Background: Posttraumatic-stress disorder (PTSD) is common in military veterans. Research has shown reduced effectiveness of commonly offered treatments in those with military backgrounds. Some research has suggested the usefulness of art therapy for veterans with PTSD. The project aimed to establish firstly participants’ perceptions of any impact of group art therapy for veterans and secondly some of the perceived mechanisms of change. Methodology: Semi-structured interviews were conducted with nine veterans who had received group art therapy, two art therapists, and a veteran’s wife. Interviews were analysed using grounded theory. Results: Theorised categories pertaining to active ingredients of art therapy and its impact included (a) the art therapy group, (b) the art therapist, (c) trust, (d) doing the work, (e) a communication tool, (f) points of recognition, (g) making things concrete, and (h) not a cure. Discussion: The developed grounded theory is linked with existing literature. Limitations of the study design and analysis are discussed. Clinical recommendation include a call for greater co-operation between mainstream and art therapists. Due to the fairly homogenous sample it is suggested to replicate the project at different sites. Elements of the model may be investigated further to establish its validity.

Introduction: This study aimed to empirically test the application of psychological theory to the issue of compassion in healthcare organisations. The study hypothesised that (1) threat-related emotion among healthcare staff would be predicted by organisational climate and (2) a mediated relationship between organisational climate and compassion-related outcome, through threat-related emotion would be found. Method: Staff from a range of UK healthcare organisations and professional roles were sampled using an online cross-sectional survey (n=154). Data were analysed using multiple regression and mediation analysis. Results: As hypothesised, a perceived climate of high pressure for productivity, low line-manager support for emotions, and low compassion from colleagues and managers was significantly predictive of reduced compassion satisfaction. This relationship was mediated by low 'social safeness' (feelings of 'positive calm', connectedness, trust and acceptance between colleagues). Other hypothesised mediators (work-related anxiety and shame) were not statistically significant, although were significantly predicted by organisational climate. Discussion: Results were supportive of the application of compassionate mind theory to the context of healthcare organisations. Implications and methodological limitations are discussed.

Objectives: Performance validity tests (PVTs) and symptom validity tests (SVTs) have been recommended by the British Psychological Society to assist clinicians in validating assessment data. The current study aimed to explore the base rate of PVT failure in an NHS neuropsychology service, a setting relatively unexplored. A secondary aim was to investigate the relationship between PVT and SVT performance. Lastly, group differences in those passing and failing PVTs were explored in terms of demographics, and psychological functioning. Method: Archival test data (n=127) was drawn from an NHS outpatient neuropsychology service. Participants completed one stand-alone PVT (the Test of Memory Malingering [TOMM]), one embedded PVT (Digit Span age-corrected scaled score [DS-SS]), and one SVT (the Personality Assessment Inventory [PAI]). Results: The base rate of failure on any one PVT was 26%. The rate of TOMM failure was 12% and 6% additionally failed an embedded PVT. A significant relationship was found between PVT and SVT performance. Significantly elevated Paranoia, Anxiety-Related Disorders, and Schizophrenia PAI scales, as well as lower Full Scale IQ scores, were found in those who failed PVTs compared to those who passed. No other group differences on demographics were found, including reported financial incentive. Conclusions: Findings suggest that PVT failure occurs in a sizable minority of NHS ABI outpatients, which is unlikely to be simply explained by malingering for material gain. Elevations in reported psychopathological symptoms may be related to emotional and cognitive sequalae resulting from the ABI itself. Careful interpretation of neuropsychological test data is endorsed.

The question of how to maintain appropriate professional boundaries with clients can be complex and further difficulties can arise for forensic inpatient nursing and healthcare workers. The literature in this area focuses mainly on boundary violations and there is little research on how staff members develop and maintain boundaries on forensic wards, despite this being beneficial for staff experience and client recovery. Interviews with eleven psychiatric nurses and healthcare workers were analysed using a grounded theory methodology, which led to the formation of a cyclical model of boundary development. Staff initially acclimatize to the forensic environment using their existing experiences and personal values and then enter a phase of calibration, where they constantly assess and address professional boundary issues in the course of their daily responsibilities. Staff members use this experience alongside reflection, social learning and supervision to undergo individual learning that parallels team development. In a fourth phase, staff members use this learning to recalibrate their views on boundaries, themselves and how they work with clients. This recalibration impacts on staff members’ further management of daily boundaries, which provides more material for learning, which leads to further recalibration. This study emphasises the consideration staff have for boundaries and echoes previous literature suggesting the importance of supervision and reflective spaces. The model is comparable to existing learning theory and highlights the importance of social and experiential learning. There are implications for training, team building, supervision and reflective spaces. Further research could explore cultural aspects of boundary development.

