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ObjectivePrevious work has raised questions about the role of general practitioners (GPs) in the identification of neurodevelopmental conditions such as autism spectrum disorders (autism) and attention deficit hyperactivity disorders (ADHD). This study aimed to explore how GPs identify these conditions in practice and their perspectives on recent changes to local referral pathways that mean referrals to the neurodevelopmental team come through educational professionals and health visitors, rather than GPs. This study also aimed to explore Child and Adolescent Mental Health Services (CAMHS) specialist’s perspectives on the role of GPs.SettingGP practices, local neurodevelopmental services and specialist CAMHS services in the UK.Participants: semistructured interviews were conducted with GPs (n=8), specialists in local CAMHS (n=7), and professionals at national CAMHS services around the country (n=10). Interviews were conducted between January and May 2019. A framework approach informed by thematic analysis was used to analyse the data.ResultsGPs drew on various forms of tacit and explicit information including behavioural markers, parental report, prior knowledge of the family, expert and lay resources. Opinions varied between GPs regarding changes to the referral pathway, with some accepting the changes and others describing it as a ‘disaster’. CAMHS specialists tended to feel that GPs required more neurodevelopmental training and time to conduct consultations.ConclusionThis study adds to the literature showing that GPs use an array of information sources when making referral decisions for autism and ADHD. Further work is urgently required to evaluate the impact of reconfiguring neurodevelopmental referral pathways such that GPs have a diminished role in identification.

Supplemental material, sj-docx-1-aut-10.1177_13623613221121413 for ‘Instruments are good at eliciting information; scores are very dangerous’: The perspectives of clinical professionals regarding neurodevelopmental assessment by Barry Coughlan, Matt Woolgar, Emma JL Weisblatt and Robbie Duschinsky in Autism

Assessing developmental differences in children can be challenging. Two of the key stages in the assessment process are identification and formal assessment. This dissertation seeks to explore some of the forms of information, including symptom profiles, which contribute these assessment practices. Specifically, this dissertation focuses on three developmental conditions: autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and attachment-related conditions. This work is designed to reflect a hypothetical child or family���s pathway through services starting with a query of ASD, moving to differential conceptualisation of ADHD and attachment-related difficulties. First, a systematic review identified that GPs had variable knowledge of autism and sometimes leaned on lay sources. Qualitative interviews helped to identify some of the implicit forms of information that GPs draw on in their assessments (e.g. familiarity with the family). Analysis of qualitative interviews also identified the different forms of information that specialists use to inform decisions. In general, specialists tended to speak about the application of diagnosis in ���natural��� and ���pragmatic��� terms. That is, some children���s behaviour was a ���natural-fit��� with diagnostic criteria, whereas the decision to diagnose, or indeed remove a diagnosis, from some children was grounded in pragmatic considerations. A conceptual review explored how attachment concepts are used in ASD and ADHD literature, which include a critical analysis of the Coventry Grid Interview, a tool which seeks to delineate symptom profiles of ASD and attachment difficulties. Qualitative interviews showed that suspicions about attachment tend to be raised by contextual factors and there were also some clear divergences between the developmental and clinical attachment theory discourses. Analysis of the Strengths and Difficulties Questionnaire (SDQ) provided further insight into the symptom profiles of children with ASD, ADHD, and attachment-related conditions, showing differences between subscales, but not in terms of total difficulties or networks of symptoms. The role of clinical judgment in assessments is often acknowledged, but rarely expanded upon. Taken together, this work illuminates some of the forms of information that shape these judgments. By foregrounding these forms of information, this work is well placed to contribute to the sociological, psychometric and applied literature on these topics. In addition, tensions were identified between various stakeholders. Recommendations for next steps include the integration of electronic healthcare records and the development of expert statements on neurodevelopment and attachment., I wish to thank NIHR School for Primary Care Research (RG94577) and Wellcome Trust (WT103343MA) for their support for work on this dissertation. Recruitment for study described in Chapter Two was supported by the Central Research Network (CRN) Eastern. The data for Chapter Five was collected through Clinical Record Interactive Search (CRIS). CRIS is supported by the NIHR Biomedical Research Centre for Mental Health BRC Nucleus at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King���s College London jointly funded by the Guy���s and St Thomas��� Trustees and the South London and Maudsley Trustees. Data are owned by a third party, Maudsley Biomedical Research Centre (BRC) Clinical Records Interactive Search (CRIS) tool, which provides access to anonymised data derived from SLaM electronic medical records. These data can only be accessed by permitted individuals from within a secure firewall (i.e. the data cannot be sent elsewhere), in the same manner as the authors. For more information please contact: cris.administrator@slam.nhs.uk. The views expressed are those of the authors and not necessarily those of the CRN, NHS, the NIHR or the Department of Health.

Supplemental material, sj-pdf-1-smo-10.1177_20503121211031310 for How UK health care professionals conceptualise parental experiences of the diagnostic process for autism spectrum disorder: A qualitative study by Natasha Faye Daniels, Barry Coughlan and Robbie Duschinsky in SAGE Open Medicine

Supplemental material, sj-pdf-1-smo-10.1177_20503121211031310 for How UK health care professionals conceptualise parental experiences of the diagnostic process for autism spectrum disorder: A qualitative study by Natasha Faye Daniels, Barry Coughlan and Robbie Duschinsky in SAGE Open Medicine

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Conference paper In this paper we present a comparative analysis of two series of conferences in the field of Computational Linguistics, the LREC conference and the ACL conference. Conference proceedings were analysed using Saffron by performing term extraction and topical hierarchy construction with the goal of analysing topic trends and research communities. The system aims to provide insight into a research community and to guide publication and participation strategies, especially of novice researchers. peer-reviewed

