Section A reviews the empirical and theoretical literature on supervision in order to gain a better understanding of how experiences of supervision during clinical training may relate to the anticipated transition of ‘becoming a supervisor’. Section B presents an initial exploratory study focusing on how trainee clinical psychologists make sense of their experiences of supervision in relation to the anticipated transition of ‘becoming a supervisor’. Semi-structured interviews were conducted with ten trainee clinical psychologists at the end of their training. Data was analysed using Interpretative Phenomenological Analysis. Analysis of the transcripts revealed three master themes: the development of the professional self; the supervisory relationship; and the development of supervisory perspectives. Developmental and relational aspects of supervision were emphasised in relation to the anticipated transition of ‘becoming a supervisor’, alongside the significance of the supervisor as a role model. Learning from peers’ experiences of supervision was also key. The study concluded that participants’ experiences of supervision and the meaning they give to those in relation to the anticipated transition of ‘becoming a supervisor’ were connected to the development of a professional self in which increasing autonomy and integration of the personal self was important. Learning took place in the context of the supervisory relationship. The human side of that relationship was valued where reciprocity and containment facilitated a safe space to explore. The development of supervisory perspectives facilitated the anticipated transition of ‘becoming a supervisor’ as experiences of supervision helped to evaluate positive and negative aspects of that role. Subsequently, an ‘ideal for self’ emerged.

Mindfulness may be one way in which common factors could be enhanced in trainee therapists. Previous research has found some support for mindfulness increasing empathy, compassion and emotion regulation, but research is affected by a lack of active control groups and interventions with multiple components. An experimental design was used with a brief (15 min) mindfulness practice compared to a brief (15 min) ‘mind-wandering’ control group, in order to overcome some of these confounds. Participants were 48 trainee therapists who were randomly assigned to two groups of equal sizes. Measures were taken at baseline and post-induction. The predicted findings for empathy and compassion for others were not found. The mindfulness group did show lower negative affect at post-test than the control group, but only in participants who were high in negative affect at baseline, a result which should be viewed tentatively due to the small number of participants in each subgroup of the analysis. Issues limiting confidence in the results are discussed, particularly that the two groups did not report different levels of state mindfulness after the brief exercises. Implications for future research, particularly in considering appropriate active controls for mindfulness, are discussed.

Eye Movement Desensitisation and Reprocessing (EMDR) therapy is a recommended treatment for Post-Traumatic Stress Disorder (PTSD). Despite its rapidly growing evidence base, relatively little is known about its treatment effects beyond improving PTSD symptoms. This preliminary study aimed to explore the capacity for EMDR to facilitate a change in attachment security in a clinical sample of adults experiencing symptoms of PTSD and Complex PTSD (CPTSD). It also explored the role of the therapeutic alliance. A within-subject, repeated-measures design was used. Participants received 10 EMDR sessions on average, as part of their routine care. Self-report measures of attachment, PTSD, CPTSD, and the therapeutic alliance were administered during therapy. No significant changes in attachment were observed; however, there was a trend in the expected direction. A significant reduction in PTSD scores was found, in addition to some associations between change in attachment security and change in PTSD and CPTSD symptoms. No significant relationship between the strength of the therapeutic alliance and attachment change was found. This study contributes to the emerging literature on change in attachment; however, the findings should be interpreted with caution due to limitations including the small sample size. Clinical implications and recommendations for future research are discussed.

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.

Understanding how change occurs in psychotherapy is imperative in informing clinical practice. Increasing attention has been given to the role that qualitative research could play in enhancing our understanding of therapeutic change. Although quantitative research suggests that parent-child psychotherapy is effective in facilitating change, no research to date has focused on how parents make sense of their change experience. Interpretative Phenomenological Analysis was used to analyse semi-structured interviews of eight parents who had completed parent-child psychotherapy about their understanding of change. Five master themes emerged which encapsulated participant’s understanding of change. These included constructing a survivor narrative, the experience of being understood enabling further understanding, adjusting expectations and practicing acceptance and feeling empowered to relinquish control. The final theme summarised how despite psychotherapy being conceptualised as a ‘precious’ resource, there was a sense that its limitations could negatively impact participant’s wellbeing. The study concluded that meaningful elements of change were identified from the parents’ experience. Findings were discussed in relation to previous research. Limitations and implications for future research and practice were examined.

