An extensive literature search reveals the profound lack of research on specialist professionals’ perspective on clinical work with asylum-seekers and refugees. This study explores the manner in which practitioners’ clinical experience with asylum-seekers and refugees informs the way they make sense of their professional identity. It is the first study undertaken in the UK that investigates the notion of professional identity among practitioners who work with this client population. Drawing on a social constructionist epistemology and a Foucauldian theoretical and methodological framework of power and discourse, I analyse extracts from semi-structured interviews that I conducted with eight specialist professionals who have provided therapeutic work to asylum-seekers and refugees. I explore how professional practices related to clinicians’ work, as well as legislative policies around asylum fall within a broader spectrum of regulatory discourses, interact and shape practitioners’ professional identity within a postmodern migration context. The findings of this study suggest that the notion of professional identity among these practitioners envelops a social and political activist stance and a deep sense of commitment towards helping and promoting social change within the wider community. Likewise, clinical work with refugees combines professional knowledge and values with a politicised involvement that fosters a psychosocial perspective on clients’ distress, takes into account the socio-political parameters of refugees’ trauma and allows practitioners to contextualise their distress and difficulties without pathologizing them. These findings are useful for professionals who work in the field of clinical practice and who conduct or consider conducting clinical work with refugees and clients that have multifaceted social and psychological needs and difficulties, as well as with clients from different socio-cultural backgrounds.

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While culture is a widely accepted issue in therapy, current approaches are criticised as unfit for purpose in a postmodern, postcolonial world characterised by large scale migration, cheap air travel and instantaneous electronic communication. This study attempts to move beyond crude ethno-cultural categories to view culture as a universal human phenomenon. It is a conception that admits characteristics of volatility, plasticity, contextuality and intersectionality; virtually unlimited hierarchical distinctions and dimensions that frequently come to stand in for each other. In addition, it attempts to view culture in positive terms, rather than as an unwanted obstacle to approaches to therapy that are historically rooted in dominant cultural groups. Four participants were selected using purposive sampling, and data was collected using semi-structured interviews, which were recorded and transcribed. The transcripts were then analysed narratively and using thematic analysis, and reported against a common subset of superordinate metacultural themes. While the study is a small scale exercise with admitted limitations, it provides support for a more universal view of culture; and the idea that it is a powerful personal resource that can be used both consciously and unconsciously. Personal factors caused participants to emphasise certain aspects of their cultural background and de-emphasise or avoid others. Participants attempted to seek out or access additional resources that helped to represent aspects of their personal story. The study provides support for three theoretical ideas: culture as a resource, cultural identity and personal culture; and it suggests ways in which culture can be used in therapy as a diagnostic and therapeutic tool. Further work includes additional case studies employing a more comprehensive methodology, the use of discourse analysis to provide a degree of triangulation and investigate the discursive processes at work, and extension of the approach to areas beyond therapy.

“What does a hug mean in counselling practice?” In this autoethnographic research, I explore the role and implications of physical touch in therapeutic practice. Researchers argue that the use of hugs is controversial, as the fields of counselling and psychotherapy do not provide either a culture in which physical touch is regarded to be an appropriate therapeutic tool or where it is suitably introduced via generalised training that best prepares professionals to appropriately apply touch in practice. Yet, I argue that the reasons behind practitioners' potential struggle with the use of touch are much more complex and involve both the personal and professional spheres. In this qualitative study, I utilise autoethnography as my research method which illuminates the dynamics between my own sociocultural values, my personal relationship with my mother and my professional experience with a counselling client who requested a hug. I also employ poetry and storytelling as I argue that these creative methods assist me to recollect, analyse and present difficult memories, which implies that reflective practice helps to reveal potential issues that may arise in our interaction with therapeutic clients. By doing so, I demonstrate how these interactions formed and deformed my subjective notion of what it means to hug a client in a therapeutic context and show how the meaning and use of touch is significantly influenced by both sociocultural factors and subjective experiences. Thus my research illustrates that a practitioner’s potential struggle with the use of physical touch in practice can be a symptom of dissonance between his/her professional and subjective perceptions of and experience with touch. This autoethnographic study aims to show psychotherapists and counsellors how they may better understand the use of touch in professional practice by reflecting on their own personal and socio-cultural experiences with physical contact in various contexts.