International audience; Poor diet, physical inactivity, tobacco smoking and alcoholconsumption are known risk factors for chronic diseaseand premature mortality. These behaviours are frequentlyreported among higher education students and may belinked to psychological distress, which is also problematicparticularly for students on programmes with practicalcomponents such as nursing and teaching. Understandinghow risk behaviours aggregate and relate to psychologicaldistress and coping among this population is importantfor health promotion.A cross-sectional survey examined lifestyle behaviours(Lifestyle Behaviour Questionnaire) and their relationshipto psychological distress (General Health Questionnaire(GHQ)1 and coping processes (Ways of Coping Questionnaire(WOC);2 among a total sample of undergraduatenursing/midwifery and teacher education students(n=1,577) in a university in Ireland.The response rate was 71% of the total sample. Therespondents were registered on nursing/midwifery(36.5%) and teacher education (63.5%) programmes. Ofthese, 53.1% were female, most were under the age of26(90.5%) and single (89.7%).Health risk behaviourswere common, including alcohol consumption (93.2%),unhealthy diet (26.3%), physical inactivity (26%), tobaccosmoking (17%), cannabis use (11.6%) and significantpsychological stress (41.9%). Females were moredistressed than males (p=0.0001). Nursing students weremore distressed than teacher education students(p=0.0027).Bivariate analyses identified strong links between lifestylebehaviours and demographic characteristics includinggender, age, programme of study and place of residence.Multivariate logistic regressions confirmed the relationshipsbetween risk behaviours, demographic characteristics,distress and coping. Compared with males, femaleshad lower levels of physical activity (OR=1.58 for females)and consumed less alcohol (OR=1.85 for males). Youngerstudents were more likely to eat convenience food(OR=1.67) than older students. Nursing/midwifery studentswere less physically active (OR=1.75) and smokedmore (OR=2.48) than teacher education students. Thosewho did not enjoy their programme were more likely todrink alcohol (OR=1.60). Compared with students whoworked full time, those who worked part-time, thosefinancially supported by their families or grant-aided hadhealthier diets (OR=0.42 and 0.35, respectively) but wereless physically active (OR=2.44 and 2.16, respectively).Conversely, students who worked part-time consumedmore alcohol than those with grant or family support(OR=2.07).High psychological stress scores were correlated with poordiet (OR=1.03), increased consumption of conveniencefoods (OR=1.04), physical inactivity (OR=1.05) andtobacco smoking (OR=1.04). Passive coping strategieswere correlated with poor diet (OR=1.55) and eatingconvenience food (OR=1.62). Those who mostly usedescape avoidance coping were more likely to drink alcohol(OR=2.13) and have lower levels of physical activity(OR=1.84). Exposure to any unhealthy behaviourincreased the risk for other risk behaviours. For examplethose who smoked tobacco had an increased risk of poordiet (OR=1.65), low levels of physical activity (OR=1.54)and alcohol consumption (OR=1.56). Cluster analysisidentified a tendency for students to cluster into twogroups: those with risk behaviours (n=733) and thosewith positive health behaviours (n=379). The group withrisk behaviours had high psychological distress and usedmostly passive coping strategies such as escape avoidance.The group with positive health behaviourscomprised students who reported a healthy diet, regularphysical activity and who did not use substances (tobacco,alcohol, cannabis).The potential multiplicative effect of these risks onstudents’ health and subsequently on their academicperformance is a concern. As these students are thenurses and teachers of the future, their risk behaviours,elevated psychological distress and poor coping also raiseconcerns regarding their roles as future health educators/promoters. Attention to promotion of health and wellbeingamong this population is essential.

The administration of psychotropic and psychoactive medication for persons with learning disability and accompanying mental illness and/or challenging behaviour has undergone much critical review over the past two decades. Assessment and diagnosis of mental illness in this population continues to be psychopharmacological treatment include polypharmacy, irrational prescription procedures and frequent over-prescription. It is clear that all forms of treatment including non-pharmacological interventions need to be driven by accurate and appropriate diagnoses. Where a psychiatric diagnosis has been identified, it greatly aides the selection of appropriate medication, although a specific medication for each diagnosis, as was once hoped, is simply no longer a reality in practice. Part one of the present thesis seeks to address many of the current issues in mental health problems and pharmacological treatment to date. The author undertook a drug prevalence study within both residential and community facilities for persons with learning disability within the Mid-West region of Ireland in order to ascertain the current level of prescribing of psychotropic and psychoactive medications for this population. While many attempts have been made to account for the variation in prescribing, little systematic and empirical research has been undertaken to investigate the factors thought to influence such prescribing. While studies investigating the prescribing behaviours of General Practitioners (GP's) have illustrated the complex nature of the decision making process in the context of general practice, no similar efforts have yet been directed at examining the prescribing behaviours of Consultant Psychiatrists. Using The Critical Incident Technique, the author interviewed Consultant Psychiatrists in the Republic of Ireland to gather information relating not only to their patterns of prescribing for learning disabled populations, but also to examine reasons influencing their prescribing in addition to several related factors. Part two of this thesis presents the findings from this study and a number of issues are raised, not only in relation to attempting to account for the findings from part one of the thesis, but also with respect to implications for improved management and clinical practice.

Child maltreatment in the family context is a prevalent and pervasive phenomenon in many modern societies. The global perpetration of child abuse and neglect stands in stark contrast to its almost universal condemnation as exemplified in the United Nation's Convention on the Rights of the Child. Much work has been devoted to the task of prevention, yet a grand synthesis of the literature is missing. Focusing on two core elements of prevention, that is, antecedents for maltreatment and the effectiveness of (preventative) interventions, we performed an umbrella review of meta-analyses published between January 1, 2014, and December 17, 2018. Meta-analyses were systematically collected, assessed, and integrated following a uniform approach to allow their comparison across domains. From this analysis of thousands of studies including almost 1.5 million participants, the following risk factors were derived: parental experience of maltreatment in his or her own childhood (d = .47), low socioeconomic status of the family (d = .34), dependent and aggressive parental personality (d = .45), intimate partner violence (d = .41), and higher baseline autonomic nervous system activity (d = .24). The effect size for autonomic stress reactivity was not significant (d = -.10). The umbrella review of interventions to prevent or reduce child maltreatment showed modest intervention effectiveness (d = .23 for interventions targeting child abuse potential or families with self-reported maltreatment and d = .27 for officially reported child maltreatment cases). Despite numerous studies on child maltreatment, some large gaps in our knowledge of antecedents exist. Neurobiological antecedents should receive more research investment. Differential susceptibility theory may shed more light on questions aimed at breaking the intergenerational transmission of maltreatment and on the modest (preventive) intervention effects. In combination with family-based interaction-focused interventions, large-scale socioeconomic experiments such as cash transfer trials and experiments with vouchers to move to a lower-poverty area might be tested to prevent or reduce child maltreatment. Prevalence, antecedents, and preventive interventions of prenatal maltreatment deserve continuing scientific, clinical, and policy attention.

It is well-known that people with an intellectual disability often face a host of health inequalities and co-morbidities. These include childhood obesity, mental health problems, and challenging behaviour. People with an intellectual disability also have reduced life expectancy. GPs are uniquely placed to advocate for and signpost these patients, ensuring they have access to appropriate support. However, it is often unclear what resources are, in reality, both available and beneficial. Here we aim to summarise some of the common inequalities and complexities when working with patients with an intellectual disability and provide an overview of some potentially helpful services.

