Paper one is a metasynthesis of studies exploring mothers' experiences of recovery from postnatal mental illness. Four databases were systematically searched using key words and index terms to identify the qualitative literature exploring mothers' experiences of recovery from postnatal mental illness. Fourteen studies met the inclusion criteria and were critically appraised and synthesised. These papers reported the views of 395 women's experiences of recovery from postnatal mental illness. Five core themes emerged from the synthesis to describe four key processes that facilitate recovery. This experience begins with recognising the problem through crisis and relational distress. Women then go through the process of seeking help which consists of subthemes of accepting help and help to access help. The next process in the in the journey is achieving recovery which includes subthemes of sharing with others like me, coping strategies and noticing recovery. The final process of maintaining recovery consists of incorporating coping strategies into daily life; acquiring a different model of motherhood and processing the experience. The role of the family was interwoven through each stage of recovery. Recommendations were made for professionals who come into contact with this group of women and their families. The review highlighted gaps in the existing evidence and made recommendations for future research. The findings and limitations were discussed with reference to the existing literature. Paper two explored the role of the baby in 12 mothers' experiences of recovery from psychosis after childbirth. A thematic analysis of the data identified three core themes that described the role of the baby in the mothers' recovery. Findings revealed that the baby was central to women's recovery and could be experienced as both helpful and unhelpful. The baby interacted with the mother; increasing self efficacy and reducing emotional distress. The baby could act as a barrier to recovery by increasing the women's emotional distress and hindering access to help and self care. The findings recommended that women receive specialist treatment in mother and baby units where they can access interventions that support parent-infant interactions. The findings of the study add to the existing evidence base on recovery from psychosis after childbirth and highlighted areas for future research. Paper three is a critique of the research carried out in Papers one and two. This paper discussed the rationale for the research design in both papers. Approaches to data sampling and data analysis are reviewed with reference to researcher reflexivity. The search strategy and critical appraisal of techniques of the metasynthesis are also critiqued. Paper three closes with personal reflections and conclusions drawn from both papers.

The thesis sought to explore the experience of caring for an individual with an eating disorder. It is comprised of three standalone papers. Paper one and two have been prepared for submission to a journal and in accordance with the journal guidelines. Paper one is a systematic literature review synthesising qualitative studies relating to the experience and impact of caring for, or living with an individual with an eating disorder. Databases were systematically searched and twenty studies were included in the review. Nine core themes emerged from the meta-synthesis. Eating disorders were found to have a pervasive impact on family members mediated by a number of factors. Cognitive appraisals affected the caregiving experience and responses to the individual. The experience of caregiving was continually reappraised leading to a process of adaptation over time. Paper two is a qualitative study which sought to examine caregivers’ accounts of managing Anorexia Nervosa with an emphasis on accommodation responses. Eight participants were interviewed and transcripts were analysed using a grounded theory approach. A theory of the processes by which accommodation responses operate was developed which emphasised the importance of caregivers’ emotional resources in mediating responses. Difficulty managing anorexia nervosa led to low perceived efficacy and diminished resources. Subsequently caregiving aims shifted in line with accommodation responses. Carers recognised accommodation as counterproductive to recovery and experienced internal conflict (dissonance) which was reduced using a number of cognitive and behavioural strategies. The clinical implications of the findings are discussed with reference to existing literature. Paper three is a critical review of the research process, focusing on the experience of undertaking qualitative research. Personal reflections of the process, as well as the implications of the research for the researcher’s professional practice and for the wider profession are discussed.

This thesis explores the experiences of men in the context of pregnancy and fatherhood using qualitative methodologies. It is presented as three papers, 1) a literature review; 2) an empirical study and 3) a personal and critical reflection of the processes involved in conducting the research.The literature review contains a systematic review of qualitative studies pertaining to men’s experiences during their partners’ pregnancy. The findings of 13 studies were synthesised to develop a comprehensive understanding of the phenomenon and to offer new insights. Noblitt & Hare’s (1998) approach was used to construct five overarching themes which housed a total of 10 sub-themes. The synthesis is the first of its kind which solely focuses on men’s experiences of pregnancy; the inter-related themes represent a temporal trajectory, from early to late pregnancy, of the emotional, psychological and social changes that men may experience during their transitory journey. Similarities between the experiences of fathers and mothers are also highlighted, and are used to inform the clinical recommendations made for health visitors and midwives in providing antenatal services.The empirical study is a qualitative investigation into the lived experiences of 10 first-time fathers during their first year; it is based on Interpretative Phenomenological Analysis (IPA; Smith, 1996). Through in-depth semi-structured interviews, six super-ordinate themes were identified which contained a total of 21 sub-ordinate themes which composed a detailed description and thorough understanding of the participants’ personal worlds. The findings support the existing literature as well as offer new insights; using contemporary Transition Theory (Draper, 2003) as a theoretical framework, the birth of a man’s baby does not mark the start of his transitional journey but a continuation of it, with many experiences carrying over from pregnancy into parenthood. Participants talk about the type of support they would have valued in the antenatal period. Recommendations are made as to how antenatal services can be adapted to meet the needs of expectant fathers and mothers. The findings are particularly relevant to clinicians who routinely work with expectant couples, as there are similarities as well as differences between the experiences and needs of fathers and mothers. The third paper is a personal and critical reflection the processes involved in carrying out the research project. It contains critical discussions on the various aspects of the research including, rationale for chosen qualitative approaches, epistemological assumptions, recruitment issues, the interviews process, data analysis. Interwoven throughout this paper are personal reflections which draw parallels between the theoretical processes and practical skills used as a researcher conducting qualitative research and as a clinical psychologist. The paper highlights how the author has developed as both a researcher and clinician. When held in mind and used appropriately, the skill set of researcher and therapist can be used in synergy to complement one another.

