This thesis explores perspectives on living and working with dementia. Chapter one reviews the literature related to the experience of dementia and identity. Themes within theoretical and empirical papers are identified which contribute to an understanding of how the available information can be utilised to inform clinical work with people with dementia. It is argued that maintaining the integrity of a person with dementia's identity is possible and important for well-being, however, more research is needed to establish what 'identity work' should contain and when it should be delivered. Directions for future research are discussed. Assessment and diagnosis have been identified as being difficult aspects of work by clinicians in areas of healthcare, such as oncology, and as crucial to the experience of clients with memory problems. Despite this, and the importance of understanding the experience of staff members to support recruitment, retention and staff well-being, research exploring the experience of clinicians of assessing and diagnosing clients within dementia services is lacking. Chapter two therefore uses interpretative phenomenological analysis to examine the experience of staff members who perform this role. Themes are identified that highlight the complex nature of this role and the conflicting aspects of it. Participants appeared to be trying to meet conflicting needs within the context of a progressive illness and service restrictions, which influenced their perceived effectiveness and caused conflict and stress. Clinical and service implications are discussed and suggestions for future research made. Chapter three utilises the author's experience of completing the research presented in chapter two to reflect on tensions between the roles of researcher and clinician. How these roles can come into conflict with each other and the implications of this for the research process is explored.

This research study is concerned with the motivation of psychotherapists who choose to train in Psychosynthesis. Psychosynthesis sits within the transpersonal school of psychology and is less well known than the mainstream schools of Psychoanalytic, Behavioural and Humanistic psychology. There has been considerable research into the motivation of those who choose a career as a psychotherapist, in general, but none into why someone should be drawn to this Spiritual model. Life narrative interviews were conducted with twelve eminent Psychosynthesis psychotherapists. The interviews were recorded on audiotape and transcribed. The format was of a semistructured interview based on five key questions. At the end of each life narrative interview, the participant was asked to reconnect with the moment of choosing, to allow an image to come and then to draw. The drawings were then explored with the participants, who were invited to explain the meanings of the images and symbolism contained in them. Comparative thematic analysis was used to identify key and minor themes in the interview data. The symbolism and imagery in the drawings were considered in relation to transpersonal theory. The initial results suggested that those choosing to train as Psychosynthesis therapists shared, to a considerable extent, the 'dysfunctional' childhood backgrounds reported in earlier research as common among psychotherapists trained in a wider range of therapies. The earlier research had framed the choice to train as a psychotherapist as stemming from a 'negative' motivation. This is an interpretation from the perspective of 'depth' psychology. This research study suggests another possible motivation, from the perspective of 'height' psychology. 'Height' psychology suggests that human behaviour and human choices, can be motivated by 'higher' as well as 'lower' needs. The findings support the concept of 'dual motivation', a term which was used by one of the research participants, based on her observations of the many therapists she had trained in Psychosynthesis over a long period of time. This term captures the essence of the two dimensions of motivation. The anticipated strong interest in Spirituality was confirmed in the data results but the dimension of Mysticism, which had not been anticipated, emerged as a strong feature in three of the life histories. All twelve participants been drawn by the inclusive nature of the model, which they felt facilitated an unusual degree of freedom in therapeutic practice, without compromising the integrity of the model. The central Psychosynthesis techniques of visualisation, meditation, imagery and disidentification, emerged as strong factors in the choice because clear and effective results had been experienced in both personal work and work with clients. Two therapists identified the dual focus on Heart and Mind as attractive to them. In Psychosynthesis theory, Heart is more than emotions; it encompasses a dimension of the Will (Good Will or the Will to Good). Surprisingly, the marginality of the model was identified as a positive attraction by two of the therapists, as it echoed their own marginalised life positions, especially in childhood. Lastly, the experiential nature of Psychosynthesis therapy was valued as giving a creative and enlivening dimension to practice. The analysis of the drawings further confirmed the strong Spiritual orientation of the therapists. The symbolism in the drawings was overwhelmingly of a Spiritual nature with the dominant symbol of Light appearing in ten of the drawings. Other transpersonal symbols appearing included a path or journey, a chalice, the rose and new birth. The results suggest that Psychosynthesis offers a model of what it is to be a human being, which is validating and affirming at a personal level to those who are attracted to a transpersonal psychology. Furthermore, it offers experiential and creative techniques, which are experienced as powerful and successful ways to work therapeutically.

