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This research described the process of first sessions of CBT for psychosis and reported on the development and validation of a new measure of affective response. It used the new measure to explore relationships between client and therapist affective response and therapy adherence, working alliance and empathy. Transcripts from first sessions of CBT were used to illustrate these relationships qualitatively. Study 1 used data from sixty two therapist/client dyads engaged in routine services and an ongoing controlled trial to develop and validate the new measure of affective response. Study 2 used data from only the controlled trial to explore and examine relationships between therapy processes. Audio-tapes from twenty five dyads were transcribed and rated on measures of adherence and working alliance The new measure of affective response demonstrated acceptable internal consistency for the total scale. Adaptations were made to the subscale structure and both scales demonstrated adequate internal consistency. Convergent validity with a measure of empathy was not demonstrated and test-retest reliability correlations were varied for the therapist scale and reasonable for the client scale. All sessions were adherent to the cognitive therapy manual used. Client and therapist affective response was predominantly positive, empathy ratings were high and the working alliance was good. No relationships were observed between affective response and working alliance or between client and therapist affective response. Increased negative affective response was associated with greater insight orientated techniques and session transcripts suggested this was because clients were unable to tolerate more active interventions and as a result this led to therapists experiencing greater negative affective responses. Study limitations are highlighted and future research recommendations are made, specifically the need to further validate the scale and examine affective response with both adherent and non-adherent therapy. Finally the clinical implications of the research are presented.

"Written words don't fade, they endure through space and time, bearing witness to the work of therapy and immortalising it" (Epston, 1994: p31) Aim: This study explored how the therapeutic letters, which are used as a standard procedure in Cognitive Analytic Therapy (CAT), contribute to the therapy from the perspective of patients. Background: CAT is a structured, time-limited psychotherapy (Ryle & Kerr, 2002). Letters form an important part of the reformulation and ending stages in CAT. However, little is known about the impact these letters have on the therapeutic process and how they are used from the perspective of the patient. Exploring the meaning and use of letters may further our understanding of this process, as well as giving value to patients' opinions. Method: Semi-structured interviews were used to elicit eight participants' perspectives of how the letters in CAT contributed to their therapy. A thematic analysis based on certain grounded theory principles was used to analyse the interview transcripts. Results: The analysis of participants' accounts suggested that the letters in CAT contributed to therapy through a process of `connecting' patients in varying degrees in the following four ways to: `understanding and awareness of self', `relationship with therapist', `perception of the structure and process of therapy', and `communicating self with others'. CAT theory has addressed many of these findings. However, the dilemmas and risk associated with the letters, such as re-invoking painful emotions by re-reading them and whether to share them with others, pervaded patients' accounts, offering a more complex understanding of the part the letters played, beyond those currently proposed by CAT theory. Discussion: It is proposed that it is the letters' ability to tap into patients' experience of connecting and relating, internally and externally, and the difficulties entailed in this that makes them such potentially powerful therapeutic tools. Clinical and theoretical implications and suggestions for future research are also discussed

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Training in psychotherapy needs to involve more than merely skills and techniques. The field of psychotherapy needs to involve more than the application of formulas in a modernistic framework. This study proposes an approach to training in psychotherapy where the emphasis is on the client and the therapeutic relationship. Psychotherapy training should be an ongoing process and this study aims to facilitate and enhance that process for students. The study combines basic therapeutic skills and interpersonal psychotherapy to form a training programme referred to as the Basic Relational Skills Training (BRST) programme. The first part of the study provides a historical perspective of basic therapeutic skills, followed by a review of the relevant literature. The second part of the study constitutes a possible format for a training manual for the proposed BRST programme. The researcher hopes that the proposed BRST programme be utilised by trainers to assess the programme's efficacy. / Psychology / M.A. (Clinical Psychology)