A literature search was carried out on the role of the Community Psychiatric Nurse (CPN) in counselling within the Primary Health Care Team (PHCT) which highlighted a lack of theoretical knowledge for the psycho-social issues and that CPNs were not trained to provide counselling. The aim of this thesis was centred around the role in counselling the CPNs in Mid-Surrey Health District had in PHCTs, and whether General Practitioners (GPs) perceived CPNs as CPNs or counsellors. Two hypotheses were devised at the beginning of the study and a methodology was pursued in proving or disproving these hypotheses. Results indicated that CPNs were aware of the meaning of the term ‘counselling’ and that all but one felt they had not enough knowledge to carry out more in depth counselling/psychotherapeutic interventions. They all felt that counselling training was inherent to their work as CPNs within the PHCT. This therefore supported the hypothesis that CPN counselling in the PHCT needs to be trained. The GPs result was that they were unaware of qualifications held by CPNs or counsellors. They felt that CPN was invaluable and it would be an advantage if CPNs had counselling training. However, some felt that CPNs needed to retrain the ‘multipurpose’ aspect of their work. From the results it was apparent that there was a misperception of the role of CPN and counsellor as some GPs felt that CPNs were already counsellors. However, the result was inconclusive in proving or disproving the hypothesis. Most GPs introduced the CPN as a CPN and not as a counsellor, although some GPs believed that CPNs were also trained in counselling. It is argued that although these findings indicate that CPNs need counselling training and counselling was perceived as an important part of their work, in depth counselling training was not regarded as necessary to carry out their work as CPN.

In counselling and psychotherapy, the issue of class is neglected both theoretically and in practice. This thesis aims to address this anomaly by focusing on the class dynamic in the therapeutic relationship. First, the study offers a theoretical exploration of the three major concepts of class. Second, the empirical research aims to highlight how the working class research participants perceive therapists and counselling, and how the counsellor participants perceive class and manage class difference. I argue that class is complex and multidimensional. Therefore, no one theory about class offers a complete account. With this in mind three theoretical concepts are explored demonstrating their potential usefulness to the provision and practice of therapy. The position taken is that two of these concepts, class as a relational phenomenon, and class maintained and reproduced through habitus, capital and dispositions of the therapist and the client provide a means by which the class dynamic can be analysed, with consequences for the therapeutic transference. The empirical inquiry constitutes a theory led, constructionist, thematic focus group analysis, cross referenced to individual counsellor interviews. The data was gathered from six focus groups situated in Sure Start Children Centres across the West Midlands. Each centre was located within the highest percentile of nationally delineated deprivation factors. The research findings suggest that all participants called on latent socio-cultural accounts of class in relationally defining themselves in opposition to others; that the power dynamic in the therapeutic relationship is constructed differently between the working class participants and the counsellors; that therapists symbolise a homogenous middle class to the working class participants; that the cultural capital of the therapist is resisted by the working class client; and that the focus group participants’ constructions of therapy, coupled with the counsellors’ terms of therapeutic engagement when working in Sure Start centres, signal implications for practice. Class, as addressed in this study, indicates it is an issue in primary processing, and confirms its centrality to the therapeutic relationship.

Background: This research was designed to explore the experience and understanding of counsellors' and psychotherapists' engagement with metaphors in the therapeutic process. The aim is to reflect on the experience of therapists involved in therapeutic metaphors from differing perspectives. Methodology: In a heuristic study a group of seven therapists (counsellors and psychotherapists) shared their use of metaphors in their therapy practice. Data were collected through an informal conversational interview that supported the participants to share their experiences in a natural dialogue. Findings: The experience of using metaphor in therapy appears to involve a multi-faceted web of generation, construction and development between the therapist and client. Various levels of depth of metaphor in therapy were identified along with links to transferential and cultural issues. Metaphors of hope also appear to be potentially important. Discussion: The findings suggest that the use of metaphors in therapy is pervasive. Metaphors that reflect an empathic connection and encounter between therapist and client were identified. Dualistic thinking around the origination of metaphors in therapy is challenged and the concept of co-creation and the mutual development of moving metaphors is discussed. Environmental and cultural influences are considered alongside transferential aspects. Conclusion: It appears that the use of metaphor in therapy is pervasive and offers an opportunity for therapeutic change. The consideration of the construction of metaphors and their mutual development may be useful for therapists to consider. This research highlights the need for more investigation with regard to client perspectives, the environmental impacts on metaphors in therapy and who the therapist and client stand for metaphorically for each other.

Both the NHS and Public Health are keen to identify how best to manage long term health condition’s as a result from obesity and vice-versa. There is evidence to support the efficacy of psychological support in weight management programmes. This study explored the perceived importance of psychological support within weight management services; perspectives of both client and healthcare practitioners, in view of considering the implications for the role of a counselling psychologist. There were nine interviews conducted with five healthcare practitioners and four clients. The professionals’ disciplines included: physiologist, dietician, health psychologist, programme manager, and a medical consultant. Of the four patients, two had accessed psychology services as part of their weight management programme and two had not. Data was analysed using thematic analysis. Five overarching themes were identified. Tension (pivotal central theme) this connected to: Lifestyle; Quality of Life (QoL); Service Delivery Model; and Professional and Personal beliefs and values. The findings highlighted that perceived importance of psychological support was influenced by an individuals’ background and experiences by both groups. The implications for the role of a counselling psychologist was to provide training to health professionals as well as raising clients’ awareness of the role of counselling and psychological support within such programmes. Further research is needed to understand better the potential of psychological support within weight management services to help contain UK obesity.