Key Issues to Consider in Therapy with Muslim Families.

We present the key issues to consider in therapy with Muslim families. Following a brief introduction, five themes are presented: self, family dynamics, causation, and coping strategies. The section on "self" includes a discussion of three terms which link the four Islamic models of "self" identified through the review. The family dynamics section pays particular attention to interconnectedness, family roles, and gender. Causation is discussed with reference to supernatural and spiritual causes. On the theme of coping strategies, religious responses are discussed as are the roles of religious leaders, and professional mental health services. Clinical implications from the key themes are also discussed in addition to limitations of the published literature in this area. This includes a discussion of the epistemological and paradigmatic issues related to the research. The review concludes by summarising these issues and presenting areas for further research.

Supervisee self-disclosure: a clinical psychology perspective.

UNLABELLED: Clinical supervision is a multi-functional intervention within numerous psychotherapeutic professions, including clinical psychology. It often relies on supervisees' verbal disclosures of pertinent information. There is limited research on supervisee self-disclosure in the UK, and none using clinical psychology populations. This study aimed to address the limitations in the evidence base. It used a constructivist grounded theory methodology to investigate qualified UK clinical psychologists' use of self-disclosure in supervision in order to develop a theoretical understanding of their self-disclosure processes. Ten clinical psychologists from various time points across the career span were recruited to the study. Four core conceptual categories were identified in the analysis as being integral to participants' decision-making processes: 'Setting the Scene', 'Supervisory Relationship', 'Using Self-disclosure' and 'Reviewing Outcome of Self-disclosure'. These four categories are comprised of a number of subcategories. The study's findings are compared with the current literature base, and it is argued that there are tensions with the scientist-practitioner model as it could be interpreted to encourage an expert stance, which may limit the self-disclosure of qualified supervisees. The implications of this perspective are discussed. KEY PRACTITIONER MESSAGE: Supervision is a key process in supporting qualified clinical psychologists and the use of disclosure appears to be important in facilitating useful supervision. It appears that clinical psychologists go through a number of complex processes in deciding whether to self disclose.

A qualitative exploration of first-time fathers' experiences of becoming a father.

This study aimed to explore first-time fathers' experiences of becoming a father, focusing on their expectations, experiences, and how they are coping with this transition. An interpretative phenomenological analysis (IPA) epistemology and methodology were adopted as the study was focused on understanding the meaning and experiences of this transition for fathers. Nine participants were recruited from seven NCT antenatal classes. The mean age of participants was 38 years (range=30 to 46 years). Participants completed a semi-structured interview between four and eleven weeks post birth. One overarching superordinate theme was derived: 'searching for a place'. This theme consisted of three sub-themes--'the separation connection struggle', 'a sense of utility, agency and control' and 'changing focus of affection'. The findings expand on our understanding of new fathers' experiences, and suggest that first-time fathers experienced an array of psychological responses during each stage of their transition as they searched for their place as father in relation to their partner, child and work. Professionals working in antenatal and postnatal services should discuss with men the possible emotional and psychological changes they may go through to enable more realistic expectations to be considered.

How Do Children Make Sense of their Parent's Mental Health Difficulties: A Meta-Synthesis.

Children of parents who experience mental health difficulties (COPE-MHD) consistently demonstrate numerous negative outcomes, including risks of intergenerational continuity of mental health difficulties (MHD). Numerous studies have analysed the experiences and understanding of parents' MHD from the perspective of COPE-MHD. This metasynthesis aims to capture, across available literature, the way in which COPE-MHD make sense of their parent's MHD and how this perception impacts their life. For inclusion in the review, research articles were required to be published in peer-reviewed journals, apply qualitative methods of data collection and analysis and report on the direct accounts of COPE-MHD regarding their understanding or experience of their parents' MHD. Five electronic databases were used; Academic Search Complete, CINAHL, MEDLINE, PsycINFO and Child Development and Adolescent Studies. Fourteen studies were included. Analysis produced three overarching themes. The findings illustrate children's sophisticated biopsychosocial conceptualisation of the cause and process of their parent's MHD. It also highlights how they utilise this understanding to manage the day-to-day concerns associated with their parent's experience of MHD. Clinical implications highlight a need for services working with children, parents and families to more frequently enquire about parents' MHD and to consider the outcomes of such enquiry in the psychological formulation of children and young peoples' mental health and development. Limitations and recommendations for future research are presented.

Exploring parents' understandings of their child's journey into offending behaviours: A narrative analysis.

Parents are perhaps the best placed individuals to comment upon their child's life story, including early life experiences, transitions and their child's needs. However, research has rarely focussed on the views of parents of young people who have committed serious offences. This research aimed to explore parents' opinions of which factors may have led to their child becoming involved with the criminal justice system. Interviews were undertaken with six parents who were asked to narrate their child's life journey into offending behaviours. The data were then analysed using narrative analysis techniques, and a shared story was created which incorporated the main transitional stages in the children's journeys, as seen by the parents. The findings suggest that it is not just the child but the whole family who have been in a state of distress throughout the child's life. Systemic and environmental factors are argued to contribute to this distress, and the use of diagnosis for this population is critically evaluated. The research highlights a life story in which the child's and family's distress remains unheard and therefore unresolved. Clinical implications for working with this population are discussed.

