Objectives: Performance validity tests (PVTs) and symptom validity tests (SVTs) have been recommended by the British Psychological Society to assist clinicians in validating assessment data. The current study aimed to explore the base rate of PVT failure in an NHS neuropsychology service, a setting relatively unexplored. A secondary aim was to investigate the relationship between PVT and SVT performance. Lastly, group differences in those passing and failing PVTs were explored in terms of demographics, and psychological functioning. Method: Archival test data (n=127) was drawn from an NHS outpatient neuropsychology service. Participants completed one stand-alone PVT (the Test of Memory Malingering [TOMM]), one embedded PVT (Digit Span age-corrected scaled score [DS-SS]), and one SVT (the Personality Assessment Inventory [PAI]). Results: The base rate of failure on any one PVT was 26%. The rate of TOMM failure was 12% and 6% additionally failed an embedded PVT. A significant relationship was found between PVT and SVT performance. Significantly elevated Paranoia, Anxiety-Related Disorders, and Schizophrenia PAI scales, as well as lower Full Scale IQ scores, were found in those who failed PVTs compared to those who passed. No other group differences on demographics were found, including reported financial incentive. Conclusions: Findings suggest that PVT failure occurs in a sizable minority of NHS ABI outpatients, which is unlikely to be simply explained by malingering for material gain. Elevations in reported psychopathological symptoms may be related to emotional and cognitive sequalae resulting from the ABI itself. Careful interpretation of neuropsychological test data is endorsed.

The question of how to maintain appropriate professional boundaries with clients can be complex and further difficulties can arise for forensic inpatient nursing and healthcare workers. The literature in this area focuses mainly on boundary violations and there is little research on how staff members develop and maintain boundaries on forensic wards, despite this being beneficial for staff experience and client recovery. Interviews with eleven psychiatric nurses and healthcare workers were analysed using a grounded theory methodology, which led to the formation of a cyclical model of boundary development. Staff initially acclimatize to the forensic environment using their existing experiences and personal values and then enter a phase of calibration, where they constantly assess and address professional boundary issues in the course of their daily responsibilities. Staff members use this experience alongside reflection, social learning and supervision to undergo individual learning that parallels team development. In a fourth phase, staff members use this learning to recalibrate their views on boundaries, themselves and how they work with clients. This recalibration impacts on staff members’ further management of daily boundaries, which provides more material for learning, which leads to further recalibration. This study emphasises the consideration staff have for boundaries and echoes previous literature suggesting the importance of supervision and reflective spaces. The model is comparable to existing learning theory and highlights the importance of social and experiential learning. There are implications for training, team building, supervision and reflective spaces. Further research could explore cultural aspects of boundary development.

The systemic model has been proposed as particularly relevant for addressing the mental health needs of refugees and asylum-seekers. Clinicians working with families from refugee and asylum-seeking backgrounds who have experienced trauma may wish to encourage family communication to promote resilience, but may find it difficult to know whether to address traumatic memories. This study aims to develop a theoretical understanding of how conversations about trauma emerge in systemic family therapy with families from refugee and asylum-seeking backgrounds. Ten systemic family therapists were interviewed, and data was analysed using grounded theory methodology. Resulting constructs highlight co-constructed conversations about trauma between families and therapists. Therapists attend to several factors in order to create a space where unspoken stories can be voiced, so that families can find new meanings and re-connect. Showcasing current practice in this field, the study emphasises the need for clinicians working with this population to actively engage with the wider context, and highlights the need for research investigating the effectiveness of systemic family therapy interventions for this client group.

Objectives: A Near-Death-Experience can be a lifechanging event initiating deep posttraumatic growth. Yet people can initially be left struggling with the internal changes and feel alienated from their life and social network. This study investigated whether Near-Death-Experiences also have an impact on people’s happiness, and if so, how long it lasts, and what kind of support they receive in making sense of the event. Method: Six semi-structured interviews were conducted with people who had a Near-Death-Experience and the data was subjected to Interpretative Phenomenological Analysis. Results: Five master-themes emerged: Sense of self, Attitude toward life and death, Effects of Near-Death-Experience, Relationship with others, and Experience of happiness. Conclusion: Almost all participants reported feeling less apprehensive towards death and simultaneously found a greater ability to embrace and appreciate life. Some gained new and profound internal insights that manifested in a renewed sense of self, stronger and more pronounced feelings of life purpose, and could reflect on the Near-Death-Experience as a precious gift. The majority of participants experienced a greater degree of happiness that gradually grew over time. This was largely located internally, which freed them from ‘the hedonic treadmill’ of pursuing it in the outside world. Stigma and a lack of awareness still represent a hurdle for connecting with others and accessing support. Clinical and research implications were discussed.

