Counselling psychology, with its humanistic value base and adherence to certain aspects of the medical model, is in a positional dilemma on issues such as diagnosis. There seems to be a current need to define counselling psychology’s epistemological position due to doubts about its independence as a profession. How counselling psychologists respond to diagnosis has been tentatively explored in the literature, but responses in terms of thoughts, feelings, perceptions, and their interpretation of these responses is absent. To address this gap, semi-structured interviews were carried out with six counselling psychologists and the interviews were analysed using Interpretative Phenomenological Analysis (IPA). Two themes were identified: ‘diagnosis is something to hang your hat on,’ and ‘the bigger picture.’ Like previous research, these themes highlight the different epistemological positions taken up by counselling psychologists on diagnosis. However, the current findings also describe the lived experience of holding these different positions; for example feelings of tension are expressed and the level of uncertainty that needs to be tolerated is explored. A suggestion is made in terms of defining this changeable position, as one of safe uncertainty (Mason, 1993), in order to facilitate clear communication regarding a position. Specific recommendations are made for research, training and practice, including: the need for tolerance of uncertainty to be made more explicit on counselling psychology training programmes; suggestions for further IPA and Grounded Theory Research; and the development of a special interest group has been suggested, where counselling psychologists and other professionals can share ways of managing the impact of diagnosis on their practice.

South Asians (SA) are a high-risk group for cardiometabolic disease, which is partly attributed, to their ‘thin-fat’ body composition (BC) phenotype. Generally, SAs have a higher % fat mass (FM) and less skeletal muscle mass (SMM), together with a more abdominal distribution of body fat, compared with white Europeans (WE) at equivalent body mass index (BMI) values. SAs also tend to have a shorter adult stature. Effective paediatric monitoring and clinical management requires improved tools for assessing body fatness and other components of BC. This is partly due to BMI being regarded as an inadequate indicator of adiposity and SMM, particularly for SAs, thus other field-based measures of BC have been investigated. In addition to BMI, several UK BC references for WE children and adolescents are available, including WC, %FM, and SMM; however, there are no similar references available for their SA counterparts. This thesis is comprised of four key studies in which ethnic variations in BC (%FM and appendicular SMM (SMMa)), WC, and leg length (LL) in particular relative LL (RLL) between SA and WE children and adolescents (aged 5-18y) were investigated. The core aim was to develop age- and sex-specific percentile references for %FM, SMMa, and WC for the SA ethnicity. In study one, the BC418 bioelectrical impedance analyser (BIA) was validated against DXA for field-based BC assessment, in a sample of SA children (n= 53; 5-21y) to develop an ethnic-specific prediction equation for FM, FFM and SMMa determination, as prior studies have found BIA underestimates %FM in SAs. This equation was found to be only valid for children ≥9y, which was attributed to the opportunistic nature of recruitment. It was concluded that no single equation was valid across the whole child and adolescent population. This equation needs to be tested in an independent group to confirm its accuracy and functionality, prior to wider application. Due to discrepancies in DXA weight and scale weight, it was not possible to develop a prediction equation for SMMa, although the existing BIA output was considered acceptable due to the very small between-method relative differences. In study two the new BIA prediction equation was applied to a large SA dataset of children (n =1,624) from low-income communities. Compared to UK90 (SDS) reference data, both SA girls and boys (9-14y) were significantly shorter, lighter, with a lower mean BMI and WC compared with their WE counterparts, with no significant differences in %FM. %FM and SMMa reference curves were constructed and comparisons were made between published WE (from affluent areas, WE1) reference curves, together with a low-income cohort (WE2). Comparisons in %FM at the 50th centile, between the SA and WE cohorts revealed that SAs had greater %FM overall, and this difference increased after application of the new equation. Similarly, across all age ranges SAs had significantly less relative SMMa than their WE counterparts. The third study generated SA sex- and ethnic-specific WC centile curves. SDS comparisons with the WE2 cohort revealed SAs had a significantly lower mean WC than their WE2 counterparts. It was concluded that, as WC acts as a proxy for visceral fat, ethnic-specific cut-offs similar to those adopted for adults in India should be considered for children. The final study on LL revealed that SAs had a longer RLL than WE children, although as RLL data for WEs was derived, this would require further verification. The outcomes from these studies provide the evidence base and assessment tools to support the use of ethnic-specific references for children and youths in the UK from a SA background. The findings in this thesis demonstrate that overweight and obesity vary across different ethnic groups and this variation needs to be considered in the context of the clinical referral for individual children as well as for population surveillance. These are the first set of reference percentile charts for BC, proportions and dimensions in the UK SA paediatric population. Our findings support the use of these ethnic-specific references that go beyond BMI as an indicator of obesity-related metabolic health risk.