The aim of this study was to explore the process of an eight-week autogenic training (AT) programme for people experiencing chronic pain, as perceived by participants, and to hypothesise about mechanism of change, where reported. Eleven semi-structured interviews were conducted with women who had taken part in AT at the Royal London Hospital of Integrated Medicine (N=8) or with a private practitioner accredited by the British Autogenic Society (N=3). A grounded theory design was employed to build an inductive model ‘grounded’ in the qualitative data. Six main categories emerged: 1) ‘Nobody knows what’s wrong with me’: Trying to get help for the pain; 2) ‘A “mind-body” conversation’: The process of AT for chronic pain; 3) ‘Something my body wanted more of – like nectar’: The effects of AT; 4) ‘Bringing us back’: Practicing AT with other(s); 5) ‘Giving yourself permission to stop’: Practicing AT independently; and 6) ‘Not just free-falling’: Comparing AT with other therapies. A number of inter-related sub-categories and dimensions were also identified. The study suggests that AT is a useful therapeutic tool with benefits for both physical and psychological well-being for people experiencing chronic pain. It illuminates the inter-connected nature of these areas of health, which have historically been treated as distinct entities. Further research is needed to explore a potential role for AT in management of stress, pain and wellbeing.

Section A is a systematic review of emotional processing in people with Anorexia Nervosa (AN). By drawing together all self-report research, it outlines the specific emotional processing difficulties experienced by this population. It concludes that theoretical assertions that poor emotional processing maintains AN are tentatively empirically supported, but data is limited and largely cross-sectional. Section B Background. Effective treatments for AN in adults remain elusive. Recent research suggests poor socio-emotional and neurocognitive functioning may act as underpinning maintaining mechanisms for AN. These difficulties are therefore indicated as treatment targets; however, their roles as maintaining factors and the benefits of including socio-emotional and neurocognitive difficulties as foci for therapy lack empirical evidence. Methods. A randomised control trial design was employed to compare the Maudsley AN Treatment for Adults (MANTRA) based on a novel maintenance model of AN seeking to target key socio-emotional factors (maladaptive emotion beliefs and over-control of emotion, alongside poor social cognition) and neurocognitive factors (poor set-shifting and extreme detail-focus), against a control treatment mimicking treatment as usual (specialist supportive clinical management; SSCM). It was hypothesised that: (1) baseline socio-emotional and neurocognitive difficulties would predict outcomes, highlighting their role as maintenance factors; and (2) MANTRA would significantly improve these factors over SSCM leading to better clinical outcomes, therefore confirming them ‘causal’ maintenance factors. Results. Emotional avoidance (behavioural/cognitive avoidance, low acceptance) and some other elements of control (submissive behaviour) predicted clinical outcomes. Social cognitive (emotion recognition, emotional Theory of Mind) and neurocognitive functioning (set-shifting, detail-focus) had limited predictive ability. There were socio-emotional (social comparison, cognitive avoidance) and neurocognitive (set-shifting) improvements following MANTRA over SSCM, but no clinical advantage. Conclusions. Emotional avoidance and submissive behaviours may represent maintenance factors for AN. Social cognitive and neurocognitive variables appear less important. No ‘causal’ maintenance factors could be concluded from the data. Implications for adapting MANTRA are discussed. Section C is a critical appraisal of this research reflecting on key learning points and the limitations of the study, as well as the impact of the study on clinical work and in planning future research.

Section A provides a critical review of the literature pertinent to children’s imaginary companions, including definitional issues, historical background, and prevalence. Empirical research concerning the characteristics of children who create imaginary companions is presented, followed by an overview of theories attempting to explain the development and functions of imaginary companions. Empirical research investigating the functions of imaginary companions in normative populations is then reviewed, followed by research into the imaginary companions of children from clinical populations. The review concludes by reviewing the literature into the use of imaginary companions as part of psychological therapy. Section B Imaginary companions represent a common childhood developmental phenomenon, to date, largely neglected in the clinical literature. The grounded theory study investigates the functions and therapeutic use of imaginary companions in a clinical population, by interviewing clinicians working therapeutically with young people accessing Child and Adolescent Mental Health Services. Participants were 10 UK clinicians, most practising as child clinical psychologists. Clinicians reported that imaginary companions served a number of fundamental functions, including serving as a communication aide, a secure attachment figure, proving mastery over a child’s world, and acting to maintain stability in the environment, and in a child’s self-image. Imaginary companions were utilised by most clinicians as part of engagement, and to gain insight into young people’s difficulties. Depending on their salience, and congruence with young people’s self-image, imaginary companions were used as therapeutic allies, to aid perspective-taking, and as a way to manage the intensity of interactions with clinicians. Imaginary companions were not therapeutically utilised by a sub-section of clinicians, owing to their perceived low salience, and to clinical risk issues. The findings are discussed in relation to existing theory and research, and methodological limitations, implications for clinical practice, and directions for future research are provided. Section C provides a critical appraisal of the research methodology and findings, and elaborates on clinical implications and future research ideas discussed in Section B.

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.

Background: Joint working between adult and child services has historically been difficult; the Think Family Toolkit was produced by the government in order to aid collaborative working. Aim: The aim of this evaluation was to explore joint working between services using the Think Family Toolkit. Method: An adult team, child team and service users were given questionnaires to explore joint working. Results: Joint working was described as something that would be useful but there were many barriers to achieving it. The child team did not respond to the questionnaire perhaps due to time constraints and potential burnout. Conclusions: Recommendations are provided to increase the effectiveness of joint working between services.