This portfolio thesis comprises of three main parts. Part one is a systematic literature review entitled, "Response to & Factors Associated with Coping in Early Pregnancy Loss – A systematic Review of the Literature." Part two of this portfolio presents an empirical paper based on the research project designed and carried out by the author. This is entitled, "An Exploration of Psychological Distress in Women Following Ectopic Pregnancy." The purpose of this study was to investigate levels of psychological distress within this client group and explore women's experiences of having had Ectopic pregnancy. Part three comprises of the appendices.

This portfolio has three parts: Part one is a systematic literature review in which the theoretical, conceptual and empirical literature relating to the impact of initial weight-related expectations on weight-loss and related outcomes is explored. Part two is an empirical paper exploring the relationships between self-efficacy and illness cognitions with the outcome variables of weight-loss, physical and mental health status, and individual perception of outcome. Part three is comprised of the appendices.

This portfolio thesis is comprised of three parts; a systematic literature review, an empirical study and a set of appendices.

<p> Depression is a serious condition experienced by many individuals diagnosed with coronary heart disease (CHD). Depression after CHD diagnosis has been associated with poor cardiac prognosis, cardiac mortality, and is postulated to influence adherence to physician recommendations, including attendance at cardiac rehabilitation programs. Cardiac rehabilitation (CR) is an empirically supported secondary intervention for cardiac patients and is recommended by the American Heart Association (AHA) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) to reduce disease progression, however many CR participants do not complete. A number of studies have investigated depression and phase II CR programs. The goal of the current systematic literature review and meta-analysis was to explore the association between depression and phase II CR completion. A literature search cross-referenced three electronic databases (PsycINFO, MEDLINE, <i>Dissertation Abstracts International</i>) up through December 2014. Studies quantifying an association between depression and phase II CR completion were reviewed. After duplicate studies were removed and study inclusion criteria applied, 17 observational studies with 19 independent samples consisting of 30,586 cardiac patients remained for meta-analysis. A random-effects model found a moderate inverse relationship between depression and phase II CR completion (<i>g</i> = -.44, 95% CI -.59 to -.29), indicating that depressed CR patients were significantly less likely to complete their program. A minor amount of publication bias was detected with a funnel plot and trim-and-fill analysis. No significant moderator variables were detected.</p>

There is a lack of knowledge about the effects of social and cultural context on partner abuse. This qualitative study uses interviews to explore the perceptions, experiences and relational interactions of 20 women with current psychological abuse from intimate partners, taking into account social and cultural context. Women were recruited from primary care practices in Hackney, east London and also from community groups and by adverts and snowballing. Semi-structured interviews were conducted with participants, following recruitment and in 12 cases also at four to six months after this. Interviews aimed to elicit rich narratives from the women, using open-ended questions. Eleven white British, five Caribbean and four African women were interviewed. The study took a social constructivist approach and was underpinned by symbolic interactionism. Analysis included a consideration of the similarities and differences across cultural and ethnic groups. All 32 interviews (from both first and second interviews) were audiotaped, transcribed, and analysed using grounded theory. Conceptualisations drew on Gillis’ and Smart’s work on social norms, Goffman’s approach to dramaturgy, and developments of aspects of Goffman’s work by Hochschild and Cavanagh in particular. This revealed the work the women did in setting up and managing their roles, identities and experiences, particularly gender and emotions work and the way they set and shifted boundaries in the relationship.

The portfolio has three parts. Part one is a systematic literature review, in which the empirical literature relating to self-defining memories is reviewed. The term 'self-defining memories' which was first coined by Singer and Moffitt (1991-1992), refers to a subcategory of autobiographical memories that are of important events in our personal histories that we believe define who we are (Singer, 2005). The systematic literature review presented in this portfolio examines which factors may affect the recollection of SDMs recall in terms of the types of memories recalled, but also the experience of recalling such poignant memories. Part two is an empirical paper, which explores the how changes in mood may affect the recollection of self-defining memories. This investigation uses laboratory induced changes in mood to examine how mood variation may affect the thematic content, and affective response to SDMs in a group of individuals with bipolar disorder, and nonclinical controls. The findings suggested partial support for the hypotheses that mood does influence the type of SDMs recalled, affective responses to memories, and perception of positive self when thinking of the memories. However, contrary to predictions, the effect of mood was not found to differ between individuals with bipolar disorder and non-clinical controls. Interestingly, this study found that individuals with bipolar disorder recalled memories that contained themes of a disrupted sense of identity, or acting out of character, when by their nature, SDMs are meant to reflect events that an individual feels defines who they are rather than who they are not. Part three comprises the appendices. This part contains additional information relating to the literature review and empirical paper, including information about ethical approval.