This study qualitatively explores the experiences of six counselling psychologists working with children and adolescents with regards to philosophy, policy, training, practice and professional identity. Interpretative Phenomenological Analysis was employed to analyse participant data. Participants were HCPC accredited counselling psychologists in individual clinical practice with clients aged 0-19. Participants worked in primary care, private practice or 3rd sector practice. Recruitment was through the Counselling Psychologists UK Facebook page, The Division of Counselling Psychology (DCoP) annual conference and a special interest group of the DCoP. Four superordinate themes emerged from the data: 1) ‘Personal and professional growth and development in working with children’ - exploring the value attained from trainee placements and the significance of wider professional support; 2) ‘Working with children is “a different ball game”’ - describing how clinical work with children and adolescents differs from work with adults; 3) ‘Developing a professional framework for working with children’ - exploring the importance of taking a developmental approach and working with the clients’ lived experience; 4) ‘Opening the doors to counselling psychologists working with children’ - exploring the construction of identity through professional development. Participants seemed to take pride in working in a niche area of the profession and felt that counselling psychology could make a unique contribution. However, challenges and difficulties during training and post-qualification appeared to raise the question as to whether working with children was seen as being outside the boundaries of the role of a counselling psychologist.

Background: Identity and health status have been linked in the extant literature, but the lived experience of depression in Black and Minority Ethnic (BME) women in the UK is an under researched phenomenon. This study therefore aimed to gain an in-depth understanding of the experience of depression in a small group of UK based BME women using Interpretative Phenomenological Analysis (IPA), affording the ability to describe, explore and provide an idiographic analysis of this lived experience. Method: Semi-structured interviews were conducted with a purposive sample of five BME women with experience of depression. Participants provided detailed accounts of how they made sense of their experience. Interviews were audio-recorded and verbatim transcripts of the interviews were analysed using IPA. In keeping with the underpinnings of IPA the researcher’s personal and epistemological reflexivity is embedded throughout to demonstrate greater transparency and demonstrate how IPA was applied in practice. Results: The analysis produced two master themes; ‘Cultural Expectations and Depression: “I just need to be me”’ and ‘The Nature of Depression: Agency, Façades and Coping’. The first theme captures how identity conflicts led to isolation for the participants, heightened stress and exacerbated or brought on depression. The experience of being a minority was considered and how this can cause stress, impacting on the ability to cope with adversity and influence perceptions of mental health. The second theme explored perceptions of the nature of depression and the stress of managing physical complaints. Participants adopted a range of coping strategies such as presenting with façades and resilience which impacted on help-seeking behaviours, diagnosis and management of their depression. Discussions around experiences of taking antidepressants served to highlight the importance of the understanding of medication for lay individuals and their implications for treatment adherence. Conclusion: The central finding of this research is that the experience of depression for BME women in the UK is heavily influenced by identity, cultural factors, minority status and pressures of societal norms. This research expands on the extant literature on the relationships between stress, coping and health, illuminating the essence of the lived experience of depression. The recommendations of this research include the need for health practitioners to better understand variabilities in the experience of depression among BME women in the UK (considering ethnic identity and culture) and the need for them to seek to work with individuals in a co-productive way. There is a need for the development of high quality, personalised services which engage with harder to reach communities along with health promotion campaigns and health services to support enhancing the health literacy of BME women with depression.