Many healthcare systems are organised such that General Practitioners (GPs) often have a key role in identifying autism spectrum disorders (hereafter collectively referred to as autism) in children. In this review, we explored what GPs know about autism and the factors that influence their ability to identify and manage care for their patients with autism in practice. We conducted a systematic narrative review using eight electronic databases. These included Embase and MEDLINE via Ovid, Web of Knowledge, PsycINFO via Ebscohost, PubMed, Scopus, ProQuest Dissertations and Thesis, and Applied Social Sciences Index and Abstracts (ASSIA) via ProQuest. Our search yielded 2,743 citations. Primary research studies were included, and we did not impose any geographical, language or date restrictions. We identified 17 studies that met our inclusion criteria. Studies included in the review were conducted between 2003 and 2019. We thematically synthesised the material and identified the following themes: the prototypical image of a child with autism; experience, sources of information, and managing care; barriers to identification; strategies to aid in identification; and characteristics that facilitate expertise. Together, the findings from this review present a mixed picture of GP knowledge and experiences in identifying autism and managing care for children with the condition. At one end of the continuum, there were GPs who had not heard of autism or endorsed outmoded aetiological theories. Others, however, demonstrated a sound knowledge of the conditions but had limited confidence in their ability to identify the condition. Many GPs and researchers alike called for more training and this might be effective. However, framing the problem as one of a lack of training risks silences the array of organisational factors that impact on a GP's ability to provide care for these patients.

Peer reviewed: True, Autism and attention deficit hyperactivity disorder are common behaviourally diagnosed conditions. One of the key aspects of diagnosis is clinical judgement. Yet despite decades of research, it is only in recent times that researchers have started exploring clinicians' perspectives on diagnosing these conditions. We aimed to add to this body of knowledge by conducting interviews with 17 experienced health care professionals in the United Kingdom to hear their perspectives on diagnosing autism and attention deficit hyperactivity disorder. Clinicians reflected that for some children and young people, diagnosis is reasonably straightforward; however, in other situations, decisions are made on more pragmatic grounds (i.e. will this be helpful). We identified some differences of opinion between professionals and organisation which adds to the complexity of applying a diagnosis. We recommend several areas for future research and point to some practical and philosophical implications of the work.

Many healthcare systems are organised such that General Practitioners (GPs) often have a key role in identifying autism spectrum disorders (hereafter collectively referred to as autism) in children. In this review, we explored what GPs know about autism and the factors that influence their ability to identify and manage care for their patients with autism in practice. We conducted a systematic narrative review using eight electronic databases. These included Embase and MEDLINE via Ovid, Web of Knowledge, PsycINFO via Ebscohost, PubMed, Scopus, ProQuest Dissertations and Thesis, and Applied Social Sciences Index and Abstracts (ASSIA) via ProQuest. Our search yielded 2,743 citations. Primary research studies were included, and we did not impose any geographical, language or date restrictions. We identified 17 studies that met our inclusion criteria. Studies included in the review were conducted between 2003 and 2019. We thematically synthesised the material and identified the following themes: the prototypical image of a child with autism; experience, sources of information, and managing care; barriers to identification; strategies to aid in identification; and characteristics that facilitate expertise. Together, the findings from this review present a mixed picture of GP knowledge and experiences in identifying autism and managing care for children with the condition. At one end of the continuum, there were GPs who had not heard of autism or endorsed outmoded aetiological theories. Others, however, demonstrated a sound knowledge of the conditions but had limited confidence in their ability to identify the condition. Many GPs and researchers alike called for more training and this might be effective. However, framing the problem as one of a lack of training risks silences the array of organisational factors that impact on a GP's ability to provide care for these patients.

Children with autism spectrum disorders (ASDs), attention deficit hyperactivity disorder (ADHD) and disinhibited and reactive attachment disorders (RAD/DAD) often experience socioemotional problems. Elucidating a clear picture of these profiles is essential. Strengths and Difficulties Questionnaires (SDQs) were analysed from cohort of children with ASD (n = 1430), ADHD (n = 1193), and RAD/DAD (n = 39). Kruskal–Wallis Tests and network analytic techniques were used to investigate symptom profiles. Children with ASD experienced more emotional problems, peer problems and fewer prosocial behaviours. Children with ADHD and RAD/DAD had higher levels of hyperactivity and conduct problems. Overall, ASD and ADHD networks were highly correlated (rs = 0.82), and we did not observe a statistically significant difference in terms of global Strength.

Objectives“Attachment difficulties” is an umbrella term often used to describe various forms of non-secure attachment. Differentiating “attachment difficulties” from autism spectrum disorder (hereafter autism) and attention deficit hyperactivity disorder (ADHD) has been characterized as challenging. Few studies have explored how this happens in practice, from the perspective of professionals.DesignQualitative study.MethodsWe conducted in-depth semi-structured interviews with (n= 17) healthcare professionals from five NHS Foundation Trusts in the United Kingdom. Participants were recruited using a combination of snowballing, convenience and purposive sampling. Data were analyzed using a thematic approach.ResultsWe identified six interrelated themes that might reflect difficulties with differential conceptualization. These include: a clinical lexicon of attachment; approaching attachment with caution; contextual factors; perceived characteristic behaviors; assessing attachment and adjacent supports; spotlighting intervention and dual conceptualization.ConclusionOur results indicate some of the ways suspicions around attachment are raised in practice. We advocate for more dialogue between research and practice communities on issues of differential conceptualization. We call for collaboration between a panel of experts consisting of attachment and neurodevelopmental orientated practitioners and researchers, to clarify issues around differentiating between attachment difficulties, ASD, and ADHD.

Attachment concepts are used in diverging ways, which has caused confusion in communication among researchers, among practitioners, and between researchers and practitioners, and hinders their potential for collaboration. In this essay we explore how attachment concepts may vary in meaning across six different domains: popular discourses, developmental science, social psychological science, psychiatric diagnosis, psychotherapy, and child welfare practice. We attempt to typify these forms of attachment discourse by highlighting points of convergence, divergence, and relay between the different domains. Our general conclusions are that diversity in the use of attachment concepts across different domains of application has been largely unrecognised, and that recognition of these differences would reduce confusion, help identify sites where infrastructure needs to be developed to support coordination, and strengthen opportunities for collaboration to mutual benefit. We suggest that academic attachment discourse would benefit from clarification of core terminology, including: “attachment”, “internal working model”, “trauma”, and “dysregulation”.

