Paper One reports a systematic review of qualitative literature involving bereaved families who were approached about organ donation at the end-of-life of their relative. The review aimed to understand the implications of the decision at least six-months after the bereavement. Fifteen studies were included in the review and were critically appraised using a quality appraisal tool. A meta-ethnographic approach yielded three themes: An ongoing relationship with the donor; The psychological impact of the decision; Support in grief. The findings are discussed in relation to the complicated grief literature. Paper Two reports a mixed-methods study, which utilised the Self-Regulation Model of Illness and Interpretative Phenomenological Analysis. People living with chronic kidney disease and pre-dialysis were surveyed (n=31) and interviewed (n=8) about their illness and treatment beliefs and experiences regarding pre-emptive living donor kidney transplantation. Responses suggested illness perceptions and treatment knowledge inform treatment preferences. Four master themes emerged from the qualitative analysis (My Kidney and I; Co-constructing Decisions; A Kidney Shared as a Problem Solved?; and Navigating the Unknown), which described the complexity the option of living donation may present to people. A desire for enhanced self-management information to delay illness progression was found.

Facial emotion recognition (FER) difficulties are associated with both mental health and antisocial presentations in adolescents and adults (e.g., Dawel, O’Kearney, McKone, & Palermo, 2012). Externalising behaviours in children are one of the earliest signs of risk for the development of such difficulties. Therefore, understanding the relationship between social-emotional skills and externalising behaviours in children is crucial to understanding how best to intervene. In the systematic review, the evidence for the possible relationship between FER and externalising problems in pre-adolescent children was synthesised and evaluated. The review suggested strongest evidence for FER problems in ADHD or Callous-Unemotional presentations, and in samples of children with higher levels of externalising problems rather than in community samples. There was no evidence for specific emotions being implicated as some others have previously theorised (e.g., Blair, Leibenluft, & Pine, 2014). The empirical paper examined FER and Theory of mind (ToM) in sixty-eight children (age 4-7), oversampled for externalising behaviour problems. Older children (aged 6-7) evidenced stronger FER and ToM performance than younger children (aged 4-5). Emotion, intensity and their interaction affected FER accuracy. High intensity emotions and happiness were easier, and of negative emotions, sadness was easier to recognise than fear. Children with weaker ToM had lower verbal IQ and poorer FER performance even when controlling for IQ. Relatively high hyperactivity and/or conduct scores were related to greater difficulty recognising anger, and regression analyses indicated that hyperactivity accounted for more of this variance. Hyperactivity and/or conduct problems did not predict ToM performance. The final paper is a critical reflection on the research conducted and the process as a whole. The paper includes discussion of the research not conducted, the decisions made and a critique of the methodologies. Clinical and theoretical implications, dissemination and directions for future research are discussed.

There is extensive research detailing the strong link between healthcare professional wellbeing and the delivery of dignified, safe patient care. While a career as a psychological practitioner is often perceived as fulfilling, it is thought to also generate professional and personal strains which may impact on wellbeing. Paper 1 presents a systematic review examining the prevalence of burnout among practitioner psychologists and the relationship between burnout and specific personal demographic and work-related variables: age, years in service, working hours, gender and work setting. This yielded eight studies meeting the inclusion criteria. Study quality was assessed and data was extracted. Due to inconsistencies with defining and assessing burnout, the overall prevalence of burnout in this population could not be validly determined. However, findings suggest that younger, less experienced individuals and those working longer hours appear to be at increased risk of burnout and/or associated dimensions. Paper 2 presents the development and validation of a new measure to assess psychological practitioner workplace wellbeing. The measure was developed in five stages, followed by an examination of the psychometric properties of the measure utilising a sample of 400 psychological practitioners. The measure was shown to have high internal consistency, high test-retest reliability and high construct validity. Exploratory factor analysis produced a set of six factors explaining 62.1% of the variance in the measure. Results indicate the measure has favourable psychometric properties for the effective assessment of the workplace wellbeing of psychological practitioners. Paper 3 presents a critical appraisal of the research process. This paper includes a reflection on the methodologies used and conclusions drawn, implications of the findings and suggestions for future research. Aspects of personal and professional competency development are also considered.

Part A: Literature Review This begins by exploring theoretical and research literature relating to bereavement, including ‘common’ and ‘pathological’ manifestations of grief in typically developing children. Following this, a number of risk and resiliency variables are presented which contribute to coping, adaptation or prolonged psychological disturbance. Although limited, the next section focuses on ‘common’ and ‘pathological’ grief responses in adults with learning and neurodevelopmental disabilities. Utilising this evidence base, and the research with typically developing children, the final section considers potential variables that might impact on risk and resilience for children with learning and neurodevelopmental disabilities (L/ND). Part B: Empirical Research Study The empirical research study investigates risk and resiliency in bereaved children with (L/ND). This was addressed with participants who had in-depth experience either caring for or working with a bereaved child with L/ND. This information was gathered from interviews with parents (N=3) and two focus groups, one with school-based professionals in a special school setting (N=5), and one with bereavement practitioners working for a national bereavement service (N=8). The data was analysed through a process of thematic analysis. The findings are discussed in relation to the literature. Strengths, limitations, future research directions and implications for educational psychologists are considered. Part C: Major Reflective Account The major reflective account provides critical reflections on a number of different elements of the research. Section two provides a critical account of the methodology, including research paradigm, data collection and data analysis. Reflections on the ethical issues are included. Section three focuses on the distinct contribution to knowledge, originality of the research and future research directions. Finally, section four provides a brief personal reflection on the research process and how this has impacted on the professional development of the researcher.