'A post-transplant person': Narratives of heart or lung transplantation and intensive care unit delirium.

Exploring patients' narratives can lead to new understandings about perceived illness states. Intensive Care Unit delirium is when people experience transitory hallucinations, delusions or paranoia in the Intensive Care Unit and little is known about how this experience affects individuals who have had a heart or lung transplant. A total of 11 participants were recruited from two heart and lung transplant services and were invited to tell their story of transplant and Intensive Care Unit delirium. A narrative analysis was conducted and the findings were presented as a shared story. This shared story begins with death becoming prominent before the transplant: 'you live all the time with Mr Death on your shoulder'. Following the operation, death permeates all aspects of dream worlds, as dreams in intensive care 'tunes into the subconscious of your fears'. The next part of the shared story offers hope of restitution; however, this does not last as reality creeps in: 'I thought it was going to be like a miracle cure'. Finally, the restitution narrative is found to be insufficient and individuals differ in the extent to which they can achieve resolution. The societal discourse of a transplant being a 'gift', which gives life, leads to internalised responsibility for the 'success' or 'failure' of the transplant. Participants describe how their experiences impact their sense of self: 'a post-transplant person'. The clinical implications of these findings are discussed.

A qualitative exploration into young children's perspectives and understandings of emotional difficulties in other children.

Research into children's perspectives and understandings of emotional difficulties is limited and methodologically varied. In this paper we explore young children's perspectives and understandings of emotional difficulties in their peers. We conducted five focus groups involving a total of 25 children. The children, aged eight and nine, were presented with vignettes representing peers experiencing emotional difficulties, and invited to discuss their perspectives on possible causes. We also explored their emotional and behavioural reactions to the vignette characters. Using interpretative phenomenological analysis we identified three themes: Searching for an Explanation; Empathy versus Blame; and Consequences and Solutions. The children drew on their own emotional experiences in their sense-making, and the extent to which they held the character responsible for their behaviour was particularly important in influencing their responses towards the characters.

What makes offenders with an intellectual disability ready to engage with psychological therapy? A qualitative study.

Although there are established links between measures of readiness for psychological therapy in offenders and subsequent reduction in recidivism rates there has been a lack of theoretical research considering this process within the intellectual disability (ID) offender population. Grounded theory methodology was used to explore the process by which offenders with ID are seen and see themselves as ready to engage with psychological therapy. Twelve participants; offenders with ID, clinical psychologists and nurses across two secure inpatient services participated in the study. The resulting model highlighted a temporal process with interlinking elements including 'stability/predictability', 'development of relationships with staff', 'reassurance about progress' and 'realising that change is needed'. The model represented participant's shared perceptions and signified the journey of offenders with ID to perceived readiness. The current model is discussed and clinical implications and future research directions suggested.

"Governed by the pain": narratives of fibromyalgia.

PURPOSE: Fibromyalgia (FM) is a chronic syndrome characterized by pain and fatigue. The aim of this study was to explore how individuals with FM make sense of the illness experience and integrate it into their personal biographies. METHOD: Ten women from a pain management service in the north west of England were interviewed for the study. A chronological summary of each life story was produced and narrative features such as plot, tone, imagery and metaphors were identified and compared. RESULTS: Findings are presented in the form of a meta-narrative incorporating all 10 narratives over five phases: (1) making sense of FM: when I was younger, I didn't have any problems at all; (2) onset and diagnosis: you just feel like you're constantly complaining; (3) invasion of FM: you're just trapped; trapped in this body; (4) coping with FM: you try to do things in a pattern it will obey and (5) ongoing struggle: I refuse to give in to it. CONCLUSIONS: The narrative is characterized by a lack of movement and resolution, with participants engaged in an enduring struggle against the challenges of FM. Psychological approaches that facilitate this ongoing adjustment process may prove beneficial in FM treatment and rehabilitation.

Muslim views on mental health and psychotherapy.

OBJECTIVES: The aim of this research was to explore with a heterogeneous Muslim population their understanding of the concept of mental health and how any mental distress experienced by an individual can best be addressed. DESIGN: A qualitative approach was taken. Participants were interviewed, and data analysed thematically. METHODS: A sample of 14 Muslims was interviewed according to a semi-structured interview schedule. Participants were recruited via electronic mailing lists, and communications with local Muslim organizations. Interviews were transcribed verbatim, and data were analysed using thematic analysis. RESULTS: Thematic analysis identified seven operationalizing themes that were given the labels 'causes', 'problem management', 'relevance of services', 'barriers', 'service delivery', 'therapy content', and 'therapist characteristics'. CONCLUSIONS: The results highlight the interweaving of religious and secular perspectives on mental distress and responses to it. Potential barriers are discussed, as are the important characteristics of therapy, therapists, and service provision. Clinical implications are presented along with the limitations of this study and suggestions for future research.