From Rogers (1961) to Stern (2004) counselling and psychotherapy practitioner-researchers have identified special moments of psychological contact within psychotherapeutic relationships that are recognisably different. These moments have a particular relational quality of 'oneness' and have been seen as indicators of movement towards change and development: a greater understanding of these seemingly palpable, but ineffable, moments may therefore contribute to the wider ideal of improvement in the art and science of psychotherapeutic praxis. Using a bricolage of visual and performance methodologies, this inquiry sought to capture psychological therapists' experiences of these 'moments of meeting' in the form of sculptural artefacts. Approximately forty co-researcher/ participants were an opportunistic sample taken from professionals attending two counselling/ psychotherapy conferences. In wishing to discover the most appropriate format for dissemination of the first cycle of inquiry, the author embarked on a second cycle that offers a discovery of the data as a script, incorporating a personal narrative of his own research journey and the words of a further half dozen colleagues. This script was then performed to another conference audience of just less than twenty counselling professionals: an audio-visual record of this performance is provided. It is suggested that the credibility of this research relies predominantly on the catalytic validity (Lather, 1986a) created through the research process and ongoing dissemination, which encourages a holistic appreciation of the cognitive, emotional, and physiological impacts of the data. This work does not seek to demonstrate findings, nor even explication, so much as offer description and opportunity: the author invites the target audience (psychotherapeutic practitioners) to immerse themselves in the images, the narrative, and the accompanying audio-visual digital files.

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This thesis examines the manifestation of global and national policies in rural distress and mental health wellbeing of cotton farmers in India. It draws upon the disciplines of medical anthropology and cultural psychiatry to argue for a re-calibration of health care systems and mental health pedagogy. The thesis addresses three interlinked research questions. Firstly, to examine the social and cultural contexts of farmer suicides. Secondly, how and why do these socio-cultural issues mediate between cotton farming and mental distress? The third question investigates the psycho-social consequences for survivors. Ethnographic field work for 12 months (2011-2012) was conducted in a village in Warangal district, Telangana State, India. A nuanced analysis points at a confluence of global and local forces in defining rural predicament when encountering modernity. Bt cotton symbolises this plight as it demonstrates the transformation of rural landscapes into environmentally and culturally toxic terrains. Such toxic landscapes amplify existing social and cultural marginalities leading to immense distress. Marginalised communities embody their suffering in both psychological and social forms. Furthermore this process generates an unrelenting state of social defeat amongst the despaired farmers. The thesis posits that shrinking state responsibility, inactive civil society and media posturing lead to an erasure of rural distress and renders it socially invisible. This is compounded by state oppression that denies cotton farmers an agency to collectivise and resist reproducing their marginalised identities. The thesis explicates that health and wellbeing of farmers are contingent on rural distress that continues to be unaddressed. The existing cultural gap between the clinic and people poses a challenge for local biomedical health care. The thesis proposes that in order to transform such toxic into ‘healing’ landscapes, a radical rethink of texts and training of professionals and policy makers is required. An interdisciplinary approach that is culturally sensitive and is critical of received wisdom and global models is vital. This applies to disciplines of agriculture, public health and social sciences.

Post-weaning social isolation or rat pups is a neurodevelopmental manipulation shown to produce behavioural, neurobiological and neurochemical changes in adulthood relating to schizophrenia. The main objective of this thesis was to further characterise the behavioural effect of social isolation, and in pm1icular, to develop a model that reflects the negative symptoms of schizophrenia and use this to investigate the effect of novel therapeutic agents. This was undertaken, by first, investigating the effect of atypical antipsychotics risperidone and clozapine on post-weaning social isolation-induced cognitive deficits. The behavioural profile in this model was fm1her investigated by examining reversal learning and set-shifting in this model. Fm1her to this, neonatal PCP, post-weaning social isolation and neonatal PCP combined with isolation rearing were examined in a social interaction paradigm as an index of negative symptoms. Final studies evaluated the effect of a novel glycine transporter 1 inhibitor ROx (the compound details have been excluded throughout the thesis at the request of the sponsors) on the social interaction deficits induced by the 'two-hit' model of schizophrenia.

