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Objectives: Recovery from sexual trauma can be complex and multi‐faceted. Most current psychological treatment protocols for trauma use a cognitive model of post‐traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT‐related variables. Methods: 155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self‐compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self‐criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms. Results: An exploratory model involving CFT‐related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self‐criticism was found to be the variable with significant contribution. Conclusions: That CFT treatments, targeting self‐criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables. [ABSTRACT FROM AUTHOR]

This study presents an analysis of the experiences of 15 men convicted of sexual offences, from England and Wales, who have completed the Horizon treatment programme in the community, facilitated by The Probation Service. We found that whilst men felt initially coerced into the programme, finishing the programme was experienced as a significant loss of support. Beyond the programme, the men described the constraints on their citizenship, difficulty accessing support, and rejection in society due to their offence. We conclude by discussing the limitations of personal rehabilitation, the need for social rehabilitation, including tailored support beyond the programme, the importance of user voice and a 'community integration paradox'. [ABSTRACT FROM AUTHOR]

There is growing recognition, in the UK and internationally, of the huge costs of recurrent appearances of parents in local authority care proceedings. This paper contributes to pressing policy and practice concerns to reduce recurrence. It presents qualitative longitudinal data from the first study of fathers' experiences of recurrent care proceedings in England. Demonstrating the emotional impact of repeat proceedings and successive loss of children on fathers, in terms of grief, loss and shame, we highlight the trauma and abuse in their developmental histories. We consider complex connections between anger and shame for these fathers, including within the arena of family justice. With the use of literature on complex trauma, shame and parental disengagement, we explore ideas for re‐framing fathers', and professionals', resistance to engagement and for better understanding fathers' intense emotions. We suggest that the link between shame and complex trauma and the value of shame reducing, dignity promoting practice in response provide a valuable way forward for working with fathers. As is recognized to be the case for mothers, without holistic, empathic interventions to address the vulnerabilities of such fathers, the risks for children, mothers and fathers are unlikely to reduce. [ABSTRACT FROM AUTHOR]

Despite extensive research looking at the phenomenon of burnout, little is known about how individuals working in traditionally high-burnout occupations understand the term. Interviews were conducted with six teachers working in state schools in England centring on how the term burnout was understood and how it was used or encountered. Reflexive thematic analysis was employed from a critical realist perspective to analyse the data generated. All participants described burnout as a stress-related condition, yet for some participants the point at which stress became burnout was unclear leading to an understanding that burnout was the point at which one was unable to work. Many participants highlighted an individualistic understanding of burnout, perceiving it as representing an individual deficit rather than an organisational failing. This was often reinforced by where the term was encountered (at work or in the media) and was linked to the stigma many participants associated with burnout. This paper concludes that individualistic framings of burnout obscure its organisational determinants while reinforcing notions that mental well-being is something which should be personally – and privately – managed by individuals. [ABSTRACT FROM AUTHOR]

Objective: Health care workers have been exposed to a variety of practical and emotional challenges because of the Covid‐19 pandemic, leaving them vulnerable to experiencing moral injury and distress. However, there is currently sparse research which directly explores such experiences. This study aimed to explore and characterise the experiences and impacts of moral injury and distress among health care workers during the pandemic. Methods: Twenty semi‐structured interviews were conducted with health care workers employed across both mental and physical health care services. Interviews were analysed from a critical realist perspective using thematic analysis. Results: Three key themes were identified: attitudes towards moral injury, experiences of moral injury and consequences of moral injury. Participants appeared to identify with the idea of acting against their morals to varying extents based on their job roles. Participants experienced a range of potentially morally injurious and distressing events throughout the pandemic and many ultimately felt that they provided sub‐standard levels of care due to extreme pressures on services. Detrimental impacts upon wellbeing were commonly reported, including high levels of emotional distress and feelings of guilt and shame. Some reported a loss of enthusiasm for their job and a desire to leave the profession entirely. Conclusion: Moral injury and distress presents a real concern for staff wellbeing and retention within the profession. During and beyond the Covid‐19 pandemic, there is an urgent need for health care providers to implement wider strategies to target moral injury and distress, and support staff within health care settings. [ABSTRACT FROM AUTHOR]