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The current research was designed to add to the youth sport coping literature by examining adolescent athletes’ stressor appraisals and coping and to understand the way in which athletes learn to cope. Two studies were conducted. Study one was a metastudy (Paterson, Thorne, Canam, & Jillings, 2001) of the qualitative research on stressor appraisals and coping among adolescents in sport. Following database searches, 20 studies were retained for analysis. Meta-data, meta-theory, and meta-method analyses were conducted followed by a final meta-synthesis of findings. Analyses produced four themes: contextual and dynamic stressor appraisals, contextual and dynamic coping, coping resources and processes of acquisition, and social networks as assets and liabilities. These findings highlighted the need for precise use of theory in the study of coping. There was also scope for greater methodological diversity to advance our understanding of coping among adolescent athletes. The second study examined how adolescent athletes learn to cope and the role of social agents (e.g., parents and coaches) in adolescent athletes’ acquisition of coping skills. Grounded theory methodology was used (Corbin & Strauss, 2008). Interviews were conducted with 17 athletes (8 females, 9 males, Mage = 15.6 years), 10 parents (6 mothers, 4 fathers), and 7 coaches. Learning to cope was an experiential process consisting of the athlete – sport experiences and learning through trial and error, reflective practice, and coping outcomes (consistent performance, independence in coping, and persistence in coping). Learning was facilitated by athletes being exposed to multiple situations and reflecting on their coping efforts. Parents and coaches helped athletes learn to cope by creating a supportive context for learning and by using specific strategies to help athletes learn to cope. This research highlighted the importance of the social context as adolescent athletes learned to cope with stressors in sport and identified specific mechanisms by which parents and coaches influenced the development of coping among young athletes.

The present study has how object of study the adjectives the work of Vygotsky received in Brazil, and having major field of study the scientific productions of psychology. aimed to perform a meta-synthesis of Brazilian production, and specifically, catalog the academic literature that uses the adjectives the work of Vygotsky, characterize the products of the field of psychology, identify if there are reports of Vygotsky summaries, characterize the concepts of adjectives used in the productions, provide subsidies to reflect the advances this theory and trace the historical trajectory of its course. For this we carried out a meta-synthesis of academic productions in Brazilian graduate in the years 2007-2011, the bench theses and dissertations from CAPES. The procedures are characterized by contextualization of production per area of knowledge, where four descriptors, socio-historical, socio-cultural, historical-cultural and historical-social were used; identifying the production of psychology; and by analysis of summaries, coupled with different spellings of the name of the author. Finally, we performed a theoretical analysis section theses marked with the socio-historical adjective coupled with different spellings of Vygotsky. The results indicate that the knowledge area with the highest number of productions in all adjectives is that of education. The field of psychology has a larger number of productions with the socio-historical adjectives, placing second in the historical-cultural adjective. The sociocultural and socio-historical adjectives show no approach to Vygotskian theory for examining abstracts. The spellings used more in psychology were: Vigotski and Vygotsky. The spelling and adjectives adopted feature was pending very emphasized aspects with preponderance theme aspects the Vygotskyan theory. The concepts of adolescence and / or youth, affection, ZPD mark discussions of theses analyzed, which linked to these concepts emphasize the use of the term socio-historical as fundamental to understanding the themes discussed, since this term indicates a overcoming the biological parameters as definitive. / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente trabalho tem como objeto de estudo as adjetivações que a obra de Vigotski recebeu no Brasil, tendo como área principal de estudo as produções científicas da psicologia. Objetivou realizar uma metassíntese da produção brasileira, e especificamente, catalogar a produção acadêmica que se utiliza das adjetivações da obra de Vigotski, caracterizar as produções da área da psicologia, identificar se há referência de Vigotski nos resumos, caracterizar os conceitos das adjetivações utilizadas nas produções, fornecer subsídios para reflexão dos avanços desta teoria e traçar a trajetória histórica de seus rumos. Para tanto, realizou-se uma metassíntese das produções acadêmicas na pós-graduação brasileira nos anos de 2007-2011, no banco de teses e dissertações da CAPES. Os procedimentos se caracterizaram pela contextualização da produção por área de conhecimento, onde foram utilizados quatro descritores, sócio-histórica, sócio-cultural, histórico-cultural e histórico-social; pela identificação da produção da psicologia; e pela análise de resumos, combinada às diferentes grafias do nome do autor. Por último, realizou-se a análise do capítulo teórico das teses demarcadas com a adjetivação sócio-histórica combinada às diferentes grafias de Vigotski. Os resultados indicam que a área de conhecimento com maior número de produções em todas as adjetivações é a da educação. A área da psicologia possui maior número de produções com a adjetivação sócio-histórica, ficando em segundo lugar a adjetivação histórico-cultural. As adjetivações sócio-cultural e histórico-social não demonstram aproximação com a teoria vigotskiana pela análise de resumos. As grafias mais utilizadas na área da psicologia foram: Vigotski e Vygotsky. A grafia e as adjetivações adotadas apresentam-se enquanto aspectos não muito enfatizados, tendo preponderância os aspectos temáticos relacionados à teoria vigotskiana. Os conceitos de adolescência e/ou juventude, a afetividade, ZDP marcam as discussões das teses analisadas, as quais atreladas a estes conceitos enfatizam o uso do termo sócio-histórico como fundamental para compreensão das temáticas discutidas, uma vez que, este termo indica uma superação dos parâmetros biológicos como definitivos.