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IPT was originally derived from what were considered to be appropriate clinical techniques, in order to mimic 'good supportive therapy' in clinical trials. IPT was not developed from a theoretical model and consequently it does not have a specific theoretical foundation for practitioners to draw on. Existing IPT research has focused on outcomes, but little is known about how or why IPT works. Literature pertaining to the epistemology of professional knowledge suggests that professionals make use of espoused and implicit theories to guide their work. Those wishing to train in IPT are required to have completed training in a relevant field and therefore may approach IPT with an existing repertoire of theories. This study aimed to explore how IPT practitioners account for theory and evidence in their practice. Interviews were conducted with eight IPT practitioners, and analysed using interpretative phenomenological analysis (IPA). The practitioners made use of a repertoire of implicit and espoused theories, applied during practice and retrospectively. The way practitioners drew on theory and evidence was influenced by their professional context, perceived level of experience, and their individual experiences and values. This study highlights differences in the way practitioners currently make sense ofIPT, and the potential implications of appending theory in a post-hoc fashion. Future research might focus specifically on examining the range of espoused and implicit theories IPT practitioners employ, and their implications for practice.

This portfolio was submitted to The University of SUlTey for the completion of the Practitioner Doctorate (PsychD) in Psychotherapeutic and Counselling Psychology. It aims to demonstrate my personal and professional development throughout my four years of training. It comprises three dossiers which reflect the academic, clinical and research work undertaken as Part of this degree. The academic dossier contains three essays written on topics of personal interest against the backdrop of theoretical subjects and philosophical contexts that were covered during my training. The first essay deals with the high rate of suicidality amongst individuals with bipolar disorder and considers psychodynamic theories on suicide and on manic-depressive disorder in the search for answers. The second essay looks at the role of the therapeutic relationship in cognitive-behavioural therapy using the example of the treatment of borderline personality disorder through Young's Schema Therapy. The third and final essay explores the individual dimensions of clinical presentations and, using the example of shame, highlights the necessity to engage with the underlying personal meaning of any expression of human distress. The therapeutic practice dossier introduces the three placements I attended during my training and gives an overview of the kind of work I conducted there. It concludes with my Final Clinical Paper 'Early Days' which gives an account of my personal and professional development over the course of my training and of how I engaged with the different therapeutic modalities. Finally, the research dossier contains a literature review and two pieces of qualitative research all concerned with the experience of suicidality in the context of bipolar disorder (BD). The literature review undertaken in the first year highlighted that BD has largely been studied from a positivistic perspective leading to a simplistic view of the condition and a lack of understanding of the idiosyncratic meaning of suicidality. The first study investigates individuals' experience of their own suicidality. It appeared that participants were experiencing a gradual loss of identity which led to an erosion of their sense of self and ultimately to the experience of suicidal feelings. The second study is a complementary project to the first one and investigated practitioners' perspective of the nature of bipolar suicidality. The role of empathy and openness to clients' idiosyncrasies are emphasised throughout the whole of the research. LITERATURE REVIEW Suicidality in the context of bipolar disorder. An existential-phenomenological critique of the psychological literature . on bipolar disorder and suicide Abstract Much research exists regarding the description, nature and management of bipolar disorder (BD). Giving an overview of the classification, course, aetiology and treatment of the condition, this literature review shows that BD has largely been studied from a positivistic perspective leading to what appears to be a rather simplistic view of the condition. Particular attention is paid to the aspect of suicidality, a risk high in those diagnosed with BD, as well as to the fact that suicide is seen as a symptom of disease rather than as a meaningful expression. Alternative writers and their views of psychopathology and suicide are considered briefly, such as Laing (1960) and Sasz (1980), as well as the concept of rational suicide and the impOltance of considering a person's intention when attempting suicide. The paper turns to the existential-phenomenological approach which emphasises the client's experience and worldview. The mainstream psychopathological view of BD is challenged with a view to the complexity, causality and relatedness of the human experience and the importance of considering the client's way of being in the world. The existential': phenomenological approach views suicide as a choice of how to respond to the existential givens of human life and emphasises the need to recognise the client's uniqueness and understand the particular meaning that suicide has for each individual. Implications for the practitioner are considered, such as the impOltance of careful exploration of the client's life values and realities in order to potentially i'educe emotional pain and suicidality. Keywords: Suicide; suicidology; phell011zenology; bipolar disorder; mania; affective disorders; self-harm; qualitative; Interpretative Phenomellological Analysis (IPA)