This paper reports on data that is part of a wider evaluation of a small‐scale project that offers support to parents, children and families affected by alcohol and substance use. Using semi‐structured interviews and a focus group, the data in this paper explore mother's sense making of their substance use and their experiences of various professional interventions which have helped or hindered their personal journeys of recovery. Mothers' narratives suggested a self‐critical inner dialogue conceptualized as shame. Fear of stigma and a sense of shame derived from historical abuse and had a profound effect on how mothers perceived themselves and how they negotiated a web of professionals involved in their lives. Community projects with a focus on understanding mothers and their needs, and not the risk they posed to their children, were considered most supportive. Interventions working within a non‐judgemental and empathetic framework that fostered the importance of relationships and connection had a greater impact on mothers' long‐term recovery goals. [ABSTRACT FROM AUTHOR]

Background: Shame can be a powerfully aversive emotion that is associated with a wide variety of mental health difficulties including non‐suicidal self‐injury (NSSI). This study used a novel mixed‐methods design (Qualitative Experiential Sequence Tracking; QUEST) to investigate the experiences of shame in a sample of individuals who self‐injure. Methods: Six participants received prompts to complete brief online diaries three times per day over a period of 2 weeks. These diaries captured information about the experience of negative emotions, especially shame. Participants then underwent an individualised qualitative interview about their experiences over the previous 2 weeks. Results: Thematic analysis suggested that participants experienced shame as a social and relational emotion. Further themes included shame being associated with feelings of failure, being trapped, dangerous or contaminated, and hidden or exposed. The phenomenology of shame, and coping with shame, were also themes. NSSI could occur as a response to shame, but often shame was triggered or exacerbated by the responses of others to NSSI. Conclusions: Consistent with previous research, shame was described as an aversive emotion occurring within interpersonal and broader societal contexts and involving a negative self‐focus. A lack of compassion or understanding in response to NSSI, or anticipation of negative responses from others often triggered more intense shame than the NSSI itself. Future studies could use QUEST methodology with more diverse samples or different populations to further investigate experiences of shame. [ABSTRACT FROM AUTHOR]

A new diagnosis of Complex Post-traumatic Stress Disorder, CPTSD, is included in ICD-11 which was adopted in May 2019 by the World Health Organisation, WHO. In addition to the symptoms of PTSD, CPTSD includes emotional dysregulation, negative self-concept, and disturbances in relationships. It may be a helpful diagnosis for trauma survivors with experiences of human mistreatment such as torture and abuse. This study explores the views of patients in the community on psychotherapy for the diagnosis of CPTSD, taking a qualitative, participatory approach. Twenty-four former patients from an NHS secondary mental health service in London interviewed each other about their treatment. Participants also collaborated in data analysis. All had a diagnosis of PTSD, with additional symptoms of CPTSD identified at assessment. The key factor in recovery was rebuilding relationships, beginning with the therapist. Groupwork was helpful in promoting relationships with others, as it may result in shame reduction. Involvement in the wider community through peer support groups was also valuable. The rebuilding of relationships based on trust was an active mechanism of change and recovery from CPTSD. Participants felt that sufficient time, at least one year of psychotherapy with weekly sessions, was needed. [ABSTRACT FROM AUTHOR]

This article explores how one middling English family – the Wilkinsons, shopkeepers in industrialising Lancashire – experienced and negotiated threats to their respectability and social status during the early nineteenth-century. It contributes to the history of downward social mobility, responding to a recent call in this journal for more work on this topic. I use a rich epistolary archive to explore the Wilkinsons experiences. [ABSTRACT FROM AUTHOR]

