Introduction. Research into children and young people’s experience of stimulant medication has been contradictory but suggests that adolescents may have more ambivalent views, and highlights identity issues related to this age group. There is a gap in the UK adolescent experience of stimulant medication. There is also a lack of research into the wider meaning of taking stimulant medication for an ADHD diagnosis. Aims. The aim of this study was to research how adolescent young people talk about ADHD, medication and themselves using discourse analysis, and how available ways of understanding ADHD and medication may impact on how they make sense of themselves. Method. This qualitative study employed a semi-structured topic schedule to guide interviews and a focus group with thirteen young people aged 13-17, analysed using discourse analysis. Additionally, leaflets available at child and adolescent services and related websites were analysed. Results. Four different ways of conceptualising medication were identified, with implications for young people’s sense of agency and control in relation to medication. The majority of participants talked about their un-medicated selves as dangerous, bad and out of control. Participants highlighted dilemmas related to balancing valued aspects of their un-medicated selves, with being in control and ‘safe’ when on medication. Discussion. Clinicians should engage with the wider meanings of medication with young people, including family beliefs about medication. A focus on medication as a tool, rather than a cure, may empower young people to be decision makers. Clinicians should also be engaging young people in conversations about impact on self, in relation to medication.

Objective: Alexithymia and hypomentalization, two traits associated with childhood emotional abuse/neglect, have not previously been studied in people with mixed-symptom functional neurological disorder (FND). This case-control study these traits in people with FND compared to healthy control participants, and explored the relationships between alexithymia, mentalization, and somatic and neurological symptoms of a generalized nature. Method: Twenty-nine participants with FND and 41 healthy control participants completed a battery of self-report measures. Between-group differences in alexithymia and hypomentalization were investigated using parametric tests, and binary logistic regression analyses examined whether alexithymia and hypomentalization were predictive of FND (vs control) group status, after controlling for depressive symptoms, anxiety symptoms and education attainment. Linear regression analyses examined whether alexithymia and hypomentalization were also associated with physical and neurological symptoms across the entire sample. Results: Participants with FND had significantly higher score on measures of alexithymia, hypomentalization, somatic symptoms and neurological symptoms compared to healthy control participants. Between-group differences in alexithymia and neurological symptoms remained significant after controlling for covariates. High scores on the alexithymia and mentalization measures were also predictive of high scores on the measures of somatic and neurological symptoms across the entire sample. Conclusion: Alexithymia and hypomentalization do appear to be significant issues for people with FND, and may contribute to the tendency to express distress via physical symptoms. Exploring these traits with individual service users may contribute to a more comprehensive conceptualisation of their difficulties, and inform treatment approaches that are engaging and supportive.

Background and aims: Improving care for people in suicidal crisis remains high on the UK government agenda. Trauma-informed approaches (TIAs) have been advocated to address the concerns raised by service-users with psychiatric hospital services. This study explores service-users’ accounts of staying at a women’s trauma-informed crisis house and in hospital whilst experiencing suicidal distress. Methods: Eight women were interviewed using a semi-structured interview schedule. Interviews were transcribed and analysed using thematic analysis within a critical realist framework. Results and discussion: Seven themes were developed: the power of talking, the limitations of medication, managing emotional safety through trusting relationships, managing physical safety through coercion, a home rather than a hospital, fostering compassion and the benefits of gender sensitivity. Participants described hospital as being dominated by a medical and custodial approach, which they said could undermine therapeutic engagement and exacerbate distress. By reframing suicidal feelings as a reasonable response to events in people’s lives, the TIA was described as enabling participants to safely work through their suicidal feelings, whilst maintaining freedom and control. This research was carried out with a small sample and both recruitment and context likely privileged positive accounts of TIAs. Clinical implications and areas for further research are discussed.

Service user involvement is under-developed with people who experience acquired brain injuries (ABI). Systemic barriers and prejudices may have contributed to this. This study explored the experiences of ten individuals who experienced an ABI and attended a service user involvement group aimed at improving organisational design and governance. Their experiences were explored in the context of their personal recovery from ABI. Semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis. The results suggested that service user involvement was predominantly a positive experience. SUI enabled participants to re-connect with pre-ABI life. It enhanced their agency in their recovery via empowerment. It also provided opportunities for developing valued peer relationships. However, not all participants experienced each of these effects, which highlighted barriers to meaningful involvement. Increased awareness of these experiences could support health care professionals to initiate opportunities for meaningful SUI that may enhance services delivered.

