Constructions of Clinical Psychology in Adult Mental Health: A Discursive Thematic Analysis

In face of the current economic-political changes facing the UK and its State institutions and of the new evidence about the impact of social inequality on human distress, this study attempts to understand the increasing practice of delivering psychological therapy by the British clinical psychology profession. A review of the critical histories of the profession in the UK identified the need for a more detailed study of the “history of the present” to reveal the discursive operations that construct professional practice. A discursive thematic analysis (DTA) based on the theoretical concepts of the late post-modern scholar Michel Foucault was used to explore public available documents produced by British clinical psychologists between 2010 and 2014. Two dominant professional discursive themes were identified: alternative and leadership. These themes were found to be supported by the discursive sub-themes of applied science, well-being, Cognitivism and therapy which align the aspiration of the profession with those of the State. The tension between the applied scientist and the therapist role - specifically the need to establish simultaneously the profession’s scientific credibility and its therapeutic abilities in order to respond to market pressures – showed recurrences of the conflicts of the early history of professionalization of clinical psychology. The positioning of clinical psychology against the use of functional psychiatric diagnosis and the challenges and opportunities identified by the opening of the NHS market to ‘any willing provider’ revealed how professional discourses operate to maintain the status quo. This study recommends that the socio-historical construction of the profession should be investigated further, in particular through the subjugated discourse identified here

‘Racialised’ pedagogic practices influencing young Muslims' physical culture

Background: There is growing concern surrounding the ‘racialised’ body and the way young people develop dispositions towards physical activity (PA) and sports, and more broadly to physical culture. This paper draws on Bourdieu's social theory in an effort to explore the ways in which the intersectionality of various fields (family, religion and school) and their dimensions (culture and social class) influence young Muslims' physical culture. Purpose: More specifically the paper examines the ‘racialised’ pedagogic practices in various fields that influence young Muslims' dispositions to physical culture. Method: The study reports on the voices of 40 participants identifying as young Muslims (12–15 years old; 20 girls and 20 boys) from one secondary school in the South of England, UK. A case study approach was used to explore participants’ understanding, meaning, structural conditions and personal agency with regard to physical culture and ‘racialised’ body pedagogies. Data include semi-structured paired interviews with participants. Data were analysed using thematic analysis. More specifically, thematic analysis based on the notion of ‘fields' informed deductive and inductive procedures. Findings: Results suggested that religion had limited influence on the participants' agency when intersecting with schooling and social class with regard to embodiment of active physical culture. Economic capital, on the other hand, had a considerable influence on participants’ physical culture as it contributed to young people's access to PA opportunities, agency and body pedagogies. In addition, the study concludes that fields outside the school play a significant role in influencing and enabling young Muslims’ physical culture. Conclusions: One of the most significant implications of this study is emphasising that young Muslims should not be viewed as a homogenous group as various fields intersect to influence their participation in physical education and their embodiment of physical culture. Identified fields and their markers make dispositions unique, dependent upon characteristics and their relative influence.

Heterotopias of mental health care: The role of space in experiences of distress, madness and mental health service use.

The change from an institutional to community care model of mental health services can be seen as a fundamental spatial change in the lives of service users (Payne, 1999; Symonds & Kelly, 1998; Wolch & Philo, 2000). It has been argued that little attention has been paid to the experience of the specific sites of mental health care, due to a utopic (idealised and placeless) idea of ‘community’ present in ‘community care’ (Symonds, 1998). This project hence explored the role of space in service users’ experiences, both of mental health care, and community living. Seventeen ‘spatial interviews’ with service users, utilising participatory mapping techniques (Gould & White, 1974; Herlihy & Knapp, 2003; Pain & Francis, 2003), plus seven, already published first person narratives of distress (Hornstein, 2009), were analysed using thematic analysis (Braun & Clarke, 2006). Mental health service sites are argued to have been described as heterotopias (Foucault, 1986a) of a ‘control society’ (Deleuze, 1992), dominated by observation and the administration of risk (Rose, 1998a), which can in turn be seen to make visible (Hetherington, 2011) to service users a passive and stigmatised subject position (Scheff, 1974; 1999). Such visible positioning can be seen to ‘modulate’ (Deleuze, 1992) participants’ experiences in mainstream space. The management of space has hence been argued to be a central issue in the production and management of distress and madness in the community, both in terms of a differential experience of spaces as ‘concordant’ or ‘discordant’ with distress, and with movement through space being described as a key mediator of experiences of distress. It is argued that this consideration of space has profound implications for the ‘social inclusion’ agenda (Spandler, 2007; Wallcraft, 2001).

