A grounded theory exploration of cultural and spiritual influences on adjustment in adolescents with liver disease. The evidence-base for adjustment in adolescents with liver disease is minimal, but treatment non-adherence in adolescent liver transplant recipients is known to range between 17-53%, increasing medical complication risks. Evidence has also shown that spirituality impacts on illness perceptions and behaviours of adolescents with other diseases. In this study, ten semi-structured interviews were conducted with 16-24 years olds, recruited from a regional liver clinic in the UK. Half were liver transplant recipients. The study found that navigating cultural expectations was challenging, particularly around education, employment and socialising (e.g. participation with peers and avoiding alcohol). Several participants reported an illness-related spiritual or socio-cultural crisis, sometimes resulting in non-adherence. This seemed to be followed by a turning point, eventually leading to a state of acceptance, personal development and possibly, spiritual growth. Trusted individuals were often instrumental in helping participants to overcome difficulties. However, for some, adjustment was transitory. As such, this appeared to be a cyclical process, entangled with universal adolescent developmental tasks. The study concluded that more exploration is required on treatment adherence and overall functioning in adolescents with liver disease, taking into account socio-cultural and spiritual influences.

This study investigated the relationship between unsupportive stressor-specific reactions to the disclosure of HIV and posttraumatic growth (PTG). Thirty-eight participants were recruited online and via non-statutory organisations. The sample was predominantly young, white, male, gay and HIV was well controlled with medication. Results showed that unsupportive reactions were not correlated with PTG. However, there was a significant indirect effect through total cognitive processing. This was broken down into a two-mediator model which was also significant. It showed that unsupportive reactions trigger intrusive rumination which, in turn, prompts deliberate rumination eventually leading to PTG. Further analysis showed that models using individual subscales of the unsupportive social interactions inventory (distancing, and bumbling subscales) also produced a significant indirect effect in, both one and two, mediator models. When the indirect effects of cognitive processing were accounted for, the negative direct effect of unsupportive interactions on PTG became significant. The findings suggest that unsupportive reactions to the disclosure of HIV may act as another ‘traumatic event’ and shows similar cognitive consequences. They also suggest that there is an alternative path to PTG, other than cognitive processing, which has not yet been identified in the literature and requires further investigation.

Despite evidence to suggest that pathways from adverse childhood experiences (ACEs) to psychological distress and offending are gender-specific, theory-driven research examining intervening factors in such pathways is rare. Utilising a mixed-method design, the research presented in this thesis aimed to a) provide further insight into gender-specific trajectories from ACEs to negative outcomes and b) to identify a theoretically viable framework within which to conduct such research. It was anticipated that comparing and contrasting the quantitative (Study 1 and Study 2) with the qualitative (Study 3) findings would help to inform interventions to reduce female offending. The literature review identified an attachment framework as appropriate for the research and highlighted a range of factors that warranted investigation. The findings from an internet survey (Study 1) in a mixed-gender community sample provided some support for the notion of genderspecific pathways to offending. Moreover, several variables were identified (e.g. emotional intelligence, empathy and anger) that warranted further examination in a second survey (Study 2) with a sample of women with a history of ACEs (ex- and non-offenders). The findings from the two studies suggested that emotion coping and management (EI) skills may foster resilience to negative experiences and also provided support for the use of an attachment framework in research that examines the negative sequelae of ACEs. The qualitative study (Study 3) utilised interpretative phenomenological analysis in order to gain a deeper insight into women’s trajectories from ACEs to psychological distress and offending. The findings strongly suggested that interventions may need to target deficits in emotion regulation in order to ameliorate the potential negative outcomes of chronic childhood adversity. The importance of context was also highlighted. Additionally, EI and an emotional approach to coping were identified as factors that were beneficial in terms of the women’s psychological well-being. The findings from the research highlighted emotion coping and management skills as useful targets for intervention in women ex-offender populations with a history of ACEs and associated psychological distress. Based on the findings reported in this thesis, recommendations were made with regard to future research in the field of ACEs, psychological distress and offending.

Section A reviews and synthesizes the extant literature on adherence to clinical guidelines, with specific reference to the use of CBT self-help interventions as a mainstay within the IAPT programme. The review also evaluates the utility of one psychological framework, namely the theory of planned behaviour (TPB), in assessing the cognitive factors that may be most associated with compliance in this context. The review ends by suggesting an avenue for future research. Section B In spite of evidence for their efficacy and effectiveness as well as the recommendations of NICE, CBT self-help materials are not used routinely or used as an intervention in their own right in mental health services. Aims: This cross-sectional study set out to assess whether the main constructs of the TPB, namely, attitudes, subjective norms (SN) and perceived behavioural control (PBC), as well as past use, self-help training and demographic characteristics, could predict IAPT psychological well-being practitioners’ (PWPs) intention to use CBT self-help materials in their clinical practice. Method: A convenience sample of PWPs (n=94) completed a web-based, mixed closed and open-response questionnaire, which was developed from an earlier elicitation study with a sub-sample of their colleagues. The data generated were analyzed by linear, multiple regression, mediation, and qualitative analyses. Results: The TPB’s main constructs predicted PWPs’ intention to use self-help materials in their clinical work, with attitude being most significant. Past use of self-help materials emerged as both a direct predictor of intention, as well as indirectly related to intention, independent of the mediating effects of the main constructs. The overall extended TPB model explained a respectable 70% of the variance in intention. However, neither self-help training nor demographic factors were associated with PWPs’ intention. Conclusion: It is recommended that future research could extend the methodology to prospective, longitudinal investigations of PWPs’ actual use of self-help materials. It is hoped that this would further elucidate the cognitive factors that are involved in PWPs’ decision-making when they are actually using the materials. Section C sets out and answers four specific questions that guide a reflective critical appraisal of the processes involved in the execution of this research project.