It is well-known that people with an intellectual disability often face a host of health inequalities and co-morbidities. These include childhood obesity, mental health problems, and challenging behaviour. People with an intellectual disability also have reduced life expectancy. GPs are uniquely placed to advocate for and signpost these patients, ensuring they have access to appropriate support. However, it is often unclear what resources are, in reality, both available and beneficial. Here we aim to summarise some of the common inequalities and complexities when working with patients with an intellectual disability and provide an overview of some potentially helpful services.

peer-reviewed Introduction: The current study sought to add to existing Mental Health First Aid (MHFA) literature by investigating the post-training experiences and helping behaviour of MHFA trainees in Ireland. In particular, this study aimed to understand the long-term outcomes of MHFA and the nature and quality of MHFA helping behaviours. The present research adopted a critical lens through which to examine MHFA experiences, exploring the impact of discourses constructing mental health and in doing so addressing a gap in the existing research. Method: A qualitative design was used to address the current research questions. Adopting a critical realist approach, previous MHFA trainees (n=256) completed an online survey gathering demographic details and brief qualitative information about their experiences. Individual telephone interviews were then conducted with 30 self-selecting survey participants (12 male; 18 female). Survey answers were downloaded online through Qualtrics. Interviews were audio recorded and transcribed verbatim for analysis. Results: Separate thematic analysis (TA) was carried out with survey and interview data, focusing on in-depth analysis of the interview data. Survey data addressed each of the following: Reasons for doing MHFA, Previous training or professional experience in mental health, Changes experienced as a result of MHFA, and Challenges in attempting to use MHFA. Interview analysis produced 6 core themes: Helping for Mental Health Problems; MHFA Narratives & Experiences, Resources & Services for Mental health, Subjective Norms, Understandings of Mental Health, and Covid-19. Conclusions: Findings confirmed the utility of MHFA training for improving general knowledge, attitudes and behaviour towards mental health problems. MHFA was found to influence helping behaviour and trainees’ confidence to provide help. Factors such as stigma, social support, previous experience and resources to support MHFA were also found to impact these outcomes. The present research provides support for mental health training that uses diverse and inclusive understandings of mental health. It also highlights the limits to using knowledge to change behaviour towards mental health. It is suggested that in order for MHFA to be effective, it should be reinforced by contexts which promote inclusion and equality for people with mental health problems.

peer-reviewed Introduction: Research has highlighted the different ways in which supervision can facilitate skill acquisition and development. It also demonstrates the impact of poor supervision processes. However, existing literature focuses primarily on experiences of trainee psychologists. The current study aimed to explore the subjective lived experience of clinical supervisors and assistant psychologists being supervised within the pilot assistant psychology scheme in Ireland. The present study attempted to address the gap in the literature, highlight lived experiences, identify what is working well, unmet needs and challenges. Method: A qualitative design was utilised involving the completion of semi-structured interviews with participants. The researcher interviewed eight individuals, four were clinical supervisors and four were assistant psychologists. Interviews were audio recorded and transcribed verbatim for analysis. Results: IPA was the chosen methodology for this research, and the analysis revealed a number of superordinate and subordinate themes for both groups. The superordinate themes for the clinical supervisor group included “Journey of Growth”, “Sense of Responsibility”, and “Challenges. The superordinate themes for the assistant psychology group included “Good Supervision” and “Negative Psychological Consequences”. Discussion: The study succeeded in addressing several gaps in the supervision literature. It provided greater insight into the experiences of clinical supervisors and assistant psychologists’ working within the pilot scheme. The results are discussed in relation to existing relevant literature, the study strengths and weaknesses are delineated, and several implications for clinical practice, education, training and future research are presented.

peer-reviewed Background: My systematic review of studies addressing research recommendations of a clinical practice guideline completed within this study was used to define the most effective factors that constitute a successful intervention in current brain injury literature. Cognitive stimulation therapy (CST) was deemed to be a close fit to these intervention recommendations. Based on this, it was postulated that CST would be a useful intervention to evaluate based on a current need for more streamlined, effective interventions across ABI rehabilitation services in a national and international context. Method: This research utilised a mixed methods approach to evaluate change in neuropsychological functioning, mental health and adjustment in the intervention group compared to a treatment as usual (TAU) group (quantitative phase). The qualitative phase explored participants’ experience of the intervention through focus groups. Quantitative data (N = 65) were analysed using a 2x2 repeated measures ANCOVA. Thematic Analysis (TA) was used to examine the qualitative findings in greater depth (N = 16). Results: Quantitative analysis indicated there was no significant difference in outcomes between two groups receiving two different rehabilitation approaches (CST vs. TAU). There was a statistically significant change over time (pre/post) for the intervention group on RBANS Visuospatial and Delayed Memory indices. Clinically significant change was observed for the RBANS Attention index and Total Scale score for the intervention group. Three qualitative themes were extracted from the data. Theme One: Differences in Personal Learning; Theme Two: Benefits and Limitations of a Group Intervention and Theme Three: Thinking Ahead. Quantitative findings were mapped onto qualitative themes to synthesise findings. Conclusions: There was no statistically significant difference in outcomes between groups in receipt of two different rehabilitation approaches (CST vs TAU). However, this study provides some preliminary evidence that a CST intervention had positive effects on adults with an ABI. It is suggested that the intervention proved engaging, meaningful and enjoyable for participants which may have aided in focusing attention. Improved attention may have subsequently underpinned cognitive improvements on visuospatial and delayed recall ability.

