Section A consists of a review of the literature relating the therapeutic use of creative writing. It highlights gaps in the literature and suggesting potential avenues of further research. Section B presents the findings of a phenomenological study which aimed to explore the experience and significance of creative writing at times of personal difficulty through the analysis of written accounts. Method. Twenty one people who had personal experience of creative writing in the context of difficult life experiences submitted written accounts. These were analysed using Interpretative Phenomenological Analysis (IPA) (Smith, Larkin & Flowers, 2009). Results. Four main themes were identified: 1) Struggle with a difficult experience, 2) Turning to creative writing, 3) Dealing with it ‘as a matter of words’ and 4) Rejoining the world. A conceptual model illustrating how these master themes are related is presented. Conclusion. Creative writing was deemed to have played an important and meaningful role in helping participants to integrate and move beyond difficult life experiences. Limitations and clinical implications of the study are discussed and suggestions are made for future research. Section C involves a critical appraisal of the study presented in Section B. Reflections on the process of the study, as well as further implications and clinical applications are discussed.

Section A: The aim of this paper was to review and provide a summary of the empirical and theoretical literature on risk assessment, recidivism and theories of offending in relation to intellectually disabled (ID) sex offenders. This work is still in its infancy when compared with the non-intellectually disabled sex offending and risk assessment research and it was therefore important to include an overview of the general sex offending literature, to establish how this relates to the more recent developments in the study of ID sex offenders. Section B is an exploratory validation study using a longitudinal cohort design. The purpose of the study was to explore the criterion validity of the ARMIDILO-S (Assessment of Risk and Manageability of Intellectually Disabled Individuals who Offend - Sexually) risk assessment tool. The study investigated the tool by using it with a clinical population of adult men with an intellectual disability, who had taken part in sex offender group treatment, due to their sex offending behaviour. Section C is a critical appraisal of the process of undertaking this research. It is a reflective and critical account of what skills and lessons the author has learnt, what could have been done differently, and how it might affect clinical work and future research.

This study aimed to determine the prevalence of anxiety specifically related to discharge in a group of 42 individuals who had sustained moderate to severe acquired brain injury and who were imminently due to return home following a period of inpatient neurorehabilitation. The study also aimed to explore differential relationships between psychological factors (self-efficacy and health control beliefs) alongside the relative influence of demographic (age, gender and ethnicity) and clinical (medical diagnosis and injury location) characteristics on discharge-anxiety. A cross-sectional, single-group design was employed, wherein correlational and multivariate analyses were used to explore relationships between variables. Data was obtained via self-report tools and retrospective reviews of medical files. While few participants (14%) reported markedly elevated trait-anxiety almost half (45%) of the sample reported levels of transient, state-anxiety which could be considered to be clinically significant. Notably, state-anxiety (appraised via the State-Trait Anxiety Inventory) was strongly associated with discharge-anxiety (appraised via the Patient Anxieties Questionnaire). Age, self-efficacy and internal health control beliefs made independent contributions to the level of discharge-anxiety reported, with perceived self-efficacy alone explaining 69% of the overall variance and mediating the effect of internal control beliefs. No other demographic or clinical characteristics examined were significantly related to discharge-anxiety. Although causality cannot be inferred, findings suggest that discharge-related anxiety is best predicted by poor perceptions of self-efficacy. Implications for clinical practice and directions for future research are discussed.

This study had two objectives: to develop an ecological understanding of personal recovery in the context of severe mental illness (SMI) with a UK-based sample, and to develop a model of the discovery of hope and meaning in recovery, and relevant helping and hindering factors. A grounded theory methodology was employed as a framework for collecting and analysing qualitative data. The study provides an emergent ecological model of growth in the context of personal recovery incorporating seven theoretical categories including; prevailing contexts, the importance of relationships, purposeful goals, values-commitment, emerging self-efficacy, wellness experience, and tangible and intangible hope. The emergent model provides a novel understanding of the individual, ecological and interactional factors facilitating the discovery of hope and meaning in life. It is anticipated that such findings will benefit the provision of statutory and peer-run mental health services, and support further research into growth in the context of SMI.

Psychotic phenomena such as delusions have recently been understood as meaningful within the context of a person’s life while recent models of psychosis implicate psychosocial influences in its aetiology. Research on women with such experiences has been limited despite recognition of their specific needs and vulnerabilities due to the nature of their lives. This study aimed to examine the processes influencing women’s understandings of their delusional beliefs in the context of their lives. It used a social constructionist version of grounded theory to conceptualize the process of women’s understandings. Ten women who had experienced delusions were interviewed. Grounded theory analysis revealed four main processes: women’s acquisition of knowledge about themselves; significant life experiences; how women experience their delusions; and the process of emerging from the delusional world. According to the constructed theory, the core process of understanding is conceptualized as residing in the space between private experience and the social world. It is mediated by the relationship women have to knowledge about the self, which in turn is mediated by the responses of others. Delusions are understood as responses to life experiences and are therefore meaningful containers of truth. Implications for clinical practice, limitations and suggestions for further research are discussed

