Research with refugees tends to be dominated by mainstream medical and trauma models. However, development of resilience theories and research on coping increasingly find that such constructs can open up currently limited understandings of the refugee experience. This research took a culturally relativist approach to explore experiences of coping in young unaccompanied refugees in the UK. Following extensive consultation, five young refugees were recruited, who were living independently or semi-independently having arrived in the UK without their family, at the age of 15 or 16. Interpretative Phenomenological Analysis was used to explore experiences and understanding of 'coping', whilst acknowledging the relative contributions of their own and my own cultural frameworks and the limitations of language; three participants made use of having an interpreter present. The accounts are presented idiographically, under three major themes that were apparent on multiple levels of the refugees' lives, from the individual to the cultural: 'Adaptation in the context of hardship and loss', 'Beliefs and worldview in shaping a new life', and 'Building strength and self-reliance'. These findings contribute to research finding resilience in refugee lives, whilst not to the detriment of incredible loss and pain. The research attests to the significance of cultural frameworks in refugee coping, with religion playing a key role. The themes are discussed in relation to existing literature and relevant texts, with implications for further research and clinical practice. The role of professionals as allies of refugees is suggested, in promoting socially inclusive practices that involves work both in the clinic and on community and social levels.

This thesis explores the relatively under-researched experiences of module design of academics employed within one UK university. In all, 96 people responded to an initial e-questionnaire survey, and 23 of these participated in follow-up semi-structured interviews. The qualitative data collected from both sources is the main focus of discussion. The thesis contextualises the research by presenting a brief description of the university of study and a sense of the social and political context of higher education in the few years preceding the onset of the project. Following this, there is a review of the existing literature around module and curriculum design. A separate chapter outlines the mixed methods employed to collect the data and the form of Interpretative Phenomenological Analysis (IPA) used to theme the qualitative data provided by the survey and interviews. The findings supported previous studies, but there was some contradictory data concerning assessment design, the value of the institutional approval procedures, and the usefulness of involving students in the design process. This study found that, as a result of the effect of institutional processes and documents on design, the consequence of changing student profiles (particularly around assessment), and the obligation staff feel to their students (despite their expressed lack of available time and resources), module design (and redesign) is more situation-informed than evidence-informed. It concludes that module designers employ a realistic and pragmatic approach to the process, even when their views, attitudes, and consciences around the rights and wrongs of the design process are sometimes questioned.

This research used interviews and Interpretative Phenomenological Analysis (IPA) methodology to explore the experiences of care staff who attended systemic consultations within an Intellectual Disability (ID) service. A systematic literature review revealed limited research in the area of systemic approaches used with people with IDs and their networks. Research questions encompassed 'How do care staff experience systemic consultations that they have attended in ID services'?, 'What do care staff find helpful in systemic consultations'?, and, 'What do care staff find unhelpful in systemic consultations'?. Seven participants were interviewed, and interview data was transcribed and analysed using IPA. Five superordinate themes emerged; 'Not knowing what to expect; it was something different', 'Our relationships improved', 'An outside person shone a new light enabling us to think and work differently', 'Making sense of what we have achieved', and 'They made us feel validated'. The research findings highlighted important clinical implications. These included a need for the context to be 'warmed' and relational reflexivity (Bunham, 2005) to be applied in order to help care staff prepare for systemic consultations and feel supported. Future research directions are also discussed in order to develop the evidence-base for systemic approaches within ID services.

Objectives: To explore how adjustment to type 2 diabetes mellitus (T2DM) can be understood using psychological (in)flexibility, the theoretical model underlying acceptance and commitment therapy (ACT). The specific research questions are: (a) what are participant experiences of adjustment and coping in T2DM? and (b) how can participant experiences be understood in terms of the processes underlying the model of psychological (in)flexibility? Design: This interview study utilised a cross-case qualitative methodology. Methods: Semi-structured interviews were conducted with 11 purposively recruited individuals with a diagnosis of T2DM. Interview transcripts were subjected to an interpretative phenomenological analysis (IPA) methodology. Results: Three primary themes were identified from the IPA: (a) ‘Eating myself into diabetes’: Managing the self in relation to perceived diabetes stigma; (b) My other illness is the real problem: diabetes minimised in the context of co-morbid diagnoses; and (c) Knowledge reduces attachment to the patient-role self-story. Conclusion The interpretation of the qualitative data generated suggests that adjustment to a diagnosis of T2DM is a complex process incorporating intra-individual and systemic factors. Whilst psychological flexibility may be a useful model for understanding and supporting adjustment, interventions are required that also address wider systemic issues such as the integration of care, health-related stigma and relationships with health professionals.