Objective : The primary aim of this study is to investigate the prevalence of anxiety, depression and PTSD disorders for people with cardiac devices, and compare differences between patients with pacemakers and ICDs. The secondary aim is to understand other factors involved in illness-related distress following device implantation including appearance related concerns and illness perception. Finally, the study will explore whether anxiety, depression, appearance related distress, symptoms of PTSD and illness representations have a relationship with one another. Design: A cross sectional questionnaire design compared differences between people with ICDs and pacemakers. Participants: Sixty nine patients with ICDs and 71 with pacemakers were recruited from an outpatient clinic (total n=140). Results: For both groups, measures for anxiety, depression and PTSD were within the normal range. No differences were found between people with pacemakers and ICDs foranxiety or depression. However, for both groups, elevated anxiety or depression was associated with higher appearance dissatisfaction, ICD patients having significantly more concerns with the appearance of their device. People with ICDs experienced significantly more symptoms of PTSD. In terms of illness concern, people with ICDs had a significantly higher overall illness threat, consequences, concern and emotional representation compared to those with pacemakers. Conclusions: The study showed that on the whole people adjusted well to having a device and scores for anxiety, depression and PTSD were within the normal range for both groups. A small proportion of people did experience anxiety and depression which was associated with other areas of psychological distress, including PTSD symptoms, appearance concerns and illness perceptions. Patients who do experience distress in these groups may require psychological treatment and support.

Introduction: The presence of psychological distress following a diagnosis of cancer is well evidenced. To meet this need, the role of oncology clinical nurse specialists (CNSs) has expanded in line with national guidance to include the provision of psychological support to patients and their families. Skills training and supervision has been provided by clinical psychologists. However, there has been little research focusing on the role and experience of the CNS doing this work. This present study researched the experience of CNSs working with patients with cancer and their families in order to understand more fully their experiences. Method: Eight CNSs from four NHS trusts were interviewed about their experience of their role, including the recent expectation of offering psychological support. These interviews were transcribed and individually analysed using Interpretative Phenomenological Analysis, before conducting a group analysis to identify overall themes. Results: Four key themes and fourteen sub-themes emerged through this analysis. The first theme ‘The everyday experience’ captured the experiences and demands of participants in their day-to-day work. ‘The impact of working with patients’ captured a range of experiences of the emotional and existential impact that doing this work involves. ‘Understanding and working out the role’ illustrated the way in which participants must work out their role and identity within their organisational context. Finally, participants experienced ‘Needing recognition and support’ as they carry out this vital role. Two overarching phenomenological themes were also identified as ‘ambivalence’ and ‘uncertainty’ and these run throughout the experiences of all the participants. Discussion: The findings were examined in relation to existing literature. The strengths and limitations of the study were presented and future research suggested. Finally, the clinical implications of this research were identified which included suggestions for training, the use of supervision and greater role clarity.

Across the expanding literature on the sense of agency, the striking reports of inserted thoughts from patients seeking psychiatric help are widely characterised as misattributions of agency for thought. However, this characterisation has recently been challenged, and key questions remain about both the phenomenology and etiology of these experiences. In this thesis, I draw a novel distinction between two distinct strands in the sense of agency for thought, ·and call on this distinction to develop a phenomenological analysis of these delusions of thought insertion, as well as another symptom of schizophrenia commonly characterised in terms of an anomalous experience of agency - auditory verbal hallucination (AVH). I point out fundamental problems with the leading etiologial model of abnormalities to the sense of agency for thought - the motor control-based comparator account - and develop a new and substantially revised version of this account. Finally, I investigate misattributions of agency for thought in the general population, presenting two novel experimental paradigms that make the source of thought ambiguous and allow measurement of the frequency, timing and --henomenology of misattributed thoughts. Across three studies, the prevalence of misattribution in a 5 minute trial was 72%,47% and 75%, respectively, suggesting that, in certain circumstances, the experience of agency for thought is not robust, and that ordinary episodes of thought will be readily misattributed to another agent. Results indicated that an arousing negative or positive thought is more likely to be misattributed than a neutral control. The results also showed that proneness to delusional beliefs - but not to auditory hallucination - was associated with greater frequency of misattributions. Overall, the results raise the possibility that thought insertion - and potentially other thought interference delusions - may be explained by appeal to general abnormalities in reasoning and belief formation, without any appeal to deficits in the sense of agency.