The Derby Functional Communication Scale (DFCS) was developed to assess functional communication in patients in hospital and rehabilitation settings. The validity of the DFCS and its sensitivity to low mood was also examined. In this study, correlation analysis was undertaken between DFCS and other existing measures of communication and mood. Assessments took place on local Stroke and Rehabilitation units. Sixteen hospital inpatients with acquired communication problems due to mixed aetiologies were assessed on the DFCS and other measures of communication and mood. Measures used included the DFCS, Frenchay Aphasia Screening Test (FAST), Edinburgh Functional Communication Profile (EFCP), Speech Questionnaire (SQ) and speech and language therapists (SaLT) ratings of global communication ability were used to assess communication. The Visual Analogue Mood Scales (VAMS) and the Stroke Aphasic Depression Questionnaire (SADQ) were administered as measures of low mood. The data indicated that DFCS scores were significantly related to other measures of communication (r = .75-.9, p<.01). Inter-rater reliability was generally good for the DFCS with the exception of the 'understanding' subscale, where a low correlation between staff and SaLT ratings was found. No significant (p>0.05) correlations between DFCS and measures of mood were found. In conclusion, the DFCS may be used for assessing observable communication skills in patients with acquired communication disorders. However, further validation and evaluation of the sensitivity to low mood is required.

Introduction The topic of study is concerned with the impact that working with sexual abuse survivor groups has on therapists. The existing literature primarily utilises quantitative methodologies and is, on the whole, concerned with the negative impact of trauma work. Previous studies have suggested that qualitative research exploring the experiences of therapists working in this field would provide a richer understanding of the potential impacts. The methodological limitations and shortcomings of the existing research base are addressed, specifically the lack of research on group therapists. Objectives This study aimed to provide a qualitative, phenomenological exploration of the impact that therapists state, working with sexual abuse survivor groups, has had on them. Design Interpretative Phenomenological Analysis (IPA) was used to conduct an in-depth study of a small sample of group therapists. Methods Multi-site ethics approval was gained to conduct the study within two local NHS trusts and an independent sector service. Therapists were selected using purposive sampling from these services. Semi-structured interviews were conducted with five therapists who ran groups for adult survivors of sexual abuse. Verbatim transcripts were analysed using IPA. Results Two concurrent theme groups were described. Themes concerned with the impact that the work has on the therapists, were discussed under the headings ‘Sense of Responsibility’, ‘Impact’, ‘Protecting and Maintaining Sense of Self’, ‘Contradictions in Narratives’ and ‘Evolving Impact’. Furthermore, findings related to the aspects of working within a group setting, were titled ‘Unique Aspects of the Group Setting’ and ‘Group Milieu’. Discussion Therapists did not ascribe to having ‘positive’ or ‘negative’ impacts, but seemed to simultaneously experience both, having created meaning for the impact of the work. Furthermore, in contradiction to previous literature, the therapists felt that working in a group setting had less potential to traumatise the facilitators. Implications for clinical practice and future research are discussed.

No description available.

