The importance of early intervention for positive outcomes following a first episode of psychosis (FEP) is recognised, however, there are still delays in young people seeking help. The aim of this qualitative study was to explore beliefs about help-seeking in young people who have recently experienced a FEP. Twelve participants were interviewed and transcripts were analysed using grounded theory. Five categories of beliefs were identified which contributed to the development of a preliminary model of beliefs about a need for help-seeking. Young people’s beliefs about their experiences as normal or abnormal, and about the process and outcome of help-seeking, influenced beliefs about needing help. Existing beliefs about mental health problems, and beliefs about the impact of experiences on the self were important to the meaning young people ascribed to beliefs about help-seeking. Social networks were important in the development of these beliefs. The study identified beliefs which promoted and inhibited young people’s help-seeking beliefs for FEP. Self-stigma was present prior to help-seeking. Implications for clinical interventions include education to promote help-seeking for distress and not abnormality, and to dispel myths about the help-seeking process and outcome. Further research is needed to determine which beliefs are most important to young people’s help-seeking for FEP.

Section A is a review of literature which has explored the experience of dementia in the context of couple relationships. Four key themes thought to be central to this experience were identified and highlight the impact of dementia upon couple relationships, and how aspects of relationships may influence the experience of dementia. Limitations and gaps in our understanding are highlighted. Most significantly, the existent literature focuses upon care partners’ perceptions and excludes people with dementia. Therefore, it is argued that a relational understanding of the experience of dementia, in the context of couple relationships, remains unknown. The review concludes with a rationale for why further research is needed and how people with dementia could be included. Section B describes a qualitative study, using interpretative phenomenological analysis, to investigate couples’ experiences of dementia. Seven couples were interviewed and five master themes (‘foundations’, ‘altered structures’, ‘self-restoration’, ‘flexible scaffolding’ and ‘reflective capacity’) emerged from analysis of the data. These themes offer an understanding of the experience of dementia from a relational perspective and depict the ways in which couples construct their experience in order to make sense of dementia, and the processes that they adopt in order to adjust to dementia. The findings of this study are supported by existing empirical and theoretical literature and have implications for future research and clinical practice.

Section A presents a literature review which aims to consolidate the theoretical and empirical psychological research regarding refugees’ post-migration, to clarify and further understand their psychological experiences and needs. The literature search yielded papers which are divided into four sections: refugees and post traumatic stress disorder (PTSD); refugees, complicated grief and cultural bereavement; refugees, resettlement and acculturation; and refugees and Quality of Life (QoL). The review highlights key findings and areas requiring further exploration. Section B reports an exploratory narrative study which aims to explore the role of QoL in the narratives of refugees with a diagnosis of PTSD. Episodic semi-structured interviews were conducted with seven refugees (5 males, 2 females), and analysed using narrative thematic, structural and performance analysis. The results illustrated containing and consistent support was important in progressing the transition from suffering during asylum-seeking to a refugee with hope, and improved QoL and psychological health. The results are applied to theory and research, and limitations of the study are discussed.

It has been suggested that professionals working with trauma survivors can experience positive change and growth, but there is a dearth of research evidence. Therefore this study aimed to develop a preliminary model, grounded in data, encapsulating the processes and outcomes involved in positive change in a sample of these professionals. Twelve professionals (clinical psychologists, psychotherapists, a psychiatrist, and a solicitor) with experience of working with trauma survivors were interviewed about their experiences of positive change in relation to their work. Semi-structured interviews were audio taped, transcribed and analysed using a grounded theory approach. A model was developed for an episode of positive change, based upon four main processes that seemed to follow on from each other: key experiences in the work, emotional disruption, coping, and enduring positive changes. Conditions that influenced the intensity of emotional disruption experienced by professionals were also identified. The model of enduring positive change provides a fuller account of the growth processes and outcomes than previous literature to date. The main implication is that experiencing an emotional disruption as a consequence of the work can be a normal reaction to the work, and it may eventually lead to enduring positive change. This has further implications for training, supervision and continued professional development.

Section A is a critical review of empirical literature pertinent to the impact of community music projects (CMPs) on the interpersonal functioning of those with complex mental health needs living in the community. Section B presents a qualitative study exploring the interpersonal experiences of ten outpatients with complex mental health needs participating in a CMP. Background: Although participation in CMPs has been associated with improved interpersonal function amongst clinical and non-clinical populations their effects on outpatients with complex mental health needs are not clearly understood. Aims: The current study aimed to explore how outpatients with complex mental health needs experience, perceive, understand and respond to interpersonal interactions whilst participating in a CMP. Method: Participants included 10 outpatients with complex mental health needs, who had attended a CMP for at least 6 months. They completed a semi-structured interview concerning interpersonal experiences and the project’s impact (if any) on such experiences. Interpretative Phenomenological Analysis was utilised (Smith, Flowers, & Larkin, 2009). Results: Interpersonal experiences of participants were conceptualised as master themes involving hope for social interaction, non-musical interpersonal experience, musical interpersonal experience, wider community experience, belonging, esteem and positive identity. Conclusion: Interpersonal learning, bridging capital and the development of self-concept components may be experienced in relation to CMP participation. The importance of social context assessment to client formulations and interventions and the need for further longitudinal, qualitative research in this area is implicated.