The way in which adolescents access online sexually explicit media (SEM) today is fundamentally different to the experiences of previous generations due to the advent of smartphones and internet enabled tablets (Berelowitz, Edwards, & Gulyurtlu, 2012). Accordingly such unrestricted availability of SEM has led to an increasing awareness that SEM is becoming a commonplace occurrence for many young people within the UK (Martellozzo et al., 2017; Parker, 2014). Adolescence is identified as a time of heightened vulnerability and a critical developmental period for social and emotional health and wellbeing. Literature suggests mixed, and somewhat limited, findings regarding the impact of SEM on adolescent development, and recent and balanced qualitative studies regarding UK adolescents’ experiences of SEM are few(Lester & Allan, 2003; Weber, Quiring, & Daschmann, 2012). There is an associated lack of clarity as to how adolescents may be educated or supported in their experiences of SEM, with a lack of clarity regarding the role of sex and relationship education (SRE) in making such a provision (particularly within Wales). This research aimed to provide a balanced account of the views of a sample of young people in the education system within South Wales regarding SEM and SRE. Eight adolescents aged sixteen to eighteen years old were interviewed via a semi-structured interview process and data was analysed using the process of thematic analysis (Braun & Clarke, 2006). Results suggest that adolescents are dissatisfied both with the widespread accessibility of SEM, particularly to early adolescents, and with the lack of discussion or education regarding SEM within both SRE, the education system, and wider society. Implications for educational psychologists and professionals are considered alongside future direction for further study.

Government data indicates that Fixed Period Exclusion (FPE) rates in primary schools are not in-keeping with an overall national trend of reduced rates of exclusion across the country. Moreover, pupils with identified Special Educational Needs and/or Disability, particularly those identified to have Social Emotional Mental Health Difficulties (SEMH), previously categorized as ‘Social Emotional Behavioural Difficulties’, remain disproportionately represented in the exclusion data. Although research has explored the phenomenon of exclusion from the perspective of secondary aged pupils, the voices of their primary school counterparts remain limited within the literature. Thus, this research explores the lived experience of FPE from the perspective of primary aged pupils, who attend a specialist provision for SEMH in England. Semi-structured interviews were completed with 7 pupils in Years 5 and 6, in order to explore their experience. Interpretative Phenomenological Analysis was conducted in accordance with guidelines from Smith Larkin & Flowers (2009). The experience of FPE was interpreted from the pupils’ sense-making. The Superordinate IPA themes included: ‘Relationships’, ‘Attribution’ and ‘Managing change’. ‘Relationships’ captured the importance of both the adult- pupil relationships and peer relationships. There was observed polarity within the adult-pupils relationships, which appeared to be positively or negatively impacted by the adults behaviour management and communication styles, and the level of practical and emotional support that was provided. Peer relationships were also noted to be important in the pupils’ narratives, as they appeared to provide a sense of belonging and security. ‘Attribution’ was a further superordinate theme emerging from the analysis, capturing the internal and external attributions held by the pupils that underpinned how they made sense of their school exclusion experience. ‘Managing change’ was the final superordinate theme identified; this describes how the pupils coped with their exclusion, the emotional impact of that exclusion and the effects of the exclusion processes. Recommendations for future research are made and the implications of the results are discussed in relation to educational psychology practice. This research highlights the value of educational psychologists (EPs) listening to pupil voice and considering their exclusion experience using an eco-systemic framework; this generates thinking about the broader systemic factors which are at play for excluded pupils and those at risk of exclusion. Additionally, findings highlight the need for further training to promote nurturing environments and better emotional support for excluded pupils’ that EPs are well placed to provide. Moreover, they would also indicate that clear guidance developed by EPs and implemented by schools in relation to the processes and effects of exclusion, with an emphasis on the involvement and communication of pupils and their families, would be beneficial.