The systemic model has been proposed as particularly relevant for addressing the mental health needs of refugees and asylum-seekers. Clinicians working with families from refugee and asylum-seeking backgrounds who have experienced trauma may wish to encourage family communication to promote resilience, but may find it difficult to know whether to address traumatic memories. This study aims to develop a theoretical understanding of how conversations about trauma emerge in systemic family therapy with families from refugee and asylum-seeking backgrounds. Ten systemic family therapists were interviewed, and data was analysed using grounded theory methodology. Resulting constructs highlight co-constructed conversations about trauma between families and therapists. Therapists attend to several factors in order to create a space where unspoken stories can be voiced, so that families can find new meanings and re-connect. Showcasing current practice in this field, the study emphasises the need for clinicians working with this population to actively engage with the wider context, and highlights the need for research investigating the effectiveness of systemic family therapy interventions for this client group.

Objectives: A Near-Death-Experience can be a lifechanging event initiating deep posttraumatic growth. Yet people can initially be left struggling with the internal changes and feel alienated from their life and social network. This study investigated whether Near-Death-Experiences also have an impact on people’s happiness, and if so, how long it lasts, and what kind of support they receive in making sense of the event. Method: Six semi-structured interviews were conducted with people who had a Near-Death-Experience and the data was subjected to Interpretative Phenomenological Analysis. Results: Five master-themes emerged: Sense of self, Attitude toward life and death, Effects of Near-Death-Experience, Relationship with others, and Experience of happiness. Conclusion: Almost all participants reported feeling less apprehensive towards death and simultaneously found a greater ability to embrace and appreciate life. Some gained new and profound internal insights that manifested in a renewed sense of self, stronger and more pronounced feelings of life purpose, and could reflect on the Near-Death-Experience as a precious gift. The majority of participants experienced a greater degree of happiness that gradually grew over time. This was largely located internally, which freed them from ‘the hedonic treadmill’ of pursuing it in the outside world. Stigma and a lack of awareness still represent a hurdle for connecting with others and accessing support. Clinical and research implications were discussed.

Schwartz Rounds are a staff support intervention which have been adopted in over 100 healthcare trusts in the UK since 2009. They aim to provide a space for staff to come together to think about the emotional impact of the work they do. Research into rounds is in its infancy, however, to date, findings are generally positive. The current study aimed to develop a theoretical understanding of staff motivation to attend or not attend rounds. Interview data from ten NHS employees and one previous employee were analysed using a grounded theory approach. A theory was developed which suggests staff will make the effort to overcome contextual factors of lack of time and resources to attend rounds if they view them as beneficial. Reported benefits of rounds were similar to those described in previous research. Staff are less likely to attend rounds if they do not understand the aims of rounds or if they view sharing emotional experience as risky. High demands and a perceived lack of support may influence the degree to which staff trust and feel able to use rounds. The limitations and implications of the study are discussed and areas of future research suggested.

Background: Literature to date claims that sex and sexuality are a core aspect of individuals’ psychological wellbeing. Literature also claims that Clinical Psychologists are not engaging in talking about these issues in their practice or training. Sex and sexuality are complex topics and argued to be impacted by social, cultural, historical and political discourses. Looking at the discourses within the profession may provide helpful insight in understanding current practice. Aim: The aim of this study was to investigate how sex and sexuality was constructed by clinical psychologist and trainees when discussing training and practice. Method: Semi-structured interviews were completed with 6 practicing CP’s and 4 trainees CP’s, 2 focus groups were also completed with trainees from 2 different universities. A Foucauldian Discourse Analysis (FDA) approach was used to explore professional and trainee’s discourses around the topics of sex and sexuality. Results: Six discourses were identified during the analysis consisting of ‘Let’s not talk about sex’; ‘Dangerous for Clients, Professionals and Society’; ‘Social and Political Movements’ and ‘Culture and Contextual Discourses.’ Two counter discourses also emerged: ‘Let’s talk about sex’ and ‘Sex and Sexuality are Positive and Healthy’. Conclusions: Various wider discourses can be seen to be impacting on clinical psychologist’s decision making when talking about sex and sexuality within practice and training. Constructions of what is expected from clinical psychologists in the therapy room appear to be reinforced by dominant social, political and cultural discourses. Counter discourses were present; bringing these alternatives more into the forefront could be beneficial for clients.

