This three-phase study explores how counselling and psychotherapy can address the post-migration stress that adult male Iraqi refugees can experience in later stages of exile (defined in this study as having lived in Sweden for a minimum of five years). In Phase 1 the exile-related experiences of ten Iraqi refugee men were explored with specific emphasis on social support, acculturation, racial discrimination, and support systems. In Phase 2 the counselling experiences of ten adult male Iraqi refugee ex-counselling clients were explored. In Phase 3 the views of eight professionals were explored regarding their experiences of counselling Iraqi refugee men. The adult male Iraqi refugee participants in Phase 1 and Phase 2 were individually interviewed using semi-structured interviewing. The twenty interviews were analysed using Interpretative Phenomenological Analysis (IPA). In Phase 3, the findings from Phase 1 and Phase 2 were used to design two focus group interviews using four mental health professionals in each group. The two focus group interviews were also analysed using IPA. The main findings of Phase 1 were that Iraqi refugee men expressed feeling disempowered, racially discriminated against, and marginalised by society. The main findings of Phase 2 were that adult male Iraqi refugee ex-counselling clients expressed a reluctance to disclose to therapists issues pertaining to their ethnic minority status and experienced racial microaggressions from therapists. The main findings of Phase 3 were that professionals described avoiding and struggling with cultural issues. Another main finding of Phase 3 was that in spite of client feedback revolving around the need for practical help and the experience of post-migration stress, professionals emphasised pre-migration trauma in discussing their views on counselling this client group. Based on the findings of this three-phase study, a pluralistic counselling approach is proposed to address the different post-migration stressors that adult male Iraqi refugees can experience in later stages of exile in Sweden and perhaps other Western countries.

The systematic review explored the effect of the initial hours of psychological therapy; a critical phase of therapy, which some studies have suggested sets the course of therapy as a whole. The 24 studies included in the review were selected because of their relevance to outpatient adult mental health services. Methodological concerns regarding the nature of the sample, diversity of outcome measures, interventions and timing of follow-up measurement are discussed. Overall, the review suggests that a significant proportion of patients report benefits, including symptom change, following initial hours of therapy and this is especially clear when compared to no-treatment controls. Furthermore, these positive effects appear to be maintained at follow-up. These conclusions are tempered by the methodological concerns outlined in the review and a recommendation is made for more robustly designed research, which could confirm the tentative conclusions of the current review. An empirical study explored whether patients attending secondary care psychology services made early gains following an extended initial 'trial therapy' session of Experiential Dynamic Therapy and what mechanisms of change facilitated these gains. Video-recordings of 31 initial sessions were rated using the Achievement of Therapeutic Objectives Scale, a process scale that assesses patients' degree of absorption and assimilation of therapeutic objectives. Outcome was assessed through comparison of pre- and post scores using the Clinical Outcome Routine Evaluation-Outcome Measure, Brief Symptom Inventory, Inventory of Interpersonal Problems, Self- Compassion Questionnaire and Remoralisation Scale. The patients achieved an initial level of therapeutic objectives, in particular insight into and motivation to relinquish their maladaptive patterns and made significant positive changes in symptoms, remoralisation and self-compassion. Ratings of some achievement of therapeutic objectives were associated with improvement on the outcome measures. The results highlight the potential clinical benefits of extended experiential dynamic therapy sessions in the initial phase of treatment in secondary care NHS psychological therapy services.

Research into the area of therapists' clothing has received only modest attention in the psychotherapy literature. The existing findings are largely outdated and have been inconclusive, emerging from entirely quantitative research designs. This current research seeks to offer a qualitative understanding of how counselling psychologists in training understand therapists' clothing in light of their experiences of being counselling psychologists in training and what this means to them. Participants were eight counselling psychologists in training who took part in semi-structured interviews. Rooted in a contextual-constructionist epistemology, Interpretative Phenomenological Analysis (IPA) was used to analyse the data and three master themes emerged: achieving an appropriate presentation; providing a therapeutic encounter; and negotiating identities: cl personal and professional spectrum. Overall, the themes suggest that the therapists are intent about making the right clothing choices for their practice of therapy, despite feeling uneasy about the amount of attention they pay to it. This is because the)' perceive their clothing to have important meaning for their understanding of the therapeutic encounter with clients, and additionally, for their own feelings and thoughts in relation to being a therapist Further research is needed to extend this area to develop a greater understanding of the complexities that have arisen in relation to these findings. Both limitations of the current study and ideas for future research are discussed.

