This mixed-methods study investigates psychological perspectives of time in a group of sixty-three individuals seeking help for alcohol/drug issues and who successfully completed a residential addiction treatment intervention. Measures of subjective time perspective (TP) were taken before and after treatment using a quantitative scale (short-form ZTPI) and a qualitative component to capture additional phenomenological experiences of time. Measures of depression and anxiety were also taken pre and post treatment. Overall significant positive associations were found between time perspectives, in particular past-negative, present-fatalism and present-hedonistic time orientations and depression and anxiety. Significant negative relationships were also found between mental health and past-positive and future time perspectives. Distinct changes were reported in temporality between pre and post measures of the addiction treatment intervention from both quantitative and qualitative perspectives. Associations were again made with more positive mental health at the post-treatment phase. The potential use and implications of findings for understanding addiction and considering psychotherapeutic treatment is discussed.

‘Nervous breakdown’ returns over nine million results on an internet search while a search of the academic literature returns as few as twenty-two. It has never been an official psycho-medical diagnosis but has tended to function as such, for variable purposes. This piece of work aims to explore contemporary popular constructions of ‘nervous breakdown’ and what the term accomplishes for those who use it. The exploration is in two parts: (i) a mapping of the contemporary discursive terrain of ‘nervous breakdown’ through a media analysis and (ii) an exploration of subjective constructions of ‘nervous breakdown’ through participant interviews. These two sites of analysis allowed for exploration of how the discursive terrain positions the subject of ‘nervous breakdown,’ and how he/she resists these positions. In order to explore this interface, a synthesis of Foucauldian and discursive psychological discourse analytic approaches was used. What emerged from the study was that the discursive terrain tends to position the subject of ‘nervous breakdown’ as not coping or as mentally ill, whereas those who employ the label do so to carve out a space in between these positions, avoiding their associated stigmas. This liminal position of ‘nervous breakdown’ and its consequences are discussed.

This portfolio explores the experience of managing living in liminality, and ensuing inter- and intrapersonal processes. The first section is an empirical study entitled “Exploring the experience of relationships and identity in adult women living in the UK with a background of high Childhood Residential Mobility”. Due to increased globalisation, individuals are experiencing increased likelihood of moving as children, and there is a paucity of methodologically sound research into how this is experienced in adulthood, especially in non-American populations. As gender differences have been suggested regarding identity and relationship formation, this study included only women. Using Interpretative Phenomenological Analysis (IPA), main findings suggest this population develop an incongruent social self and fluid identity to manage changing social landscapes, resulting in an inconsistent identity which subsequently precludes the development of emotional depth in interpersonal relationships. Additionally, results suggest this population struggle to know where ‘home’ is, having felt ‘orphaned’ by both passport and host countries, and subsequently internalise the identity of ‘traveller’ which further challenges their ability to settle and develop roots. The professional component is entitled, “An Integrative Approach to Depression: A Case Study”, which presents clinical work conducted with a man with a history of drug abuse. Therapy focused on supporting him to develop an internal locus of evaluation, and explore his identity post drug use. The final section is a publishable piece focusing on one superordinate theme, “Managing the Self in Relation to the Other”, and is presented using guidelines for submission to the British Journal of Psychology.

Background: Diabetes prevalence rate in Malaysia has risen much faster than expected. The prevalence of diabetes in Malaysia is above average when compared to the estimation by the International Diabetes Federation (IDF) for all regions in the world and has already reached the projected prevalence for the year 2030. The latest Malaysian National Health and Morbidity survey (2011) indicated that the prevalence of diabetes is 15.2% for population above the age of 18 years old. Various studies in Malaysia have demonstrated poor diabetic self-management among patients and high complications. Research on diabetes in Malaysia has mainly adapted a biomedical and epidemiological approach. Thus far, research in Malaysia has failed to assess patients’ personal beliefs about their illness. This study employs a mixed- methods approach that triangulates findings from two data collection methods to gain a coherent insight into illness beliefs among Malaysian Type 2 diabetes patients using a psychological approach grounded in self-regulatory theory. Aims: Study 1 was conducted to investigate: (1) the cognitive representations of illness among patients suffering from type 2 diabetes in Malaysia, (2) the emotional representations of illness among patients suffering from type 2 diabetes in Malaysia, and (3) the management/coping styles adopted by patients suffering from type 2 diabetes in Malaysia. Study 2 was conducted to investigate the relationships between patients’ illness perceptions and their adherence to self-care regimens. As Malaysia is a country with diverse ethnicity, the secondary aim of this study is to determine whether there are cultural differences in the way in which patients with type 2 diabetes from different ethnic groups conceptualise their illness and treatment. Method: In study 1, data was obtained by conducting semi-structured one-to-one interview with participants. The data obtained was analysed using principals of grounded theory. In study 2, data was obtained using structured questionnaires. Participants were required to fill in 3 questionnaires (demographic questionnaire, IPQ-R Diabetes questionnaire and summary of diabetes self- care activities). Data were analysed using SPSS version 22.0. Various analyses, such as descriptive analysis and Pearson correlations, were conducted. Group differences were examined by a Kruskal–Wallis H test. Results: Study 1 found that patients adopted positive cognitive representation, such as determination. The findings also suggest that patients viewed their relationship with their healthcare provider positively, which supported disease management. Patients with determination and good health provider support adopted problem based coping. Some patients had negative emotional representations towards diabetes, such as fear. In addition, patients’ management of diabetes was affected by various psycho-social factors, such as the lack of understanding of family and stress. All patients expressed that Malaysian food culture had a negative impact of diabetes management. This study also revealed that some patients adopted emotional focused coping, specifically by keeping their diabetic status a secret. Results of Study 2 indicated there was a strong negative correlation between the self-care total score and consequences subscale, personal control subscale, treatment control subscale and emotional representation subscale. There was a significant negative correlation between the self-care total score and illness cohesion subscale. There was also a significant negative correlation between the self-care total score and identity subscale. This study also found that there was a difference in the ways in which different ethnic groups conceptualise their illness.