This study explores the moral ethos of contemporary psychotherapy as represented in the psychoanalytic and systemic therapeutic traditions. It examines current moral/ethical debate in the field and presents a detailed critique of the individualistic normative orientation of this debate; its peripheral status within the discourse of psychotherapy; its restrictive focus on professional micro ethics; and the eschewing of engagement with wider macro level moral themes and concerns. The disjuncture between this individualistic moral ethos and the vigorously relational thrust of wider developments in psychotherapeutic theory and technique is highlighted. An argument is made for the reformulation of moral/ethical debate in terms that take account of these relational developments, which might in turn serve as a catalyst for the realization of what is arguably their progressive and democratizing potential. The failure of hermeneutical, post-structuralist and postmodernist influences in recent decades to move this debate forward and the entrenched modernist/postmodernist divide within psychotherapeutic discourse are also explored. Underlying the limitations of current moral/ethical debate is the restricted paradigm of individual consciousness within which this debate unfolds and which it appears unable to transcend. In this study the critical social theory of J!rgen Habermas serves as a touchstone for exploring potential for movement from the paradigm of consciousness to that of communication as a framework for moral/ethical deliberation. It is argued that key trends within psychotherapy are already straining towards a communicative ethical orientation which is implicit in current practice and that the theoretical vacuum around this subject is impeding recognition of its full potential. Alongside Habermasian theory, Axel Honneth's theory of recognition and Anthony Giddens's social theoretical perspective on psychotherapy offer key points of reference for the dialogue between critical social theory and psychotherapy which this study seeks to promote. Drawing on the work of Habermas and Honneth, it is argued that the underlying moral “grammar” of the psychotherapeutic encounter may be framed in terms of the struggle for understanding and agreement and the struggle for recognition. The theme of reflexivity emerges as an important organizing framework for this discussion and as a bridge for dialogue between psychotherapy and social theory. It is proposed that we can helpfully think of significant discursive moments in the therapeutic encounter as islands of heightened reflexivity in which the full communicative power of language is potentially unleashed. The study concludes with a view of psychotherapy as a reflexive resource and potential carrier of communicative reason helping people to develop and enhance cognitive and emotional capacities that may in turn help them participate in spheres of discursive communication and move towards genuinely communicative use of language.

Section A: This section critically considers reflective practice definitions, conceptualisations and implementation within dominant theoretical models. The value and limitations of the favoured method for developing reflective capacities in clinical psychology training, the reflective practice group (RPG), are described. Group theory and the current empirical evidence base for RPGs within counsellor and clinical psychology training are critically considered and future research is suggested. Section B: This section presents a preliminary grounded theory study of qualified clinical psychologists’ experiences of attending a reflective practice group during training. Reflective practice has become implicit within the clinical psychology profession; there is a lack however of empirical research on the methods through which reflective capacities are developed in trainees. This study aimed to build upon earlier research by Knight et al. (2010), which investigated the impact of reflective practice groups (RPG) whilst training, through further qualitative exploration of the mechanisms of experience related to participants perceiving the RPG as valuable and the role of distressing experiences. Eleven qualified clinical psychologists from a UK training programme who had previously (Knight el al. 2010) been categorised into 1 of 4 factor groups based on level of perceived value and distress (e.g. high value-low distress), took part in semi-structured interviews. Grounded theory methodology informed the data collection and analysis. A preliminary interactional map of experience was constructed from the data and five categories were important in understanding how the groups were perceived as valuable in the context of varying distress levels: ‘negotiating the unknown’; ‘managing emotion’; ‘negotiating the development of self-awareness’; ‘negotiating the reciprocal impact of others’; and ‘reflection-on-reflection’. It was recommended that training programmes should consider: trainee expectations; approach and motivation; the dual-relationships within groups/cohort; and facilitator style in offering RPGs. Recommendations were made for future research to attempt to match trainee personal learning style with appropriate reflective development methods, to build an evidence base for reflective practice methods generally and to establish the benefits of reflection for clinical practice. Section C: This section presents a critical appraisal of the study undertaken in relation to 4 stipulated questions. Learning outcomes and future research skill development needs are considered, limitations of the study and proposed retrospective changes are highlighted and the impact on practice is considered. Finally suggestions for future research are elaborated upon.

