Black and Minority Ethnic (BME) communities are encouraged to engage with psychological services and psychodynamic approaches are recommended to meet their diverse needs. Although external aspects have been explored, there is a gap in the literature regarding internal processes of BME clients in this type of therapy. This thesis aimed to fill this gap by using a multi-level, pluralistic qualitative design to explore the internal processes of three BME participants in psychodynamic therapy; ultimately investigating shared and/or unique elements. Three semi-structured interviews were analysed using three analytic strategies: descriptive phenomenological, discursive and psychodynamic readings. The main themes from the phenomenological reading were the importance of the therapeutic relationship, ‘strong persona’ defences, the past and the present: personal and family history, ‘aha’ moments, fear and vulnerability, and differences to the therapist: not feeling fully understood. The common discursive themes were maintaining control, externalizing difficult aspects of therapy, fragmenting parts of themselves, and struggling to vocalise differences in ethnicity, leading to frustration and compartmentalization. The main findings of the psychodynamic reading were recreating the original culturally infused injury, cultural differences in the transference, feeling different/same, multiple identities and a further exploration of defences. The findings suggested that both the client’s and the therapist’s ethnicity, culture and race impacted the clients’ internal processes in psychodynamic therapy. The practical implications are to enhance therapeutic work with BME clients by increasing the applicability and usefulness of psychodynamic therapy with this specific ethnic minority group. This thesis’ emphasis on individual perspective, reflexivity, intersubjectivity and diversity are in-line with Counselling Psychology principles. Recommended future research could focus on BME participants in a specific and structured model of psychodynamic therapy and perhaps use data collection methods that go beyond semi-structured interviews.

Background and Aim: Mental health costs UK businesses billions of pounds each year through high levels of absence and presenteeism. Despite improved interventions around enabling people with mental health conditions back into and remaining in work through Supported Employment, the figures around retention are discouraging. People with mental health conditions see employment as a sign of recovery and clinicians also support returning to work as an important step in development. Research has largely focused on trying to improve the employment rates of people with mental health conditions who have already accessed mental health services. However, there are many people in employment who are struggling with poor mental health who have chosen not to disclose to their employer about their condition, leading to issues around presenteeism. This study therefore focuses on developing psychological interventions for people struggling in work, who may not access Supported Employment services. Method: Four participants took part in a collaborative action research process over four group sessions. Participants were co-researchers in the process, where the group worked to identify and test out interventions that might improve managing mental health conditions at work. The transcripts were then analysed using constructivist grounded theory to develop an overarching model. Results: The model proposed highlights the role of the individual and the organisation in improving the management of mental health conditions at work, facilitated by the line management relationship. The model suggests that individuals could improve their own mental health by developing their self-awareness, work-life balance, mindfulness practice and aligning job choice with personal values. The organisation could further work on establishing a culture and physical environment centred on well-being to support individuals through line management relationships. Discussion: Counselling Psychologists could play an important role in developing interventions around retention and also champion piloting mental health support groups in work to enable sustained change.

Objectives: The purpose of the study was to understand British Asian Indian older adults’ experiences of multiple acculturation processes and family care receiving. Design: The study followed a qualitative research methodology. Analysis was undertaken using Interpretative Phenomenological Analysis (IPA), to develop a deeper understanding of the participants’ experiences. Method: Six fully consenting British Asian Indian older adults, who had migrated multiple times before settling in Britain, were interviewed using semi-structured interviews in their preferred language. Findings: The study revealed that acculturation, following forced migration, may affect an older adults’ sense of self in a negative and positive way. Following forced migration to Britain, the participants tended to revert to protecting and preserving their Indian identity. The participants identified various cognitive and innate psychological strategies to manage the distress of acculturation. The study identified that the participants valued their Indian identity and tended to maintain it in old age through family care receiving experiences. However, living in Britain tended to cause tension with the family carer. The participants were reluctant to explore tensions of familial care, but did highlight various cognitive-behavioural, spiritual and innate psychological strategies to manage issues with the carer. The study suggests that care can be a multifunctional phenomenon as it can offer an opportunity to negotiate, mediate and represent one’s lost culture. Conclusions The study offers an insight into British Asian Indian Older adult’s lives and highlights the psychological meaning of care. Implications for clinical practice and further research are discussed.

