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The aim of this research was to account for the meaning practitioners and clients gave to Guided Human Equine Interactions (GHEI). GHEI is a term that covers a range of interactions between human and horse for the purpose of facilitating emotional and social development in the human participants. There is paucity of research to evidence assumptions inherent in practice and little is known about the meaning participants give to GHEI. Despite this, practice is rapidly expanding in Britain following similar growth in America where GHEI originated. An underlying premise in this thesis is that the discourses employed to account for equine involvement in therapy and learning will construct practice. Therefore, language samples were obtained from interviews with ten GHEI practitioners, two GHEI websites, and from the personal experience of one client through their diary entries. The data were interrogated, analysed and interpreted according to a discursive strategy based on work by Ballinger and Cheek (2006). Five dominant discourses (metaphysical, sensory, social, mental distress and symbolic) were surfaced across three studies. These discourses served differing functions and woven together, formed a discursive framework that accounted for the meaning practitioners and clients gave to GHEI. This incorporated not only the cognitive, affective and behavioural elements seen in mental health interventions such as Cognitive Behavioural Therapy (CBT), but also included the added dimensions of spiritual, sensory and symbolic meaning. These added factors provided for a more holistic experience for the client than office based therapy alone. The insights gained suggest the horse has an impact, not only on the spatial distancing between the client and practitioner, but also on their relational distancing. This distancing enables the client to be positioned as the expert at the centre of the intervention. However, expert client positioning was only apparent as long as the practitioner did not draw on a dominant mental distress discourse, or tried to market GHEI. There was a lack of risk discourse across all studies, which was considered an important added factor in positioning the client as expert. Spatial and relational distancing may assist GHEI practitioners in being alongside individuals who decline to engage in more formal interventions It was noted that adaptation had taken place in the discursive construction of GHEI from practice developed in America. This had led to culturally relevant practice being accounted for in Britain. It was concluded that the inclusion of a horse in therapeutic and learning practice is at an intersection between past discourses where the metaphysical, such as spirit and healing, were privileged and contemporary discourses where social care and treatment of mental illness are authoritative. There is a symbiotic relationship between the function of the horse in accounting for the meaning given to GHEI and the function of dominant discourses. This results in a centaur-like enmeshment of human and horse.

The 6-Part Story Method (6PSM) involves the participant creating and telling a fictional story which is then discussed with the interviewer. Stories were recorded from NHS mental health clinicians, and from adult mental health patients with and without a diagnosis of Borderline Personality Disorder (BPD). Statements describing the stories could be reliably scored by raters who were blind to the authorship of the stories. It was possible to use these statements to assemble a scale with good internal consistency, inter-rater reliability and test- retest reliability over a one-month period. The scale statements all related to the degree of negativity and failure expressed in the story. Ratings on this negativity scale given to stories from patients with a cluster B personality disorder diagnosis were significantly higher than the ratings given to stories from other participants. The text of the story transcriptions was analysed using computerised text analysis programs, which detected some patterns of language use that appeared to distinguish reliably between stories from participants with BPD and other stories. Participants were asked for their reactions to the 6PSM process, and their responses analysed using a Grounded Theory approach. This suggested that for most participants, the 6PSM works through increasingly close emotional identification with an initially distant and metaphorical main character.

Social processes have been investigated as a maintaining factor in chronic fatigue syndrome, also known as myalgic encephamyelitis (CFS/ME), and the responses of the significant others (SOs) of people with CFS/ME (PwCFS/ME) have been shown to be associated with illness outcomes. Experiences of PwCFS/ME and their significant others have been explored, but with limited depth and/or breadth. This study aimed to develop a nuanced understanding of relationships between PwCFS/ME and their SOs, describing emotional and relational characteristics, processes and consequences. 15 participants consisting of PwCFS/ME (n=9) and SOs of PwCFS/ME (n=6) completed a total of 26 audio-recorded, semi-structured interviews which were analysed according to grounded theory methodology. Four categories are presented: Onset, The Problem Pattern, Cohesion and Acceptance, with The Problem Pattern being the core category. Within these, patterns of family functioning are identified and discussed in relation to family systems theory and models of family cohesion. Three key dimensions of cohesion are identified in the data: disengagement, enmeshment, and healthy cohesion, as are the emotional experiences that accompany these relational patterns. Future research and interventions that incorporate the significant other should aim to improve togetherness, autonomy, and acceptance in relationships, with the goal of improving quality of life within the limitations of the illness.