Ending therapy well is widely acknowledged as crucial for therapeutic gains to be maintained over time, yet numerous authors comment on the paucity of termination research. There appears to be no extant research into counsellors’ experiences of ending time-limited counselling in primary care (CPC), despite this being a rapidly-expanding area of practice, and theoretical literature suggesting elevated stress levels, ideological battles and burnout as counsellors adjust to time-limited working within Improving Access to Psychological Therapies (IAPT) services. When the ‘hallmark’ of a good ending is mutual agreement concerning client readiness, to what extent do traditional models of termination still hold? The aim of this research is provide some preliminary understanding of counsellors’ experiences of endings within this context. A qualitative design was employed. Data were collected in semi-structured interviews with six counsellors, and analysed using interpretative phenomenological analysis (IPA). Four overarching themes emerged: ‘self-experiencing’, ‘the quality of the therapeutic process’, ‘conflicting frameworks’, and ‘towards congruence’. These are related to wider literature and implications for counselling psychology (CoP) are discussed. Limitations and suggestions for future research are explored.

Behavioural Family Therapy (BFT) as a family intervention has previously been evaluated, with specific attention to its effectiveness in reducing relapse rates in psychosis. Less research, however, has focused on the subjective experiences of having BFT and no known research has explored fathers’ experiences of BFT. More generally, limited research has explored fathers’ experiences across other types of family therapy. This is interesting in the light of theories suggesting fathers benefit from family approaches and are considered to play an important part in them (Martin, 1977). A gap in contemporary literature provided a solid rationale to explore this concept further. This research represents an original investigation into the subjective experiences of fathers who have participated in BFT. Semi-structured interviews were carried out with five fathers to explore their experience of BFT. Interpretative Phenomenological Analysis (IPA) was used to analyse verbatim transcripts which generated three themes: Fathers’ Reflections prior to BFT, Fathers’ Reluctance about BFT and Fathers’ Positive views of BFT. The results were considered in relation to existing research in this field, with reference to counselling psychology philosophy. The findings highlighted specific reservations fathers have about the process of family therapy, and drew attention to the significance of engaging fathers in family interventions. This study contributes to knowledge by considering how the above themes inform counselling psychology, other clinical practice, service provision and training. The implications for future research are also discussed.

A recent systematic review suggests the effectiveness of Cognitive Behavioural Therapy (CBT) with brain injury client groups has been inconclusive and limited (Cattelani, Zettin & Zoccolotti, 2010). Although CBT has beneficial results in many specific psychiatric disorders, the rates of positive outcomes for managing psychological difficulties in the acquired brain injury (ABI) client group are still not satisfactory. Mixed or negative results have been reported in the existing literature (Cattelani, Zettin & Zoccolotti, 2010). Indeed, recent literature has highlighted a need to further develop existing CBT approaches for clients with ABI (Wilson, 2011), to assist practitioners in overcoming potential challenges caused by the complexities faced in this field. This qualitative study explores ABI clients’ experiences of CBT to provide better understanding of what may produce a greater therapeutic alliance and positive outcome. Six participants with ABI were interviewed in a semi-structured format about their experiences of CBT. Interpretative Phenomenological Analysis (IPA) was employed to develop an in-depth and coherent understanding of participants’ experiences. Three super-ordinate themes were identified namely, ‘Professional relationship’; ‘Understanding my struggles’; and ‘Acceptance’. Each super-ordinate theme was associated with three sub-themes. Findings of the present study highlight the essential elements for the effectiveness of CBT. These elements are the quality of the therapeutic relationship, the client’s willingness and readiness to engage in therapy, the adaptations needed in therapy to address the client’s limitations, and the need for a balanced focus between the behavioural and cognitive components employed in therapy. Furthermore, findings imply that process-based adaption is as important as technique-based adaption when delivering CBT to ABI clients, suggesting that the quality of therapeutic relationship and the process issues are both relevant to the therapeutic outcome.

