Section A: Critically reviews the literature pertinent to how services are helpful for people diagnosed with borderline personality disorder (BPD). This includes service-user research and evidence based on clinicians' experiences. Relevant theories are discussed and the gap in the current evidence base is provided. Section B: Most research evidence relating to BPD focuses on how specialist psychological models are helpful rather than how mental healthcare services relate helpfully to people with this diagnosis. This study explored this further using grounded theory methodology. Semi-structured interviews were conducted with eight mental healthcare clinicians and eight service-user participants diagnosed with BPD. The results suggested that the most helpful services are those that can form a secure, safe and consistent attachment to individuals with BPD. These services should be accepting and validating where responsibility is shared. Least helpful are those with disorganised attachment styles where themes around dependency, invalidation, and rejection are suggested. Further research would be beneficial to ascertain if these findings are supported by other specialist mental healthcare teams with a more diverse population. Section C: Critically appraises the research project and provides reflections about the research process and how the researcher felt when conducting this research project.

The work comprises of three sections, Section A: Literature review This section reviews men's underutilisation of professional health care services and brings together the extant literature on men's help seeking for psychological difficulties. This is discussed specifically in relation to theories of male gender role socialisation and male development. Section B: Empirical Paper. Introduction: Men’s reluctance to access health care services has been under researched even though it has been identified as a potentially important predictor of poorer health outcomes among men. Male gender role socialisation and male development may be important in accounting for men’s underutilisation of mental health service in the UK. Method: A cross-sectional online survey was used to administer standardised self-report measures that were subject to regression analysis. Five hundred and eighty-one men from the UK general population completed the survey and 434 participants formed the final regression model sample. Results: Men who score higher on measures of traditional masculine ideology, normative alexithymia and fear of intimacy reported more negative attitudes towards seeking professional psychological help. Normative alexithymia accounted for the variance in help seeking previously observed by fear of intimacy during regression modelling. Sexuality and ethnicity also significantly accounted for a proportion of unique variance in men’s help seeking attitudes. People who had received previous support from a mental health professional showed more positive attitudes towards seeking psychological help. Conclusions: Men’s attitudes towards seeking psychological help were closely related to traditional masculine ideology and normative alexithymia. A degree of content or construct overlap may exist between normative alexithymia and fear of intimacy in men. Limitations of this study and implications for future research are discussed. Section C: Critical Review. This section provides critical appraisal and reflection on the study and research process. Personal learning is discussed alongside clinical implications and ideas for further research.

Section A provides a conceptual critical review of the literature pertinent to the consideration of Mothers living with HIV/AIDS (MLWHA), with a particular focus on African mothers. This review first highlights relevant contextual factors, including discussing prevalence rates and the current reconceptualisations of HIV. This is followed by theories and research relevant to MLWHA, whilst considering wider contextual, social and cultural factors. Thirdly, the theoretical links of the reviewed literature to coping models and strategies are made, and specific cultural factors considered. Finally, suggestions for future research are highlighted. Section B provides the findings of a qualitative investigation conducted to explore the experience of African women living in the UK after being diagnosed with HIV during their pregnancy. Twelve participants completed a short demographic questionnaire, and participated in a one-to-one semi-structured interview. The interview was designed to address multiple personal, interpersonal, and systemic issues related to their HIV status, and HIV in the context of motherhood. Data were analysed using interpretative phenomenological analysis (IPA). Themes which emerged included: HIV being part of one’s wider tapestry, community and systemic influences and responses to HIV, experiencing a different story of HIV, and the mother-child relationship. Strikingly, the aspect of HIV that these women reported finding most distressing was their inability to breastfeed, which seemed central to their cultural identity as mothers. While the generalisability of these findings is clearly limited, nevertheless it seems important for clinicians to (i) recognise that HIV may not always be the primary difficulty facing their clients, and may be amongst numerous other factors, (ii) consider systemic and contextual factors, including cultural influences and past trauma, (iii) focus on client resources and capacity for resilience, and (iv) support clients to access local resources, including support groups, (v) attend to issues around confidentiality, disclosure decisions and breastfeeding, and (vi) hold in mind the potentially powerful and helpful affect for these women of witnessing different narratives around HIV. The continuing need to counteract stigma and discrimination, including from health professionals and from the media, was also apparent. Section C provides a critical appraisal and reflection on the research process, including, evaluating what research skills were learned, which research skills the researcher wishes to develop in the future, what would the researcher have done differently given the chance, how will the research shape or inform the researcher’s clinical practice, and what future research related to the studied area would the researcher consider carrying out.

