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 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 reviews and critically evaluates the empirical literature on psychosocial interventions for multiple sclerosis (MS), the determinants of adjustment to MS, and the theoretical frameworks to account for these. Further, a conceptual and empirical review of the literature on narrative therapy is provided and an argument advanced for the utility of narrative therapy in facilitating adjustment to MS. Possible areas for further research are outlined. Section B describes a feasibility study which aimed to begin to test a theoretical argument for the application of group narrative therapy to facilitate psychosocial adjustment to MS, and to ascertain the feasibility of a larger scale randomised controlled trial. Fourteen MS patients received 8 weekly sessions of group narrative therapy delivered at two sites in England. Quality of life, coping processes, and illness representations were assessed at two time points prior to the intervention and immediately after the intervention, and analysed using Wilcoxon Matched-Pairs tests. Additional qualitative measures were taken and analysed using content analysis. The feasibility of a larger scale study was, in part, assessed by means of semi-structured interviews with health professionals involved in the study, and analysed using thematic analysis. Although none of the findings reached statistical significance upon correcting for multiple comparisons, positive trends were revealed for the mental health component of quality of life, confrontive coping, and the consequences component of illness representations. With respect to the feasibility of this study, several issues pertaining to recruitment and data collection emerged from the data that can inform future research. Taken together, the results of this pilot study are promising and warrant further investigation using a sufficiently large sample. Section C provides a reflection on the skills and abilities developed and learning needs identified whilst undertaking the research. It further offers a critical reflection on the study‟s methodology and the potential implications for clinical practice. Further potential lines of enquiry are outlined.

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.

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Dropout from therapy for personality disorder (PD) represents a clinically-important but poorly understood phenomenon in the existing literature. The present grounded theory study explores the experiences of clients with PD, and their therapists, of treatment dropout from a National Health Service outpatient psychotherapy service, specialising in psychodynamic interventions for PD. Pre-therapy questionnaires for 20 clients were initially reviewed to generate hypotheses about the differences between treatment dropouts and completers, before a focus group was conducted with six therapists to explore their beliefs about and experiences of client dropout. Finally, six individual interviews were conducted with clients with PD, five of whom had dropped out from therapy at the host service. The final model highlighted the importance of clients’ treatment expectations, how they perceived their therapist’s behaviour, and their interpersonal history in making decisions about whether to stay in or drop out of therapy. The impact of therapy endings upon clients is also discussed, as well as therapists’ beliefs about managing complex clients, both individually and within a team, under current financial and clinical pressures. The findings are then discussed in relation to existing theory and research, and the clinical implications and limitations of the study are presented.

There is increasing interest in the personal benefits of writing poetry and a growing field of practical application within healthcare. However, there is little direct research and a need for practice-based theoretical integration to improve understanding of the specific changes, creative processes and challenges involved. This study investigates the way that writing poetry can affect self-experience. It also contributes to the development of combined modes of creative and critical inquiry. A first-person account of the experiential and creative outcomes of writing poetry over an extended period is presented. The results of this are subjected to reflexive analysis and a critical theoretical explication. Four factors relating self-experience to the experience of writing poetry are identified: a failure of conscious intention; an inhibiting objectification of experience; an implicit assumption of a separate self, and a changed experience of self that felt more embodied and fluid. These findings are the basis of a theoretical examination that utilizes the work of Ignacio Matte Blanco and Michael Polanyi, in conjunction with insights derived from contemporary psychoanalysis, embodied cognition, neuroscience and attention training. An original theoretical integration is developed. It is proposed that poetry has a characteristic bi-logical form that condenses and integrates difference and identity in a simultaneous and concentrated manner. The process of composition requires a reciprocal interplay of conscious and unconscious processes, which can be enhanced by an increase in embodied awareness, a decrease in the exercise of deliberate volition, and the facilitative use of images. This involves a flexible oscillation of awareness that, modulated by the breadth of attention and the degree of identification or separation from experience, directly alters the boundaries and quality of self-experience. This framework avoids the limitations of reductive or eliminative views of the self and allows for the creative operation of what is dubbed the 'nondual imagination'.

Preliminary results from research show some promising results for the Sex Offender Treatment Services Collaborative – Intellectual Disability (SOTSEC-ID) treatment on offence recidivism. However, further research that explores the processes of behaviour change is required. This study answered the research question: What are the key mechanisms to therapeutic change in individuals with ID who have completed a sex offender treatment programme (SOTP)? A qualitative grounded theory methodology was used to understand the processes of change. A semi-structured interview was used with 12 participants. The results showed that relationship experience, acceptance of responsibility, being able to remember the details of the group, group processes, understanding their own risk and practical strategies were the key areas that are influential in the change process. Barriers to change were also highlighted. The study concluded that there are other factors such as group processes important in the process of change that influence behaviour change, other than the content of the treatment. Group treatment is supported for this population.

The present study explored how authenticity is constructed by clinical psychologists and asked what might be the implications of these discourses. The study is concerned with offering a focus on the making of authenticity in discourse as well as providing an understanding of the complexity of authenticity within clinical psychology. The study used a discourse analytic approach known as critical discursive psychology to examine clinical psychologists’ talk of authenticity. Participants included twelve qualified clinical psychologists working in adult mental health services who took part in semi-structured interviews. Following a detailed critical discursive analysis of the texts, four discourses were identified with regard to the construction of authenticity. These discourses were commonly used to construct authenticity in extremely positive terms, however, some participants did draw attention to an ideological dilemma of authenticity versus professionalism. Participants used authenticity to establish their identity and manage their relationships with service users, colleagues and institutions. Drawing upon psychotherapeutic and professional discourses positioned participants as having power and being more authentic than others. Authenticity was problematised in relation to the participants need for professional boundaries. It is suggested that psychologists internalise dominant discourses of authenticity from the profession of clinical psychology, which is itself influenced by wider societal discourses around what it means to be authentic or inauthentic. Extra-discursive factors including institutions and embodiment were found to influence and constrain available discourses. The limitations of this study’s research findings are discussed as well as implications for future research and clinical psychology practice.

A literature review in Section A reviews the conceptual and empirical literature with regard to the usefulness and challenges inherent in applying recovery approaches in secure services, with a particular focus on women with a diagnosis of personality disorder. Section B. Background: Some studies have suggested that recovery approaches could be facilitated in secure mental health services despite a number of inherent tensions. However, none have explored if this applies to women with a diagnosis of personality disorder in secure care. A group whose needs have historically been overlooked, and can present with complex care-seeking behaviours. Aims. To explore how staff working with these women understand and apply recovery approaches in secure units. Method. Eleven multidisciplinary staff members working in a medium-secure unit in the UK participated in in-depth interviews. The data was analysed using grounded theory. Results. A preliminary model was generated, which comprised of five categories: secure base, balancing tensions, therapeutic relationship, initiating recovery, and nurturing recovery. These appeared to interact and influence each other throughout the recovery process. Conclusions. Staff are required to continually balance a number of tensions and as such they need a secure base from which to explore the service-users’ unique recovery process through the medium of collaborative therapeutic relationships. Staff sharing a recovery ethos that is embedded in the culture of a conducive environment, and is supported by supervision and teamwork, fosters the actualisation of recovery principles of empowerment, identity formation, and hope. Section C provides a critical appraisal of the study as well as a personal reflection on what was learnt through the process of the conducting the study.