Illness, normality and identity: the experience of heart transplant as a young adult.

PURPOSE: End stage heart failure and transplant present great opportunities and challenges for patients of all ages. However, young adulthood may present additional specific challenges associated with the development of identity, career and romantic relationships. Despite recognition of greater mortality rates in young adults, consideration of the experience of transplant during this life stage has been largely overlooked in the literature. The aim of this study was to explore the experience of heart transplant in young adults. METHOD: Interviews were conducted with nine participants across three transplant services in the United Kingdom and the data subject to interpretative phenomenological analysis. RESULTS: Analysis identified three themes. "Separating from illness" and "working toward normality" involved limiting the influence of illness on identity, as well as reengaging with typical functioning in young adulthood. "Integrating transplant into identity" involved acknowledging the influence of living with a shortened life expectancy. CONCLUSIONS: The need for support that recognizes specific challenges of transplant as a young adult is discussed (e.g. the development of age specific end of life pathways, improved communication between transplant recipients, their families and teams), including consideration of the impact of societal discourses (e.g. gift of life) which provided additional challenges for patients. IMPLICATIONS FOR REHABILITATION Heart transplant presents specific challenges according to the recipient's life stage. The needs of young adult recipients should be considered. Transplant professionals should consider providing opportunities for peer support and addressing the identities and values of young adult transplant recipients during rehabilitation.

How do clients experience reliving as part of trauma-focused cognitive behavioural therapy for posttraumatic stress disorder?

OBJECTIVES: Reliving is an integral part of trauma-focused cognitive-behavioural therapy (CBT), a recommended treatment for post-traumatic stress disorder (PTSD) with a convincing evidence base supporting its use. However, the literature suggests that clinicians are reluctant to use reliving in therapy. The aim of this study was to explore participants' experiences of undergoing reliving as part of CBT for PTSD in order to further clinicians' understanding of client experiences of reliving. DESIGN: This was a qualitative study. Semi-structured interviews were conducted and the transcripts analyzed using interpretative phenomenological analysis (IPA) (Smith, Jarman, & Osborn, 1999). METHOD: Seven participants who had completed the reliving component of trauma-focused CBT in the previous month were recruited through therapists working in specialist trauma services, and semi-structured interviews were conducted using a topic guide. The transcripts were analyzed using IPA to enable the research questions to be addressed. RESULTS: Three super-ordinate themes and 11 subordinate themes were developed to reflect participants' common and distinct experiences. The three super-ordinate themes were 'overcoming ambivalence', 'painful but achievable', and 'positive change'. CONCLUSIONS: This study provided useful information about participants' experiences of reliving during CBT for PTSD. Clinical implications regarding the therapeutic relationship, preparing clients for reliving, and the impact of reliving were suggested. Implications for future research were identified including extending the score of the study, exploring differences in participants' experiences, and exploring unexpected findings.