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This portfolio was submitted to the University of Surrey for the completion of the Doctorate (PsychO) in Psychotherapeutic and Counselling Psychology. It is comprised of three dossiers which reflect the academic, clinical and research work undertaken as part of this degree. The academic dossier consists of three essays. The first essay presents Freud's dream interpretation theory and Jung's dream theory and elaborates on the features of each theory respectively. The second essay describes Compassion Focus Therapy, its therapeutic benefits and challenges and some of its divergences from Cognitive Behavioural Therapy. Finally, the third essay provides an understanding of anorexia nervosa from an attachment perspective, offering some clinical implications for therapeutic work and discussing some of the challenges and benefits of using this theoretical framework in clinical practice. The therapeutic dossier provides a description of my clinical placements over the four years of training. Within this dossier there is also a 'final clinical paper' which gives an explicit account of my professional and personal development towards becoming a counselling psychologist. The research dossier contains a literature review and two research projects conducted during the four years of my training. The literature review explores the role of the body in psychotherapy. The first research report is a qualitative study that examines counselling psychologists' experience of the use of body in the therapeutic encounter. Finally, the second research report is a quantitative study that explores therapists' attachment styles and how they impact on their use of touch in clinical practice with adult clients. The research dossier concludes with a copy of the poster presentation delivered at the Annual Conference of the Division of Counselling Psychology in Cardiff, 2013.

This thesis describes a quasi-experimental study exploring psychotherapeutic process and outcome in 25 young adults sequentially assigned to psychoanalysis (n=14) or psychodynamic psychotherapy (n=11) at the Anna Freud Centre in London, England. Analysts reported process using a novel 899-item questionnaire, the Young Adult Weekly Rating Scale (YAWRS). Patients were assessed by an independent psychiatrist at intake, termination, and at 18 month intervals after intake and termination with Main and Goldwyn's Adult Attachment Interview (AAI) and on a host of symptomatic and diagnostic measures. The patients suffered from depression, anxiety, and personality disorders. Over the course of treatment (6 months to 8 years long), 12 of 19 patients (with adequate data) improved symptomatically on an aggregate measure. Ten of 12 improvers were in the psychoanalysis group, suggesting that it is a more effective treatment in this population. Data from 1,314 YAWRS questionnaires were factor analysed and used to test hypotheses from the psychotherapy process literature. In the first year of psychoanalysis (as compared with psychodynamic psychotherapy), higher scores on therapist dynamic technique, patient dynamic material, and negative patient transference were found. In the combined sample, higher scores in the first year on therapist dynamic technique, patient dynamic material, and discussion of contract were predictive of positive outcome. The AAI classifies patients according to security of "state of mind with respect to attachment" from narratives about early life relationship experiences. Our results show a high proportion of secure classifications at initial assessment and, in successful treatments, a movement towards a preoccupied-entangled attachment pattern which began to resolve by termination. We propose that the AAI be used to measure both structural health and regression/transference neurosis, which must occur and then resolve for treatment to succeed. Further research using the YAWRS and AAI is proposed.

Complaints and complaining in counselling and psychotherapy have been largely ignored in the research literature. The research in this thesis used various methods to address different but related questions within this area. An in-depth analysis of the documentary archive of complaints made to the British Association for Counselling and Psychotherapy (BACP) was undertaken. Descriptive statistics were compiled relating to the Association's Professional Conduct Procedure and Article 4.6 procedure. Thematic analysis was used to examine allegations in complaints letters and the resulting categories were then used to produce descriptive statistics. An online questionnaire was developed to explore the reasons why clients do not bring formal complaints in cases where they have experienced poor or harmful therapy. Finally, in-depth semi-structured interviews were undertaken and analysed using interpretative phenomenological analysis to explore these themes in more detail. The findings show that BACP has lower rates of complaints received and upheld than in comparable literature; male therapists are disproportionately represented among those complained about; and lay people are underrepresented as complainants. This is the first systematic research to examine therapy complaints in the UK in an area that has received minimal research attention internationally. The online survey found differences in reasons for not complaining between lay people and clients who are themselves therapists, while the interviews revealed a complex constellation of reasons for not complaining. These findings make an original contribution to debate about regulatory issues in counselling and psychotherapy and have implications for policy-makers as well as practitioners.

Previous research indicates that developmental trends in semantic and phonological false memory are dissociated. Using the Deese-Roediger-McDermott paradigm, seven experiments investigated these trends as well as manipulations that may be used to increase false memory in both children and adults. Experiments 1 and 2 provided evidence for dissociated developmental trends such that semantic false memory increases with age and phonological false memory does not. Experiment 1 also demonstrated that massing associates, as opposed to spacing them within a longer list increases both semantic and phonological false memory. In Experiment 2, presenting associates within a story format was used to increase semantic false memory levels in children but not adults. Experiments 3 and 4 further investigated semantic false memory for long and short lists and stories. False memory increased across development for short stories and long lists only. Importantly, these developmental effects were nullified when short and long study materials were matched for presentation duration. Experiments 5 and 6 investigated developmental effects of Length in phonological false memory for lists that converge on one critical lure. False memory increased with age for long lists but not for short lists. Moreover, controlling for presentation duration did not reliably affect this result. Experiment 7 provided limited support for the overadditivity of false memory for hybrid lists. Taken together, these experiments demonstrate that semantic false memory increases with age and that developmental trajectories for phonological false memory are less clear and appear to be determined by the nature of study and test conditions. The findings of this thesis are discussed within both activation-monitoring and fuzzy trace accounts of the false memory illusion. Although support is provided for both models, activation accounts provide a more-comprehensive account of all the results detailed in this thesis.