Transportations of space, time and self: The role of therapeutic reading groups in managing mental distress in the community.

Background The practice of reading and discussing literature in groups is long established, stretching back into classical antiquity (Fischer, 2004). While benefits of therapeutic reading groups have been highlighted, research into participants’ perceptions of these groups has been limited (Walwyn & Rowley, 2011). Aims To explore the experiences of those attending therapeutic reading groups, considering the role of both the group, and the literature itself, in participants’ ongoing experiences of distress. Method Eleven participants were recruited from two reading groups in the South East of England. One focus group was run, and eight individuals self selected for individual interviews. The data were analysed together using a thematic analysis drawing on dialogical theories. Results Participants described the group as an anchor, which enabled them to use fiction to facilitate the discussion of difficult emotional topics, without referring directly to personal experience. Two aspects of this process are explored in detail: the use of narratives as transportation, helping to mitigate the intensity of distress; and using fiction to explore possibilities, alternative selves and lives. Conclusions For those who are interested and able, reading groups offer a relatively de-stigmatised route to exploring and mediating experiences of distress. Implications in the present UK funding environment are discussed.

A Psychological Exploration of Long-Term LSD Users

All research involving the psychoactive compound lysergic acid diethylamide (LSD) was terminated globally following its prohibition more than 50 years ago, though illicit use remained fairly stable. A considerable resurgence of research interest in LSD has received considerable attention in various publications and professional fora. One of the main applications considered is LSD-assisted psychotherapy to address a number of difficulties like end-of-life anxiety, addiction/alcoholism, post-traumatic stress, and depression. However, due to the highly contradictory nature of early research findings and division in the literature, one is left uncertain as to whether psychology as a profession is currently equipped to critically evaluate these advances, let alone embrace them. The purpose of the present study was to contribute to current psychological knowledge on long-term LSD use. A group of long-term LSD users who claimed beneficial use were the focus here. A mixed methods design was employed. 110 users completed an online survey assessing for demographics, patterns of use, and specific personality traits through three psychometric measures, Big Five Inventory (BFI), General Self Efficacy scale (GSE) and Satisfaction With Life Scale (SWLS). Eight individual interviews were also conducted and analysed by Thematic Analysis (TA). Gaining different perspectives on reality and increasing self- awareness appeared to be essential elements of the belief system that these non-problematic long-term LSD users adopted in order to make sense of their LSD use. Qualitative findings also suggested the existence of a common set of life values, rules and the adoption of a hierarchical system between LSD users. Novices appeared to be tutored and guided by elders whose presence and input was valued and who were listened to and respected. A role for ‘wiser/elder’ users as those imparting valuable knowledge to novices was therefore also suggested. The underlying aim may possibly be an attempt to minimise risks and maximise potential benefits of LSD use. A prospective role for LSD as a deterrent of substance misuse, a ‘gateway drug to no drugs’ was also hinted and remains in need of iv further investigation. Claims regarding beneficial LSD use and ‘change’ through LSD use were confirmed by the participant sample. No noteworthy differences between psychometric scores of the LSD-using group and those of the general population (as suggested by normative data comparisons) were found, possibly due to methodological limitations, especially considering the highly subjective nature of the LSD experience and its effects. The determining role of extra-pharmacological variables or ‘set and setting’ in the outcome of LSD use suggested in earlier literature was re-validated. Knowledge on their specific components was enriched, and a potentially significant value for adopting a flexible, adaptable and solution-focused mind-set in order to better manage the effects of LSD was highlighted. Due to the highly selected nature of the participant sample, present findings should serve as suggestions for further research in order to clarify the aforementioned issues and to make explicit the mechanisms by which they operate. The complex nature of LSD, its use and its effects have been re-confirmed here. It is imperative that the current knowledge base on the substance is enriched before LSD is introduced in a clinical psychology professional context.