Distinguishing autism spectrum behaviours from behaviours relating to disorganised attachment can be challenging. There is, for instance, a notable overlap between both conditions in terms of behaviours deemed stereotypical. In addition, there are also similarities regarding some atypical social overtures. Responding to this overlap has been the subject for much debate in the literature. Disorganised attachment was first introduced and conceptualised by the attachment researcher, Mary Main. Main is considered the leading authority on coding this phenomenon. During the course of archival research, we obtained Main’s notes on coding attachment in a group of fifteen children with autism spectrum conditions (hereafter ASC). Drawing on these texts, this paper explores Main’s reasoning when making distinctions between ASC and attachment at the behavioural level. Our approach is informed by Chang’s (2017) argument for the potential of “history as complementary science. Analysis indicate that, for Main, frequency and timing was an important differential factor when attributing a behaviour to either ASC or the child’s attachment pattern., The authors wish to thank the Wellcome Trust [Grant WT103343MA] and the NIHR School of Primary Care Research [RG94577]

peer-reviewed Introduction: The existing literature confirms time and again that parents of children with Autism Spectrum Disorder (ASD) experience higher levels of stress than other parents. The current study aimed to explore the subjective lived experience of mothers of children with Autism Spectrum Disorder and gain insight into their perspectives on sources of stress as well as strategies and supports they engage in or would like the opportunity to explore. Methods: A qualitative design was undertaken and semi-structured interviews were conducted with participants. Twelve mothers of children with a diagnosis of ASD were interviewed. Interviews were audio recorded and transcribed verbatim by the researcher for analysis. Results: Data analysed using Interpretative Phenomenological Analysis (IPA) led to the development of five super-ordinate themes: Experiences of ASD; Interacting with Services; Experiencing ASD in the Family; Recognising Mental Health; and Aspiring for Change. Discussion: This study provided an opportunity for mothers to speak openly and subjectively about their experiences of the stressors associated with raising a child with ASD. The study findings are discussed in relation to the existing literature. Implications for policy, education, clinical practice, and future research are discussed with particular emphasis on family-centred practice in service delivery.

peer-reviewed Introduction: Research suggests that people with an intellectual disability (PWID) have historically been suppressed in their expression of relationships and sexuality. Adult ID service structures, staff member’s attitudes and PWID’s family viewpoints have been reported to influence this suppression. In Ireland, three other factors are noteworthy; a restrictive legislative framework; a conservative culture influenced by religion; and the adaption towards the biopsychosocial model of care and advances in Special Needs Education. This current study aims to explore the current attitudes and views of Irish Adult ID service providers and their staff on PWID’s expression of relationships and sexuality. Method: A mixed methods design was employed. During the quantitative phase, staff (n=86) completed an online survey to assess their ‘attitudes to sexuality’ relating to PWID. Meanwhile, qualitative methods were utilised to analyse Adult ID service provider ‘Relationship and Sexuality’ policy documents (n=5). These methods were also used to analyse staff participants open-ended questionnaires (n=86). Findings: Thematic Analysis was applied to the ‘Relationship and Sexuality’ policy documents and staff open-ended questionnaires. Five themes were generated from the policy documents; ‘Rights of PWID’, ‘Values’, ‘Training and Educational Supports’, ‘Welfare and Protection’, and ‘Supportive Structures’. Policies were interpreted to contain mixed messages on these themes, while also providing a dominant reference towards the protection of PWID. Three themes generated from the questionnaire; ‘Unsupported and Frustration’, ‘Taboo Subject Matter’, and ‘Vulnerability and Access to Education’. Participants reported a lack of service supports, dominant conservative viewpoints and PWID vulnerability. Staff ‘attitudes to sexuality’ were reported to be affected by demographic factors of age, education, practising religion and reading of service policy. Discussion: This study provided a comprehensive current account of Adult ID service provision regarding relationships and sexuality in Ireland. It highlighted the need for updated service policy, improved service practices, and enhanced provisions for staff and the PWID that they support. Implications for future research and clinical practice are also discussed, in terms of improvements in education, training, and the need for increased discourse on the subject matter.

peer-reviewed Primary aim of research: The study aims to evaluate the effectiveness of implementing a brief Transdiagnostic Cognitive Behaviour Therapy Group intervention for young people experiencing common mental health conditions. The “Mind and Mood Group” seeks to empower young people to manage and understand their symptoms and to make changes with positive effects. It is a six-session, skills-based group, which models a stepped care approach based on the Improving Access to Psychological Therapies (IAPT) initiative devised in the United Kingdom. The Health Service Executive (HSE) has demonstrated a commitment to developing services for young people, following A Vison for Change (2006). It is hoped that by modelling a stepped care, evidence-based approach, services will be better equipped to meet the demands of this growing population. Method: The study used a deployment focused, multi-site mixed-method approach to incorporate a pre- and post-intervention repeated measures experimental design. Seven intervention groups across individual Child and Adolescent Mental Health Services (CAMHS) were involved in the study. Data was collected from participants who gave signed informed consent to take part in the study and completed the programme, N=40. Results: The findings were analysed for statistical significance and clinically meaningful analysis such as crossing clinical thresholds and reliable change. Participants’ experience of the intervention was elicited to provide richer in-depth data as a means to determine whether the intervention is meaningful and valuable to this population. Discussion: This study provided a deployment focused approach to introduce an innovative transdiagnostic group intervention to adolescents to assist services meet the growing demands for this population. It succeeded in addressing the current gaps in the transdiagnostic group literature for adolescents. The findings of this study are therefore discussed with reference to relevant literature, and the implications for clinical practice, policy, and education. Finally, the limitations and strengths of the study are discussed with recommendations for future research.

peer-reviewed Introduction: Research has found that respite care has a positive impact on the well-being of caregivers of children with disabilities and is associated with lower levels of stress, reduced levels of depression and anxiety, and more time for rest and rejuvenation. To date there has been limited research carried out with parents of children with autism spectrum disorder, so the aim of this study is to explore their experiences of accessing respite care for their child with ASD. Method: Semi-structured interviews were carried out with six parents of children with a diagnosis of ASD, who were all in receipt of respite care from a children’s disability service. Interviews were audio-recorded and transcribed verbatim, before being analysed. Results: Analysis of the interview data, using Interpretative Phenomenological Analysis (IPA), revealed five superordinate themes. These were: ‘Living with ASD’, ‘The Respite Worker’, ‘Role of Respite’, ‘Emotional Conflict’, and ‘Service Provision’. Discussion: This study provided an insight into the unique, lived experience of parents accessing respite care for their child with ASD in Ireland. The findings of the current study are discussed in relation to the existing literature. Implications for clinical practice, education, policy, and future research are also discussed.

peer-reviewed Introduction: Research has highlighted the increasing need for prevention and early intervention approaches for children who experience adversity. There is growing support for attachment-focussed interventions targeting the parent-child relationship in supporting optimal child development. In 2017, an area-based initiative aimed at improving outcomes for children experiencing disadvantage commenced the delivery of the Circle of Security- Parenting intervention to parents in the community. The current study aimed to explore the subjective experience of parents’ engaging in the COS-P programme. Method: A qualitative design was utilised involving the completion of semi-structured interviews with participants. The researcher interviewed ten parents who participated in the COS-P intervention. Interviews were audio recorded and transcribed verbatim for analysis. Results: Analysis using Interpretative Phenomenological Analysis (IPA) generated three phases of a journey within participant narratives. These were: Group as safe base for selfdiscovery; Understanding my child in a new way; and New beginnings; reaching our potential together. Discussion: This study provided a comprehensive account of the phases of a journey that parents move through in their participation in the COS-P intervention. The findings are discussed in context of existing literature. Implications for policy, education, clinical practice and future research are discussed and outlined.

