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

Given the high rates of completed suicide and poor help-seeking among young men, this research explored how young men, who had successfully sought help from a Child and Adolescent Mental Health Service (CAMHS), experienced help-seeking. This study focused on the factors that facilitated initial access and on-going engagement in services. Eight young men between the ages of 16-18, who had entered CAMHS following self-harm or suicidal ideation, and who were engaged in on-going therapy, were recruited. Each young man was interviewed to elicit his personal experiences of help-seeking and help-receiving. Interviews were transcribed and subjected to Interpretative Phenomenological Analysis. Five dominant themes, that overarched participant’s individual experiences, emerged from the data: Role of external adult in recognising, normalising and initiating help seeking; Influence of another;Challenging and renegotiating perception of need for help and meaning behind this need; Change in perspective; Maintaining an independent self; Mechanisms of engagement and Shared experience. Help-seeking was described as a journey of two stages; 1) initial access and 2) on-going engagement, during which the presence and timing of external influences (parents, teachers) and internal influences (personal beliefs and attitudes) were crucial. A model of help-seeking is presented. This study is the first of its kind to consider factors that facilitate the help-seeking journey of young men aged 16-18 following self-harm. It highlights the need for provision of information to parents and teachers about how to identify need and ways to facilitate access to services. Information and guidelines on how to adapt services to meet the complex developmental needs of young men, is highlighted for service developers, commissioners and clinicians.

Research suggests that working with trauma survivors can result in a range of negative effects including ‘vicarious trauma’, ‘secondary trauma’, ‘compassion fatigue’ and ‘burnout’ amongst other things. Although the impact of being exposed to traumatic stories has been investigated in a range of professionals no studies to date have explored the impact of this on UK mental health workers known as care coordinators. The aim of this study was to explore a sample of care coordinators responses to client’s traumatic stories and the role of coping and perceived organisational support. Twelve UK care coordinators (community psychiatric nurses, occupational therapists and social workers) from two NHS mental health recovery teams completed interviews about their experiences of hearing clients’ traumatic experiences. Grounded theory was employed to analyse the interviews. The care coordinators heard traumatic stories in their role and were ‘active participants’ in these disclosures. They also experienced short and long-term levels of distress which included a range of negative emotions, a mixture of positive and negative responses and a broadening of their perspectives on themselves, their clients and the world. Care coordinators also developed a range of individual coping strategies, experienced individual and organisational barriers to seeking support and experienced limited organisational support for hearing traumatic stories. This is the first UK study to investigate care coordinators’ responses to clients’ traumatic experiences. Therefore further exploratory studies are required in addition to studies with larger sample sizes and measures of trauma related symptoms.

Recent studies with offenders have identified a growing distrust in psychologists and that this may be due to the changing role of clinical psychologists working within these settings. In addition to the traditional role of alleviating psychological distress, psychologists in these settings also have the additional role of providing expert risk assessment. Clinical psychologists working in forensic mental health settings (FMHS) are also tasked with this ‘dual role’. To date, there is no research exploring the impact of this dual role in FMHS. Semi-structured interviews were carried out with eight inpatients in two medium secure units. A grounded theory analysis produced a model of how trust was built and relationships developed. Despite the ‘dual role’ held in these settings, with an approach that is transparent, open, collaborative, and patient-centred; service users are able to build trusting relationships. Furthermore, they report making positive therapeutic gains. Where ‘coercive’ experiences were described, this appeared to be a representation of more distant times, with recent experiences being described as more satisfactory. Clinical psychologists also seem to be placed in a position of ‘mediator’ amongst the wider care team. Further research is required to explore these findings and whether they apply in other secure settings.

The aim of this grounded theory study was to explore the social identity of members of service user groups that train mental health professionals (SUG-TR). Additionally, the study aimed to construct an explanatory model of how participating in such groups contributes towards the achievement and maintenance of positive social identity. Semi-structured interviews were conducted with eight members of SUG-TR. Grounded theory was used to build a preliminary model, which contained 5 main categories: ‘Impact of mental illness/ impact of receiving a psychiatric diagnosis’; ‘The experience of stigma’; ‘Participating in SUG-TR’; ‘Contributing to positive identity’; and ‘Challenges to participating’. The constructed theory suggests that participation in such groups can contribute towards the achievement and maintenance of a positive social identity and that participants adopted specific strategies to achieve positive distinctiveness (i.e. an individual striving for positive self-concept) in the SUG-TR meetings and training environments. The constructed theory extends current research and suggests that SUG-TRs provide unique opportunities for the development of socially valued roles. The limitations and clinical implications of the research are explored and suggestions for further research are presented.

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.

The dementias are illnesses which have significant cultural prominence and feature in a wide range of contemporary writing, often as a trope for old age. This thesis examines how stories of dementia are told in fiction and in the clinic. To do this, the work uses Arthur Frank's socio-narratology to examine twelve selected texts in which a key protagonist has dementia. Three of the selected texts have been written by authors with direct experience of dementia within their family and form a subset of texts, memoir fiction. How stories of dementia are told is considered by examining the clinic as a storytelling venue, the creation of faux medical notes from information in the texts and a Triple Analysis of the memoir fiction using three reading templates. The templates have been created from clinical practice, using the questions posed by Frank's socio-narratological practice of Dialogical Narrative Analysis, and using the parameters of Rita Charon's version of Close Reading drill in Narrative Medicine. The work is informed by autoethnography which uses my position as a clinician and reader to examine how fiction has been used in my clinical practice and how it informs my reading of the selected texts.

Despite older adolescence being a risk period for the development of mental health concerns, mental health service engagement is low amongst 16-18 year olds. As therapeutic attendance is linked to clinical outcome, it is important to understand engagement in this population. There is a paucity of research looking specifically at the older adolescent engagement phenomenon. Previous qualitative research into adolescent experiences has provided rich and detailed results. Ten 16-18 years olds, engaged in Child and Adolescent Mental Health Services, were recruited from two London-based services. Each young person was interviewed in order to understand their personal experience of engaging in mental health services. Interviews were transcribed and underwent Interpretative Phenomenological Analysis. Analysis produced twelve subthemes subsumed within five superordinate themes: engagement begins at help seeking, strength of inner resolve, evolution of the self, in the clinic room, and, existing within service walls: physical and policy-based boundaries. Themes are discussed in detail. Conclusions are drawn in relation to previous theory and research. When considering 16-18 year understandings of the engagement phenomena, key elements include: clinician and service developmental appropriateness, negotiation of developmental tasks in relation to engagement, experience of the physical building environment, and awareness of service policy limitations. Suggestions for clinical practice in relation to engagement facilitators and threat are made, and recommendations for future research proposed.

The Mental Health Recovery Star (MHRS) is a therapeutic tool and outcome measure, used widely in the UK and internationally for clients and keyworkers in mental health services to jointly assess and work towards client-centred recovery goals. As such it has been recognised as potentially offering a means of building a positive working alliance between clients and workers. The alliance is increasingly being highlighted as a key common factor across therapeutic models that may underpin positive clinical outcomes. This study employed Grounded Theory Methods to explore the alliance within the context of using the MHRS in rehabilitation mental health services. Semi-structured interviews were carried out with ten clients and four workers across three services. The findings are presented in a theoretical model that explains the core category that emerged from this study – “being engaged in working together towards improved wellbeing”. Working with the MHRS was seen to inform three particular alliance processes: collaborative working; negotiating new or shared perspectives; and motivation towards improved wellbeing. The findings also highlighted challenges that can hinder these processes when using the MHRS, calling for improvements in practices of negotiation and better support for workers. Further clinical implications alongside avenues for future research are discussed.