Section A reviews the literature from two areas: it looks first at empirical studies exploring self-stigma in psychosis and secondly at psychological flexibility in psychosis. In doing so, the review aims to consider the question as to whether the psychological flexibility model, as presented by Acceptance and Commitment Therapy, can help us to understand how and why self-stigma can have a detrimental impact on some individuals experiencing symptoms of psychosis. Section B reports on a quantitative study of self-stigma, psychological flexibility, psychological well-being and quality of life in a First Episode Psychosis population. Research suggests that individuals experiencing psychosis may self-stigmatise, whereby negative beliefs and stereotypes about mental health difficulties are internalised. This in turn has been found to impact negatively on a number of areas. The psychological flexibility model presented by Acceptance and Commitment Therapy may help us to understand this. This study aimed to explore self-stigma using both an explicit and implicit measure of self-stigma to see how these were related to psychological flexibility, quality of life and well-being. Twenty-six participants experiencing first episode psychosis were recruited. They completed self-report questionnaires pertaining to quality of life, psychological well-being, psychological flexibility and explicit self-stigma. In addition, they completed a computer based reaction-time task designed to measure implicit self-stigma. Significant relationships were found between explicit self-stigma and well-being, and between psychological flexibility, explicit self-stigma, quality of life and well-being. Explicit self-stigma was found to statistically mediate the relationship between flexibility and well-being. Implicit self-stigma was not related to any investigated variable. The findings suggest psychological inflexibility may lead to greater self-stigma, which in turn decreases psychological well-being. This implied that interventions geared towards increasing flexibility may not only improve well-being, but may also help address issues of self-stigma.

There is limited research concerning the sharing of writing associated with times of personal difficulty. This study aimed to explore the experience and significance of this process with a focus on the interpersonal factors involved and how the potential benefits could be conceptualised. Eight participants were recruited through purposive sampling and interviewed regarding their experiences. Interpretative Phenomenological Analysis was used to analyse the transcripts. Four superordinate themes of ‘Putting the self into the world’; ‘Taking ownership of the process’; ‘Making connections with others’; and ‘Moving beyond surviving to thriving’ were interpreted from the data. Interpersonal factors were of great significance and were discussed in connection with a range of theorists including those from fields of psychoanalysis, phenomenology and humanism. The overall findings were conceptualised through identified links with Ryff’s (1989) multidimensional model of well-being. The findings suggest that the sharing of creative writing associated with times of personal difficulty may be a valuable activity in promoting well-being in both clinical and non-clinical populations. It may be particularly helpful for people who have experienced, or are at risk of social isolation given the experiences that first led the participants to creative writing, and the centrality of ‘connection within others’ within their accounts.

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'.

This study aimed to develop and test the feasibility of a peer-led parenting intervention for parents living in London in temporary accommodation, seeking help with managing behavioural difficulties of a child (aged 2–11). A structured, group-based intervention (‘Empowering Parents, Empowering Communities- Temporary Accommodation’) was delivered by peer facilitators to N=15 parents across three group cohorts. Twelve parents (80%) completed the group programme at first attempt; one parent completed on their second attempt after re-joining in a different cohort. A mixed-method formative evaluation was used. The intervention’s feasibility was assessed in terms of attendance and completion rates (% parents completing ≥6 sessions); acceptability was assessed by satisfaction measure and qualitative participant interviews; and potential for impact was assessed by parent-reported standardised measures of child behaviour, parenting behaviour, parental wellbeing, parenting stress and social support. Reductions in child behavioural difficulties and improved parenting knowledge and practices were reported on standardised measures. Improved parental outcomes were described in qualitative interviews. Participants were highly satisfied with the intervention. The study concluded that peer-led parenting groups are feasible and potentially effective interventions for parents living in temporary accommodation. These findings warrant further testing under controlled conditions.

Section A reviews the clinical and risk implications of dual diagnosis along with the treatment context. The value of gathering firsthand accounts of service users to inform the planning and delivery of healthcare is touched on. The second part of the paper centres on theories of motivation and how they might be applied to help explain low rates of dual diagnosis treatment uptake and engagement. Finally, gaps in the literature are highlighted with recommendations for further research. Section B There is an emerging evidence base to support the use of integrated approaches that treat co-existing mental health and substance use disorders simultaneously. However, low rates of treatment uptake and engagement remain a concern. To address this, it would seem important to understand dual diagnosis treatment motivation and engagement, an area that has received little attention from the research community. The aim of this study was to explore service users’ and clinicians' understandings of how treatment motivation and its relationship with treatment engagement relate specifically to people with dual diagnosis. Transcripts from semi-structured interviews with four service users and four clinicians were analysed using narrative methodology. The study suggests that the factors underpinning treatment motivation and engagement among people viewed as having dual diagnosis are similar to those thought to be associated with addictions and mental health disorders generally although their relative influence and interaction effect might be different. It is suggested that negative perceptions of services, difficulties with trust, and therapeutic relationship are particularly important issues among dual diagnosis populations. Clinical and theoretical implications of the study are discussed in relation to the literature as well as recommendations for future research. Section C: Critical Appraisal. This paper provides a general overview of narrative research, including strengths and limitations as they relate to this study. With reference to the literature, clinical and theoretical implications are elaborated along with recommendations for future research. The author’s critical self-reflections regarding the process of initiating, carrying out and completing the study are highlighted. Following this, there is a section on the ethical considerations of the study. Finally, the measures taken to ensure the quality of the study and maximise internal consistency are presented.