During the period of recovery from drug and alcohol misuse the individual starts to move gradually away from former habits and patterns of thinking whilst learning new skills, however returning to a normal diet can be challenging for many recovering substance misusers. Studies involving substance misuse have mainly focused on weight changes and eating behaviours during active substance addiction, whilst research on how substance misusers experience weight changes and how they describe the functions and meaning of food and eating behaviours in recovery from substance addiction is scarce. This is a qualitative study using a constructivist grounded theory approach which aimed to explicate the experiences of food, eating and weight changes from eight women in different stages of recovery (ranging from early, mid and late recovery) from drug and alcohol addiction. The areas identified from ‘the meaning of food’ included: substituting alcohol with food, structure and social benefits. The areas identified from ‘weight changes’ included: weight gain and weight loss, and the areas identified from ‘eating behaviours’ included: distorted eating and dieting. The findings lead to an emerging theory that indicated: ‘Food during recovery involved providing structure to the day, enjoyment of social eating and substituting alcohol with food, particularly sugar rich foods during early recovery to 1. Replace the substances by filling a void, 2. Satisfy the cravings and urges experienced from the substances and 3. Experience a change in mood. The excessive intake of sugar rich food caused weight gain and in turn resulted in dieting and distorted eating behaviours later in recovery’. The theory that emerged from this research should prove useful to substance misuse facilities in order to enhance and incorporate nutrition education into treatment programmes to address food, eating and weight issues faced by women in recovery from substance addiction.

Binge Eating Disorder (BED) appears to have a fairly equal prevalence in men and women. However, men with BED have been overlooked in research as studies have mainly focused on women. As a result, there appears to be a limited understanding of men’s experiences and treatment needs of BED, including from a Counselling Psychology perspective. A qualitative study was undertaken to explore men’s experiences and understanding of BED including their experiences in seeking, accessing and receiving treatment. Semi-structured interviews were carried out with six men who had a diagnosis of BED. Data was analysed using Interpretative Phenomenological Analysis resulting in four super-ordinate themes: the experience of BED; the process of understanding; the stigmatised male self and the experience of treatment. The experience of BED was described as a divergent experience of negative and positive facets, characterised by a futile struggle to control their eating. The men described living a constrained life with BED similar to living in an inescapable trap. In trying to make sense of their BED, the men discussed the function of BED in their lives and they compared BED to an addiction. The experience of BED in men encompassed feelings of isolation and stigma due to having what they perceived as a female and/or homosexual disorder. These men discussed their strong adherence to male stereotypes of masculinity and having BED was perceived as unacceptable and emasculating. The participants’ struggles with treatment were emphasised as they sought to find unavailable support and received what they felt to be inadequate treatment care. The applicability of these findings for professional practice and Counselling Psychology practice are discussed and include exploring men’s recommendations towards tailoring treatment to meet their needs, for example all-male group therapy and addressing masculinity and stigma.

Counselling psychology’s Professional Practice Guidelines state that "counselling psychologists will consider at all times their responsibilities to the wider world". (Division of Counselling Psychology, 2005, p.7). It is suggested that the way in which counselling psychologists construct their relationship with the wider world could impact on practice, training, research and counselling psychology professional identity. A critique of the extant literature found that this issue has not previously been researched. Five counselling psychologists were asked in semi-structured interviews about their responsibilities to the wider world. Foucauldian Discourse Analysis was applied to the transcript of the interviews. Different constructions of the relationship between counselling psychology and the wider world were identified in the transcript and located in four wider discourses: professionalism, scientific, social activism and guru. Common themes across responsibilities constructed by participants utilising the different discourses included: the wider world being outside of the consulting room; difficulties defining responsibilities; and responsibilities being weighty. Responsibilities to communicate knowledge were constructed using three of the discourses. Both the guru and scientific discourses were mobilised to construct responsibilities to engage with technologies of the self (Foucault, 1988). In contrast the professionalism discourse was used to construct a responsibility to perform to others in order to appear professional. The implications of these constructions for counselling psychology, and the discourses mobilised by participants, are discussed.