‘Not like rose-tinted glasses… like taking a pair of dirty glasses off’: A pilot intervention using positive emotions in expressive writing

Studies conducted in various contexts and with varied populations have found expressive writing enhances physical and psychological wellbeing. This pilot intervention study countered the predominantly quantitative evidence by adopting a qualitative methodology, exploring the experience of using positive emotions in expressive writing. Participants (n = 10), who all had previous experience in expressive writing, were asked to select one of ten positive emotion cards (PECs) each day for three days. Participants were then asked to write expressively through the ‘lens’ of their chosen emotion. Semi-structured interviews were conducted and experiences were evaluated using Thematic Analysis. The results identified two main themes that compared the experience of expressive writing both with and without the PECs. The first theme, Processing (without the PECs) contained three sub-themes: sense of relief, habitual perspective and reactive to experience. The second main theme, Progressing (with the PECs) contained three different sub-themes: sense of direction, changed perspective and interactive with experience. This study found that, for expressive writers, positive emotions may function in three ways: to relate to others or self-expand, to move past challenges cognitively or change unconstructive perspectives, and finally as a way to interactively link or ‘bridge’ from the written subject matter to constructive action, thus breaking cycles of reactive writing and rumination. Implications of the study on the practice of expressive writing and its potential as a positive psychology intervention (PPI) are discussed.

Mindful Living in Older Age: a Pilot Study of a Brief, Community-Based, Positive Aging Intervention

Although mindfulness-based interventions have been successfully used with older adults, there have been few interventions that, (a) are created specifically for older adults, (b) are delivered in the community, and (c) aim to promote ‘successful aging’ (rather than just treating dysfunction/disorder). To this end, the current study piloted a brief ‘positive aging’ intervention, comprising two 150 minute sessions, with six female older adults living in the community. Data were gathered through focus groups that were interwoven throughout the intervention. Using thematic analysis, four main themes were identified: (a) aging as a mixed blessing; (b) understanding mindfulness; (c) the challenges of mindfulness; and (d) the benefits of mindfulness. Overall, the intervention was successful in introducing participants to mindfulness and potentially forming the basis of a longer term practice. However, the study also highlighted important points on the challenges of practising mindfulness, in relation to which the paper makes recommendations pertaining to the teaching of mindfulness with older adults.

Brief Psychotherapy with Children in a Specialist School: An Exploration of the Underlying Issues for Children and Mainstream Schools

This thesis explores brief psychotherapy with children on placement at a specialist school setting, as part of an on-site, child psychotherapy outreach provision. The study sought to explore two research questions concerning the themes that could emerge in brief work with children and how these themes could be discussed in relation to the understanding formed by their mainstream school teachers. A qualitative research design was used to investigate these questions. The methods used to collect data were case studies, concerning the brief psychotherapy with 4 boys, aged 7 years, and and semi-structured interviews were conducted with the teachers. Thematic analysis was used to explore the data. The themes that were derived from the analysis were described in detail. The research found that brief work has considerable benefit for children and mainstream schools. Through the brief work intervention, the children all made significant progress in all areas of their lives a school. Contributions that the research makes to related fields, the implications that it has for policy and practice and recommendations for future research were all discussed.