Personality disorders are complex mental health difficulties that were previously considered untreatable. However there is now increasing evidence that psychological therapy can be useful, with Borderline Personality Disorder (BPD) in particular attracting considerable research attention. The first paper systematically reviews 22 studies on psychotherapeutic interventions for BPD. Focusing on the last seven years six distinct therapies, as well as one approach that could not be further classified, were included. The methodological strengths and limitations of each study are discussed. No particular treatment emerged as superior, although it appears that different treatments may target different aspects of BPD and may therefore be more suitable for different BPD subtypes. However, further research is required to establish this clearly. The empirical paper investigated how change occurs in one particular treatment for personality disorder, the therapeutic community (TC). Fifteen former members were interviewed and transcripts were analysed using a modified version of grounded theory. Participants followed two broad trajectories depending on whether or not they overcame initial resistance towards treatment. Those who accepted responsibility for change and were open to TC principles could use relationships and boundaries within the TC to effect wide- ranging change, although the process of change was rarely straightforward. Those who remained resistant and hostile towards the TC experienced a repetition of previous dysfunctional interpersonal patterns, which frequently led to participants leaving the TC with little change having occurred. The results are discussed in the context of wider theories, such as attachment theory. Clinical implications and ideas for future research are highlighted.

Abstract: A qualitative research study, aimed at exploring the wounded healer and the way in which this historic archetype is applied to the modern day therapist's personal and professional development and practice. The literature that has been published has provided various hypotheses about the influences of being a wounded healer on both the therapist and the work carried out with the client. The claims made however are not conclusive and there appeared to be very few empirical studies to support them. The aim of this study was to explore 'The Therapeutic Use of the Self: The Personal and Professional Journey of the Wounded Healer", so as to give a voice to those who identify as wounded healers and may be considered as a marginalised and disempowered group. A sample of eight participants were used, a combination of psychotherapists and psychologists. Data collection was carried out in the form of one-ta-one semi-structured, open-ended interviews which were then analysed using interpretative phenomenological analysis. Five master-themes were identified with associated sub-themes. The findings indicate that personal experiences inform professional practice. There appeared to be both contributions made to and barriers existing in, the participants' professional worlds when it was chosen to work in a way that involved drawing from their own suffering and woundedness to inform their practice. These seemed to be mediated by the context in which the participants found themselves. The study makes a case for the theory that the therapists' own suffering and woundedness can be a great strength and a resource in their work with clients and can facilitate healing in both the client and the therapist

The aim of the study was to examine whether clients' attachment styles and their perception of therapist empathy and working alliance predicted therapeutic rupture revelation, resolution, repair and leaving therapy after rupture. Data for 108 participants, who had experienced rupture, were collected using an on-line cross-sectional survey. Logistic and multinomial modelling showed that higher empathy and working alliance ratings, but not attachment style, were associated with a higher likelihood of rupture resolution, repair and slaying in therapy after rupture. None of these variables predicted rupture revelation. The implications for rupture resolution and therapist training are discussed.

Background: While there is a substantial body of research on clients' experiences of chronic illness. there is a dearth of qualitative research examining chronic illness from practitioners' perspectives. Aims and Objectives: The aim of this study was to explore how practitioners make sense of clients' long-tern conditions. The objective was to develop a better understanding of Long-term conditions from the perspective of psychotherapists. For this purpose the research asked: How do psychotherapists make sense of their clients' long-term conditions? Method: Five female therapists who had worked with people with long-term conditions for a range of 3-27 years were interviewed. Data was analysed using an Interpretative Phenomenological Analysis approach. Results: Two superordinate themes emerged from the data analysis: No 'them' and 'us' and Redrawing boundaries. Participants in this study anchored their understandi.ng of their clients' experiences and of their therapeutic work by drawing similarities between themselves and their clients and non–health-related distinctions with other client groups. Conclusions: Dealing with chronic conditions in a psychotherapeutic context is a process that requires psychotherapists' understanding of their clients' experiences and of their . therapeutic work together. This study elucidated some psychological and therapeutic processes relevant to practitioners working with people with long-term health conditions

Psychological mindedness is a theory originating in the psychoanalytic literature. However it has broad implications and is applicable to nearly all psychological frameworks. Existing research has examined numerous s factors associated with psychological mindedness. Yet no published research exists which examines psychological mindedness in older adults. Older adults grew up at a time where negative cohort beliefs existed around the treatment of mental illness. This thesis aims to investigate whether psychological mindedness is perceived to be different in older and younger adults. One hundred and seven participants were recruited. Fifty were in a younger group (aged 25-40) with the remaining 57 making up an older group (aged 65-80). Each participant was randomised to receive a vignette describing a GP referral to a clinical psychologist for depression. Two vignettes existed which were identical with the exception of the age of the protagonist. After reading the vignette participants completed the adapted psychological mindedness scale and the PANAS.