identifies the client's unconscious curative abilities to guide the treatment process, while also acknowledging the practitioner's potential to also disturb the therapeutic procedure. The major thrust of Communicative Psychotherapy is related to the significance of death anxiety. This notion is consistently addressed around the boundary issues (as they arise) of the therapeutic environment. The approach emphasizes the interpersonal influence that this ongoing existential concern has on the quality of the therapeutic relationship. The school of Existential Phenomenology is generally viewed as antagonistic to theories of human behaviour that stress the role of the unconscious. The research has examined the connections between some major existential themes, taken from a specific tradition of European existentialism and the communicative approach to psychotherapy. The discourse has explored and juxtaposed some key existential concepts of being in the world in order to clarify the interpersonal communicative focus on being - between client and therapist in the consulting room. The work has sought to display a common philosophical thread that unites existentialism to the communicative model. The research has also systematically applied and revealed a link between fractal patterns that signify disorder in Dynamical Systems Theory and communicative practice, which is principally focused on the client's recurring narrative themes that relate to the boundary disturbances in the therapeutic system. The context statement has extended, amplified and grounded the main topic of the thesis by integrating three further features. (1) By augmenting the triple link between Existential Philosophy, Chaos Theory and Communicative Psychotherapy. (2) By displaying the relational principles that are implied in the three manifestly divergent disciplines. (3) By illustrating the phenomenological aspects of the communicative method.

Introduction Studies examining outcome in schizophrenia have either not considered religion as a relevant variable; or else they have failed to disentangle religious delusions from normal religious beliefs. Method. The measures were developed. The psychometric properties of the Religious Life Inventory modified for use in patients with schizophrenia were examined (study 1). A reliable categorisation procedure was developed for separating religious delusions from normal religious beliefs. A cross sectional investigation (study 2) established the prevalence of religious delusions, and categorised them into meaningful categories. Response to treatment and satisfaction with treatment was evaluated (in study 3) using a quasi-experimental approach. Results. The prevalence of religious delusions was 24%. The most common examples were the delusion of being God or Jesus and the interpretation of an auditory hallucination to be the voice of God or the Devil. Religious delusions were most commonly found in religious people, especially those who have had alterations in their level of religiosity in the past and who hallucinated. Those with religious delusions had higher scores on psychotic symptom measures than those who did not have religious delusions on admission. There was no difference between the religiously deluded and not religiously deluded, or religious and not religious patients in their response to routine treatment. Conclusion Religiosity is not a relevant factor in response to routine treatment for patients with schizophrenia.

The thesis explores how practitioners in Mental Health nursing can be empowered and how this empowerment impacts on the care provided for clients The study begins by exploring the origins of the research, where the initial idea came from and how it builds on and develops previous work. (Nichols 1991, 1993) Questions raised in the introductory chapter about the worth and value of practitioners and their self motivation led to an exploration of the traditional scientific research approach. The detrimental effects of excluding subjects/participants from the research process was discussed. This included an exploration of how the outcomes of a research study can be better applied and have greater influence once they become part of the articulated experiences of practitioners. The main part of the thesis describes the work of a collaborate inquiry group made up of 12 practitioners working in Mental Health Nursing. The group worked together for 12 months identifying their own ideas for developing practice in order to provide a platform to enable empowering concepts to emerge. Data collection and analysis centred on the use of the dialectic as a question and answer approach to generate new knowledge. Tape recordings of group meetings and . one-to-one interviews enabled data to be recorded and analysed. Recorded conversation was systematically analysed using a framework devised by Stenhouse (1980). This framework enabled original recordings(as archives) to be condensed into meaningful statements about the impact of empowered practitioners. Chapters are organised in order to assist the presentation of data. The thesis shows the impact the dynamic of a collaborative inquiry has on practitioners and their experiences of empowerment, how practitioners used their empowerment to improve client care and the kinds of limitations that impinge on empowered practise. The authenticity of the thesis rests on the way that practitioners validated their own experiences and the concepts that emerged about empowered practise. This validation process was enhanced by seeking the views of practitioners, not involved with the research, about the process and outcomes of the collaborative inquiry. The thesis is drawn together by considering how the outcomes of this research could be further utilised and how by transforming prepositional statements into questions the dynamic of the dialectic assists with the further development of knowledge.