Science-based entrepreneur project development process for pre-service science teachers: difficulties faced*

This study used a phenomenological research design to determine the difficulties faced in the science-based entrepreneur project development process for pre-service science teachers.. Qualitative data were obtained through interviews conducted with ten pre-service science teachers. The data were analysed using an inductive thematic analysis. The results indicated that pre-service science teachers have most difficulty ‘making decisions on one of the innovative ideas’ and ‘making predictions about unexpected situations’. They also have difficulties ‘calculating the cost as a result of design or work analysis’, ‘identifying if the idea already existed (similarity analysis)’ and ‘making decisions on the required materials, tools, services’. These results show the need for pre-service science teachers to communicate with other institutions and organisations.

Competency Based Assessment Using Virtual Reality (VERT): Is It a Realistic Possibility ?

The education of the radiography profession is based within higher education establishments, yet a critical part of all radiography programmes is the clinical component where students learn the practical skills of the profession. Assessments therefore not only have to assess a student’s knowledge, but also their clinical competence and core skills in line with both Health and Care Professions Council and the Society and College of Radiographers requirements. This timely thesis examines the possibility of using the Virtual Environment for RadioTherapy (VERT) as an assessment tool to evaluate a student’s competence so giving the advantage of a standard assessment and relieving time pressures in the clinical department. A mixed methods approach was taken which can be described as a Quantitative Qualitative design with the emphasis being on the Quantitative element; a so called QUAN  qual design. The quantitative evaluation compared two simulations, one in the virtual reality environment and another in the department using a real treatment machine. Students were asked to perform two electron setups in each simulation; the order being randomly decided and so the study would be described as a randomised cross-over design. Following this, qualitative data was collected in student focus groups to explore student perspectives in more depth. Findings indicated that the performance between the two simulators was significantly different, p < 0∙001; the virtual simulation scoring significantly lower than the hospital based simulation overall and in virtually all parameters being assessed. Thematic analysis of the qualitative data supported this finding and identified 4 main themes; equipment use, a lack of reality, learning opportunities and assessment of competence. One other sub-theme identified for reality was that of the environment and senses.

A qualitative study of the emotional coping and support needs of children living with a parent with a brain injury

Primary objective: To examine emotional coping and support needs in children of persons with acquired brain injury, with a view to understanding what interventions would be helpful for these children. Design: The study was qualitative, using a thematic analysis approach. Methods and procedure: Six children between 9 and 18 years of age, six parents (three with ABI), and three support workers were interviewed either at home or at a support centre, using a semi-structured interview guide. Results: Children reported using a variety of adaptive and maladaptive emotional coping strategies, but were consistent in expressing a need for credible validation, i.e. sharing experiences with peers. The results are presented under four overarching themes: difficulties faced; emotions experienced; coping strategies; and reported support needs. Conclusions: The results reveal an interaction between the child’s experiences of complex loss that is difficult to acknowledge, emotional distancing between parent and child, and the children’s need for credible validation. All children expressed a desire for talking to peers in a similar situation to themselves, but had not had this opportunity. Interventions should set up such peer interaction to create credible validation for the specific distress suffered by this population.

Self-Harm in Secondary Schools: What are the Perceptions and Experiences of Staff ?

The purpose of this study is to explore the perceptions and experiences of secondary school staff with regard to adolescent self-harm. The research was conducted in a Local Authority where there were particular concerns about rising numbers of young people presenting with self-harm. While the majority of young people who self-harm are supported in the community and never access clinical services, surprisingly little research has considered the role of schools and their staff. The research that has been done suggests that school staff can feel underqualified and overwhelmed in their attempts to support young people who self-harm. Further, there is a growing evidence base that when young people experience negative attitudes towards self-harm it is distressing and reduces the chance of them seeking further help. To address this, qualitative exploratory research was conducted with thirteen members of staff working in secondary schools. Since the research was concerned not just with experiences, but also with perceptions of adolescent self-harm, the participants were from two groups: those with direct experience of supporting young people who have self-harmed and those without any direct experience. Data collection involved individual semi-structured interviews which were analysed using thematic analysis. The research indicated that secondary school staff are keen to help and understand young people who self-harm, but that they do not always feel skilled or confident enough to do so, often feeling that some kind of specialist is required and/or fearing that they might make a situation worse. Findings highlighted the emotional impact of this work and illustrated the importance of supporting staff, who expressed a desire for further training and other forms of professional support such as supervision.