This study aimed to investigate whether quality of life in patients with thyroid eye disease (TED) improves as a result of having orbital decompression surgery and whether any demographic, clinical or psychosocial factors can predict which patients might benefit from this surgery. One hundred and twenty three adults with TED were recruited from Moorfields Eye Hospital (MEH), London. Clinical measurements were taken by the clinical team at MEH and participants completed a range of psychosocial questionnaires prior to surgery and again 6 weeks and 6 months after surgery. The Appearance Research Collaboration’s (ARC) framework of adjustment to living with a disfiguring condition was used to guide the study’s measures and analysis. The Graves’ Ophthalmopathy Quality of Life Questionnaire (GO-QOL; Terwee et al., 1998) was completed by participants at each time point and was the dependent variable in each hierarchical multiple regression model. Semi-structured interviews were conducted with fourteen patients from Birmingham and Midland Eye Centre (BMEC) to explore expectations of orbital decompression and thematic analysis was performed. Prior to surgery, the regression model explained 55% of the variance in GO-QOL visual function scores and 75% of the variance in GO-QOL appearance scores. Although vision-related quality of life was associated with age and asymmetrical disease, it was intervening psychosocial processes that were more consistently associated with both vision- and appearance-related quality of life. Patients had high expectations for surgery to return them to the “normality” of their lives, and appearance, before TED. High expectations were often a result of great confidence and trust in surgeons and information they had accessed about the surgery online. Significant improvements were found in all clinical characteristics following surgery and in most psychosocial variables. Vision-related quality of life did not change significantly until 6 months after surgery whilst appearance-related quality of life significantly improved 6 weeks post-surgery and continued to significantly increase 6 months post-surgery reaching a minimal clinically important difference (MCID). Ethnicity and a small number of clinical factors patients presented for surgery were unique predictors of the variance in change in vision-related quality of life and appearance-related quality of life. None of the changes in clinical or psychosocial outcomes significantly predicted change in vision-related quality of life. The hierarchical regression model explained 81% of the variance in change in appearance-related quality of life however, with improvement in personal evaluation of appearance uniquely predicting improvement in appearance-related quality of life. Further research is required to establish whether expectations are met after surgery. Recommendations for clinical practice include routine psychological assessment and the provision of clear and comprehensible information about surgery. Patients with TED in the future would benefit from interventions targeting the intervening psychosocial processes identified by this thesis as amenable to change.

Emotional eating plays a significant role in the aetiology of eating disorders and obesity, and has been observed in healthy, non-restrained individuals. Despite this, research that examines emotional eating has mainly focused on females, obese populations and individuals who have a formal diagnosis of an eating disorder, the studies of which have been mainly involved surveys, experimental, observational or quantitative methods. Research has also found significant gender differences in emotional eating, yet there has been limited investigation into emotional eating in men. This research attempted to understand the process of emotional eating in men using constructivist grounded theory. The purpose of this study was to understand the way in which men use food in response to emotions and the impact it has on their psychological well-being. Semi-structured interviews were conducted with thirteen male participants aged between 23-61 years of age. All participants were fluent in English, half of the participants were from the UK, 4 were from Europe, and the remaining three were from Mexico, Egypt and Malaysia. Four main categories were developed from the data: Negotiating Masculinity, Emotional Eating Serving a Function, Seeking Control and Stuck in the Cycle. One core category encompassed all of the categories: Navigating Emotions and Masculinity through Eating. The categories were complex and linked to one another, demonstrating the cyclical nature of emotional eating. An emergent theory was developed and mapped onto a conceptualisation that attempts to explain the process of emotional eating in men, demonstrating the way masculinity affects the way that these men cope with their emotions through eating. The findings of this study provide an insight for Counselling Psychologists and other mental health practitioners working with men who struggle with managing their emotions and turn to food in attempt to cope.

This study explores unusual interventions (UIs) in counselling and psychotherapy, as defined by Akhtar (2011, p. xvii): “Clinical surprises ... when the [therapist] makes a radical departure from the set and familiar rules of technique”. There is currently a paucity of literature and research in this area, and the present study aims to contribute to an emerging theory: Under what circumstances do UIs occur, how do they manifest, and what are the therapeutic consequences? A qualitative methodology, constructivist grounded theory (Charmaz, 2006), was used in this endeavour. 10 psychotherapists and psychologists, of varying theoretical orientations and training backgrounds, were recruited via email, and subsequently interviewed about UIs. 2 pilot interviews with trainees were included in the final sample, which, otherwise, consisted of practitioners with a minimum of 10 years clinical experience. The Grounded Theory is comprised of 21 UI proposals, derived from 4 core, sequential categories. A distinction is made between Full and Partial UIs, with the former denoting a spontaneous, ‘not thought through’ therapist response. The UIs reported in this study predominantly had a positive therapeutic effect. The UI process may lead to therapist self-conflict as it represents a deviation from prescribed, standard technique.

The notion of diagnosis has been shown to have a profound influence within mental health practice with much attention focusing on the controversies and challenges surrounding the diagnostic classification of eating disorders. However, research focusing on how patients experience their eating disorder diagnosis is scarce. The purpose of this research, therefore, was to address this gap in the literature by exploring patients’ experiences of receiving a diagnosis of an eating disorder. Ten female patients were recruited from an adult community eating disorders service in the UK. All patients had received an eating disorder diagnosis and were interviewed using a semi-structured interview schedule. Transcribed interviews were qualitatively analysed using the principles of Interpretative Phenomenological Analysis (IPA). Four master themes emerged from the data: (1) Living with an unlabelled condition, (2) Perception of the patient-therapist relationship and interpersonal qualities, (3) Living with the diagnostic label, (4) A pathway to recovery. The findings provide a rich description on how participants experienced diagnosis. Patients’ experiences were both negative and positive whereby their experiences progressed from disbelief and rejection of the diagnosis to ideas of acceptance and recovery. Receiving and living with a diagnosis of an eating disorder has a significant impact on patients which should be considered throughout their assessment and treatment process. The need for compassionate care from professionals was an important component that was highlighted and recommendations were made in this regard. It is argued that increased awareness of patient experience will help clinicians to develop stronger therapeutic alliances and develop new clinical interventions.