Section A consists of a critical review examining the research evidence relating to the effectiveness of reflective practice groups for staff in psychiatric inpatient settings, and the role of psychologically trained practitioners in providing facilitation using psychological formulations. Section B. The role of applied psychologists working in inpatient services is developing with a greater emphasis on providing support and consultation to staff teams. The research suggests that psychologically trained practitioners who facilitate reflective practice groups using psychological formulations can assist staff in developing a deeper understanding of patients’ difficulties, with the potential for improved treatment outcomes. This study aimed to address some of the gaps in the research by exploring the experiences of acute psychiatric inpatient ward staff attending reflective practice groups facilitated by psychologically trained practitioners. Using semi-structured interviews, nine multidisciplinary staff from four acute wards participated in the study. Grounded theory methodology was applied to investigate how staff experienced, processed, and operationalised psychological knowledge in their clinical practice. The results suggested staff increased their psychological understanding through a process of guided reflection, development of theory-practice links, and validation. This enhanced a capacity for mentalization, which generated a more compassionate and empathic stance. The clinical, theoretical and research implications are presented. Section C presents a critical appraisal of the research process.

Inledning: Syftet med den här uppsatsen att undersöka hur fem psykodynamiskt inriktade privatpraktiserande psykoterapeuter definierar begreppet det psykoterapeutiska kontraktet, hur de arbetar med det psykoterapeutiska kontraktet och vilka effekter de anser att detta arbete ger. Frågeställningar: Hur definierar du begreppet psykoterapeutiskt kontrakt? Hur arbetar du praktiskt med det psykoterapeutiska kontraktet? Vilka effekter ser du av ditt arbete med det psykoterapeutiska kontraktet? Metod: En kvalitativ induktiv analys har använts. Fem psykodynamiskt inriktade psykoterapeuter har intervjuats med semistrukturerade frågor. Därefter har materialet kodats, tematiserats, analyserats och sammanställts. Resultat: Det psykoterapeutiska kontraktet som begrepp har inte upplevts som vedertaget av de intervjuade. Samtliga använder sig dock av ett psykoterapeutiskt kontrakt på olika sätt. Samtliga intervjuade upplever fördelar av att arbeta med det psykoterapeutiska kontraktet under förutsättning att det används på rätt sätt. Diskussion: Det psykoterapeutiska kontraktet tolkas och tillämpas på varierande sätt beroende på teoretisk inriktning. Utifrån uppsatsens ramar kan slutas att psykodynamisk psykoterapi tolkas och utövas på olika sätt beroende på hur psykoterapeuten förhåller sig till det psykoterapeutiska kontraktet. / Introduction: The purpose of this paper to examine how five psychodynamic oriented private practice psychotherapists define the concept of the psychotherapeutic contract, how they work with the psychotherapeutic contract and what effects they think this work provides. Issues: How do you define the concept of psychotherapeutic contract? How do you work practically with the psychotherapeutic contract? What impact do you see your work with the psychotherapeutic contract? Method: A qualitative inductive analysis has been used. Five psychodynamic oriented psychotherapists were interviewed with semi-structured questions. The material has thereafter been encoded, thematized, analyzed and compiled. Results: The psychotherapeutic contract terms have not been perceived as acknowledged by those interviewed. All uses, however, a psychotherapeutic contract in different ways. All interviewees are experiencing the benefits of working with the psychotherapeutic contract provided it is used correctly. Discussion: The psychotherapeutic contract is interpreted and applied in various ways depending on the theoretical orientation. Based on the frames of the essay it can be concluded that psychodynamic psychotherapy is interpreted and practiced in different ways depending on how the psychotherapist relate to the psychotherapeutic contract.

Stress is both a health risk and an economic risk for our society. Employers search for ways to offer possible stress reducers for their employees. Mindfulness as a stress reducer is a fairly new research area but with a good amount of research papers suggesting that mindfulness programmes over several weeks are successful in reducing subjective perceived stress as well as physiological stress, such as blood pressure and cortisol levels. This study aims to examine whether mindfulness could show positive effects on stress at work, after only one mindfulness session, compared to being on an extended break. Measurements includes the Shirom-Melamed Burnout Questionnaire (SMBQ), blood pressure and pulse. The results show that engaging in one single mindfulness session does have an effect on lowering blood pressure as well as lowering perceived tension, which is one of four parts of the SMBQ.