An Exploration of Clinical Psychologist and Educational Psychologist Constructs of Mental Health in the Context of Secondary School Aged Children

Over the past decade, Mental Health (MH) has increasingly appeared on the ‘school agenda’, both in terms of rising levels of MH difficulties in the student population, and also the expectation that schools have a role to play in supporting good MH. MH is a term fraught with ambiguities leading to uncertainty around the most appropriate ways to provide support. A review of current literature reveals a wide range of definitions and interpretations, sometimes within the same team of supporting professionals. The current study seeks to explore the perspectives held by two professional groups seemingly well placed to support young persons’ (YPs’) MH. Six Clinical Psychologists (CPs) and six Educational Psychologists (EPs) are interviewed, exploring their constructs of MH, and their perceptions of their own role and the roles of others in supporting secondary school aged YPs’ MH. The data are analysed through Thematic Analysis. Findings suggest that there are variations between the two professions’ constructs of MH, and EPs in particular have no unified concept of MH. This is likely due to less experience or training in this area. CPs and EPs hold similar perceptions of the school’s role for promoting good MH, and flagging up concerns to more specialist professionals when necessary. However, there are discrepancies in the EP and CP perceptions of each other’s roles. The conflicting views appear to emerge through incomplete information about the other, and professional defensiveness in a context where resources and funding are scarce. The current study suggests that these challenges can be addressed through: greater reflectivity on professional biases, exploration of MH constructs within other epistemological positions, and greater communication regarding professional roles, leading to clearer collaboration in supporting the MH of YP.

Using Action Research to Develop My Solution-Focused Practice in Collaboration with Year 6 And 7 Pupils When Discussing Their Behavioural Self-Regulation at School

This action research study aimed to develop the researcher's use of solutionfocused techniques when working with Year 6 and 7 pupils’ self-regulation. A systematic literature review highlighted an evidence base that demonstrated the efficacy of solution-focused methods when working with this population. The researcher’s intention was to add to the body of Educational Psychology practice-based evidence in this area. The researcher recruited eight participants from primary and secondary school provisions. Solution-focused techniques were systematically trialled in partnership with the pupils and were modified through an action research cycle. Semistructured interviewing provided participants the opportunity to critically evaluate the researcher’s solution-focused practice. Thematic Analysis was used to assess feedback in order to adapt the delivery of solution-focused techniques. Developments to practice explored within this study included modifications to the use of the six core components of Solution Focused Brief Therapy. Adaptations have the potential to inform the use of these solution-focused approaches with other educational practitioners.

Supervision For School Staff: What is Valuable about Solution Circles?

Group supervision is used for support, education and/or monitoring. Despite the potential value of these elements for school staff, it is rarely practised. This mixed methods research, from a critical realist perspective, explored the use of Solution Circles to structure staff supervision groups in three schools. Five circles were run in each school, involving thirty-one participants, eighteen of whom contributed data. Thirteen staff trained as facilitators. The self-efficacy, resilience and anxiety levels of the staff taking part were not found to be significantly different as a result of the intervention. However, a small effect size was noted for self-efficacy, perhaps worthy of further investigation in the context of the small sample size. Thematic analysis of participant feedback (gathered during the last circle, which ran as a Focus Group) indicated the following mechanisms as affecting the value of Solution Circles for staff supervision groups: the structure of the sessions; aspects linked to the groups meeting a ‘need to talk’; elements which helped participants to ‘feel like a team’; and, school context factors. Semi-structured interview data from six facilitators indicated that the structure of the circles, individual characteristics of facilitators, the provision of support for facilitators, and elements of the wider school context, were all mechanisms which affected the facilitation of the programme. Further research might implement elements of these mechanisms and measure their impact.