MDMA is a popular psychoactive drug that is highly associated with raves and clubbing culture. Consumers experience feelings of euphoria, joy, and confidence. Despite the considerable research on MDMA, non-problematic aspects of use remain under researched. The aim of this study was to understand MDMA use and pathways into and out of consumption. More specifically, the research examines the experience of ex-heavy MDMA users through their MDMA journeys. This qualitative study employed an online questionnaire inspired by the Life Story Approach. Participants were recruited using ethnographic research methods and through related online forums. The inclusion criterion was individuals who self-identified as ex-heavy MDMA users, who have now cut down or completely stopped MDMA use. 104 former heavy MDMA users were surveyed. Data was analysed thematically from which six main categories were identified: Journey; Polydrug use; Role of drugs during consumption; Changes in drug use pattern; Changes in life; and Advice. A common positive tone runs through all the themes, and most reported negativity is due to drug use as a whole. Data analysis highlighted Harm reduction and Function and pleasure enhancement as important overarching themes for participants. MDMA was generally used in specific settings to enhance an event or experience, such as music related events. But MDMA also enhanced intimacy, social bonding, meditation, and was used by some as a cognitive enhancer and therapeutic aid helping to think and feel differently. Many described positive psychological and social effects of use that remained after MDMA use, and often lasted permanently. Although a stop or a cut-down in MDMA use is often a natural process, it could still be cut-down or stopped actively by making lifestyle changes such as distancing oneself from the associated scenes and people. The results of this study bring a foundation of understanding MDMA use and pathways into and out of frequent use, which could particularly be useful in designing appropriate harm reduction programs and inform policy making. Likewise, present findings could help to address further aspects of MDMA use and non-problematic drug use in general.

Depression is one of the world's leading causes of disability. Current methods used to treat it, both medication and psychotherapy, are effective for some but not all; new approaches need to be developed to complement the ones already available. This need is particularly acute for chronic and recurrent depression. A single case experimental design with replications was implemented for a preparatory investigation into the potential of Eye Movement Desensitisation and Reprocessing (EMDR) to treat long term depression. Ten people with recurrent and/or chronic depression were recruited from primary care mental health services and received Standard Protocol EMDR for a maximum of 20 sessions. Levels of depression and social functioning were measured before and after treatment and at follow up, clients also rated their mood each day. Before and after treatment the participants recorded their target memories whilst recording psychophysiological parameters and after treatment they were interviewed about their experience of EMDR. Eight people engaged with the treatment, seven of these had clinically significant and statistically reliable improvement on the Hamilton Rating Scale for Depression and this improvement was linked to the progress of treatment. Heart rate variability was significantly reduced indicating a less withdrawn parasympathetic nervous system. Interviews elicited a highly favourable opinion of EMDR from the participants including all participants saying they would recommend it to others. EMDR has shown potential to be an effective treatment for depression. This phase I study has provided a platform for a phase II pilot trial and phase III randomised controlled trials to gauge efficacy and effect size in a larger sample. This study's results are consistent with the working memory taxation theory of mechanism of change in EMDR.

This thesis explores the development of a treatment manual focused on a dyadic approach to art therapy that involves both children and their caregivers. The research took place in four phases: a survey of 85 British art therapists to establish the prevalence of, rationale for, and influences on dyadic art therapy; a Delphi study involving a panel of eight experts to gain consensus on core principles, practices and competences; a qualitative study involving six practising dyadic art therapists and four service users; and finally the construction of a web-based draft manual based on the empirical research findings and feedback from stakeholders on the first draft. The survey demonstrated that in the United Kingdom the use of dyadic art therapy is common, that few art therapists have received any specialist training in this approach, and that there is a desire amongst art therapist to develop their knowledge and skills further. The Delphi and the qualitative studies were used to develop content for a draft manual. A web based manual was constructed which stakeholders were invited to review. Feedback from the stakeholders indicated that the manual was seen as a refreshing, aesthetically pleasing resource with potential applications in training, practice and research and also as charting new territory for the art therapy profession as a whole. The expert-informed research-based manual developed here seeks to present a developing and evolving description of dyadic art therapy rather than a definitive one. The content of the manual is based on therapists' and service users' accounts of dyadic art therapy. The research which led to the development of the manual did not focus on mechanisms of change. The manual is a resource which can be used to train art therapists and specify the intervention for future research into dyadic art therapy.

How do clients elaborate throughout therapy? This was the question that broadly framed this research and situated it in the field of psychotherapy process research. The process chosen was assimilation which was conceived as a global process of change focused on the client. To study this process, this research used narrative indices which are elements of the narrative that are considered to represent particular processes. The use of indices depends on the understanding of language not as a rigid signal system to denote psychological concepts; but as an interactional process of communication in which narrative processes are represented. This research was divided into two studies. The first study sough to develop the system of indices based on a qualitative analysis and then adjust it to meet the reliability standards with respect to consistency and interrater reliability. To this end, 30 single sessions of adult clients with depression were recorded and analysed. After the system of indices had been developed it was analysed and contrasted with an existing coding system. Study I resulted in a system of indices grouped into five dimensions – external distress, pain, noticing, decentring and action – which showed acceptable interrater reliability, internal consistency and convergent validity. The second study was a longitudinal application of the system of indices. The goal was to contrast the cases with regard to their success status as defined by the pre-post variation of the depression level. Nine psychotherapies were recorded and analysed. Of these nine cases, only three showed a non-straightforward relation between the success status and the dimensions. The in-depth analysis of these three cases showed the usefulness of using the system of indices to understand the complexity of the psychotherapy and the non-linear relationship between psychotherapy and symptom change. The results suggest the importance of the indices in understanding assimilation and are discussed with emphasis on the practical implications that can be derived.