Audit is found increasingly in clinical settings, and attempts are being made to extend its impact and effectiveness. This has given rise to debates about its relevance as a form of intervention into professional practices in spheres as different as accountancy, engineering, medicine, and psychoanalysis. These debates are examined, together with attempts to develop forms of `clinical audit' relevant to psychotherapy services in general. A case is made that psychoanalytic psychotherapy has not been subject to successful or convincing audit processes. This is especially true of couple psychoanalytic psychotherapy. A case is made for the development of forms of `conceptual research' in psychoanalytic modalities - particularly ones which respect the unique nature of the psychoanalytic `clinical fact' and the influence of the practitioner's pre-conscious. The development of couple psychoanalytic psychotherapy in the UK from its early roots in the Family Discussion Bureau to its current institutional practice at the Tavistock Marital Studies Institute and its private practice within the Society of Psychoanalytic Marital Psychotherapists is examined to show how couple psychoanalytic psychotherapy has developed as a discrete modality of psychoanalytic treatment. A research project is described which attempted to survey the field of couple psychoanalytic psychotherapy. A questionnaire gathered demographic data, theoretical orientation and conceptual orientation data, and approaches to clinical material and concepts. The analysis of the research data (utilising quantitative and qualitative methods including those of Grounded Theory) showed that within the field of couple psychoanalytic psychotherapy there are clear groupings of practitioner, with a good degree of congruence between their self-reports and their practice when approaching clinical material. The reasons for, and make-up of, these groupings is described. Recommendations are made in three areas of couple psychoanalytic psychotherapy practice: audit, training and research. The need for audit processes to be developed out of the psychoanalytic experience is underlined as part of a way of developing reflexive couple psychoanalytic psychotherapy practitioners.

This study aimed to explore the subjective experiences of people leading up to their first experiences of psychosis. It was conceptualised in response to the increased interest in mainstream psychiatry in this period (often termed the 'prodrome') within the paradigm of early intervention, for the purposes of identifying and intervening with people at risk of developing psychosis. Eight individuals were interviewed about their experiences and transcripts of these interviews were analysed using the qualitative research methodology of Interpretative Phenomenological Analysis. A number of themes were identified concerning issues of transition, identity, relationship, existence and withdrawal. For example, all participants described going through a major transition in their lives, which placed greater personal demands than they had the capacity and resources to manage. Conflicts in constructing a desirable identity in the face of an invalidating social context were also found to be pertinent in the participants' accounts. Themes concerning their relatedness to others highlighted experiences of extreme loneliness and isolation in the context of a desire for connection with others. These findings are discussed in relation to existing theories and their implications for understanding the development of psychosis. The implications of these findings for the concept of the 'prodrome' are also considered.

Clinical psychologists have an increasing presence in the media, however the way they are portrayed rarely distinguishes them from other types of psychologists and psy-professionals, and the information communicated is often unclear, inaccurate and lacking usefulness. Therefore, this thesis sought to examine how people working in the media understand clinical psychology and the way this then informs the portrayal of clinical psychologists. On the basis of this, possible solutions to improve their portrayal in the media would be identified. A secondary aim of the thesis was to investigate what clinical psychologists wanted the media to know about their profession. Fifteen media personnel were interviewed and the data were analysed using a descriptive analysis and a critical discourse analysis (CDA). Sixteen clinical psychologists answered a single question survey about what they would like the media to know regarding their profession and their answers were analysed using a content analysis (CA). The media samples' responses to the interview, and the clinical psychologists' responses to the survey question were then subjected to a descriptive comparison. The descriptive analysis of the media samples' interviews highlighted much confusion about clinical psychology, the activities of clinical psychologists and the way they are different from other psychologists and psy-professionals. The CDA revealed three main discourses underlying the way in which media personnel spoke about clinical psychologists, these being: i) the clinical psychologist as authority/expert, ii) the clinical psychologist as mind reader, and, iii) the clinical psychologist as rescuer. Another descriptive analysis highlighted how decisions were made by media personnel as to when and how to portray the profession. The CA revealed 25 separate coding categories indicating what clinical psychologists would like the media to know about their profession. A comparison of both sample's responses revealed similarities and differences as to how they conceptualised clinical psychology. On the basis of the above analyses, new possibilities to improve the portrayal of clinical psychologists were identified and the results are discussed in relation to the broader literature.