Background: Community participation is one element of the recovery process for people with schizophrenia, however little is known about how this occurs for persons of South Asian origin. Aims/objectives: This study explores the concept and experience of community participation and recovery amongst South Asians with schizophrenia living in Toronto, Canada. Methods: This longitudinal study took place over the course of eight months. Seven people of South Asian origin with schizophrenia were recruited through purposeful sampling strategy and interviewed at three time points. A theoretical sampling approach was employed to recruit 19 key supports and community members who were interviewed at least once during the course of the study in an effort to capture multi-level perspectives of persons of South Asian origin. Qualitative data was analysed using social constructionist Grounded Theory informed by Charmaz. Results: A rigorous grounded theory approach revealed five themes; i) cultivating an autonomous self within the collectivist family-based culture, ii) cultural conceptualizations of self and mental illness, iii) developing individual ethnic identity and sense of belonging in a community context, iv) points of exclusion in the community, v) points of inclusion in the community. These five themes interlinked, creating a complex dynamic between individuals, families, various communities’ people belonged to and, in turn, experience of mental health. The multi-level approach to data collection provided insight into the many systems and structures that impact on this community. These experiences shaped identity, self-concept, perceptions of self as well as other racial/ethnic groups, and in turn the spaces, places and people interacted with. Spaces that provided acceptance and inclusion also facilitated the cultivation of an empowered sense of self. Conclusions: Provider efforts to encourage community participation and recovery for persons of South Asian origin with schizophrenia should take into account the multiple and intersecting aspects of individual identity as well as those at a community level. A multi-level approach informed by social capital theory could lead to the promotion of social inclusion and integration of persons with schizophrenia. It is recommended that this strategy focus on three areas; i) advancing mental health service provision and psychological therapies, ii) education and training of health professionals and community members for example faith leaders, iii) local and national policy that addresses poverty and mandates services to address the specific needs of mental health in South Asian communities.

Nurses in the UK currently face significant challenges: Austerity measures and efficiency drives have led to staff shortages (Nursing Times, 2013), and nurses suffering from higher rates of stress-related sickness when compared to other sectors (Foureur et al, 2013). The nature of the nursing role leaves nurses particularly vulnerable to burnout (Farrington, 1995). A pragmatic epistemological framework was adopted to conduct a mixed methods study, with qualitative focus, which set out to retrospectively explore how the nurse becomes vulnerable or resilient to burnout. Initially 100 nurses working in the high intensity fields of cancer care or ITU, in a leading UK, NHS Trust, were invited to take part in a quantitative study exploring burnout levels, using the MBI. 100 took part, 53% showed burnout on at least 1 dimension of burnout, ie. emotional exhaustion. 16 nurses were interviewed qualitatively: 10 showing various degrees/patterns of burnout and 6 showing high levels of resilience to burnout. A modified, analytical approach of classical grounded theory was adopted. Findings suggest burnout is a continuous, multi-faceted process involving a complex interplay of internal/interpersonal/external factors. The process is mediated by how reflective, insightful and adaptable a nurse is to work-based stressors, with marked differences being found between the vulnerable and resilient nurse positions. Of note the inherent preference for taskfocused or emotionally-driven nursing orientations variably influences how burnout develops. The pervasive culture of communication was also identified as significant with the optimum culture being one of understated stoicism, acceptance and collective management of vulnerability. Findings suggest far reaching implications for nursing training policy, selection, nursing practice and intervention development, which should function at the individual/interpersonal and organisational level, taking into account the impact of nursing orientations and the pervasive culture of communication on burnout.