Background: Post-stroke depression (PSD) is a common phenomenon and has a negative impact on rehabilitation, recovery and quality of life. About one third of stroke patients suffer communication problems, including aphasia, which is a condition that mainly affects their ability in understanding and/or producing language. The frequency of depressive symptoms in post-stroke aphasia has been difficult to determine as most studies have excluded stroke patients with aphasia due to methodological limitations. As a result, depression remains often under-diagnosed and untreated in these patients. Objectives: The purpose of this thesis was 1) to develop and validate a revised version of the Visual Analogue Mood Scales (YAMS), and 2) to identify factors which may be associated with low mood in stroke patients with aphasia. Method: The items Happy and Energetic of the VAMS were reversed for a more consistent format. All participants completed a questionnaire including the revised version of the VAMS (VAMS-R), the Hospital & Anxiety Depression Scale (BADS), but also four key items of the VAMS-R which were repeated with and without verbal descriptors to assess their content and test-rest reliability. Aphasic stroke patients were recruited both from hospital and community settings and completed assessments at recruitment and at six months follow up. Participants were assessed on measures of communication, cognition, mood, activities of daily living, and disability associated with living with aphasia. Carers also completed assessments of caregiving strain and satisfaction with care at six months follow up. Results: The VAMS-R showed good evidence of validity and reliability in a community sample of 50 older adults and in 71 stroke patients with aphasia. In the main study, 132 aphasic stroke patients were invited to take part, 71 consented and completed baseline assessments and 63 were followed up at six months. Most participants (n=47) were recruited in the community, 38 were men, mean age was 70 years old and the mean time post-stroke was 15 months. Almost half of the aphasic stroke patients recruited had low mood at baseline (55%) and at follow up (44%) based either on their self-report or the observer-rated mood scores. Physical impairment, demographic and medical information, ADL and leisure activities were not shown to be significant predictors of depression. Communication impairment was significantly related to low mood, but was not predictive of self report mood outcomes at both end points. Disability and emotional consequences living with aphasia were predictive of low mood and accounted for 37% of the variance in self-report mood scores at recruitment and for 48% of the variance at follow up. Baseline language battery scores and follow up Carer Strain Index scores were predictive of the observer-rated mood scores at follow up. Conclusions: The VAMS-R, VASES and SADQ-21 could be used to screen for symptoms of low mood in aphasic stroke patients who cannot complete conventional mood assessments that rely on verbal communication. The main factors found to predict low mood in stroke patients with aphasia were disability associated with living with aphasia, carer strain and communication impairment. The factors identified are amenable to psychological intervention and future research should address interventions for the management of post-stroke depression in aphasia. The need to include people with aphasia in future post-stroke depression research is also highlighted.

The aim of this thesis is to explore the social and ethical issues surrounding the use of neurotechnologies to control sleep and enhance cognition in British society. Empirically, the project is based on a case study of the wake-promoting drug modafinil. Data analysis involved the study of a corpus of 77 UK news articles and 40 semi-structured interviews with three stakeholder groups: scientists and clinicians, shift workers and students. The analytical framework used was informed by previous work in both medical sociology and bioethics and developed using key concepts drawn from Science and Technology Studies. Conceptualising modafinil as a sociotechnical object, different discourses surrounding sleep, cognitive enhancement and pharmaceutical use were explored to assess how sociotechnical spaces for ‘therapy’ and ‘enhancement’ are being constructed and negotiated in different domains of social life. The analysis of the ways in which modafinil use was positioned and of how various uses were negotiated in both media and stakeholder discourse shows how different groups can conceptualise the same technology in very different ways depending on who is doing the defining, how the users are imagined and the specific context of use. It was apparent that drugs contain not only technological scripts for how and by whom they are to be used, but also strong cultural scripts relating to legitimacy and acceptability of when, where, for what purpose they should be used. Importantly, it demonstrates that although norms may overlap to some degree, there is no universal set of norms defining and delimiting how modafinil should be used in contemporary society. The adoption of an STS perspective, which takes a critical stance towards both technology and users, has shown how the adoption of a therapy-enhancement distinction devoid of context oversimplifies the debate around the use of drugs such as modafinil and does not capture the reality of stakeholder perspectives.