This thesis explored paediatric professionals' perceptions of stress and coping whilst working within inpatient settings. Paper one outlines a systematic literature review and meta-synthesis of 13 qualitative studies regarding burnout and resilience in paediatric healthcare professionals. The studies were critically appraised using the Critical Appraisal Skills Programme (CASP, 2017), before being synthesised using meta-ethnography (Noblitt & Hare, 1988) in order to conceptualise factors relating to burnout and resilience in this group. The findings indicate that professionals felt unprepared for the emotional aspects of the work, culminating in feelings of helplessness. Professionals coped with challenges through a process of connection and disconnection, and described the role as one which provides opportunities for personal growth. Paper two describes an empirical qualitative study of resilience in health play specialists working in inpatient paediatric settings. Ten health play specialists (HPS) from three children's hospitals were interviewed, and their responses were analysed using grounded theory methodology. A theory of resilience development in HPS was developed, resulting in one core-category: 'a unique role', and three categories describing the challenges they face: 'being misunderstood', 'being pulled in different directions', and 'being there'. Each sub-category describes the processes and conditions required to develop resilience for HPS. Findings from both papers demonstrate the importance of individual and organisational support structures to promote wellbeing for staff working within paediatric inpatient settings. Paper three presents a critical appraisal of the research conducted. The key decisions made are discussed, alongside reflections of the strengths and limitations within each paper. This section also considers the key clinical psychology competencies developed through conducting a large-scale research project.

Despite legislative changes and an increase in policy provision (see The Children Act 1989; The Children Act, 2004; The Children and Young Persons Act, 2008; The Social Services and Well-being (Wales) Act, 2014; Welsh Assembly Government, 2007; Welsh Government, 2015a; 2016a), there continues to be a significant achievement gap between Looked After Children (LAC) and their non-looked after peers, which increases across the key stages and continues in to higher education (Department for Education (DfE), 2018; Welsh Government (WG), 2018). LAC are also disadvantaged as they move in to adulthood, with poorer life outcomes compared to the general population (Dixon, 2008; Hook & Courtney, 2011; Centre for Social Justice, 2015). While there is a proliferation of research examining why LAC underachieve (Harker et al. 2002, 2004; Zetlin, Weinberg & Shea, 2006a, 2006b; Forrester et al. 2009; Brodie, 2010; Berridge, 2012; Berger, 2015), it is argued that there remains limited empirical consideration of the lived experiences of LAC in education. Therefore, this research sought to provide an in-depth examination of the lived experiences of LAC in secondary school. Data was gathered in an urban local authority in Wales. Semi-structured interviews were held with 6 LAC at Key Stage 3 across two secondary schools. Recordings of the interviews were transcribed verbatim, and Interpretative Phenomenological Analysis (IPA) was conducted. 4 super superordinate themes were identified; sense of belonging, relationships, exposure to judgement and foster care experiences. The research findings are discussed in relation to existing theoretical and research literature. The implications of the present study for the practice of educational psychology are discussed, together with future directions for research and the strengths and limitations of the present study.

This thesis investigates the adjustment processes to involuntary childlessness and the psychological distress associated with unmet parental goals. Paper one reports a systematic review of quantitative studies looking at how trauma theory informs the clinical understanding of adjustment to involuntary childlessness. This yielded eight studies which were reviewed and rated using a quality appraisal tool. The data extracted, focused on the prevalence of trauma and post traumatic growth to infertility. No studies included, focused their research on cohorts of women who identified as being involuntarily childless through delayed childbearing or circumstantial reasons. The findings suggested that for women who are, infertile, who had accessed or were accessing fertility treatment and were childless, trauma theory can aid clinical understanding of both their experience of infertility distress and adjustment to involuntary childlessness. Paper two describes a three round, online Delphi Study which investigated, infertility practitioners’ clinical experience of psychological distress associated with unmet parental goals, following unsuccessful fertility treatment. Nine practitioners, from five countries participated, rating 58 statements on the presentation and nature of distress observed in the post treatment phase. Infertility practitioners perceived distress to be associated with statements concerned with individual’s identity and relinquishing the desire for biological children. The fertility practitioners agreed that the core element of therapy was to facilitate meaning making, acceptance and pursuit of new life goals. Paper three provides a critical account of the strengths and limitations of both the systematic review and empirical paper. The theoretical and clinical implications of the research included addressing pertinent issues, which arose during the research process. Finally, the competencies developed from conducting this research will be described in relation to becoming a clinical psychologist.

Emotional stimuli can influence the performance of a cognitive task when presented in conjunction with it, although irrelevant to its completion. However, several criticalities and relevant gaps in the current literature on emotional distraction can be detected, and the present work aims to contribute to a better definition and understanding of the electrophysiological and, above all, behavioural correlates of the interaction between the two domains of cognition and emotion. Following a brief overview of this manuscript, chapters 2-3 provide background information on emotions, their properties and their interaction with cognitive processes. Chapters 4-8 report five experiments conducted to study this interaction, all employing behavioural and self-reported measures, and the first comprising electroencephalographic recordings. Further, for the first time, we analysed how individual approach/avoidance dominance can be associated with the effects of emotional distractors on task performance. After studying the effects of the valence of the distractors and the effects of task difficulty, we analysed how different types of distractors (words and pictures) affected the completion of emotionally salient and neutral tasks. A general discussion commenting on the results obtained in all the studies closes this work. The framework delineated here is absent in the current literature. The unicity and relevance of the work proposed lies particularly in the methodological approach toward the study of emotional distraction, which can in principle help to unveil the neural and behavioural mechanisms of physiological interaction between emotion and cognition dimensions.