Section A is a literature review evaluating the role of Therapetuic Care Workers (TCWs) and Therapeutic Foster Carers (TFCs) working relationally with a sub-group of Looked After Children (LAC) who are highlighted as having intense emotional and behavioural needs. These LAC are thought to benefit from living in specialist, therapeutic placements where carers work relationally. However, to date, there is no known review evaluating relational residential interventions or the role of TCWs and TFCs. Therefore, literature exploring the theoretical underpinnings of the work, and the emotional impact and protective factors involved in the carer role is considered. Implications for future research and clinical practice are suggested. Section B describes a qualitative study which explores how TCWs experience their role and their perceptions of the potential benefits for LAC. A qualitative design using Interpretative Phenomenological Analysis (IPA; Smith, Flowers & Larkin, 2009) was applied. Methods. Nine TCWs currently working in one of two therapeutic communities were interviewed. Results. Five master themes were identified: ‘Therapeutic group living’; ‘Importance of carer-child relationships’; ‘Working with the unconscious’; ‘Personal meaning of professional role’, and ‘Children’s progress’. Participants considered that forums for reflection were crucial to their ability to think clearly and analytically about the children, and utilised psychodynamic concepts to gain insight into the children’s inner worlds. TCWs’ increased self-awareness was central to this process. Participants also reported experiencing their role as emotionally challenging. One focus of reflection was on the small steps of progress the children were perceived to achieve. Conclusions. Overall, the findings suggested a synergy between relevant theory, descriptive accounts of therapeutic childcare, and TCWs’ perceptions of their role. New information regarding the personal investment of TCWs and internalisation of the framework of practice was identified. Further research is needed to extend the evidence-base. The clinical implications of the findings are discussed.

Dropout from therapy for personality disorder (PD) represents a clinically-important but poorly understood phenomenon in the existing literature. The present grounded theory study explores the experiences of clients with PD, and their therapists, of treatment dropout from a National Health Service outpatient psychotherapy service, specialising in psychodynamic interventions for PD. Pre-therapy questionnaires for 20 clients were initially reviewed to generate hypotheses about the differences between treatment dropouts and completers, before a focus group was conducted with six therapists to explore their beliefs about and experiences of client dropout. Finally, six individual interviews were conducted with clients with PD, five of whom had dropped out from therapy at the host service. The final model highlighted the importance of clients’ treatment expectations, how they perceived their therapist’s behaviour, and their interpersonal history in making decisions about whether to stay in or drop out of therapy. The impact of therapy endings upon clients is also discussed, as well as therapists’ beliefs about managing complex clients, both individually and within a team, under current financial and clinical pressures. The findings are then discussed in relation to existing theory and research, and the clinical implications and limitations of the study are presented.

Service user and carer involvement has become a priority in the education of mental health professionals. While preliminary evidence suggests that service user and carer involvement is perceived positively by mental health students, there is a paucity of research investigating impacts relating to changes in learners’ knowledge, skills, attitudes or behaviour. The present qualitative study sought to investigate what, and how, (trainee) clinical psychologists learn as a result of service user and carer involvement in their training. Overall, 12 (trainee) clinical psychologists were interviewed and grounded theory methodology was used to analyse the data. Findings indicated that (trainee) clinical psychologists learned from service user and carer involvement in a variety of ways and a preliminary model was proposed, encompassing four main categories: 'mechanisms of learning', 'relational and contextual factors facilitating learning', 'relational and contextual factors hindering learning' and 'impact'. The findings are discussed in relation to extant empirical research, taking into account theoretical considerations. Recommendations for educators in clinical psychology training programmes are provided alongside suggestions for a future research agenda. A methodological critique of the study is offered.

This study had two objectives: to develop an ecological understanding of personal recovery in the context of severe mental illness (SMI) with a UK-based sample, and to develop a model of the discovery of hope and meaning in recovery, and relevant helping and hindering factors. A grounded theory methodology was employed as a framework for collecting and analysing qualitative data. The study provides an emergent ecological model of growth in the context of personal recovery incorporating seven theoretical categories including; prevailing contexts, the importance of relationships, purposeful goals, values-commitment, emerging self-efficacy, wellness experience, and tangible and intangible hope. The emergent model provides a novel understanding of the individual, ecological and interactional factors facilitating the discovery of hope and meaning in life. It is anticipated that such findings will benefit the provision of statutory and peer-run mental health services, and support further research into growth in the context of SMI.

The potential for green interventions to promote mental wellbeing and reduce mental distress is increasingly being recognised (Mind, 2007). Preliminary evidence suggests that allotment gardening activities may have a significant effect on mental wellbeing, but a paucity of research, particularly in non-clinical populations, has been highlighted (Partridge, 2010). A cross-sectional online survey of 171 allotment gardeners was conducted. Measures of subjective wellbeing (quality of life), eudaimonic wellbeing, connectedness to nature and preference for solitude were administered. Qualitative data were also collected through open-ended questions. Allotment gardeners’ scores on measures of environmental quality of life and eudaimonic wellbeing were significantly higher than those reported in the literature, but social quality of life was lower in allotment gardeners. Regression analysis showed that time spent on the allotment during summer predicted eudaimonic wellbeing. This relationship was fully mediated by feelings of connectedness to nature. A relationship was observed between spending time on the allotment and preference for solitude. Four main themes emerged from the qualitative data: allotments provided a space of one’s own, meaningful activity, increased feelings of connectedness, and improved physical and mental health. The results suggest that allotment gardening is associated with increased eudaimonic wellbeing, but not subjective wellbeing (also referred to as hedonic wellbeing). Furthermore, a mechanism through which allotment gardening enhances wellbeing is suggested: increased connectedness to nature. Limitations of the current study and clinical and research implications are discussed.

