The aim of this thesis was to contribute to our understanding of the therapeutic relationship between clinicians and individuals who have committed sexual offences against children and adults. To do this a systematic review was carried out which explored the relationship between attachment styles and types of sexual offending to investigate whether there is an association between types of sexual offences and types of insecure attachment styles. 16 articles were identified and evaluated. The results of this review indicated that individuals who have sexually offended against children demonstrated more insecure childhood maternal and paternal attachments alongside higher rates of insecure adult attachment styles whereas individuals who have sexually offended against adults demonstrated a more variable pattern of maternal and paternal attachments. Types of sexual offending did appear to be related to different insecure attachment styles with child molesters predominantly identified as preoccupied and fearful and rapists classified as dismissing. A separate qualitative study using Interpretative Phenomenological Analysis was also completed which explored the experiences of therapists involved in the delivery of group treatment for sexual offenders. Some of the experiences reported were similar to those outlined in previous studies (the importance of collegial support, the experience of intrusive cognitions, managing challenging characteristics of sexual offenders and the perception of being involved in protecting the public) but some were not (the prestige felt from belonging to a niche profession, the pride of pushing professional boundaries and the perception of protecting the patient and managing professional challenges) offering further insight into the possible types of experiences encountered. An awareness and appreciation for the integral role attachment status plays in sexually deviant behaviour enables clinicians to anticipate the relational dynamics that may emerge during treatment and modify interventions appropriately to facilitate effectiveness and maintain the therapeutic alliance. In addition by exploring the experiences of sex offender therapists an understanding of the ways in which the therapeutic relationship and a therapist’s sense of self may be impacted can be garnered (Hernandez, Engstom & Gangsei, 2010; Lyn & Burton, 2004) assisting individuals and organisations in ensuring that the rewards are maximised and the challenges supported and reduced.

Background: Family members of people with eating disorders are often involved in caregiving. To better understand the impact on them, outcomes such as burden, distress, and less frequently quality of life (QoL) are taken into consideration. Despite advancements in the knowledge base surrounding the experiences of adult and parental caregivers of individuals with eating disorders, particularly Anorexia Nervosa, there is a scarcity of qualitative exploration from the sibling perspective, particularly that of adolescent siblings. Objectives: The systematic review aimed to identify research and synthesise findings relating to informal caregivers’ quantitative ratings of quality of life in the context of eating disorders. The primary study aimed to explore in detail the lived experience of adolescent siblings with a brother or sister with Bulimia Nervosa or Eating-Disorder-Not-Otherwise-Specified. Method: Applying a priori inclusion and exclusion criteria to papers identified from a combination of systematic searches of electronic databases and hand searches of other pertinent literature, revealed eight studies to be included for review. Within the qualitative study, eight semi-structured interviews were carried out with siblings (aged 12-19-years) who had a brother or sister with an eating disorder. An interpretative phenomenological analysis approach was utilised to analyse interview data. Results: The review highlighted low ratings for aspects of quality of life for informal caregivers of individuals with eating disorders, and some emerging comparative and subgroup differences. Three super-ordinate themes emerged from the qualitative exploration: Sibling Identity, The Vulnerable Social ‘Self’, and Intra- and Inter-Personal Coping. Discussion: Overall the findings provide particular insight into the quality life of informal caregivers and the unique experiences, feelings and various roles of adolescent siblings of people with eating disorders. Implications regarding caregiver support and the needs of siblings specifically are considered. Strengths and limitations, as well as future research possibilities are outlined for both the systematic review and empirical study.

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.

Background: Both Freud (1921) and Skinner (1971) were regarded as 'hard determinists' who saw human thought and action as determined by prior events, and the idea of free will as simply an illusion. While this belief system clearly impacted on the models of therapy they developed, whether such beliefs also had an impact on their ability to develop qualities of effective therapy, such as empathic and genuine therapeutic relationships, is not known. Furthermore, whether there is something about holding this belief system that could affect therapists' abilities to attain and nurture such qualities, remains unclear. Research Question: The research study reported here sought to gain some insight into the above question, and into what it is like to deliver therapy from a hard determinist philosophical frame, by asking how clinical psychologists who hold a hard determinist philosophy, experience delivering therapy. Method: The study made use of a qualitative design methodology. Semi-structured interviews were conducted with seven hard determinist clinical psychologists, and interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Results: Four super-ordinate themes emerged from the analysis: 'From Hell to Utopia: How it feels to be a hard determinist therapist', 'Hating the sin, loving the sinner: Enhancing the therapeutic relationship', 'Free will: A felt vs reflective understanding', and 'Therapist as thinker'. Implications: The themes to emerge from the data gave rise to a number of implications and recommendations for practice and further research. In particular, it was recommended that the link between hard determinist beliefs and a perceived enhancement of the therapeutic relationship warrants further research. Furthermore, since the philosophy was linked to ideas about power, self-control, therapeutic models, science, and research, discussions of the philosophy may add valuable contributions to clinical psychology's understanding of these issues. In addition, a replication or development of this study with a broader range of therapists is recommended, to establish whether the findings reported here can be generalised to therapists from fields outside clinical psychology.