Schwartz Rounds are a staff support intervention which have been adopted in over 100 healthcare trusts in the UK since 2009. They aim to provide a space for staff to come together to think about the emotional impact of the work they do. Research into rounds is in its infancy, however, to date, findings are generally positive. The current study aimed to develop a theoretical understanding of staff motivation to attend or not attend rounds. Interview data from ten NHS employees and one previous employee were analysed using a grounded theory approach. A theory was developed which suggests staff will make the effort to overcome contextual factors of lack of time and resources to attend rounds if they view them as beneficial. Reported benefits of rounds were similar to those described in previous research. Staff are less likely to attend rounds if they do not understand the aims of rounds or if they view sharing emotional experience as risky. High demands and a perceived lack of support may influence the degree to which staff trust and feel able to use rounds. The limitations and implications of the study are discussed and areas of future research suggested.

Background: Literature to date claims that sex and sexuality are a core aspect of individuals’ psychological wellbeing. Literature also claims that Clinical Psychologists are not engaging in talking about these issues in their practice or training. Sex and sexuality are complex topics and argued to be impacted by social, cultural, historical and political discourses. Looking at the discourses within the profession may provide helpful insight in understanding current practice. Aim: The aim of this study was to investigate how sex and sexuality was constructed by clinical psychologist and trainees when discussing training and practice. Method: Semi-structured interviews were completed with 6 practicing CP’s and 4 trainees CP’s, 2 focus groups were also completed with trainees from 2 different universities. A Foucauldian Discourse Analysis (FDA) approach was used to explore professional and trainee’s discourses around the topics of sex and sexuality. Results: Six discourses were identified during the analysis consisting of ‘Let’s not talk about sex’; ‘Dangerous for Clients, Professionals and Society’; ‘Social and Political Movements’ and ‘Culture and Contextual Discourses.’ Two counter discourses also emerged: ‘Let’s talk about sex’ and ‘Sex and Sexuality are Positive and Healthy’. Conclusions: Various wider discourses can be seen to be impacting on clinical psychologist’s decision making when talking about sex and sexuality within practice and training. Constructions of what is expected from clinical psychologists in the therapy room appear to be reinforced by dominant social, political and cultural discourses. Counter discourses were present; bringing these alternatives more into the forefront could be beneficial for clients.

This thesis deals with how group members respond to wrongdoing committed in their group's name. In particular, I investigate whether individuals feel ashamed or guilty for these acts, and in turn, what motivational effects these emotions have. A review of the literature on shame and guilt turns up serious inconsistencies regarding both the charac- terisation of these emotions and the empirical evidence relating to them. In particular, shame is found to be related to both prosocial and antisocial outcomes, and guilt is some- times associated with prosocial acts and sometimes not. My empirical work tests an explanation for these inconsistencies. Notably, I test a novel way of seeing shame, and propose that not only are there different forms of shame but that these different forms have divergent motivational effects. I focus on two important forms of shame: moral shame and image shame, which arise when one sees the ingroup's actions as threatening one's morality or reputation, respectively. I show that moral shame is consistently related to increased prosocial attitudes (support for apology and compensation) and decreased an- ger, avoidance and cover-up; whereas image shame is predictive of higher levels of anger, avoidance and cover-up. The effects of guilt are weak or non-existent in the presence of these two forms of shame. I also show that these emotions have a meaningful influence on how group members relate to unrelated minorities in society, borne in part of a feeling of moral obligation for past wrongdoing. A study is also reported that shows that, depend- ing on their individual motivations, different group members prefer different emotional expressions within apologies offered by their leaders.