Section A: A literature review was conducted to identify the negative and positive impact that working with adult trauma clients has on therapists. Key theoretical concepts and possible causal mechanisms are summarised and the research evidence supporting these concepts is reviewed. The key limitations to the extant literature and future research are discussed. Section B: Background: Therapists who work with trauma clients are impacted by this work both positively and negatively. However, most studies have tended to focus on the negative impact of the work, the quantitative evidence has been inconsistent, and the research has primarily been conducted outside the UK. Method: An online questionnaire was developed which used a standardised measure to assess compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) in 253 UK therapists working with adult trauma clients. Results: Whilst the majority of therapists scored within the average range for CS and burnout, 70% of scores indicated that they were at high risk of STS. Maturity, time spent engaging in R&D activities, and a higher perceived supportiveness of management and supervision predicted higher potential for CS. Youth and a lower perceived supportiveness of management predicted higher risk of burnout. Higher risk of STS was predicted in therapists engaging in more individual supervision and self-care activities, as well as those who had a personal trauma history. Discussion: These results are discussed in light of previous research. Of particular note is that exposure to trauma stories did not significantly predict STS scores as suggested by STS theory. Contextual and methodological limitations and ideas for future research are highlighted. Section C: A critical appraisal of the research process is summarised which answers the four set questions. A final personal reflection is also given.

Section A presents a literature review of the issues and challenges facing fathers in the postnatal period, in the context of an historical marginalisation of fathers in the study of child development. The review leads to a specific focus on the limited research evidencing the increased risk fathers face to their mental health, when coping with a partner's admission to a Mother and Baby Unit (MBU). Section B Fathers' experience of the joint admission of a partner and child to an MBU has been the subject of limited research, despite initial findings suggesting fathers are at increased risk of postnatal paternal mental health difficulties. This qualitative study aimed to explore the lived experience of fathers in this context, to inform the validity of future research in the area. Interpretative phenomenological analysis was carried out following semi-structured interviews with six fathers in south east England. Five master themes showed that these fathers experienced the onset of their partners' postnatal mental health difficulties as unexpected and traumatic. Fathers needed to acknowledge limits in their ability to help, and the necessity of calling on specialist services. During admission, fathers felt pulled physically and emotionally between managing their own needs, and the needs of their partner and new baby. Themes showing the MBU admission challenged their fathering role and identity were contrasted with the importance fathers placed in treatment needing to be a 'family affair', inclusive and supportive of the father, and mindful of the impacts on the couple relationship. The impact of culture on fathers' adjustment to involvement at the MBU was noteworthy. In conclusion, this research helps understand the importance of including the father where appropriate in a mother's recovery programme, and helping the father define a role alongside the clinical team. The findings of the study validate the efforts of government policy to build effective family focused perinatal services. Section C sets out the journey taken from the ethnographic inception of the research idea, through dilemmas encountered in carrying out the study, to reflections on what was learnt during the process.

Section A provides an overview of the impact of parental mental health difficulties on the person’s family. The current health policies and clinical guidelines in relation to family-inclusive care are discussed, along with research exploring service users’ families' views and experiences of adult mental health services. Studies investigating mental health professionals’ family-inclusive care practices are critically reviewed, followed by a consideration of how psychological theories conceptualise parenthood. The paper concludes by identifying areas for future research in this field. Section B is an empirical paper. Background. Potential negative outcomes for children who grow up with a parent suffering from mental illness are well-documented, including attachment difficulties and later mental health problems. However, research to date has not investigated how therapists conceptualise their clients’ parenthood, with the aim to protect the future mental health of the clients’ children. Aims. To explore how parenthood is considered in therapies provided by psychologists in adult mental health services. Method. In-depth interviews were carried out with psychologists working in adult mental health services in the UK. Thirteen psychologists were interviewed, and the data were analysed using grounded theory. Results. A preliminary model was generated, which comprised of five categories: drivers, therapist factors, psychological theorising, client variables, and risks. The inter-relations between these categories are complex, and the degree of psychologists’ consideration of their clients’ parenthood is based on the nature of such overlaps. Conclusions. Psychologists are skilled at formulating the role of their clients’ parenthood, but do not necessarily address and support this role directly. The reasons for this are multifaceted, but any lasting change in practice is likely to require changes in services’ infrastructures and policies that support family-inclusive practices. Section C provides a critical reflection of the research project by addressing four pre-determined broad questions: the development of my own research skills in the course of the project, how the project could have been improved, how conducting this research has impacted on my own clinical work with clients, and areas for future research.

Section A reviews the literature which has investigated variables found to relate to recovery style in individuals with psychosis. Studies exploring the attachment, self-esteem, depression and executive functioning are evaluated and conclusions drawn. Section B reports the findings of an empirical study investigating the relationship between metacognition, recovery style, anxiety and depression in a community sample of individuals with psychosis. Objective; Research has shown that individuals with psychosis will either integrate their experience of psychosis or seal the experience over. Little is known about what leads to these different styles of recovery but poor attachment, depression, low self-esteem and poor executive functioning have been linked to a sealing-over style. This study hypothesised that sealing is linked to unhealthy metacognitive beliefs and also to higher levels of anxiety and depression. Method; Forty-three participants with a diagnosis of psychosis were recruited. They completed the Metacognitions Questionnaire-30, Recovery Style Questionnaire and the Hospital Anxiety and Depression Scale. Results; Correlational analysis revealed that only one facet of metacognition linked to sealing over; this being positive beliefs about worry and this was maintained when the effects of anxiety and depression were accounted for. Contrary to the hypothesis, recovery style did not correlate with anxiety or depression but unhealthy metacognition was linked to both anxiety and depression. Conclusions; The findings of this study suggest that a sealing-over recovery style may be linked to one specific area of metacognitive dysfunction. They also cast doubt on previous theories which link low mood to a sealing-over style. Limitations of this study include its cross-sectional design. Future research which expands on these findings is encouraged and longitudinal research is particularly called for. Section C provides a critical evaluation of the project, answering four questions regarding what the author has learnt from the study, what might have been done differently, how the study might affect the author‟s clinical work in future and possible future research directions.