A series of three studies was conducted to investigate burnout in counsellor/therapists working with the National Counselling Service (NSC) in Ireland. The NCS was established specifically to meet the needs of adult survivors of institutional abuse. and providing a service for such clients may be very challenging. In Study I, which included 26 NCS counsellor/therapists over a period of a year, mean levels of depersonalisation, but not emotional exhaustion or personal accomplishment, increased significantly. Only 12% were in the high or clinical range for depersonalisation on the Maslach Burnout Inventory at Time 1, but 34.6% were in the high range a year later at Time II. There was a significant increase over a one year period in the number of therapists reporting that work was having a negative effect on their personal lives. The most stressful aspects of therapeutic work were the content of therapy sessions; feeling isolated and lacking support; and working with highly traumatized clients. The main negative effects of therapeutic work on therapists' lives were emotional exhaustion, sadness, and mood spillover. The main positive effects were admiring the resilience of clients and developing increased humility. In Study II, which involved 35 NCS counsellor/therapists, the impact of therapist, client, organisational, and extra-organisational factors on burnout was examined. The use of image distorting defenses was found to be associated with emotional exhaustion and depersonalisation. The percentage of cases improved was also negatively correlated with depersonalisation. On the positive side, therapist empathy for clients was associated with increased experience of personal accomplishment. Study III was a qualitative focus group investigation involving 8 NCS therapist/counsellors. A thematic content analysis identified three factors associated with spillover. These were the stigma associated to working with survivors of child abuse/neglect; the power of a client's narrative; and challenges to the boundaries of the therapeutic relationship. Three themes were identified concerning methods for managing spillover. These were separating from a client; developing and using personal energy renewal routines; and channelling of work intrusions when at home. Implications for the results of the series of three studies for an ecological model of therapist burnout, and for NCS therapist/counsellor support and supervision were discussed.

This research project examines the impact of therapeutic performance-making within Dramatherapy practice for clients with schizophrenia. 'Dramatherapy Performance', a specific model of therapeutic work which is defined and presented here, consists of the clients' construction of a performance through a therapeutic process and its presentation to an invited audience of their Significant Others. The context of existing evaluation methods in Dramatherapy concerns either the development of the clients' abilities within a group process, such as role-playing or dramatic involvement, or the change of the clients' symptoms after a groupwork as measured by existing psychometric scales. However, no specific method of evaluation of performance-making to be used within clinical practice has been constructed yet. For this reason a new instrument for evaluating this model of work was formulated, namely the 'Dramatherapy Performance Evaluation', which derives from a combination of psychiatric and theatre semiotics. This instrument is inspired by Aristotle's 'Poetics', used for the first time for assessment in Dramatherapy and analyses the structural elements of a performance in relation to the clients' schizophrenic psychopathology. Furthermore, this project examines the effect of a 'Dramatherapy Performance' on the clients' overall psychopathology, and their relationship to self and others. A clinical trial conducted in a Day Hospital for young adult clients with schizophrenia allowed a qualitative evaluation of the therapeutic process as well as quantitative measurements of the clients' symptom change. The outcomes of this project suggest that 'Dramatherapy Performance' has a significant effect on the clients' dramatic involvement within the group process, on the decrease of their overall 'negative symptomatology', on increasing their 'competence and efficacy' and on changing their perceived support from their significant others. The 'Dramatherapy Performance Evaluation' showed the importance of the performance's unifying cathartic structure as well as demonstrating how non-verbal therapeutic processes reinforce the impact of verbal processes. It also distinguished the usefulness of collective techniques - such as participation in a chorus - for the less functional clients as opposed to character work for the more functional clients. This research confirms the value of 'Dramatherapy Performance' as a treatment for specific schizophrenic symptoms, in addition to medication, and provides Dramatherapy practice with a new and useful instrument for the evaluation of both the therapeutic process and the progress of clients with schizophrenia.

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Anxiety is known to run in families and evidence suggests there is a high correlation between parent anxious cognitions and child anxious cognitions. It has been suggested that parental expectations of their child‟s anxiety may mediate this relationship. This systematic literature review aimed to investigate the relationship between parental expectations about their child‟s anxious cognitions and child anxiety. PsycInfo, Web of Science, Scopus, and the Cochrane Library were searched. Ten articles met the inclusion criteria. The review found support for the relationship between parent expectations of their child‟s anxious cognitions and child anxiety. Parental expectations also appeared to develop over time and within a reciprocal relationship with child cognitions. However, due to the limited data, methodological flaws, and heterogenity of the studies, firm conclusions could not be made. This area warrants further research. The limitations of the review are discussed.