This thesis set out to explore the experiences of being detained and admitted to an inpatient unit. It is comprised of three papers. Paper one and paper two have been prepared according to the guidelines of the journal they will be submitted to. Paper one is a systematic review of the qualitative literature which has explored participants’ experiences of involuntary detention. This paper provides an update to a review previously carried out and attempts to answer some questions that the previous review were unable to answer. Databases were searched and studies were screened for their relevance. Fifteen studies were located and the results were synthesised using a standardised metasynthesis methodology. Seven overarching themes emerged, illustrating positive and negative experiences of involuntary detention and factors which impact on these experiences. The synthesis resulted in clear recommendations for clinical practice and future research. Paper two is a qualitative study which sought to explore the experiences of detention under the Mental Health Act for anorexia nervosa. Four participants were inpatients and under the Mental Health Act at the time of interview and eight participants had been discharged. A grounded theory analysis revealed four overarching themes which capture their experiences over time and how these experiences impact on a person’s recovery. The findings have been incorporated into a framework and are discussed in relation to existing literature. The paper outlines recommendations for clinical practice and future research. Paper three is a critical appraisal of the overall research process. It draws on the researcher’s reflective journal to highlight the theoretical, methodological, personal challenges and learning outcomes which the researcher encountered. It discusses the clinical implications in relation to the researcher’s future career as a clinical psychologist within the NHS, as well as the wider implication for the profession as a whole.

Patient influence for women giving birth in Caseload midwifery Background: According to the Patent Safety Act, a patient must be provided with expert and caring health care that meets certain requirements. The patient must be shown care and respect and the care is designed with and carried out in consultation with the patient, in that the patient has influence over their care. Person-centered, here women-centered, is about meeting the patient's need for coordination, continuity and with the participation of the patient. Motive: There are no studies done regarding patient-influence in caseload midwifery, which is so far the most women-centered model this author has found.Aim: To, based on previous research, describe and interpret women's experience of patient influence when they give birth to children in Caseload midwifery. Method: A search for qualitative articles using the PubMed and CINAHL databases was performed to make a metasynthesis. Inclusion criteria was articles were published from 2010 onwards in English and peer reviewed. Quality review was performed using SBU's protocol for review of qualitative studies, which resulted in sex articles. Results: Five themes that all showed that Caseload contributed to an increased patient influence. Continuity in the relationship, Consent to and be inclusive of, Empowerment and decision-making, Ownership and being in the moment and Alteration and normality.Conclusion: Continuity in the relationship by being remembered helped the woman to focus, on things that were important to her. This increased the woman's self-confidence, she got a sense of context and felt prepared for the birth. Participation in informed decisions about her pregnancy and childbirth, gave her empowerment. The woman experienced control and got an active role in the birth, they owned their birth. Childbirth as a philosophy gave women additional perspectives on childbirth as a normal phenomenon but at the same time as a transforming process of becoming a mother. The summary of this meta-synthesis is that all experiences flow together and are interdependent of each other, patient influence is complex. The synthesis of the six qualitative studies showed that Caseload midwifery contributed to an increased patient influence.