There is a significant volume of research evidence documenting the sexual problems experienced by women survivors of childhood sexual abuse (CSA). Accordingly, existing treatment paradigms for sexual problems in this population tend to equate the absence of symptoms with adequate sexual functionality, implying that CSA survivors can aspire to sexual functionality at best. However, this false dichotomy reinforces a medicalized, genital-focused view of women's sexuality, and provides no information about what connotes a positive sexual experience for CSA survivors. The current mixed-methods study is centered on the research question, “how do women survivors of CSA experience 'good sex'?” Semi-structured interviews were conducted with 15 women who self-identified as CSA survivors and self-reported having experienced good sex. Participants were also asked to complete standardized quantitative measures of women's sexual functioning, sexual satisfaction, and sexual self-schema. Using interpretative phenomenological analysis (IPA), four themes emerged from the qualitative portion of the study. The women expressed a clear definition of good sex (theme one), identified factors that contributed to their experience of good sex (theme two), conceptualized good sex within a developmental context (theme three), and discussed similarities in the experience of good sex between survivors and non-survivors, though noted that the pathways to this experience were different for survivors (theme four). Participants' scores on the quantitative portion of the study varied widely from each other and were inconsistent across individual scores of sexual functioning and sexual satisfaction. These findings demonstrate that women survivors of CSA can and do experience good sex, and this experience of good sex may not be captured accurately by constructs of sexual functioning, sexual satisfaction, and sexual self-schema as depicted in commonly-used questionnaires. Implications for health practitioners, clinicians and researchers are discussed. / Graduate

Background: Personality Disorder treatment is a contentious subject in health care. Despite available research concerning the diagnosis itself and also available treatments, there is little research regarding treatment thresholds or defining how treatment decisions can be formulated. This problem has been identified by clinicians, patients, supervisors and specific organisations, particularly linked to recent healthcare changes associated with austerity measures. Research Question: How can mental health care staff use a formulated decision process concerning therapeutic interventions for people with PD, when considering the recent service changes and rationalisation of available treatments? Methods: An Action Research study has been conducted over a four year period, using predominantly qualitative methods including: a hermeneutic literature review (n=144 papers), patient questionnaires (n=15) and Interpretive Phenomenological Analysis (IPA) of clinician and supervisor semi-structured interviews (n=10). Results: Difficulties have been found when making decisions with people who either do not accept their diagnosis and/or do not accept the current evidence-based treatments for personality disorder. Other challenges have been identified regarding the patient/clinician relationship, the level of distress the patient presents with, and also the clinician view concerning the individual, the diagnosis, and the available treatments. The IPA produced five super-ordinate themes related to decision-making regarding treatment choices for people with personality disorder, including: difficulties with boundary management, diagnostic stigma, a focus upon time, metacognitive ability, and the potential for iatrogenic harm. Conclusions: Multiple factors require consideration when examining treatment choices for people with a personality disorder, concerning the patient's individual symptom profile, needs, attitude towards treatments; the clinician's profession, attitudes, opinions, and wellness on the day of the assessment, and also the treatments available within the locality. A diagram has been presented summarising these formulation factors. Recommendations have been made based upon the results, analysis, synthesis and discussion sections, indicating potential practice changes and areas for future research.

Background and aims: The qualitative literature that has examined the topic of sudden and profound transformation has mostly focused on the antecedent and facilitative factors associated with this form of change. However, previous empirical research has noted the great difficulty participants experience when trying to arrive at an explanation for their change. Within this study, I have aimed to explore the lived experience of sudden personal transformation. Having experienced a life altering epiphany myself, I was compelled to investigate how others, who also identified as having experienced a sudden, transformative change, made sense of it. Participants' struggle to find the 'words that work' when retelling and interpreting their transformation experience developed to become one of the central focuses of this thesis. The lived body is conceptualised as an essential source of meaningful understanding, and therefore, is sought to be used as an instrument of data analysis. Method: Six participants took part in unstructured interviews which were transcribed, before applying an interpretative phenomenological analysis. With the aim of facilitating the development of emotionally receptive forms of understanding, an embodied interpretation was applied to each account, via the application of Gendlin's method of focusing. Found poems were also constructed. Findings: Five master themes were identified: 1) Making sense of what it is difficult to make sense of; 2) Who I was, what happened, who I am now; 3) Illuminating purpose; 4) Compelled to act; and 5) Attempting to capture the ineffable quality. Each master theme was identified as having two related sub-themes. The acceptance and appreciation of the experience as one which can never be fully explained played a vital role in the emerging meaning of the experience. Participants appeared to make sense of their transformation through the separation of their lives into the temporal categories of before and after the event. The lives of the participants were changed. New life paths became clear, and purpose was suddenly illuminated. For all the participants in the study, purpose appeared to be intimately linked with the creation of positive connections with others. Conclusions and Implications: Examination of how people experience positive change outside of the therapy room is of use to those seeking to support people who want to change within the realms of psychological therapy. Attendance to the researcher's bodily response to the research data was understood as enabling movement towards a fuller understanding of the phenomenon under examination, as well as facilitating the production of 'words that work'. It is concluded that therapeutic practitioners and other mental health professionals may benefit from understanding the dimensions of transformative change described here, in such qualitatively rich terms.