United Kingdom Independence Party (UKIP) supporters and non-voters in England participate respectively in forms of engaged and disengaged anti-political activity, but the role of individual, group-based, and collective emotions is still unclear. Drawing upon recent analyses of the complex emotional dynamics (e.g., ressentiment) underpinning the growth of right-wing populist political movements and support for parties such as UKIP, this analysis explores the affective features of reactionary political stances. The framework of affective practices is used to show how resentful affects are created, facilitated, and transformed in sharing or suppressing populist political views and practices; that is, populism is evident not only in the prevalence and influence of illiberal and anti-elite discourses but also should be explored as it is embodied and enacted in "past focused" and "change resistant" everyday actions and in relation to opportunities that "sediment" affect-laden political positions and identities. Reflexive thematic analysis of data from qualitative interviews with UKIP voters and non-voters (who both supported leaving the EU) in 2015 after the UK election but before the EU referendum vote showed that many participants: 1) shared "condensed" complaints about politics and enacted resentment towards politicians who did not listen to them, 2) oriented towards shameful and purportedly shameless racism about migrants, and 3) appeared to struggle with shame and humiliation attributed to the EU in a complex combination of transvaluation of the UK and freedom of movement, a nostalgic need for restoration of national pride, and endorsement of leaving the EU as a form of "change backwards.". [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to offer a viewpoint on the impact that the COVID-19 pandemic has had on people's engagement with an online alcohol service in the UK. This paper examines whether self-reported mental health concerns increased during the pandemic compared to pre-pandemic times. Design/methodology/approach: A comparison was made between service data captured in one contract area – West Sussex, England – pre-pandemic (April 2019 to March 2020) and during pandemic (April 2020 to March 2021). Findings: Self-reported mental health treatment needs increased during the pandemic period (71.2% of presentations compared to 50% pre-pandemic) via the online coaching service. Male referrals increased by 74% during the pandemic period compared to the previous year. Female referrals decreased by 4% in the same time period. Feelings of shame and guilt as well as loss of a confidential space to engage in online interventions were common concerns reported by service users. Research limitations/implications: Research limitations include the relatively small sample size, the sample comprised of self-referred treatment seeking clients, and there was no control group. All data collected is self-report therefore subjective and not necessarily meeting diagnostic criteria. Practical implications: Of note was the impact of the pandemic on women and their reduced access to the online service during the pandemic. Commissioners and services must adapt their service design and delivery alongside the new "normal" way of living and working. Routine screening of mental health and alcohol use are recommended. Originality/value: This paper offers insight from an established online/digital service and the impact of the pandemic on people's engagement with the service. [ABSTRACT FROM AUTHOR]

The SECURE STAIRS Framework for Integrated Care was developed by NHS England as a way to promote a trauma-informed, evidence-based and whole system approach to children and young people accommodated in the Secure Estate. A pilot 'Attachment and Developmental Trauma' training module was developed by the Atkinson Secure Children's Home in conjunction with members of the SECURE STAIRS Professional Collaboration Network (PCN). Fifty-six staff members working within a Secure Children's Home in the North East of England completed the 2 day training. A pre and post evaluation method was utilised to analyse the results. The data indicated increased staff knowledge, understanding and confidence in attachment theory, developmental trauma, brain development and working with guilt and shame. The data also demonstrated the importance of safety and containment in the training environment in fostering opportunities to learn and grow. The need for ongoing training, supervision and reflective practice within the SECURE STAIRS Framework for Integrated Care is considered in order to consolidate knowledge and implement learning into practice. [ABSTRACT FROM AUTHOR]

Dietary change is needed to improve health and reduce the environmental burden of food production and consumption. Using an Intervention Mapping approach, this study aimed to explore the views caterers and customers held towards point-of-choice interventions that promote healthy and environmentally friendly (EF) food and beverage choices at the University of Sheffield. Intervention options proposed during focus groups were devised using the Nuffield Bioethics ladder of intervention. Ten focus groups were held involving caterers (n  = 16) and customers (n  = 45). Thematic analysis was conducted on the transcripts of caterer and customer focus groups seperately, and then comparisons were made to identify concerns about the acceptability and feasibility of intervention options. Attitudes towards intervention options varied considerably amongst stakeholders, with the greatest disparity of opinion in the acceptability of interventions that restrict or limit personal choice, particularly with regards to meat consumption. Information provision was favoured as an acceptable intervention by both customers and caterers. However, labelling products in terms of their environmental impact was considered practically unfeasible. Social norms around eating also emerged as influencing the acceptability and feasibility of interventions with concerns raised about: shaming customers who chose meat, the exclusivity of vegan choices and the limited availability and appeal of meatless café options. Financial considerations were the main priority of caterers when discussing point-of-choice interventions. An acceptable and feasible café-based intervention ought to increase awareness and understanding of healthy and EF food choices, protect customer choice and avoid additional costs. [ABSTRACT FROM AUTHOR]