Section A is a literature review evaluating the role of Therapetuic Care Workers (TCWs) and Therapeutic Foster Carers (TFCs) working relationally with a sub-group of Looked After Children (LAC) who are highlighted as having intense emotional and behavioural needs. These LAC are thought to benefit from living in specialist, therapeutic placements where carers work relationally. However, to date, there is no known review evaluating relational residential interventions or the role of TCWs and TFCs. Therefore, literature exploring the theoretical underpinnings of the work, and the emotional impact and protective factors involved in the carer role is considered. Implications for future research and clinical practice are suggested. Section B describes a qualitative study which explores how TCWs experience their role and their perceptions of the potential benefits for LAC. A qualitative design using Interpretative Phenomenological Analysis (IPA; Smith, Flowers & Larkin, 2009) was applied. Methods. Nine TCWs currently working in one of two therapeutic communities were interviewed. Results. Five master themes were identified: ‘Therapeutic group living’; ‘Importance of carer-child relationships’; ‘Working with the unconscious’; ‘Personal meaning of professional role’, and ‘Children’s progress’. Participants considered that forums for reflection were crucial to their ability to think clearly and analytically about the children, and utilised psychodynamic concepts to gain insight into the children’s inner worlds. TCWs’ increased self-awareness was central to this process. Participants also reported experiencing their role as emotionally challenging. One focus of reflection was on the small steps of progress the children were perceived to achieve. Conclusions. Overall, the findings suggested a synergy between relevant theory, descriptive accounts of therapeutic childcare, and TCWs’ perceptions of their role. New information regarding the personal investment of TCWs and internalisation of the framework of practice was identified. Further research is needed to extend the evidence-base. The clinical implications of the findings are discussed.

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.

Service user and carer involvement has become a priority in the education of mental health professionals. While preliminary evidence suggests that service user and carer involvement is perceived positively by mental health students, there is a paucity of research investigating impacts relating to changes in learners’ knowledge, skills, attitudes or behaviour. The present qualitative study sought to investigate what, and how, (trainee) clinical psychologists learn as a result of service user and carer involvement in their training. Overall, 12 (trainee) clinical psychologists were interviewed and grounded theory methodology was used to analyse the data. Findings indicated that (trainee) clinical psychologists learned from service user and carer involvement in a variety of ways and a preliminary model was proposed, encompassing four main categories: 'mechanisms of learning', 'relational and contextual factors facilitating learning', 'relational and contextual factors hindering learning' and 'impact'. The findings are discussed in relation to extant empirical research, taking into account theoretical considerations. Recommendations for educators in clinical psychology training programmes are provided alongside suggestions for a future research agenda. A methodological critique of the study is offered.

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.

The potential for green interventions to promote mental wellbeing and reduce mental distress is increasingly being recognised (Mind, 2007). Preliminary evidence suggests that allotment gardening activities may have a significant effect on mental wellbeing, but a paucity of research, particularly in non-clinical populations, has been highlighted (Partridge, 2010). A cross-sectional online survey of 171 allotment gardeners was conducted. Measures of subjective wellbeing (quality of life), eudaimonic wellbeing, connectedness to nature and preference for solitude were administered. Qualitative data were also collected through open-ended questions. Allotment gardeners’ scores on measures of environmental quality of life and eudaimonic wellbeing were significantly higher than those reported in the literature, but social quality of life was lower in allotment gardeners. Regression analysis showed that time spent on the allotment during summer predicted eudaimonic wellbeing. This relationship was fully mediated by feelings of connectedness to nature. A relationship was observed between spending time on the allotment and preference for solitude. Four main themes emerged from the qualitative data: allotments provided a space of one’s own, meaningful activity, increased feelings of connectedness, and improved physical and mental health. The results suggest that allotment gardening is associated with increased eudaimonic wellbeing, but not subjective wellbeing (also referred to as hedonic wellbeing). Furthermore, a mechanism through which allotment gardening enhances wellbeing is suggested: increased connectedness to nature. Limitations of the current study and clinical and research implications are discussed.