Transitional care is an important process for professionals to consider, particularly as recent studies have shown how a mental health difficulty in adolescence will persist into adulthood. This indicates that a number of those seen in Child and Adolescent mental health services are likely to make the transition into Adult services. For professionals from both services, barriers can arise when supporting young people across service boundaries and recent studies have stated that the current practice of transitional care in mental health is deemed to be problematic. However at the time of conducting this study, there was a paucity of literature, therefore the aim of the study was to add to the existing knowledge. The study followed a Social Constructivist grounded theory (Charmaz, 2014) approach to explore the experience of stakeholders of the transition process. Semi-structured interviews were conducted with professionals, young people and parents. There were a total of eight interviews which were transcribed and analysed. The findings present the core category as Facing the transition, with three sub- categories: Changing status, Manoeuvring the boundaries and Reflections on the process. The tentative theory explains how facing the transition involves stakeholders adjusting to the changing status of the service user. This category triggers the service transition but also describes how societal perceptions about adulthood influence the expectations placed on young people. Manoeuvring the boundaries describes and explains service transition, identifying a range of barriers and strategies to overcome these. One of the most significant barriers was identified as cultural differences between the two services. The third category describes how stakeholders make sense of their experiences, and how these are managed within the therapeutic relationship.

Aims: Research examining the process of clinical psychology training has essentially focused on the outsider perspective and given little consideration of the trainee’s lived experience. Using qualitative methodology this project aims to listen and privilege personal narratives of individuals who occupy the role of trainee clinical psychologist and parent simultaneously during CAMHS training (i.e. placement and associated teaching) in order to increase awareness of the challenges and existing resources of this population. Method: Six parent-trainees were interviewed using semi-structured interviews. Transcripts were individually analysed using methodology drawn from Interpretative Phenomenological Analysis (IPA; Smith, 1996a) to identify emergent themes and complete cross-case analysis. Results: This study demonstrates how the occupancy of a parental role during Child and Adolescent Mental Health training has significant implications for individual trainees within both their professional and parental role. The three main themes emerging from the study are: i) A changed Identity: seeing and being seen in a different light ii) A journey from dependency towards autonomy and iii). Cutting the cord doesn’t destroy the bond: The inseparable nature of the parental and professional self. Implications: This study highlights the significant impact that the occupancy of a parental role may have in the experience of a trainee clinical psychologist’s CAMHS training, and how such findings may have been overlooked in the available literature base. Findings suggest that to optimise professional and personal wellbeing and minimise potential for compromised professional conduct the impact of the relationship between parent-trainees’ personal and professional self needs to be widely recognised by individual parent-trainees, training providers and the wider context of clinical psychology. The results from this study may also have wider implications for the ethical practice of those occupying any dual role in the training context as well as the broader field of therapeutic work.

Background: Self-compassion which may be shaped by early attachment experiences involves being kind to oneself at times of difficulty and is consistently linked to psychological well-being. Self-compassion may be particularly useful in adolescence during which, difficulties associated with physiological and psychosocial transitions can lead to psychological distress. Aims: The aims of this thesis were twofold. First: to review the literature exploring the relationship between self-compassion and psychological distress in adolescents. Second: a research study to investigate the emerging theory that self-compassion may offer a healthier self-relating construct than self-esteem. The study examined whether self-compassion or self-esteem mediated the relationship between attachment and depression and anxiety in adolescents attending child and adolescent mental health services (CAMHS). Method: A systematic search of articles related to the relationship between self-compassion and psychological distress in adolescents was conducted. The quality of included papers was assessed. In the research study, 53 adolescents (mean age 15.52 years; 75% female) attending CAMHS presenting with symptoms of anxiety and/or depression were asked to complete five self-report questionnaires measuring: self-compassion, self-esteem, quality of life, satisfaction with attachment relationship and current symptoms of depression and anxiety. Results: The systematic review revealed 25 studies for inclusion. Studies reported an inverse relationship between self-compassion and psychological distress in adolescents. Quality ratings illustrated variation in methodological quality of included studies. In the research study self-compassion and self-esteem were both negatively correlated with depression and anxiety. The mediating impact of self-compassion was only apparent in the relationship between attachment availability and depression, but not anxiety. Contrary to the hypothesis, self-esteem mediated the relationship between attachment security and depression and anxiety to a greater extent than self-compassion. Conclusions: Self-compassion may have clinical implications in improving psychological well-being among adolescents. Future studies with different measures of self-compassion; varying study designs and consideration of contextual factors would increase understanding of the relationship between self-compassion and psychological distress in adolescents.