peer-reviewed Background:. Minimal research has been carried out investigating Helping Professionals (HPs) experiences of working with children and families that have experienced Child Sexual Abuse (CSA). Furthermore, there is a significant dearth of literature examining individual processes of making sense and meaning of these experiences. The current study aimed to address these gaps in the literature through an exploration of HPs lived experiences of working with CSA in a Specialist Service (SS). Method: Twelve HPs working across two SSs for the assessment and treatment of CSA volunteered to participate in this study. Semi-structured interviews were carried out to explore HPs perceptions and experiences of working in this area. An Interpretative Phenomenological Analysis (IPA) provided a framework for the analysis of this data. Results: Five Master Themes and several associated Sub-Themes emerged through analysis procedures. These themes included ‘Evoked and Embodied’, ‘Process’, ‘Collective Support’, ‘Contained Spaces’, and ‘Worth the Journey’. Discussion: This study provides a novel contribution to the literature in its exploration of HPs experiences working with CSA in a SS. The results of this study are discussed in the context of previous literature. Clinical and service-based implications of these findings are outlined. Limitations and strengths of this study are then presented, as well as avenues for future research.

peer-reviewed Background: In the context of ageing populations in the western world, people with lifelong disability are among the fastest growing groups of older people. The largest sub-group of these are older people with intellectual disability. Yet little is known about how men and women with lifelong intellectual disability experience their later years. The purpose of the study is to develop a better apprehension of what ageing implies for those with lifelong intellectual disability, through direct consultation about psychosocial aspects of their lives. Method: This is a cross-sectional study carried out in a community based service for adults with moderate to severe intellectual disability in South West Ireland. It utilised a qualitative approach with a non-experimental, exploratory design. Participants (n=46) ranged in age from 36 to 76, with a mean age of 52. There were 24 males and 22 females. Participants lived in community residential houses (54%), with family (39%), in supported living (4%) and in a community hospital (2%). Fifty five interviews were undertaken. Data analysis drew on the principles of the Constructivist Grounded Theory Method. Results: The findings point to a life course theory of ageing and show that outcomes in ageing with lifelong intellectual disability are a function of both the ageing process and how age-related changes interface with the lived environment. Ageing well is linked to the quality and timing of supports received across five areas (1) self-determination (2)safety and security (3) social participation (4) loss and spirituality (5)coping patterns. A planning tool is developed from the findings and is used to identify individualised supports required across these five areas (Wellness in Ageing Tool – Intellectual Disability – WiAT-ID). Conclusions: (1) ageing experience cannot be set apart from whole of life experience (2) a five area support model, grounded in the experiential reality of actual lives, facilitates psychological and social wellness as men and women with lifelong intellectual disability grow old.

peer-reviewed Introduction Despite global uptake of the ‘Circle of Security Parenting Programme’ (COS-P), limited research on its effectiveness has been carried out to date and implementation now exceeds its evidence-base. Dissemination of COS-P has been ongoing in Ireland since the autumn of 2016 and emerging evidence suggests it to be a potentially powerful intervention tool for enhancing parent-child relationships and addressing childhood emotional and behavioural difficulties. The primary focus of the current study was to elucidate the lived experience of parents who have participated in the COS-P and to explore potential mechanisms of change. Method The method of inquiry involved a qualitative design. Semi-structured interviews were conducted with nine parents (eight mothers and one father) within seven weeks of completing the COS-P. Interviews were audio recorded and transcribed for analysis. A subsidiary quantitative investigation, involving the completion of standardised psychometric questionnaires at baseline, post-intervention, and again, following a six-month interval, was included to explore the feasibility of future hypothesis testing studies. Results Interpretative Phenomenological Analysis (IPA) was applied and the interview data culminated in the uncovering of six themes including ‘Seeking Help and Engaging with the Programme’, ‘Learning to be Vulnerable’, ‘Learning to Manage Emotions’, ‘An Improved Parent-Child Relationship’, ‘A New Experience of Parenting’ and ‘Evaluating the Experience’. Participants appeared to have developed more sensitive and reflective parenting practices and greater emotion regulation capacities. Participants expressed their immense satisfaction with the programme as well as its potential utility for wider audiences. Conclusion In-depth examination of parental experiences revealed that COS-P appears successful in its key objectives. Parental practices and affective change following COS-P appeared to occur through several interactive processes, some of which are common to other parent training programmes. Implications for practice, policy and future research are discussed.

peer-reviewed Introduction: Peer Support Workers (PSWrs) are employed in mental health services with the purpose of supporting service users by utilizing their own personal experience of mental health difficulties. The introduction of a new role into an existing team or to complement an existing care pathway constitutes a complex intervention, for which systematic feasibility and piloting work in both development and evaluation are a necessity. Objectives: The aim of the study was to explore and compare the views and experiences of PSWrs, Supervisors, and Mental Health Professionals (MHPs) in relation to the employment of PSWrs in 4 mental health services in Ireland. Methodology: The overall research design aimed to collect information and draw conclusions for the future employment of PSWrs within statutory mental health services. Each participant group took part in a semi-structured interview (PSWrs: 4; Supervisors: 2; MHPs: 6) yielding a total of 12 interviews. Thematic analysis was conducted and the data compared across the three participant types. Results: Across nine topics, a total of 53 themes emerged from qualitative data. Discussion: Diverging views across participant groups, methodological strengths and weaknesses and significant implications for future directions for research, implementation and policy were discussed. Conclusions: The results of this study suggest the importance of developing clear guidelines for the effective implementation of peer support working before the role is widely rolled out in mental health settings and further research into their effectiveness be considered.

