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Section A consists of a review of the literature relating to positive contribution to families in first-episode psychosis. It highlights potential gaps in the research and possible avenues for future research. Section B presents the findings of the study. The aim of this grounded theory study was to explore whether individuals who have experienced first-episode psychosis positively contribute to their families. Additionally, the study aimed to construct an explanatory model of how positive contribution to families is viewed and supported following first-episode psychosis. Method: Fifteen participants took part in the study. Seven had direct experience of psychosis, seven were relatives and one was a partner of an individual with direct experience. Participants were interviewed separately, with the accounts analysed using Charmaz’s version of grounded theory (Charmaz, 2006). Results. The constructed theory suggested that individuals who have experienced first episode psychosis can and do contribute to their families, and that such contribution when noticed and valued can lead to an increase in well-being. The model suggests that contribution is shaped by the self-concept, the impact of psychosis, the opportunity for contribution and whether it is noticed. Conclusion. The constructed theory extends current research, and suggests that contribution can positively impact both the individual and family. Limitations and clinical implications of the research are explored and suggestions for further research given. Section C offers a focused evaluation of the research study. Topics of evaluation included reflections on the research process, learning experiences, further clinical implications and possible future research.

The subjective experience of paranoia and persecutory delusions is largely overlooked in the extant literature, especially in first episode psychosis (FEP). This study explored the personal experience and understanding of threatening thoughts in FEP, guided by three over-arching research questions addressing: thought content and emotional distress; the role of life events and context; change in experience over time. Semi-structured interviews were conducted with eight participants. Transcripts were analysed using Interpretative Phenomenological Analysis. Five master themes were identified reflecting recurring characteristics of all participants’ experiences: Exposure of vulnerable self; At the limits of endurance; Elusive sense of agency; The urge to explain it all and FEP as a finite experience? 16 sub-themes indicated elements of master themes that varied among individual narratives. Findings indicated the highly interpersonal nature of threatening thoughts and their role as a key organising factor in people’s lives. Emotional distress was often viewed as consequential to multiple types of thought content, overwhelming pressure, powerlessness and expectation of negative judgement. Difficult life contexts often seemed to contribute to thought manifestation. Reduction of novelty was important to positive change. Several participants framed experiences as terrible but completed, rather than as the beginning of chronic difficulties.

The Mental Health Act 1983, amended in 2007, appears based on the assumption that an undisputed entity of “mental disorder” exists, that people who are designated mentally disordered should be treated, and if necessary, detained by doctors. This study aimed to examine how mental disorder was discursively constructed and how different institutional interventions and practices were justified and legitimised in the House of Commons’ debates regarding the Mental Health Act 2007. Verbatim transcripts from House of Commons debates on the Mental Health Act (conducted between 24th April and 15th May 2007) were studied through a discourse analysis. Seven primary discursive constructions were identified: “The Trusted and Medically Objective Expert,” “The Emergency,” “A Fair Process,” “Supporting Subjects,” “The Decision-Making Impaired and Vulnerably Ill Patient,” “The Lawyer’s Field Day,” and “Societal (Dis)Order.” The study concludes that mental disorder was represented in selective and systemic ways that can help justify and legitimise different interventions and practices, for example, enforced medication, making government legislation and psychiatric practices seem necessary. Consideration was given to how psychiatric practices could be problematic for some service users and how legislation could be based on political and public concerns about social disorder.

Psychosis is suggested to be a leading cause of disability, not only as a direct result of the distressing experiences, but due to the social adversity, increased isolation and subsequent negative impact upon quality of life. While psychological therapies for psychosis show promise in assisting people in recovering from psychosis, relatively little is known about the processes involved, specifically the processes worked through to allow clients to understand and adopt strategic, therapeutic approaches to care. This study aimed to explore how people experiencing psychosis made use of understandings and strategies developed during the joint activity of therapy. Semi-structured interviews were conducted with 11 participants (six psychologist-client pairs) towards the end of, or recently after, finishing therapy for psychosis. Transcribed interviews were analysed using grounded theory. The model constructed presents multi-directional, dynamic interactions between three core categories; ‘Enabling Personal Empowerment’, ‘Navigating a Collaborative Journey’ and ‘Building Belief to generate Trust’. This study explored how processes are derived during therapy, both individually and collaboratively, to help clients better understand and implement the most beneficial strategies introduced through therapy. Through exploring these derived processes, a possible model for the conceptualisation of processes which occur during therapy for psychosis, grounded in client and psychologist accounts of therapy, was generated.