La méthode qualitative est en plein essor en médecine et particulièrement en psychiatrie, où la place du sujet, et ses représentations de la maladie et du soin sont centrales dans la prise en charge. Dans le champ de la santé de l'adolescent, de grands travaux permettent des avancées importantes dans la compréhension de la souffrance et les propositions de soins. Les méthodes qualitatives sont pourtant souvent critiquées de par leur contextualité et leur manque de pouvoir de généralisation. Une façon d'améliorer ces deux aspects consiste à appareiller les études traitant la même problématique de manière à en synthétiser les principaux résultats. Cet exercice de synthèse, notablement différent de celui de méta-analyse propre à la recherche quantitative, est réalisé depuis longtemps dans le champ des sciences humaines. Il s'agit de la métasynthèse, ou meta-ethnography. L'exercice de synthèse de la littérature est aujourd'hui de plus en plus codifié en recherche scientifique. Pourtant, certains points sont toujours en discussion - critères d'inclusion des études, critères de qualité des études-. De plus, aucune équipe psychiatrique ne s'est approprié l'outil de la métasynthèse pour l'adapter à la discipline. Ce travail décrit les étapes de la construction et de l'adaptation, à partir du corpus existant, d'une méthode rigoureuse, effective, simple à transposer et enseigner, permettant la métasynthèse de données de la littérature dans le domaine du soin psychique de l'adolescent. Il s'agit d'une part d'une réflexion théorique, épistémologique et méthodologique sur les métasynthèses et leur adaptation au champ de la clinique psychiatrique. Il s'agit d'autre part d'une construction pratique, réalisée à partir de métasynthèses effectuées sur des thématiques du soin psychique de l'adolescent. Les deux premiers articles sont deux travaux de métasynthèse. Le premier concerne l'obésité de l'adolescent. Les résultats obtenus mettent en lumière les limites de la méthode utilisée. Le deuxième article s'intéresse à la question des comportements suicidaires à l'adolescence. Les enseignements méthodologiques du premier article ont permis de perfectionner la méthode de métasynthèse. Enfin, le troisième article propose une description détaillée des étapes de la méthode construite. En discussion, nous proposons de resituer la méthode de la métasynthèse dans le contexte historique du niveau de preuve scientifique. Nous illustrons avec les articles les plus récents les liens toujours plus forts qui se construisent entre la méthode de la métasynthèse, aujourd'hui appelée Qualitative Evidence Synthesis, et la médecine fondée sur les preuves. La métasynthèse est une méthode moderne, qui montre tout son intérêt dans la recherche médicale. Notre méthode appliquée à la psychiatrie de l'adolescent est rigoureuse et fiable, et permet d'accroître la connaissance scientifique et d'améliorer la prise en charge des patients. / Qualitative research is expanding fast in medicine and especially in psychiatry, where the patient and his representations of illness and care are central to treatment. In the field of adolescent health, great work provides important advances in the understanding of suffering and care. Qualitative methods are however often criticized because of their contextuality and their lack of generalization power. One way to improve these aspects is to match studies addressing the same issue so as to synthesize the main results. From a long time, human sciences have taken hold of this exercise of synthesis, which is significantly different from meta-analysis of quantitative research. They have called this work metasynthesis or meta-ethnography. The literature synthesis exercise is now increasingly codified in scientific research. However, some points are still under discussion - For example, inclusion criteria for studies, study quality criteria -. Moreover, no metasynthesis exist in the field of psychiatric research. This work describes the stages of construction and adaptation of a simple, rigorous, efficient, easy to share and teach method, which enables to do qualitative data synthesis in the field of psychological care to adolescents. On the one hand, we propose a theoretical, epistemological and methodological reflection on metasyntheses and their adaptation to the field of psychiatric care. On the other hand, we describe a practical progression: our method is built from metasyntheses conducted on two themes of adolescent psychological care. The first two papers are both metasyntheses. The first one is about adolescent obesity. The results highlight the limitations of the method we used. The second article focuses on the issue of suicidal behavior in adolescence. The methodological lessons of the first article helped us to improve the meta-synthesis method. The third article provides a detailed description of each steps of the method. In discussion, we propose to situate the method of metasynthesis in the historical context of the scientific evidence. We illustrate with recent papers the increasingly strong links that exist between metasynthesis, now called Qualitative Evidence Synthesis, and Evidence-Based Medicine. The metasynthesis is a modern method. It shows its interest in medical research. Our method applied to adolescent psychiatry is rigorous and reliable, and can increase scientific knowledge and improve the care of patients.