The purpose of this study was to discover how relaxation in general works, and how components of Autogenic Training (AT) (Luthe and Schultz, 2001), a relaxation therapy, may be working together and separately in an anxiolytic process. A corollary purpose was to develop recommendations for clinical practice. Data consisted of personally and historically collected interviews (n=46) and diaries (n=34). Participants with less than moderate anxiety volunteered from the community at large; and, participants with moderate to severe anxiety were drawn from the Royal London Hospital for Integrated Medicine’s AT Department and British Autogenic Society therapist’s client lists. A classical Glaserian grounded theory analysis methodology was used to determine participants’ main concern (self-balancing) and the way they continually resolved this concern (sanctuarying). The theory of relaxation as a self-balancing sanctuarying process emerged from analysis of what 21 people from the community at large say they do to relax in everyday life. The activities they choose for sanctuarying are self-emergent, and their continuing use is contingent upon managing hindrances and integrating feedback to the process so that the benefits of doing the activity are maximized. Three switching strategies, distracting and blocking, managing and controlling, and letting go and allowing, are central. Benefits which are not consciously or analytically generated are: restoring, refreshing and re-energizing me; maintaining and building me; and growing and developing me. Maintaining and building me are characterized by integrating and strengthening the core self and connecting to the community; growing and developing me is characterized by expanding self-discovery. The theory of self-balancing sanctuarying was used on an emergent fit basis to analyse 25 interviews and 34 diaries gathered from people with symptoms of moderate to severe anxiety whilst learning to practice Autogenic Training. This analysis broadened and deepened the grounded theory. This thesis contributes to knowledge in many areas. It is the first classical grounded theory of relaxation and of Autogenic Training, theoretically situating and/or challenging extant descriptive and conceptual models of both relaxation and AT. It supports the clinically functional equivalence of certain forms of relaxation and supports Teasdale and Barnard’s (1995) Interacting Cognitive Subsystems Model. It supports and challenges certain aspects of core affect theory, of the cognitive appraisal theory of emotions, and of Fredrickson’s (2001, 2003) broaden and build theory of positive emotions. It adds a grounded perspective to the spiritual well-being debate, bringing new knowledge to it. It adds new data to the field of the phenomenology of hypnagogic images. It discusses the implication of Self-balancing Sanctuarying for training of AT therapists and for their clinical practice with anxious clients.

Art therapy research studies neglect the description of practice. A literature review revealed that art therapists narrowly rely on self-reported case studies to build theory, but that approach tends to result in a description of the therapist's intention rather than the actions they undertook. Comparable forms of psychological therapy have constructed descriptions of practice from observational research but this method has been relatively underused by art therapists. The present study used observation to build a description of practice of how art therapists interacted with service users and their artworks in a mentalization-based art therapy group for people diagnosed with borderline personality disorder. Three fifteen minute video edited sequences of in vivo art therapy sessions were viewed by focus groups who described what they observed. Because the study assumed a social constructionist epistemology, focus groups were chosen to represent a range of service users, psychological therapists, art therapists and the treating art therapists' perspectives. A modified grounded theory approach was used to analyse transcripts from those focus groups which resulted in two core conceptual categories. The first proposed that when art therapists demonstrated their engaged attention, it supported a more reliable therapeutic interaction. The second, conversely, proposed that when the art therapists gave the appearance of passivity, it exacerbated dismissive interactions between group members and with artworks. This added new theoretical concepts to art therapy group literature. However, that theory was not tested in the present study.

Section A explores the theoretical underpinnings of the four concepts included within the umbrella term ‘falls-related psychological concerns.’ These are fear of falling, falls-related self-efficacy (FSe), balance confidence and outcome expectancy. It goes on to examine the empirical literature on psychological factors associated with falls-related psychological concerns, and the limited literature exploring how the psychological factors mediate between falls-related psychological concerns and falls. A model of falls-risk is presented to consider these mediating roles. The clinical and research implications of the review findings are considered. Section B reports an empirical study, which explored cognitive coping responses employed by community-dwelling older people to manage their falls-related psychological concerns. It explored if these coping responses mediate the relationship between falls-related psychological concerns and falls. Correlation and regression analyses were employed to explore the relationships between these variables. Robust analysis was conducted using bootstrapping, and a bootstrapped mediation analysis, based on Baron and Kenny’s (1986) model was employed. The study concluded that FSe and falls were strongly associated, and ‘self-controlling’ coping was found to be a partial mediator of this relationship. Study limitations, theoretical and clinical implications, and suggestions for further research are provided.