Literature review: This review explores the literature on clients' retrospective accounts of their therapy, looking at satisfaction with services, both short and long-term changes reported and factors found helpful and unhelpful in therapy. There are many factors that seem to be common to clients' experiences regardless of the type of therapy they received, although there is limited evidence that some specific factors are important too. Clients' views of therapy also appear to vary according to the time point at which they are measured. However, future work needs to be less theory driven and concentrate more on including clients in the research process in order to decrease constraints on their accounts. Research report: An Interpretative Phenomenological Analysis of therapists' experiences after ending psychoanalytic psychotherapy. A sample of eight therapists who finished therapy at least two years ago was interviewed about their experiences. Four master themes were identified including 'Therapy Stays with Me', 'Personal Growth', 'Life and Therapy Becoming Interwoven' and 'Contrasting Information'. Associated sub-themes were also outlined and their relationship to the literature and implications for clinical practice were discussed. Critical Appraisal: This section gives a commentary on the processes of planning and undertaking the research, including personal reflections on learning and experience within this.

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Depression is a common mental health disorder which affects around one in ten people. A range of psychotherapies have demonstrated efficacy for treating depression. Transactional Analysis (TA) is a relatively under-researched therapeutic approach which had hitherto not been tested for effectiveness for depression. This study used systematic case study research which incorporated both quantitative and qualitative methods to investigate the process and outcome of TA psychotherapy for depression. A naturalistic design was used and five cases were examined to explore the application of up to sixteen sessions of TA therapy in community-based routine practice. Four of the cases were analysed using Elliott’s (2001, 2002) Hermeneutic Single-Case Efficacy Design. This involved the recruitment of a number of independent psychotherapy researchers who adjudicated the cases and provided a verdict on the outcome of these cases. Case study method and cross-case analysis techniques were also developed during this investigation. The findings show that TA therapy can be effective for the treatment of depression. A benchmarking strategy suggests that TA is likely to have comparable effectiveness to other therapies. It is proposed that therapy is more effective when the type of therapy and therapist style is matched to client preferences and that pre-therapy preparation/ role induction is beneficial to overall outcome. TA appears to be a coherent and integrative approach to psychotherapy, which can be used flexibly according to client need and preferences. The clients in this series all reported finding the use of TA theory to understand their own process and take charge of their own change process to be helpful. The use of TA concepts and language provides the therapist and client with a framework for a collaborative approach to therapy. The integrative nature of TA and the use of shared language are two distinctive features of the approach that make a useful contribution to the wider psychotherapy literature. Further research is warranted to confirm and develop these findings.

Literature Review: A systematic review was conducted exploring the use of language switching in therapy and its role in therapeutic engagement for bilingual therapists and their bilingual minority ethnic clients. The review identified three main themes of research focusing on the training needs and professional development of bilingual therapists; the emotional aspects of language use; and the use of language switching and its perceived effects on the therapeutic process. Findings highlighted that language switching can be a powerful and useful tool to enhance therapeutic engagement and client self-disclosure though gaps in the training needs of bilingual therapists was evident. Implications for future research and practice are discussed for enhancing our understanding of a tool which may prove valuable for bilingual therapists when accessing and engaging with diverse populations in the therapeutic domain. Research Report: A two-part investigation was conducted to explore the current practices on language switching amongst bilingual clinical psychologists in the United Kingdom. A survey indicated the prevalence of language switching across a diverse range of language skills and backgrounds whilst semi-structured interviews explored, in depth, experiences of South Asian clinical psychologists and the complexities associated with language switching. Findings highlighted the value of language switching and the tensions which arise relating to psychologists‟ identity, professional boundaries and supervision needs. Clinical implications are discussed and recommendations for future research are provided for an area of practice which is valuable in engaging bilingual minority ethnic populations. Critical Appraisal: A reflective diary provided an account of the research process considering the research strengths, limitations and learning outcomes. Those issues pertinent to the researcher have been discussed in this section.