peer-reviewed Introduction: Research has shown that anxiety during the perinatal period is experienced by many women and indeed may even be more common than depression (Carroll, Begley, & Clarke, 2014). However, to-date there is a dearth of qualitative studies exploring this experience. The current study aimed to contribute to the understanding of women’s lived experiences of anxiety and providing care to their babies during pregnancy and the year after birth, defined in the current study as the perinatal period. Method: The present study utilised a qualitative design and used Interpretative Phenomenological Analysis (IPA) as the methodological approach. The researcher recruited nine women with past experiences of anxiety who had given birth to their youngest child within the previous 30 months. All of the women participated in a semi-structured interview. Results: The transcripts were analysed using Interpretative Phenomenological Analysis (IPA) and four Superordinate themes were generated: (1) Early Fears (2) Being the Caregiver (3) Needing Care and (4) Gaining Confidence. Discussion: The present study provided a rich account of women’s lived experiences of anxiety and caregiving during the perinatal period. The findings of the study are discussed with reference to previous literature, the strengths and limitations of the study, clinical implications and future research. Conclusion: The present study highlighted the need for healthcare professionals to provide more support to women who experience perinatal anxiety. It also highlighted the need for increased preparation and support for women in the transition to motherhood. Perinatal anxiety needs to receive greater attention in the area of perinatal care.

peer-reviewed Background: The importance of emotional regulation on our capacity to function in the world has been comprehensively addressed in the research literature. According to attachment theory and research, the quality of parent-child interactions has a significant influence on children’s development of emotion regulation. In fact, emotion regulation is now regarded as an essential component of effective parenting. Much of the evidence-based parent training programmes delivered universally are cognitive and behaviour based. Although these programmes do contain elements of emotion regulation and relationship skills training, the emphasis is on behavioural management. In Ireland relationship-based parent training programmes have yet to be established, and consequently the evidence base is difficult to find.

peer-reviewed Introduction: Trans individuals report experiencing pervasive discrimination, microaggressions, harassment and stigma across their lifespan. Transphobia has been identified as a key contributor to elevated rates of mental health problems and suicidal ideation among trans individuals. The aim of the current study is to gain a deeper understanding of transgender individuals’ experiences of transphobic discrimination and hate crime, and how they describe their coping following these experiences, in their own words. This research aims to explore how resilience manifests in trans people with regards to stigma and discrimination. Method: The researcher interviewed seven trans individuals. Semi-structured interviews were utilized to explore participants’ subjective experiences of transphobic discrimination and how they described their coping following these experiences. Interviews were transcribed verbatim. Findings: An Interpretative Phenomenological Analysis (IPA) approach was employed and revealed a number of superordinate, subordinate, and minor themes in the interview data. The superordinate themes included ‘Aftermath of Experiences’, ‘Coping’, and ‘Moving Forward’. Discussion: The research project succeeded in addressing a number of gaps in the transgender discrimination literature; providing greater insight into trans peoples’ experiences of discrimination and/or hate crime and how it impacts on their coping and resilience. The results of the study are discussed in relation to the literature, and a number of implications are discussed in the context of clinical practice, education, policy, and future research. Limitations and strengths of the study are also discussed, as well as a critical reflection on the research process

peer-reviewed Introduction: Research has highlighted high levels of unmet need among people with severe mental illness experiencing homelessness. The current study aimed to explore the subjective lived experience of a sample of this population to explore their perspective on areas of unmet and met need, and to examine their perspective on engaging with mental health services in an effort to promote personal recovery. Method: A qualitative design was utilised involving the completion of semi-structured interviews with participants. The researcher interviewed ten individuals with experience of homelessness and a diagnosis of severe mental illness currently in receipt of mental health support from a specialist mental health service for homeless people. Interviews were audio recorded and transcribed verbatim for analysis. Results: Analysis using Interpretative Phenomenological Analysis (IPA) generated five stages among participant narratives. These were: Tough Beginnings – A Bumpy Start; Critical Events – Losing Control of the Wheel; Striving to Survive – Seeking Help to Share the Drive; Stabilising and Healing – Finding a Safe Road Together; and Growing – Retaking Control of the Wheel. Ongoing threats to recovery via ongoing trauma, and recovery facilitators in the form of resilience are also discussed. Discussion: This study provided a comprehensive novel account of the stages encountered on the recovery journey of individuals with severe mental illness experiencing homelessness in Ireland. The findings of the current study are discussed in the context of previous literature. Implications for policy, education, practice and future research are discussed with particular emphasis on trauma-informed and personal recovery-oriented approaches to service delivery.

peer-reviewed Introduction: Residential child care has a long and ignoble history both in Ireland and throughout many parts of the Western World. A small but established field of research exists within the sector. The qualitative studies in the area tend to highlight various phenomena within residential child care while providing little context for those phenomena. The qualitative studies tend to provide more context for the phenomena and reflect the multifaceted nature of residential child care and how the answers to the questions about residential child care tend to depend significantly on who is asked.. The Assessment Consultation and Therapeutic Service (ACTS) was established to provide clinical services to young people residing in special care residential centres and detention centres in Ireland. Method: The study aimed to capture the experiences of clinicians working within the ACTS service. Semi-structured interviews were carried out with 11 ACTS clinicians who are based in each of the three regional centres of ACTS and in each of the professional disciplines represented within the service. Results: An Interpretative Phenomenological Analysis approach was utilised and three superordinate themes entitled ‘The Journey’, ‘The Path’ and ‘The Passengers’ were identified under the heading of ‘Going the Extra Mile’. Discussion: The findings are discussed in the context of relevant therapeutic approaches and previous research within the field. The application of the findings of the current study to further research, clinical practice, education and policy are discussed. The strengths and limitations of the study as well as the reflections of the primary researcher are also discussed.

peer-reviewed Introduction: Professionalization is said to be composed of knowledge, autonomy and responsibility. There is, however, a significant lack of research into professionalization and the field of clinical psychology specifically. The present study aimed to explore clinical psychologists' interpretation and experience of professionalization here in Ireland. Method: The researcher conducted ten semi-structured interviews with practising clinical psychologists from different teams and services across the country. The use of semistructured interviews ensured that the individual and unique experiences of each participant were explored. Interviews were transcribed verbatim and an Interpretive Phenomenological Analysis (IPA) was applied. Results: Two superordinate themes emerged from the data; 'standardisation' and 'Internal characteristics, alteration? Or acceptable?'. Each superordinate theme encompassed a range of subordinate themes. Relevant participant quotes were provided to support each theme. Discussion: The research project succeeded in highlighting clinical psychologists' need for standardisation in relation to a number of external characteristics of their profession. Continuing Professional Development (CPD), self-care and registration were included. While others are reported to reach a satisfactory level of standardisation, namely supervision and training. The problematic nature of autonomy, knowledge and responsibility was exposed, with only the latter two being interpreted as requiring change. The findings are discussed in relation to previous literature. The study's limitations and strengths were explored and possible future research directions named. A range of recommendations regarding policy and clinical practice were presented.