This thesis deals with how group members respond to wrongdoing committed in their group's name. In particular, I investigate whether individuals feel ashamed or guilty for these acts, and in turn, what motivational effects these emotions have. A review of the literature on shame and guilt turns up serious inconsistencies regarding both the charac- terisation of these emotions and the empirical evidence relating to them. In particular, shame is found to be related to both prosocial and antisocial outcomes, and guilt is some- times associated with prosocial acts and sometimes not. My empirical work tests an explanation for these inconsistencies. Notably, I test a novel way of seeing shame, and propose that not only are there different forms of shame but that these different forms have divergent motivational effects. I focus on two important forms of shame: moral shame and image shame, which arise when one sees the ingroup's actions as threatening one's morality or reputation, respectively. I show that moral shame is consistently related to increased prosocial attitudes (support for apology and compensation) and decreased an- ger, avoidance and cover-up; whereas image shame is predictive of higher levels of anger, avoidance and cover-up. The effects of guilt are weak or non-existent in the presence of these two forms of shame. I also show that these emotions have a meaningful influence on how group members relate to unrelated minorities in society, borne in part of a feeling of moral obligation for past wrongdoing. A study is also reported that shows that, depend- ing on their individual motivations, different group members prefer different emotional expressions within apologies offered by their leaders.

<p>Syfte och frågeställningar</p><p>Syftet med studien var att undersöka om en kortare period av motiverande samtal (MI) kunde påverka livskvaliteten positivt hos en arbetande population. De tre frågeställningarna var: Kan en kort period av MI förändra livskvaliteten positivt? Vilka eventuella effekter har en kortare period av MI på livskvaliteten? Finns det några skillnader i eventuell förändring av livskvalitet mellan kön, ålder samt utbildningsnivå?</p><p>Metod</p><p>Studien bestod av två MI-samtal med tre veckors mellanrum, samt en enkätundersökning som genomfördes före och efter samtalsperioden. Ett företag kontaktades och deltagarna rekryterades genom information på företagets intranät. 25 anmälda bildade MI-gruppen och därefter efterfrågades kontrollgruppsdeltagare via mail, 23 anställda bildade kontrollgruppen. Företaget hade sedan många år tillbaka haft ett nära samarbete med företagshälsovården. En redan framtagen livskvalitetsenkät, SF-36, användes tillsammans med en egen kompletterande enkät om kön, ålder och utbildning. Enkätsvaren kodades om och analyserades enligt manualen för SF-36. Därefter utfördes statistiska tester för att få fram eventuella skillnader inom och mellan grupperna. Det totala bortfallet blev fyra personer från kontrollgruppen, resultatet beräknades utifrån 19 deltagare i kontrollgruppen och 25 deltagare från MI-gruppen.</p><p>Resultat</p><p>Resultaten visade att en kortare period av MI inte kunde förändra livskvaliteten och att det inte heller fanns någon signifikant skillnad i livskvalitet mellan grupperna. Vi tror att det bland annat kan bero på det tidigare hälsoarbetet på företaget. Däremot kunde en signifikant förbättring av den mentala hälsan inom MI-gruppen konstateras som en effekt. Det fanns inga skillnader i förändring av livskvalitet mellan kön, ålder och utbildningsnivå.</p><p>Slutsats</p><p>Slutsatsen blev att signifikanta resultat på livskvaliteten inte går att uppnå på så kort tidsperiod som studien avsåg. Utifrån de givna tidsramarna var studiens modell hanterbar och kunde ändå uppvisa resultat i form av en förbättring av mental hälsa hos MI-gruppen.</p>