The aim of the research was to study if social media usage had any influence on women between the ages of 18 – 25. The research questions answered were: How does Social Media influence young women? How do young women perceive their usage of SM related to their interaction with people? The study was qualitative and made five deep one-on-one interviews, held with semi-structured questions and used convenience sampling. The literature consisted of five articles related to the topic and the theoretical framework used was the social constructionist theory and the top-down, bottom-up factors theory. The results found in the study were that these women were influenced by SM on how they look upon their bodies. Further, news and companies influence the participants through SM in negative manners, but at the same time they experience SM as a great tool of communication. Thematic analysis was used when analysing.

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Inledning: En utlandstjänstgöring i försvarsmaktens regi är ingen enskild angelägenhet för den försvarsanställde utan påverkar hela familjen. Det finns forskning som visar att när föräldern lämnar ett barn för militär utlandstjänstgöring, är barnets mående och förmåga att hantera en period av separation till stor del beroende på hur barnet har det för övrigt. Utifrån förförståelse och tolkning av tidigare forskning, undersöks möjligheterna kring hur det gestaltar sig för dessa barn att leva ett liv tillsammans med pappa efter militärt utlandsuppdrag. Går relation att reparera helt, återanknytas och återgå till de roller som familjesystemet en gång haft, eller utgör det större komplikationer? Frågeställningen är hur gestaltar sig möjligheten för unga vuxna att leva ett liv tillsammans med pappa efter militärt utlandsuppdrag? Metod som har använts för genomförandet av semistrukturerade intervjuer är kvalitativ metod, där sex respondenter varav fyra män och två kvinnor har deltagit. Det insamlade materialet har analyserats med tematisk analys med induktiv ansats. Det som beskrivs är det fenomen som undersöks; respondenternas tankar, upplevelser och känslor kring den egna subjektiva erfarenheten och dess mening i deras livsvärld. Resultatet knyts till tre huvudteman; separation från föräldern, systemets påverkan av utlandsuppdrag och återanknytning med föräldern samt åtta underteman som sammanfattningsvis redogör för respondenternas subjektiva upplevelse. Respondenterna upplever en avsaknad av dialog och kommunikation mellan pappa och den hemmavarande föräldern i anslutning till pappas utlandsuppdrag som militär. Respondentens upplevelse är en brist på öppenhet i dialogen, vilket har reglerat och undantryckt dennes dåvarande känsla, fantasi men även åsikt om det militära uppdrag och verksamhet pappan deltog i. Separationen har berört respondenterna varierande, men en generell uppfattning är att det uppstått anknytningsbrott. Respondenterna menar även att pappans beslut att åka på militärt utlandsuppdrag har påverkat hela familjesystemet. Rollförändringar och friktioner har uppstått och pappans roll till övriga familjemedlemmar har förskjutits och respondenternas roll som barn i familjen har behövt revideras. Diskussion tar upp de relationella problemen som är följder av tidigare anknytningsskador och anknytningsbrott. Återupprättad kommunikation med pappa möjliggör att återanknytningen förbättrar relationen, samtidigt som behovet av en ökad förmåga hos pappan till känslomässig bearbetning är en förutsättning för förändring. När kommunikationen i vuxen ålder förbättrades fick respondenten möjlighet att uttrycka de känslor som varit förknippande med separationen och livet utan pappa, vilket tycks ha haft en läkande effekt på relationen och anknytningen till pappa. / Introduction: An overseas service in the defense forces is no single concern of the defense staff, but affects the entire family. Research shows that when parents leave the children for military service abroad, the child's mood and ability to cope with a period of separation greatly depending on how the child’s life is in general. Based on the understanding and interpretation of previous research, this study will see into how it’s manifested for these children to continue to live a life with their father after military foreign missions. Is it possible for the relationship to repair completely, re-attach and return to the roles that the family system once had, or is there more complications? Question: How is life portrayed for young adults to live with their father after his military missions abroad? Method used in this research for carrying out semi-structured interviews are qualitative approach, where six respondents, three men two women participated. The collected data were analyzed with thematic analysis with inductive approach. What is described is the phenomenon; respondents' thoughts, experiences and feelings about their own subjective experience and its meaning in their life. The results are linked to the three main themes: separation from the parent, the impact of military missions abroad to the system and re-attachment with the father. There are also eight sub-themes that collectively describe the respondents' subjective experience. Respondents perceive a lack of openness in the dialogue and communication between their father and themselves regarding the subject of the father's international assignment as military. The separation has touched the respondents in varied way, but the general opinion is that respondents also believe that the father's decision to go on military assignments abroad affected the entire family system, not least, the role changes and frictions that arise as a consequence.  Discussion: The relational problems are consequences of previous attachment failures. Repairing the communication to their father enables re-attachment, which can improve the relational difficulties between the father and the young adult. When communication in adulthood increased the respondents had the opportunity to express the emotions associated with the separation that can act as a healing effect on the relationship and association with their father.