Section A reviews the literature related to compulsory admissions under the Mental Health Act (MHA) 1983/2007 of adults presenting with psychosis. It outlines the legal framework and examines empirical data relating to admissions under the MHA 1983/2007. A brief overview of psychosis, its aetiology and key psychosocial models are provided. Consideration of mental health within the legislative framework is offered and the experience of being compulsorily admitted is explored. Finally, further qualitative research is recommended. Section B: The study’s primary objective was to explore the experience and impact of compulsory admissions (under the MHA 1983/2007) on the psychological functioning of adults with psychosis. The study also aimed to develop a preliminary theoretical model. Design: The qualitative ‘Grounded Theory’ method (Glaser & Strauss, 1967) was chosen since it worked inductively from the data and enabled the development of a model. Method: Seventeen participants (eight service-users with psychosis, nine psychiatrists) involved in compulsory admissions were interviewed. Analysis and interviews were undertaken concurrently so initial findings could influence subsequent data collection. Results: Five higher-order categories and 47 categories were identified. These contributed to the development of the ‘A disturbing journey: To and from detention’ model of compulsory admissions. Conclusion: This small-scale qualitative study achieved its objectives, providing a preliminary model and understanding of the compulsory admission experience for adults with psychosis. Key service and clinical implications are discussed. Despite its limitations, the findings indicated scope for further investigation. Section C: addresses four key questions about the study. The first relates to skills the researcher learnt through conducting the study. The second relates to improvements that could be made if conducting the study again. The third relates to clinical implications, and the fourth to further research.

Section A reviews and synthesizes the extant literature on adherence to clinical guidelines, with specific reference to the use of CBT self-help interventions as a mainstay within the IAPT programme. The review also evaluates the utility of one psychological framework, namely the theory of planned behaviour (TPB), in assessing the cognitive factors that may be most associated with compliance in this context. The review ends by suggesting an avenue for future research. Section B In spite of evidence for their efficacy and effectiveness as well as the recommendations of NICE, CBT self-help materials are not used routinely or used as an intervention in their own right in mental health services. Aims: This cross-sectional study set out to assess whether the main constructs of the TPB, namely, attitudes, subjective norms (SN) and perceived behavioural control (PBC), as well as past use, self-help training and demographic characteristics, could predict IAPT psychological well-being practitioners’ (PWPs) intention to use CBT self-help materials in their clinical practice. Method: A convenience sample of PWPs (n=94) completed a web-based, mixed closed and open-response questionnaire, which was developed from an earlier elicitation study with a sub-sample of their colleagues. The data generated were analyzed by linear, multiple regression, mediation, and qualitative analyses. Results: The TPB’s main constructs predicted PWPs’ intention to use self-help materials in their clinical work, with attitude being most significant. Past use of self-help materials emerged as both a direct predictor of intention, as well as indirectly related to intention, independent of the mediating effects of the main constructs. The overall extended TPB model explained a respectable 70% of the variance in intention. However, neither self-help training nor demographic factors were associated with PWPs’ intention. Conclusion: It is recommended that future research could extend the methodology to prospective, longitudinal investigations of PWPs’ actual use of self-help materials. It is hoped that this would further elucidate the cognitive factors that are involved in PWPs’ decision-making when they are actually using the materials. Section C sets out and answers four specific questions that guide a reflective critical appraisal of the processes involved in the execution of this research project.

Section A consists of a critical review examining the research evidence relating to the effectiveness of reflective practice groups for staff in psychiatric inpatient settings, and the role of psychologically trained practitioners in providing facilitation using psychological formulations. Section B. The role of applied psychologists working in inpatient services is developing with a greater emphasis on providing support and consultation to staff teams. The research suggests that psychologically trained practitioners who facilitate reflective practice groups using psychological formulations can assist staff in developing a deeper understanding of patients’ difficulties, with the potential for improved treatment outcomes. This study aimed to address some of the gaps in the research by exploring the experiences of acute psychiatric inpatient ward staff attending reflective practice groups facilitated by psychologically trained practitioners. Using semi-structured interviews, nine multidisciplinary staff from four acute wards participated in the study. Grounded theory methodology was applied to investigate how staff experienced, processed, and operationalised psychological knowledge in their clinical practice. The results suggested staff increased their psychological understanding through a process of guided reflection, development of theory-practice links, and validation. This enhanced a capacity for mentalization, which generated a more compassionate and empathic stance. The clinical, theoretical and research implications are presented. Section C presents a critical appraisal of the research process.