Background: Sensorimotor Psychotherapy is an approach for working with people who have experienced trauma (e.g. post-traumatic stress disorder [PTSD]) that is based on contemporary philosophies of embodiment and the expanse of neurobiological evidence for the effect of psychological trauma on the physical body. Thus, Sensorimotor Psychotherapy places central importance on working with the body in therapy. Method: This study explored the experiences of 10 therapists and 2 clients who have had Sensorimotor Psychotherapy, and in particular, what it was like to use the body in therapy. Semi-structured interviews were used in order to gain detailed information regarding how the using the body in therapy is experienced. Results: An inductive thematic analysis of interview transcripts identified four main themes: 1) accessing the truth through the body, 2) dilemmas of mind and body, 3) the elusiveness of words, and 4) change occurs through and within the body. 'Accessing the truth through the body' had three further subthemes: 'access', 'truth', and 'depth'. In this theme, participants described Sensorimotor Psychotherapy as being able to access the core of a problem through its use of working with the body ('access'), and that in doing so it reaches the truth of a problem or previous traumatic experience ('truth'). In order to reach and access the truth, participants described the work as having great 'depth'. 'Dilemmas of mind and body' had two further subthemes: 'the interfering mind' and ' the telling body'. In this theme, participants described the mind and body in very different ways, suggesting a dualism of mind and body. Participants described how 'the interfering mind' can distract from dealing with the real and genuine issue (accessed through the body), and that 'the telling body' was a source of genuine and important knowledge regarding a traumatic experience. The 'elusiveness of words' referred to how the participants found it difficult to describe their experiences in words, alluding to the elusiveness of words to describe the process of Sensorimotor Psychotherapy. Participants considered and discussed progress and change in Sensorimotor Psychotherapy as occurring through and within the body ('change occurs through and within the body'). Discussion: In conclusion, the participants in this study felt that by working primarily with the body, Sensorimotor Psychotherapy is able to deeply access the direct core of traumatic experience, and that parts of this process are difficult to describe in words. Furthermore, a dualism of mind and body was implicated by the participants, and change was considered to occur through and within the body. Other therapies for PTSD could consider including more focus on the body, and also consider acknowledging perceived dilemmas between the mind and body. The limitations of this study include possible sampling bias, and the verbal interview technique being unable to explore the nuanced bodily experience of the therapy. Future research should expand the sample to include those who had neutral or negative experiences of Sensorimotor Psychotherapy, and explore methods that can capture the bodily experience of the therapy considering the difficulty of the 'elusiveness of words'.

Intrapersonal Externalities are outcomes from a decision which affect the payoffs from future decisions. Positive intrapersonal externalities represent self-investment in one's future self, such as learning a musical instrument or exercising. Negative intrapersonal externalities represent a disinvestment in one's future self, such as eating sugary food or smoking a cigarette. An individual who succumbs to the lure of an immediate payoff in lieu of future potential earnings is considered to be choosing myopically, and it is hypothesised that addictions are one such situation. This failure of the decision-making system to optimise its choices contrasts with delay discounting, in which an individual is assumed to choose rationally but to discount the future, and impulsive disinhibition, in which an individual is assumed to be unable to control their actions even while they state a preference for an action they do not take. This thesis starts by measuring the relationship between delay discounting and impulsive disinhibition with a range of addictive behaviours in a large online study, and finds that while they are consistent predictors there is further variance to explain. It then examines the validity of the intrapersonal externalities model, and finds that it adds independent variance beyond delay discounting and impulsivity in predicting smoking behaviour; there is no evidence that performance in intrapersonal externalities tasks is related to trait impulsivity. It also uses intrapersonal externalities in the laboratory to study advice seeking and taking in an impulsive decision-making context, which would be incompatible with delay discounting or impulsive disinhibition theory. This thesis concludes that the intrapersonal externalities model has been shown to be a viable third model to understand addictive decisions, and suggests that it could be extended to study social addictions.

Self-harm thoughts and behaviour have been found to be associated with a wide variety of distal and proximal factors; however, few studies have examined how these factors work together to increase the risk of self-harm. A key distal factor is a history of child and family adversity, which attachment theory views as a precursor of attachment insecurities that may increase the risk of later self-harm. A key proximal factor is the desire to escape from overwhelming distress, and Williams (2001) cry of pain model describes a process that could help better understand the reasons behind seeking escape via self-harm. This research investigated whether insecurely attached individuals tend to feel trapped and whether entrapment leads to self-harm thoughts (suicide ideation [Chapter 2] and thoughts about non-suicidal self-injury [Chapter 3]). This research also investigated whether feelings of entrapment among insecurely attached individuals varied as a function of problem-solving (as assessed with the Means-Ends Problem-Solving [MEPS] procedure [Chapter 4] and a diary study [Chapter 5]). The effect of stressful events on subsequent feelings of defeat and entrapment, and the role of attachment, was also examined using an experimental design (Chapter 6). Self-harm thoughts were common among insecurely attached individuals and among those who felt trapped. Entrapment was reported by insecurely attached individuals, but this feeling did not explain their self-harm thoughts nor did it vary as a function of problem-solving. In response to a laboratory stressor, attachment insecurities seem to exacerbate negative emotions. The findings suggest that assessment of attachment styles could help to identify individuals at risk of self-harm. Moreover, interventions aimed at reducing feelings of entrapment could decrease the risk of self-harm. Still, studies are needed to clarify the direction of the relationships between attachment, entrapment and self-harm, and the psychological mechanisms that might underlie these relationships.