Psychotic phenomena such as delusions have recently been understood as meaningful within the context of a person’s life while recent models of psychosis implicate psychosocial influences in its aetiology. Research on women with such experiences has been limited despite recognition of their specific needs and vulnerabilities due to the nature of their lives. This study aimed to examine the processes influencing women’s understandings of their delusional beliefs in the context of their lives. It used a social constructionist version of grounded theory to conceptualize the process of women’s understandings. Ten women who had experienced delusions were interviewed. Grounded theory analysis revealed four main processes: women’s acquisition of knowledge about themselves; significant life experiences; how women experience their delusions; and the process of emerging from the delusional world. According to the constructed theory, the core process of understanding is conceptualized as residing in the space between private experience and the social world. It is mediated by the relationship women have to knowledge about the self, which in turn is mediated by the responses of others. Delusions are understood as responses to life experiences and are therefore meaningful containers of truth. Implications for clinical practice, limitations and suggestions for further research are discussed

Given the high rates of completed suicide and poor help-seeking among young men, this research explored how young men, who had successfully sought help from a Child and Adolescent Mental Health Service (CAMHS), experienced help-seeking. This study focused on the factors that facilitated initial access and on-going engagement in services. Eight young men between the ages of 16-18, who had entered CAMHS following self-harm or suicidal ideation, and who were engaged in on-going therapy, were recruited. Each young man was interviewed to elicit his personal experiences of help-seeking and help-receiving. Interviews were transcribed and subjected to Interpretative Phenomenological Analysis. Five dominant themes, that overarched participant’s individual experiences, emerged from the data: Role of external adult in recognising, normalising and initiating help seeking; Influence of another;Challenging and renegotiating perception of need for help and meaning behind this need; Change in perspective; Maintaining an independent self; Mechanisms of engagement and Shared experience. Help-seeking was described as a journey of two stages; 1) initial access and 2) on-going engagement, during which the presence and timing of external influences (parents, teachers) and internal influences (personal beliefs and attitudes) were crucial. A model of help-seeking is presented. This study is the first of its kind to consider factors that facilitate the help-seeking journey of young men aged 16-18 following self-harm. It highlights the need for provision of information to parents and teachers about how to identify need and ways to facilitate access to services. Information and guidelines on how to adapt services to meet the complex developmental needs of young men, is highlighted for service developers, commissioners and clinicians.

Research suggests that working with trauma survivors can result in a range of negative effects including ‘vicarious trauma’, ‘secondary trauma’, ‘compassion fatigue’ and ‘burnout’ amongst other things. Although the impact of being exposed to traumatic stories has been investigated in a range of professionals no studies to date have explored the impact of this on UK mental health workers known as care coordinators. The aim of this study was to explore a sample of care coordinators responses to client’s traumatic stories and the role of coping and perceived organisational support. Twelve UK care coordinators (community psychiatric nurses, occupational therapists and social workers) from two NHS mental health recovery teams completed interviews about their experiences of hearing clients’ traumatic experiences. Grounded theory was employed to analyse the interviews. The care coordinators heard traumatic stories in their role and were ‘active participants’ in these disclosures. They also experienced short and long-term levels of distress which included a range of negative emotions, a mixture of positive and negative responses and a broadening of their perspectives on themselves, their clients and the world. Care coordinators also developed a range of individual coping strategies, experienced individual and organisational barriers to seeking support and experienced limited organisational support for hearing traumatic stories. This is the first UK study to investigate care coordinators’ responses to clients’ traumatic experiences. Therefore further exploratory studies are required in addition to studies with larger sample sizes and measures of trauma related symptoms.

Recent studies with offenders have identified a growing distrust in psychologists and that this may be due to the changing role of clinical psychologists working within these settings. In addition to the traditional role of alleviating psychological distress, psychologists in these settings also have the additional role of providing expert risk assessment. Clinical psychologists working in forensic mental health settings (FMHS) are also tasked with this ‘dual role’. To date, there is no research exploring the impact of this dual role in FMHS. Semi-structured interviews were carried out with eight inpatients in two medium secure units. A grounded theory analysis produced a model of how trust was built and relationships developed. Despite the ‘dual role’ held in these settings, with an approach that is transparent, open, collaborative, and patient-centred; service users are able to build trusting relationships. Furthermore, they report making positive therapeutic gains. Where ‘coercive’ experiences were described, this appeared to be a representation of more distant times, with recent experiences being described as more satisfactory. Clinical psychologists also seem to be placed in a position of ‘mediator’ amongst the wider care team. Further research is required to explore these findings and whether they apply in other secure settings.

The aim of this grounded theory study was to explore the social identity of members of service user groups that train mental health professionals (SUG-TR). Additionally, the study aimed to construct an explanatory model of how participating in such groups contributes towards the achievement and maintenance of positive social identity. Semi-structured interviews were conducted with eight members of SUG-TR. Grounded theory was used to build a preliminary model, which contained 5 main categories: ‘Impact of mental illness/ impact of receiving a psychiatric diagnosis’; ‘The experience of stigma’; ‘Participating in SUG-TR’; ‘Contributing to positive identity’; and ‘Challenges to participating’. The constructed theory suggests that participation in such groups can contribute towards the achievement and maintenance of a positive social identity and that participants adopted specific strategies to achieve positive distinctiveness (i.e. an individual striving for positive self-concept) in the SUG-TR meetings and training environments. The constructed theory extends current research and suggests that SUG-TRs provide unique opportunities for the development of socially valued roles. The limitations and clinical implications of the research are explored and suggestions for further research are presented.