Objectives: Many individuals hold different beliefs about the voices that they hear and have distinct relationships with them, the nature of which may determine the distress experienced. Understanding what factors contribute to these beliefs and relationships and consequently the resulting distress is important. The current research examined whether shame and social deprivation, in a sample of adult voice‐hearers, were related to the relationships that individuals had with their voices or the beliefs that they held about them. Design: The study utilized a cross‐sectional, Internet‐based design. Methods: Eighty‐seven adult voice‐hearers from England were recruited to the online survey. Participants completed measures regarding shame, beliefs about voices, and relationships with voices and provided demographic information and postcodes that were used to refer to Index of Multiple Deprivation data. Results: Social deprivation and shame were not associated. Shame was positively associated with variables describing negative voice‐hearing beliefs/relationships but not positive voice‐hearing beliefs/relationships. Principal component analysis on the eight voice‐hearing variables yielded two components related to positive and negative voice‐hearing qualities. A multiple regression conducted on the two components identified that shame was only associated with negative voice‐hearing qualities. Conclusions: The results suggest that therapies that target shame may be helpful when working with negative voice‐hearing beliefs and relationships. Future research should utilize experimental or longitudinal designs to examine the direction of the relationship. Practitioner points: The results contribute to the limited research evidence available regarding the relationship between shame and voice‐hearing.The results suggest the utility of psychological therapies that focus on shame such as compassion‐focused therapy and that conceptualize voices interpersonally such as cognitive analytic therapy.No conclusions can be made regarding causation. The sample size was relatively small, and results cannot be generalized to other areas of the United Kingdom.Future research should utilize experimental and longitudinal designs to examine the impact of shame on voice‐hearing experiences and to examine other factors that may predict shame. [ABSTRACT FROM AUTHOR]

Young men tend to be constructed as being at low risk of harm and able to extract value from sexting, compared to young women. Drawing upon findings from a qualitative study exploring practices and perceptions of sexting among 14–18 year-old participants in southeast England, I discuss the meanings and norms surrounding young men's sexting practices. I outline how these meanings and norms underpinned perceptions regarding the value available to young men through sexting. Young men were not, however, equally able to extract value and social capital through sexting, and participants discussed examples of the social shaming of young men who sext. I discuss how young men took up diverse positions with regard to masculine heterosexuality within youth sexting culture, in which they reworked and challenged the ideals and assumptions inherent to 'hegemonic masculinity'. I draw two conclusions: firstly, it should not be assumed that young men are inherently able to gain value through sexting; secondly, narratives of risk and shame may mean that while young men distance themselves from sexting, gendered assumptions and inequalities regarding bodily and sexual expression remain. [ABSTRACT FROM AUTHOR]

Aims: The main aim of our study was to produce an understanding of factors contributing to drug-using trajectories among men and women from a Bangladeshi background living in East London. Methods: Fifteen semi-structured, one-to-one interviews were conducted with male and female Bangladeshi drug users accessing treatment services. A macro-structural lens was adopted to interpret participants' accounts of their drug use and explored the intersecting factors that at a micro, meso, and macro level impacted on their drug-using trajectories. Findings: Problem drug use (heroin and crack cocaine) among participants was the result of inter-related factors such as their friendship networks and the embeddedness of drugs in drug-using networks, the structural disadvantages participants experienced, and the need for concealment of their drug use which impacted on participants' effective utilisation of drug treatment services. Problem drug use was a functional way of responding to and dealing with social, economic, and cultural disconnection from mainstream institutions as participants faced severe multiple disadvantages engendering stigma and shame. Conclusions: We propose a 'life-focused' intervention aimed at creating extra opportunities and making critically-needed resources available in the marginalised environment of the study's participants, which are key to restoring and maintaining agency and sustaining well-being. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Although intercultural couples are increasingly the norm there is a paucity of systemic literature on working with interfaith couples and families. This paper, based on composite case examples, attempts to address this gap. I use two examples of couples where one partner is South Asian Muslim, to illustrate four inter-related themes that emerged in the process of the work. The themes were: therapists' positioning, the importance of the wider socio-political context, honour, shame and gendered beliefs, and the family life cycle. I also highlight how embodied and non-verbal representational systemic techniques can be used when working with interfaith couples to access domains of relationality, which may be inaccessible to exclusively verbal strategies. [ABSTRACT FROM AUTHOR]