There has been relatively little robust research investigating the experience of family therapy from a client’s perspective. Much of the literature fails to make clear their methods for analysing the data, and takes an ‘either or’ approach to family and individual perspectives. Thus, either whole family perspectives, or the perspectives of a particular group are sought, making it difficult to understand the impact of the family context on individual perspectives or vice versa. The present research seeks to understand the family therapy experiences of individuals within their familial context. Two families of three were interviewed using a semi-structured interview guide and interviews were analysed using Interpretative Phenomenological Analysis. Results are presented as two family case studies. One over-arching theme of ‘the safety of the therapeutic relationship’ emerged from the accounts of both families. The therapeutic relationship provided the safety to talk and explore problems and relationships. This was described as cathartic and helped family members to see themselves and each other differently. Varying degrees of exploration of individuals was associated with differing levels of engagement with therapy. Being able to explore relationships for both families allowed them to develop new understandings of each other. Gender also emerged as an important theme and this is discussed in relation to issues of power and gender. Some key methodological limitations of the research including the small number of participants and the impact of an overly detailed interview schedule on the data are discussed. As this study involves two case studies of three family members each, it is not easily transferable, but points to some key themes and processes which have implications for practice and future research.

Bakgrund: Den psykiska ohälsan bland unga har ökat de senaste två decennierna. Barn- och ungdomspsykiatrin, BUP, ansvarar för den specialiserade psykiatriska vården för de under 18 år medan vuxenpsykiatrin har ansvaret för de som blivit myndiga. Det finns stora skillnader mellan BUP och vuxenpsykiatrin och övergången mellan vårdformerna innebär en process för de unga vuxna, vilket kan beskrivas i termer av transition.  Syfte: Syftet var att undersöka patienternas beskrivna upplevelser av överföring från barn- och ungdomspsykiatrin till vuxenpsykiatrin. Metod: En kvalitativ litteraturöversikt med systematisk ansats. Resultat: Resultatet baseras på 13 vetenskapliga artiklar med kvalitativ design som sammantaget tydliggör tre övergripande teman som beskriver förändring. De unga vuxna beskriver förändrat ansvar, förändrade relationer samt förändrad identitet till följd av övergången mellan BUP och vuxenpsykiatrin. Slutsats: De unga vuxna beskriver bristande information, ostabila vårdrelationer och en ökad känsla av hopplöshet under transitionen. Fram till att de etablerat en tillitsfull kontakt finns en ökad risk att de unga vuxna faller ur vårdsystemet. En viktig faktor för att säkerställa kontinuitet är att det finns närvarande sjuksköterskor som stöd innan, under och efter transitionen. I detta avseende finns strukturell och individuell förbättringspotential som kräver forskning och metodutveckling.

Introduction: Young people with high functioning autism spectrum disorders (HFASD) are particularly vulnerable to developing comorbid depression. It has been suggested that young people with HFASD and comorbid mental health difficulties are likely to experience difficulties during the transition to adulthood. This transition involves significant changes in both services and daily routine, something which people with HFASD often find difficult. Aims: This thesis includes two distinct pieces of work. A systematic review aiming to understand the prevalence of depression in children and young people with HFASD. A qualitative study aiming to explore transition to adulthood from the perspectives of young people with HFASD, who currently attend child and adolescent mental health services (CAMHS), and their families. Methods: For the systematic review, literature reporting the prevalence of depression in children and young people with HFASD was systematically searched and reviewed. For the qualitative study, data collection and analysis followed the principles of Interpretative Phenomenological Analysis (IPA). Four dyads of a young person with HFASD and a parent were interviewed. Results: The systematic review identified 18 studies which described results from 17 independent samples. The prevalence reported varied from 0% to 83%. This variation is most likely explained by methodological differences between studies. In the qualitative study, transition to adulthood was described as a process during which the young person is developing independence, while parents continue to have a role in providing support. Current and future support needs were perceived differently by the young people with HFASD than their parents, with the young people reporting less need for support. Conclusions: Further research is needed to better understand how to assess depression in this population, as well as the impact of age, gender, setting, medication use and other comorbidities. Transition is a time of uncertainty and change for young people, during which they become more independent of their families. Services need to consider the impact of these processes and young people’s perceptions about what it means to receive support.

This study developed and validated the Youth Empowerment Scale (YES) for young people with psychosis. This PhD thesis consisted of four phases. Phase 1 conceptualised empowerment from the perspective of young people with psychosis. Phase 1 qualitative findings informed the development of the measurement of empowerment; the Youth empowerment Scale (YES). Phase 2 developed and validated the YES in a non-clinical population. Phase 3 explored the relationship between psychological processes (self-efficacy, control, coping, thinking style, and social support), empowerment, mental health wellbeing and recovery. The YES was then validated again in phase 4 on a clinical population, young people within Child and Adolescents Mental Health Services (CAMHS). This study confirmed that the YES is a valid and reliable measure of empowerment which can be used in future work identifying and supporting empowerment for young people with psychosis.