Section A is a review of the literature on cognitive functioning difficulties in psychosis. It focuses on these difficulties as they relate to cognitive models of psychosis. After outlining relevant cognitive models, the literature on cognitive functioning is critically reviewed. The review highlights methodological limitations; gaps in our understanding; and a need for research exploring people's experiences of cognitive functioning difficulties. Section B describes a qualitative study investigating the experience of cognitive difficulties in people with psychosis. Background: An overview of research on cognitive functioning in psychosis reveals limitations in existing understandings, including the absence of a rigorous account of how people with psychosis experience cognitive functioning difficulties. Aims: This study aimed to provide an account of the experience of cognitive functioning difficulties in people with psychosis, including how these difficulties are perceived and understood, how people respond to these difficulties, and what people’s perceptions are of others’ views of these difficulties. Method: A semi-structured interview was carried out with eight participants, focusing on participants’ experience of cognitive difficulties, how they respond to these, how participants perceive others’ understandings, and available support. Interpretative Phenomenological Analysis (Smith, Flowers, & Larkin, 2009) was used. Results: Cognitive impairment was understood in terms of master themes focusing on controlled and reflective thinking; physical experiences; explaining the origins of impairment; identity; and anticipating the future with fear and hope. Conclusions: The findings had significant implications for clinical psychology, including staff and client education about cognitive difficulties, and the importance of cognitive functioning to formulation. New areas for research include interventions stimulating metacognition; managing identity changes in response to cognitive difficulties; and ascertaining staff understanding of cognitive difficulties. Section C is a critical appraisal of the qualitative study 'The experience of cognitive functioning difficulties in people with psychosis: An investigation' described in section B. It provides critical and reflective answers to four questions on the following topic areas: research skills acquired; what one would do differently if repeating the study; clinical consequences of the study; and future research projects.

Section A: A review of literature focused on African Caribbean men with diagnoses of both conduct disorder (as an indicator of antisocial behaviour) and severe mental illness. The review concludes that disorganised infant attachments appear to be predictive of conduct disorder, psychosis and poor engagement with services in a reciprocal 'vicious circle'. Section B: Empirical Paper: This study examined the relationships of African Caribbean men with severe mental illness and a history of conduct disorder, linking this to engagement with services. This was explored qualitatively using attachment theory and Lacanian discourse analysis within a psychosocial methodology. Four interviews were conducted and the texts were analysed. The findings echo the evidence base in showing that, according to this interpretation, all participants showed signs of disorganised attachment. All had had adverse encounters within mental health services although all could also cite discrete experiences which had been helpful and supportive. Each participant held different views about the interaction of ethnicity with care. Section C: A critical reflection on the research process, including: thoughts on learning experiences; retrospective changes to the study; clinical implications; and ideas for future research.

Research on art therapy and psychosis has typically focused on individuals who have experienced psychotic symptoms for many years. This study used a grounded theory methodology to explore how service users experience art therapy following their first diagnosis of a psychotic disorder, and the possible mechanisms through which art therapy might be helpful for such individuals. Eight participants were interviewed, with two participants being interviewed twice. A preliminary theory was created and seven categories were constructed from the data, namely unpressured atmosphere, pleasure and engagement in art-making, expression and communication, connecting with others, changing emotional experience and experience of self, supporting recovery and continuation of art, and barriers. Participants reported that through the atmosphere of art therapy, art-making, and communication, they were able to build relationships, connect with others, experience a sense of commonality, absorption, sense of freedom and discover alternative perspectives and different understandings. Whilst this study suffered from some limitations, the results build on the current research base by suggesting possible processes and mechanisms through which art therapy is helpful, and focusing on a previously under-represented population. The findings are considered alongside existing research and theoretical perspectives. Clinical implications and recommendations for future research are also highlighted.

Theoretical assumptions and emerging research point to possible mechanisms of change in acceptance and commitment therapy (ACT) for psychosis. However, the specific processes by which change occurs remain unclear and under-researched. No current research has explored processes facilitating change in the group format of an ACT intervention for psychosis. Participant perspectives were sought to help elucidate potential mechanisms of change. Nine participants of ACT groups for people with psychosis were interviewed about their experiences of the intervention. Interviews were analysed using methods and techniques informed by grounded theory. A proposed model outlined key mechanisms of awareness, relating differently and reconnecting with life, which led to reductions in distress and behavioural change. Leaning on others highlighted the importance of the group context in supporting change processes. The processes identified, and the mechanisms through which these were achieved, as articulated by participants, were consistent with proposed change processes. Participants also offered additional insights based on experiential accounts. Contributions to theoretical understandings and clinical practice are discussed.

Recovery focus has shifted in recent years towards understanding the impact of mental health difficulties on the wider individual context. This includes focus on social inclusion, engendering hope and peer support. For adolescents, psychosis and mental health treatment may interrupt typical developmental tasks such as individuation and successful stage progression. The aim of this research was to expand understanding of how young people with psychosis experience hope. This included how hope was experienced in specific domains and to which factors young people attributed changes in their hopefulness. The study employed a qualitative non-experimental design, using a semi-structured interview schedule developed in accordance with narrative methodology. Ten young people between 16 - 26 years old were interviewed. The experience of hope as an overarching strand throughout the narratives had three common elements; a sense of belonging, the importance of information and the significance of planning and occupation in relation to hope. Work was often a goal within domain-specific hope, and friendships seemed to be less apparent. The study concludes that for some young people, psychosis can act as a turning point towards hopeful thinking. Information can both promote and hinder hope and the importance of meeting others with lived experience in engendering hopeful thinking and greater social inclusion should be considered when working with young people.