Adolescent-to-parentviolence(APV) has received little attention in the social work literature, although it is known to be a factor in families whose children are at risk of entry to care. The behaviour patterns that characterise APV include coercive control, domination and intimidation. Crucially, parental behaviours are compromised by fear of violence. This article discusses the unexpected findings from two recent adoption studies of previously looked after children in England and Wales. The studies exposed the prevalence of APV in the lives of families who had experienced an adoption disruption and those who were finding parenting very challenging. Two main APV patterns emerged: early onset (pre-puberty) that escalated during adolescence, and late onset that surfaced during puberty and rapidly escalated. The stigma and shame associated with APV delayed help seeking. The response from services was often to blame the adoptive parents and to instigatechild protection procedures. There is an urgent need for a greater professional recognition of APV and for interventions to be evaluated with children who have been maltreated and showing symptoms of trauma. [ABSTRACT FROM AUTHOR]

Emotions such as guilt and blame are frequently reported by non-breastfeeding mothers, and fear and humiliation are experienced by breastfeeding mothers when feeding in a public context. In this paper, we present new insights into how shame-related affects, cognitions and actions are evident within breastfeeding and nonbreastfeeding women's narratives of their experiences.As part of an evaluation study of the implementation of the UNICEF UK Baby Friendly Initiative CommunityAward within two primary (community based) care trusts in North West England, 63 women with varied infant feeding experiences took part in either a focus group or an individual semi-structured interview to explore their experiences, opinions and perceptions of infant feeding. Using a framework analysis approach and drawing on Lazare's categories of shame, we consider how the nature of the event (infant feeding) and the vulnerability of the individual (mother) interact in the social context to create shame responses in some breastfeeding and non-breastfeeding mothers.Three key themes illustrate how shame is experienced and internalised through 'exposure of women's bodies and infant feeding methods', 'undermining and insufficient support' and 'perceptions of inadequate mothering'. The findings of this paper highlight how breastfeeding and non-breastfeeding women may experience judgement and condemnation in interactions with health professionals as well as within community contexts, leading to feelings of failure, inadequacy and isolation. There is a need for strategies and support that address personal, cultural, ideological and structural constraints of infant feeding. [ABSTRACT FROM AUTHOR]

Transracially adopted adults are largely invisible as users of adoption support services in England and their voices are rarely heard in discussions about appropriate provision. This article reports findings from interviews with transracially adopted adults and transracially adopted adult participants at a lesbian, gay and bisexual focus group, carried out as part of a mixed-method study of service users’ views and experiences of post-adoption services delivered by an independent agency. The article opens by outlining the policy context and what is known from existing research about the experiences of domestic transracially adopted adults. It then considers the experiences of 12 adults receiving support services. Drawing on their own words, it describes the difference that adoption support services can make, before highlighting gaps in existing provision and identifying the support needs specific to this group. [ABSTRACT FROM AUTHOR]

“Honor”-based violence (HBV) is increasingly recognized as form of violence against women and girls, but is neither fully conceptualized nor integrated into risk management strategies that are increasingly used to address gender-based violence in Europe and Anglophone states. This article will argue that there are grounds for the differentiation of HBV as a sub-category of gender-based violence which may affect risk management. Research was based in an analysis of 40 case files taken from Arabic- and Kurdish-speaking clients of a London nongovernment organization (NGO) providing services to women facing violence. Interrelations were found between “honor,” agnation, and collectivity in their experiences of violence, with ramifications for service provision. [ABSTRACT FROM AUTHOR]