The aims of this study were to examine the associations between current self-reported attachment styles, retrospective reports of childhood experiences, and the development of the therapeutic alliance. It was hypothesised that anxious and avoidant attachment would be correlated with negative childhood experiences and that both attachment anxiety and avoidance would be inversely correlated with the therapeutic alliance. The third hypothesis stated that negative childhood recollections would correlate inversely with the quality of the therapeutic alliance and that this association would be mediated by adult attachment styles. One hundred adult counselling/psychotherapy clients referred for psychological therapy in primary care were asked to complete the Childhood Experiences Survey (Meyer, 2005) as a measure of retrospective childhood experiences, the Experiences in Close Relationships Scale (Brennan, Clark, & Shaver, 1998) as a measure of adult attachment styles and the Working Alliance Inventory (WAI) (Horvath & Greenberg, 1989) as a measure of working alliance. The first hypothesis which stipulated that negative childhood experiences would be correlated with anxious and avoidant attachment style was partially supported. Avoidant attachment style but not anxious attachment style was significantly and moderately strongly associated with rejection experiences as measured by the CES. The second hypothesis, which stated that both anxious and avoidant attachment would be correlated with the therapeutic alliance, was also partially supported. Avoidant attachment but not anxious attachment correlated significantly and inversely, moderately strongly with the therapeutic alliance. The third hypothesis stated that the relationship between childhood experiences recollections and the alliance would be mediated by both attachment anxiety and avoidance. The third hypothesis could not be explored further as childhood experiences did not correlate significantly with the therapeutic alliance. Findings and implications for further research are discussed.

This study sought to explore, analyse and interpret the lived experience of partners of problem drinkers (PPDs) such that it may make considered therapeutic recommendations for this potentially vulnerable group of individuals. Ten middle-aged female partners of male problem drinkers were interviewed in semi-structured interviews. Accounts were analysed using Interpretative Phenomenological Analysis (IPA). Nine of the ten women were living with a ‘dry’ problem drinker at the time of the interview, only Ruby remained with Ray who continued to drink heavily. The resultant narratives strongly evoked a ‘journey’; entitled, ‘drinker’s path as partner’s adversity and challenge’. Six superordinate themes (and their associated subthemes) were located along the journey. Namely: ‘Life before the drink problem’; ‘a creeping onset’; ‘in the thick of it’; ‘rock bottom’; ‘resurfacing reservedly’; ‘navigating new relationships’. The themes describe and present many complex, dynamic, and multi-faceted processes of understanding and change along the journey. The themes are further discussed and synthesized in order to provide responsive platforms for therapeutic endeavour which is mindful of the PPDs need to maintain both their relationship and their personal well-being.

Compassion is frequently discussed in relation to nursing. However, to date, research in this area has been largely theoretical, and empirical investigation has been limited. This qualitative study aimed to construct an understanding of the nature of compassion in nursing and what makes it possible, in order to address the paucity of research and lack of consensus in this field. Semi-structured interviews were conducted with six nurses and six patients across three hospital departments, with the resulting data systematically analysed and categorised in accordance with principles of constructivist grounded theory. This study has facilitated a broad and multifaceted understanding of the construct of compassion, which emphasised the delicate interpersonal nature of compassionate care that occurs between the nurse and patient. Study findings suggest some factors that inhibit and facilitate compassion which play a powerful role in a nurse’s ability to care compassionately. The findings of the present study challenge the suggestion that feelings-based care practices for patients should be abandoned in favour of etiquette-based approaches; it also contests contemporary wisdom that the best cost-effective measures are achieved through driving for efficiencies. Suggestions are made regarding the role of counselling psychology in supporting the emergence of compassion in healthcare and implications for nursing practice and future research directions are explored.

This empirical study explores ‘Men’s experiences of being circumcised men’ using the methodological approach of Interpretative Phenomenological Analysis (IPA). Semi-structured interviews were undertaken with eight adult participants. The interview data was analysed using the IPA protocol (Smith, Flowers, & Larkin, 2009). From this analysis, three main themes emerged: The first is ‘Who am I? – Circumcision and my Self’ in which the participants’ experiences of male group belonging, feeling different from other men, and their perception of others are explored. The second main theme is ‘The physical experience – Circumcision and my body’ exploring how the men talk about circumcision affecting their bodies, in the way it looks, feels and in terms of how they talk about health and the impact of the procedure itself. The final theme that emerges is ‘Reflecting on the decision’ in which the men’s experiences of the choice that was made and their sense of whether it was ‘right’ are presented. The three main themes are discussed in relation to broad theories of body image, theories of identity and theories of male hegemony, drawing tentative links between these. Throughout the research process the impact of culture and context acts as a background that informs the study. The findings have implications for Counselling Psychologists who work with men who enter therapy and for whom such issues may remain unexplored. The research informs the male circumcision debate and offers a way of understanding opposing viewpoints. The quality, transferability and limitations of the study are considered together with a discussion of the findings in the light of theory and research. Areas for future research are suggested.