The National Institute of Health and Clinical Excellence (NICE) has suggested that 1.6 million people in the UK are affected by eating disorders (NICE, 2004). Generally speaking, eating disorders have major physical, psychological and social consequences (Hjern et al., 2006), often characterized by a poor quality of life (De la Rie et al., 2007) and a high health burden (Mond et al., 2009). Furthermore, anorexia nervosa has the highest rate of mortality of any psychiatric disorder, due to both medical complications associated with the disorder and suicide (BEAT, 2014). This statistic alone is indicative of the vitality of eating disorder research particularly that focused on treatment and prevention. Though the ‘poor quality of life’ and ‘high health burden’ are attributed to the individual sufferer, these adverse complications often seep into the immediate family, including children (Stitt & Rupert, 2014). The majority of studies in this field have explored the impact of parental eating disorders on their children; with a focus on the quantitative relationship between the maternal eating disorder and child development, birth weight and feeding logistics (Stitt & Rupert, 2014). The mother’s subjective experience has been widely neglected. Linville et al. have explored the sociocultural influences on the development of eating disorders. Their evidence suggested that the parents, as the primary socialization agents to their children, significantly influence the development of body image disturbances and disordered eating (Linville et al., 2011). Familial eating disorder pathology has long been a source of ongoing investigation, as studies have consistently indicated that the immediate relatives of individuals with anorexia nervosa show an increased risk of developing an eating disorder themselves (Watkins, Cooper & Lask, 2012). Though the degree of correlation pertaining to genetic and environmental influence is unclear, the link itself is consistent and compelling (Lilenfeld & Kaye, 1998). This chapter will consider the literature surrounding mothers’ experiences of feeding her children while having a disordered relationship with food. First I will consider the impact that parental psychiatric disorders have on their children, specifically, the relationship between maternal eating disorders and child development. I will then review the evidence that characterizes the children of mothers with eating disorders as a ‘at risk’ population. Previous research has identified a number of difficulties that mothers with eating disorders encounter within their parenting role; these will be explored, with a particular focus on the mothers’ subjective experience of feeding their children. And finally, the literature on the transgenerational transmission of eating disorders from mother to child will be reviewed. Treatment options will be contemplated, with a view to creating interventions specifically tailored to mothers with eating disorders and their families. A look forward in the direction of future research will be explored, specifically the effectiveness of family therapy for adults with eating disorders. There is an uneven distribution in the literature of research focused on the quantitative impact of maternal eating disorders on children and the risk of transmission. This bias manifests in an unsaturated body of evidence exploring the mothers’ experience. The current chapter will reflect this disproportionate emphasis and attend to both the majority and minority perspectives. This literature review will illuminate the need for more qualitative research, exploring the mothers’ experience of being a parent while having an eating disorder, specifically, her subjective account of engaging in the function of feeding her children.

This study explores the experience of counselling psychologists who use mindfulness in their personal lives and professional practice. It aims to shed light on the lived experience of mindfulness for these individuals. The research took the form of a qualitative, idiographic inquiry and due to the relative lack of existing literature on the therapists’ experience of using mindfulness, it was deemed important to remain rooted to the participants’ experience. Seven females and one male participant took part in in-depth, semi-structured interviews exploring their experience of using mindfulness. The interviews were transcribed and analysed using Interpretative Phenomenological Analysis. Three master themes emerged from the analysis, these are, mindfulness and spirituality, relational component of mindfulness and clinical applications of mindfulness. These master themes have a number of subthemes within them. The results of the analysis represent my interpretation of the participants’ interpretation of their lived experience. These findings are discussed with a focus on the spiritual component, empathic connections and advice for novice mindfulness therapists. The clinical implications specifically relevant to the practice of counselling psychology are also discussed.

Chronic pain is a mysterious and challenging problem that affects a significant number of people in a significant number of ways. Perhaps one of the greatest challenges of these conditions is the highly subjective nature of pain, coupled with the apparent absence of any observable abnormality. In this study Interpretative Phenomenological Analysis was adopted in order to gain access to elements of these subjective experiences and in response to its ‘invisibility’, a creative approach was also incorporated into its design. Seven working age female participants were recruited and invited to share aspects of their pain experience through both narrative accounts and pictorial representations. Participants’ images and their accounts of them provided a rich gestalt which communicates a range of difficulties in a single cohesive image, which in turn also served to compliment the other themes identified in the study. Participants’ unanimously found this feature of the study facilitative as well as cathartic and it is suggested that these positive experiences may also hold a significant clinical value. The current study supports that, by adopting multimodal methods as a means of exploring lived experience, a potential opportunity has arisen which could help to bridge the ‘gap’ between what is ‘seen’ and what is ‘felt.’ It is suggested that in the development of ever more creative means of approaching the ‘problem of pain,’ art and art therapy may be considered for its potential in helping patients to reveal aspects of their difficulties in order to be both better understood and supported.