Background: There is little consensus at policy or treatment level as to what defines ‘recovery’ in the alcohol addiction field. Aim: From interviewing a cohort of eight severely alcohol‐dependent people who fulfilled all categories of DSM‐IV and ICD 10 diagnostic criteria and had achieved long‐term recovery (LTR) of between 8 and 48 years, and who are long‐term AA members, a definition of recovery that is inclusive, and achievable, was sought from their lived experiences. Methodology: Interpretative Phenomenological Analysis was used. Findings: This research uncovers the processes involved in long‐term recovery, and identifies them as: sober; maintaining sobriety; and recovery. It suggests a move away from the acute model of cure by brief, time‐limited therapy, towards a model of sustained, on‐going and life‐long recovery management, combined with pro‐social aid resources. Individuals need to observe, and hear, the success narratives of others, and the therapeutic conditions of empathy, unconditional positive regard and congruence need to be strongly experienced by the individual. [ABSTRACT FROM AUTHOR]

Objective Studies have established a link between shame and eating disorder symptoms but have generally been cross-sectional or failed to differentiate between general shame and bodily shame. The present study addressed both these issues. Design This study used a longitudinal panel design. Method Fifty-five women with a past or current eating disorder participated. They completed measures of eating pathology, depression, general shame (internal and external) and bodily shame (current feelings of bodily shame as well as bodily shame that is anticipated were the individual to gain weight) and were followed up over 2.5 years. Results Bodily shame uniquely predicted an increase in anorexic (but not bulimic) symptoms. Current bodily shame predicted an increase in the degree of underweight and the misperception of body size. Anticipated bodily shame predicted an increase in fear of weight gain. Discussion Current versus anticipated bodily shame predicts different anorexic symptoms. Both therefore should be considered in developing interventions and aetiological models of anorexia nervosa. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper reports research undertaken in two sites in England which captured the views of parents and young people who had experienced domestic violence. Survivors, perpetrators and young people described feelings of guilt and shame that acted as barriers to the disclosure of domestic violence. They identified a range of effects on children, which continued beyond separation. All three groups of participants valued professionals who listened to them and validated their accounts. Professionals who appeared ineffective in the face of domestic violence could reinforce children's and victims' own sense of powerlessness. Mothers wanted support with managing the effects of separation and assistance with contact arrangements. The research identifies the need for practitioners to engage with the emotional content of disclosure of domestic violence and to undertake this work in separate sessions with parents and with children so that differing accounts can be heard safely. Interventions that enable parents to engage with children's experiences of domestic violence appear valuable. Rather than taking separation as the end-point of intervention, social work needs to take account of the dynamics of separation and contact in parents' relationships and consider how they interact with violence and abuse to impact on children and young people. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper explores non-relinquishing birth parents' experiences of contested child care and adoption proceedings. It highlights the perceptions and voices of birth parents which are rarely prioritized in dominant discourses of professional practice in this area. The paper reviews previous related research and also discusses a small-scale empirical study which elicited the perspectives of three birth parents whose children had been made subject to care proceedings and placed for adoption in England. Drawing on previous research and this study, the paper makes range of practice recommendations for sensitive professional practice with birth parents during contested child care and adoption proceedings. [ABSTRACT FROM AUTHOR]

Objective. To test the proposal that 'poor-me' (PM) and 'bad-me' (BM) paranoia can be differentiated in terms of (1) current emotional experience and presence of grandiose delusions and (2) early caregiving and threats to self-construction. Method. Participants experiencing persecutory delusions were separated into PM ( N= 21) and BM ( N= 15) groups on the basis of perceived deservedness of the persecution. The groups were compared on measures examining grandiose delusions, shame and depression, parental care, and threats of alienation and insecurity. Results. As predicted, BM patients scored higher on shame and depression, and lower on grandiose delusions, than PM patients. BM patients reported higher levels of parental overprotection, but PM patients were not characterized by neglect, and the groups did not differ in type of threat to self-construction. Conclusion. The two paranoia types were differentiated on symptomatic and emotional presentation, but predicted differences in early relationships and self-construction were not fully supported. [ABSTRACT FROM AUTHOR]