Background: This thesis explores, in-depth, the experience and sense-making of transactional analyst psychotherapists working with clients who present with Internet addiction (IA). It engages with the therapist’s broad experience and understanding of Internet addiction presentation, therapeutic assessment, ‘diagnosis’ and ‘treatment’ rather than the singular experience, expression, and meaning-making of the individual client. Method: As a counselling psychologist trainee, I was particularly interested in sampling highly experienced therapists, with an extensive range of skills developed through a robust clinical training. Four therapist participants, all professional members of the European Association of Transactional Analysis (EATA), were interviewed using semi-structured, one-to-one interviews and the material was analysed using interpretive phenomenological analysis (IPA). Findings and Discussion: Four higher-order concepts emerged within this study. They concerned: the complexity of IA; aetiological and predisposing factors; functions and features of IA; and treatment factors. Practical and theoretical implications for future research, clinical supervision, treatment, psycho-educational and political programmes are presented. Of the key emergent findings the Internet was understood by participants as a conduit or medium for addiction given a high prevalence of an underlying ‘disorders’. All of the participants believed in the existence of childhood aetiological roots which underpinned comorbidity with IA. Attachment difficulties in childhood would often predispose individuals to develop issues around loneliness, low self-esteem, control, loss and instability, and cognitive dissonance later in life. Participants believed a relationship existed between depression, low self-esteem and escapism as contributing factors. Conclusion: A systematic review of the extant research is proposed, along with quantitative studies to specifically evaluate the strength of this relationship. Further empirical research is particularly recommended to explore how these factors can predispose individuals to developing sub-types of IA, and especially in the context of historic childhood abuse and / or neglect. The complex nature and aetiology of IA can demand a high level of clinical expertise from professionals who would benefit from specific trainings concerning childhood attachment difficulties. Integrating a psychodynamic approach, or being aware of transference processes, could possibly enhance treatment effectiveness, and help safeguard both clients and therapists from counter-therapeutic interventions.

Background: The aim of this study was to explore the experience and sense making oftherapists working with clients who present with a PTSD diagnosis. The study engaged with therapists experience and understanding of predisposing factors to PTSD and how they incorporate this understanding into the therapy process. Further to this the experience of the therapists understanding of the influence of predisposing factors on the expression of PTSD was explored. Literature Review: A literature review is presented identifying core research relating to PTSD, predisposing factors to the development of PTSD and the treatments used when working with PTSD as a presenting issue. Methodology: To address the aims of the study 9 therapist participants were interviewed. Semi-structured, one to one, in-depth interviews were utilised to elicit participant’s experience of the issues outlined within the aims. Interpretative Phenomenological Analysis (IPA) was used to identify re-current themes across the interviews and analyse the data, which emerged. Findings: The main findings present thirteen sub-ordinate themes that reflect the essence of the participant’s experience of the phenomenon under investigation. These were based around eight Super-ordinate (master) themes of Previous history, Therapy relationship, Psychoeducation and Normalisation, Identity, Culture, Attachment, Presenting Therapy Themes, and Support Systems. Discussion and Conclusion: The study identified the participant’s experience of predisposing factors on the expression of PTSD. There was consensus from the participant’s in relation to the significant impact of client’s previous life experience on their expression of PTSD. The participants further identified that the client’s previous life experience influenced their formulation and treatment of PTSD. Significant issues that were described by all of the participants regardless of their theoretical or therapeutic perspective were (1) the central importance of the therapeutic relationship, (without a strong, trusting and safe relationship the participants would not engage the therapy work), (2) the importance of in-depth history taking (identification of previous life experience and its impact on the current response to the trauma), (3) the impact of previous trauma(s), and (4) the impact of support systems, environment and identity. These issues are discussed alongside the existing literature around this topic. Additionally, suggestions for future directions of research and recommendations for practice are presented.

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This study explored the subjective interpretations of five adolescent athletes who experienced a sport-specific version of the Mindfulness-Acceptance-Commitment (MAC) approach. The MAC approach is an alternative sport psychology intervention to more traditional control-driven approaches, such as Psychological Skills Training (PST). An in-depth qualitative study was conducted at the High Performance Centre (hpc) of the University of Pretoria (UP). The sport-specific MAC programme was developed for the sport of athletics. The programme was facilitated to five adolescent athletes who participate in the sport of athletics. Semi-structured interviews were conducted after the participants experienced the programme. The interviews were based on written reflections provided by participants during the programme. The research position for this study was phenomenology, and specifically Interpretive Phenomenology (IP). Interpretive Phenomenological Analysis (IPA) was used to analyse the material. The results revealed that there was only one theme that was common to all five participants. Furthermore, the results portrayed diversity amongst the participant experiences and subjectivity in their interpretations of the MAC approach. The results displayed how some themes are consistent with MAC-related literature, and how other themes contradict the literature. Additionally, some themes have not been reported in MAC literature before. Thus, the study contributed to the expansion of literature on the MAC approach. / Dissertation (MA)--University of Pretoria, 2013. / lk2014 / Psychology / MA / Unrestricted

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