Section A summarises theory and research relevant to understanding the interaction between intimate-partnership and depressive relapse. Interpersonal theories of depression are introduced. Following this, extant empirical studies examining the effects of interpersonal processes on depressive relapse are critically evaluated. As these studies do not consider how depressive relapse might affect the intimate-partner over time, a separate body of literature examining the impact of depression on intimate-partners is reviewed. Limitations and gaps in the existing evidence-base are discussed, and areas for future research are outlined, such as studies to understand the bidirectional interaction and to explore alternative interventions that enable both partners to cope with relapses. Section B presents a Grounded Theory study of the process of engaging in mindfulness-based cognitive therapy (MBCT), which is a relapse prevention strategy for depression, as an intimate-partnership. Twelve participants took part in a semi-structured interview about their experience of the MBCT course. These data were triangulated with sessional data from an MBCT course and facilitator validation. The proposed theory captured the ‘process of learning new mindfulness skills together’. While intimate-partnerships who engaged in an MBCT course seemed to learn similar mindfulness skills as in individual MBCT courses, learning as a partnership seemed to facilitate home practice, attendance and a sense of mutual support, which led to unique outcomes for the partnership and their sense of responsibility for each others’ wellbeing. Limitations and implications are discussed. Section C provides a critical appraisal of the process of conducting this research study, including the researcher’s learning experience, implications for clinical practice and future research.

Section A is a review of the literature on psychological adjustment following stroke. Empirical research is critically reviewed with reference to two research questions: (1) What do we understand about adjustment following survival of stroke? (2) What psychosocial interventions have been used to support adjustment post-stroke and what are the outcomes? Theoretical models for adjustment to stroke are drawn upon to illuminate the findings. Gaps within the literature are discussed and future directions for research are suggested. Section B describes a study using mixed methods. The purpose of the study was to evaluate whether narrative group therapy could facilitate psychosocial adjustment in survivors of stroke, and to explore the impact of stroke on survivors’’ lives through their shared narratives. Methods: Ten participants took part in a six-week narrative group therapy intervention for stroke survivors. Quality of life, use of coping strategies and illness representations were measured pre- and post-intervention, and thematic analysis was conducted on the content of the intervention sessions. Results: There was no statistically significant change on the outcome measures post-intervention. However the inductive thematic analysis resulted in the identification of four master themes: ‘using the group’, ‘negative talk’, ‘positive talk’ and ‘relationships’. These themes, respectively, revealed that the social aspects of the group allowed comparing experiences and exchanging information; participants were able to discuss the perceived negative aspects of surviving a stroke; with support, participants could identify the adaptations and achievements made since the stroke; and how the stroke impacted on relationships between the survivor and the systems around them. Conclusion: The findings indicate that narrative therapy requires further evaluation in terms of facilitation of adjustment. However, the thematic analysis supports the utility of group discussions and the provision of information to stroke survivors and their carers, thus indicating potential development of psychoeducation group programmes, provisionally as part of a stepped care model.

Research has shown mindfulness-based interventions (MBIs), such as mindfulness-based cognitive therapy (MBCT), to be effective for adults with clinical difficulties, but little research has focused on MBIs for mental health difficulties in adolescents. This study investigated a 6-week MBCT-based intervention, testing the hypotheses that mindfulness-training would reduce anxiety, and depression, and improve mindfulness, self-compassion and executive function, in adolescents with anxiety disorders. It also explored the experience of mindfulness-training and the changes experienced with mindfulness practice. The study used a mixed-methods multiple-case AB design with 6- and 12- week follow-up. Adolescents aged 14-17 (N=8), meeting DSM-IV criteria for an anxiety disorder, completed personal anxiety measures weekly during baseline, intervention and follow-up phases. The resulting time-series were analysed using simulation modelling analysis (Borckardt et al., 2008). Adolescents and parents also completed standardised measures at the start and end of each phase. Qualitative analysis of post-intervention interviews used Critical Incident Analysis (Butterfield et al., 2009) to identify helpful and hindering themes. Significant reductions in anxiety and/or concern about anxiety were found from baseline to follow-up for three participants. Reliable reductions were also found for some participants in anxiety and/or depression, and improvements in mindfulness, self-compassion, and executive function, on self- and/or parent-reported standardised measures, mostly maintained at follow-up. Qualitative themes included the importance of the group and usefulness of mindfulness practices in everyday life. The study concludes that an MBCT-based intervention may be effective for anxiety in adolescents, but further research with a randomised controlled trial is required.

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.