peer-reviewed The current research project explored the research question: “How are Clinical Psychologists Affected by a Client’s Ability to Adapt to Adversity (Resilience)?” Little is known about the impact that clients have on clinical psychologists, and less is known regarding the positive impact that clients have on clinical psychologists. It has been suggested that a client’s resilience positively impacts clinicians. However, the area remains under explored. Thirteen clinical psychologists partook in this study. Semi-structured interviews explored their experiences with resilient clients. Grounded theory principles were applied to the collection and analysis of data. The results revealed four key themes: (1) Virtuous Action, (2) Psychologists’ Resilience, (3) Collaborative Crusade, and (4) Fortitude Spiral. Working with resilient clients resulted in outcomes that appear to help maintain a psychologist’s ability to continue with clinical work. These findings, the subthemes that comprise them, and recommendations for clinical practice and future research will be outlined in this paper.

peer-reviewed Background: Suicide is one of the most common causes of death worldwide. Research targeting an understanding of the phenomenon of suicide, however, is still in its infancy. Connectedness is a key construct of suicide that has not been previously researched in depth using qualitative methodologies. Aims: The current study aims to explore the role of connectedness in the paths to and from suicide with psychotherapists working in the applied field of suicide intervention. A goal of the research is to develop a theoretical framework for the role of connectedness in relation to suicidality. Method: Psychotherapists (N=12) from a suicide-specific intervention service in Ireland were interviewed in relation to their understandings of connectedness and suicide. The transcripts of these interviews were analysed using a Constructivist Grounded Theory approach. Results: A tentative theoretical model for the role of connectedness in an individual’s path to and from suicide was developed. The model incorporated two strands: 1) the role of connectedness on paths to suicide and (2) the role of connectedness on paths from suicide. The connection an individual has with themselves was posited as the foundation for all other connections. The quality of connections and family were seen central to one’s propensity for developing suicide intent. Furthermore, the therapeutic relationship was noted as the connectedness vehicle for recovering from suicide intent. In order to develop connectedness for recovery, elements of the therapy, the client and the service required were seen as crucial to the current theory. Conclusions: Connectedness and relationships play essential roles in the trajectory of suicide. The development of positive connections can be sustaining and protective against suicide whereas maladaptive connections or a lack of connection can contribute to one feeling suicidal. The therapeutic relationship can be crucial to one’s recovery from suicide intent.

peer-reviewed Empirical research has demonstrated a wide range of beneficial outcomes for cultivating self compassion in people with mental health difficulties (Gilbert et al. 2010a, Neff et al. 2003b). Emerging research also suggests people can experience a multitude of barriers when attempting to develop self compassion (Gilbert et al. 2014). This phenomenological study explored the lived experiences and barriers to cultivating self compassion in an Irish Primary Care mental health sample to expand on the predominately quantitative evidence base. The sample was derived from a GP Practice in a Southern region of Ireland. Eleven participants with a diagnosis of Depression, and/or an Anxiety disorder attended individual semistructured interviews. The audio recorded interviews were transcribed verbatim, and analyzed using Template analysis (Crabtree et al. 1992). The emerged themes are as follows; Diverging perceptions: 'self pity' versus 'self promotion', Socio-Cultural Effects, ‘Emptiness' and Mental Health difficulties, Distrust: 'It's not allowed', and ‘Seeing the Colours': Recovery. The superordinate and subordinate themes are contextualised within the current literature, and the clinical implications are discussed. The strengths and limitations of the research are explored with reference to recommendations for further research.

peer-reviewed Background: To ensure the right of the child with an intellectual disability to grow up in the family home is maintained, this study explores mothers ability to overcome the many challenges to the provision of care so as to guarantee a good quality of life for their child. Aims: This study will explore mothers experiences of the disclosure process of a disability and the impact it had on their ability to cope with providing care for their child. It asked mothers to describe their relationships in the family and community since the disclosure of their child???s disability. It explores how mothers made decisions regarding care, and what impact, if any, disability policies had on their lives. Method: In this exploratory qualitative study, eleven interviews were carried out with the assistance of a bilingual interpreter with mothers of children with disabilities who live at home, in the South of Romania. Of these, eight mothers??? interviews fulfilled the criteria of the study resulting in the transcription and analysis of these interviews using Interpretative Phenomenological Analysis. Results: The analysis uncovered four master themes of uncertainty, disempowering bureaucracy, a lack of understanding and the desire of mothers in going forward. Due to various socio- cultural barriers and ambivalent attitudes, mothers struggled to navigate the bureaucratic processes of meeting specialists. These encounters contributed to a lack of understanding by themselves and others, of their child. However, all mothers spoke of the desire in going forward with their child and thus continuing to provide care for them at home. Conclusions: This unique study reveals the strength of these mothers through their ability to cope with caring for their children in the face of a dearth of formal supports. The research has the potential to form the basis for change in the areas of clinical practice, policy, future education and research and continued professional development.

peer-reviewed The quality of teaching that occurs within academic institutions has begun to feature more frequently in recent academic discourse. However, the types of educative relationships created with students features less frequently in the discourse. Yet they are an important aspect of the learning process. How academics understand the nature of their teaching and their impact on the learning of their students is an important consideration for those who seek to champion the development of mindful and empowering teaching in higher education. This research sought to explore my lived experiences of teaching and learning in higher education. A self-study action research methodology was chosen in which I sought to examine how students understood the nature of the educative relationships they experienced in higher education. It also explored in depth the nature of the educative relationships that I created with my students and how this impacted on their learning. The research was characterised by deep reflection on my practice as an educator in a university setting. A qualitative approach was employed and data were collected from a variety of sources such as student interviews, student focus groups, student reflective journals, evaluations of my teaching, focus groups with a team of critical peers, and my own research diary. Self-study action research facilitated me to develop my own theory of my practice as a higher education teacher. It illuminated the importance of educative relationships and the role of empowerment in student learning. It also gave me insight into the potential of empowerment as a prevailing ethos in higher education which can be facilitated by encouraging teachers to be more pedagogically reflective. Supervision is an important pedagogical relationship and needs to be reconceptualised in a manner that does justice to its pedagogical dimensions. Universities need to find creative and engaging ways to really listen to the voices of their students and action research is one way in which to do this. Action research has much to offer because it encourages academics to think in scholarly ways about their practice. It is important that we listen to and gain deeper insight into higher education teachers??? conceptualisation of their identity as teachers in order to champion teaching as a scholarly activity. It could significantly aid the development of a more holistic higher education pedagogy that prioritises scholarship of teaching and supervision.