This thesis is concerned with the impact of professional background on role fulfilment. In the United Kingdom current policy in health and social care in mental health is underpinned by integration; the idea that responsibilities can be accomplished irrespective of profession. Approved mental health practice is one example of a psychiatric statutory role and function, until recently carried out by the profession of social work, which is now extended to other, non-medical, mental health professions. This thesis aims to explore the role and experiences of current practitioners in order to understand the impact, if any, of professional background on the fulfilment of approved mental health practice and the way in which it is experienced. Qualitative data are generated through semi-structured individual interviews with twelve approved mental health practitioners: five nurses, two occupational therapists and five social workers and the use of rich pictures to supplement the interview discussions. Interpretative Phenomenological Analysis was applied to the verbatim transcripts. Key findings were that approved mental health practice can be accomplished irrespective of professional background. Its practitioners require particular shared attributes, specifically a cognitive and affective capacity to deal with and use discord and to manage the disparate emotions that occur. Conceptualised in this thesis as "pull," this finding constitutes a different understanding of the use of emotion in the workplace and provides evidence of a new emotional dimension; the active use of dissonance. Professional identity is also found to be influenced by approved mental health practice thereby turning on its head the original hypothesis of this thesis. Last, personhood is found to be an additional aspect of the moral framework for approved mental health practice and is being practiced in a different circumstance than previously considered. The implications of this work are that it challenges the perception that approved mental health practice is synonymous with the profession of social work. It also revives the theory that its normative moral framework is inherently contradictory. The present study appears to be the first to associate personhood with approved mental health practice and shows role fulfilment as sophisticated emotion management, primarily the active use of dissonance. Both provide new insights into the enactment of approved mental health practice and are important issues for the future training and development of practitioners. The influence on role of professional identity may also help policy makers better understand the impact that new ways of working in mental health might have on traditional professional roles and boundaries in integrated services.

Background: Therapeutic training is considered as the beginning of therapists' professional development. Research exploring the experiences of therapeutic training, particularly the experiences of trainee counselling psychologists is scarce. Additionally, research exploring the experiences of therapists integrating a new model of therapy is also limited; this is a surprising fact given the growing development of the integration movement in the therapeutic world. Aims: The present study explores how trainee counselling psychologists, with a prior training in a 'core' therapeutic model, experience and make sense of their current training in counselling psychology. As a secondary aim, this study explores how these trainees experienced integrating a new model of therapy in their practice and the process of integration within the context of counselling psychology training. Participants: Six trainee counselling psychologists from three different training courses based in the UK, who had all been previously trained in a single school model (primarily person-centred) participated in the study. Method: The present study is an Interpretative Phenomenological Analysis (IPA) study. Data were collected through single, semi-structured, in-depth interviews during which participants were invited to reflect on their experiences of training. Findings: The five super-ordinate themes that were identified in the participants' narratives are: 'Desires, Expectations and Needs from counselling psychology training', 'The turbulence of counselling psychology training', 'The Questioning I', 'The Changing Self' and the 'Finding Peace'. Each of these themes described different components of these trainees' experience of counselling psychology training and reveal that it is a challenging experience on both an emotional and an intellectual level. Discussion: The identified findings of the present study deconstruct, illuminate and are illuminated by existing theoretical and empirical literature. These findings shed light on the cyclical process of professional development within the context of professional training in counselling psychology in the UK.

The phenomenon being explored in this study was the understanding of minority clients' perceptions in relation to their rehabilitation counselors' cultural competence. A descriptive qualitative research methodology consisting of eight participants was used. Hycner's (1985) phenomenological analysis was used to investigate the in-depth interviews. The investigation revealed seven different themes that comprised of the essence of the phenomenon. The themes include: clients' understanding of the term cultural competence, self, attitudes, advocacy, understanding culture is important, role of culture, and expectations from the agency. The invariant structure that was consistent through all the above mentioned themes was the representation and manifestations of culture in the lives of the clients that continually challenged rehabilitation counselors' cultural competence through different phases of the vocational rehabilitation counseling experiences. The essence behind cultural competence was - perceiving the phenomenon as an experiential relationship based concept, where the client and the rehabilitation counselor educate one another about the all inclusive nature of the term culture and its role in the vocational rehabilitation process.