This research study has enquired into the circumstances as to when it is appropriate for systemic therapists to use self-disclosure of personal information to their clients as a clinical intervention. Eight experienced systemic therapists were interviewed and the interviews analysed using grounded theory analysis. A wide range in the readiness to self-disclose was found amongst the research participants. This thesis discusses how family/systemic therapy practice and theory have evolved and how this process has affected the development of systemic interventions such as therapist self-disclosure. The systemic literature on the topic of therapist self disclosure is sparse and generally does not differentiate between its uses in different clinical scenarios. It shows that systemic therapy theory has concentrated on the teaching of models and technique while neglecting the development of the therapeutic relationship and interventions such as therapist self-disclosure. The research, supported by the literature, identifies a systemic professional culture that encourages caution in using therapist self-disclosure which has its origins in a number of areas including being overly influenced by Freudian thought and theory The thesis builds on work by Rowan & Jacobs (2002). Their model identified distinct ways of being a therapist which help the therapist to determine the type of therapeutic inventions that are appropriate to be used or not. Three therapist positions were found the instrumental, the fluid and the relational and these are discussed. They are related to four different self-disclosure types that have been identified in the research. Other variables that emerged from the research, in relation to self-disclosure and systemic therapy, are also discussed. The systemic 'self-disclosure framework' has been devised identifying the place of these variables in systemic therapy, with the aim of informing the systemic therapist of their options in their use of self-disclosure. Recommendations are made for systemic clinical practice and theoretical development.

There has been a substantial amount of interest in self-harm in young people over the last 8 years, with attempts to understand, define and identify models of intervening. The main focus of the literature has been on understanding the young person from a medical model perspective. This perspective has positioned the problem within the individual and tried to seek ways to cease the self-harm. However what seemed to be a limited way of understanding the young persons struggle has been described as leaving them feeling stigmatized, humiliated and misunderstood. In more recent years there has been an attempt to hear the perspective of the young person and self-harm has been considered as being a reflection of an underlying deeper problem, that could be located within relational, social or cultural origins. `Professionals' have also seemed to struggle and have described feeling overwhelmed, fearful, and disturbed by those who self-harm. Questions have been raised surrounding the understanding the `professionals' had of the young persons difficulties and if they met their needs sufficiently. Therapists from a range of theoretical orientations are known to work with young people who self-harm, however there is very little in the literature describing their experiences and understanding of such a phenomenon. There is also a dearth of studies focusing on self-cutting specifically, which is considered the most prevalent yet hidden form of self-harm. The research study aimed to qualitatively explore therapists' perceptions, experiences and understanding of the phenomena of self-cutting. The participants were therapists registered with a professional body who provided therapy for young people (aged 13-25 years old) who self-cut. Areas of interest explored through the use of a semi-structured interview; were the feelings and beliefs aroused within a therapist and how they coped with these, how the therapist viewed self-cutting in relation to a client's development and the therapists view of the therapeutic relationship when working with this client group. An IPA methodology allowed for an in depth analysis of the lived experience of therapists. Results highlighted three super-ordinate themes; `Who am I: struggle managing boundaries of therapist role'; `Therapists understanding of client's struggle' and an entwining of the struggles within `negotiating the therapeutic relationship'. Discussion surrounded the fluidity of the boundaries between client and therapist, whereby both struggled with identity and a merging between client/therapist could be expected to occur. There was not one specific theoretical model or intervention highlighted as being of particular use when working with this client group. It could be concluded that therapists have transferable skills that need to be applied flexibly within the broad context of the client's socio-cultural needs. Self-cutting seemed to represent a deeper underlying struggle for the client. The therapist could approach this struggle through the use of the therapeutic relationship as a vehicle and bridge for all therapists no matter their therapeutic orientation.