Background: Mental health service users are at high risk of domestic violence but this is often not detected by mental health services.Aims: To explore the facilitators and barriers to disclosure of domestic violence from a service user and professional perspective.Method: A qualitative study in a socioeconomically deprived south London borough, UK, with 18 mental health service users and 20 mental health professionals. Purposive sampling of community mental health service users and mental healthcare professionals was used to recruit participants for individual interviews. Thematic analysis was used to determine dominant and subthemes. These were transformed into conceptual maps with accompanying illustrative quotations.Results: Service users described barriers to disclosure of domestic violence to professionals including: fear of the consequences, including fear of Social Services involvement and consequent child protection proceedings, fear that disclosure would not be believed, and fear that disclosure would lead to further violence; the hidden nature of the violence; actions of the perpetrator; and feelings of shame. The main themes for professionals concerned role boundaries, competency and confidence. Service users and professionals reported that the medical diagnostic and treatment model with its emphasis on symptoms could act as a barrier to enquiry and disclosure. Both groups reported that enquiry and disclosure were facilitated by a supportive and trusting relationship between the individual and professional.Conclusions: Mental health services are not currently conducive to the disclosure of domestic violence. Training of professionals in how to address domestic violence to increase their confidence and expertise is recommended. [ABSTRACT FROM AUTHOR]

There has been little research into the association of shame and other self-conscious emotions in bipolar disorder, although there is evidence linking shame to various psychopathologies. Objectives: This research investigates the levels of shame in individuals with bipolar disorder. Design and Methods: A cross-sectional design was used to compare 24 individuals with a diagnosis of bipolar disorder to a clinical control group of 18 individuals with unipolar depression, and 23 age-matched non-psychiatric controls on measures of mood (Beck Depression Inventory [BDI] and Self Report Manic Inventory [SRMI]) and of self-conscious emotions (Internalized Shame Scale and Test of Self-Conscious Affect). Results: Higher levels of trait shame and lower guilt-proneness were found in the bipolar group. Higher levels of shame-proneness were found in the unipolar group in comparison to the bipolar and control groups. BDI scores positively correlated with trait shame and shame-proneness, and accounted for a large proportion of the variance in these scores. SRMI scores positively correlated with trait (internalized) shame and negatively correlated with guilt-proneness. Conclusions: There was evidence for the presence of shame within bipolar disorder, but this differed to the evidence for shame in individuals with unipolar depression. Clinical implications are discussed. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: • Evidence suggests that cognitive–behavioural therapy is not effective in individuals with bipolar disorder with more than 12 illness episodes. • Shame has been elucidated as a factor is some chronic mental health problems, including depression. • Compassionate mind training has recently been developed to address experience of shame and is designed as an adjunct to cognitive–behavioural approaches. • This paper finds evidence for the presence of shame within bipolar disorder, but with a different manifestation than that found in individuals with depression. • This suggests that clinicians should consider shame as a factor for exploration within therapy, possibly using compassionate mind therapy, and its inclusion may improve on therapeutic outcome. [ABSTRACT FROM AUTHOR]

The impact of shame, guilt, and remorse on the culture of seventeenth-century England is apparent in the literature of the time. The social construction of these emotions lies heavily within the Catholic and then Protestant churches and arises largely from congregants' fears of punishment. Throughout the century preceding Milton, clergy, natural philosophers, and even social scientists like Thomas Hobbes demonstrate the social origins of these emotions. For Milton, however, these emotions begin with Adam and Eve before the Fall. They are inherent attributes meant to serve for protection against temptation and sin and for justification of God's ways. In Paradise Lost, Milton not only demonstrates the wide range of meaning these terms suggest, but he also posits a system of understanding that allows for some social construction of shame and guilt as an appendage to Adam and Eve's inherent shame, guilt, and prelapsarian knowledge of good and evil. [ABSTRACT FROM AUTHOR]

The article presents the author's response to the lecture delivered by Gerhard Wilke entitled "Second Generation Perpetrator Symptoms in Groups" at the 31st S. H. Foulkes Annual Lecture on May 18-20, 2007 in London, England. She stresses that Wilke's talk focuses on the symptoms of social trauma as well as the collective guilt and shame experienced by Second Generation perpetrator children as a post-war effect of the Second World War in Germany. The author stresses that Wilke's group analysis is centered from a group perspective towards the individual perspective. The author argues on how the atrocities present during the Second World War has affected the social unconscious of new generations which resulted to xenophobia and fear of terrorism.

Objectives: To test the hypotheses that (1) women who know that human papillomavirus (HPV) is sexually transmitted will expect to experience higher levels of stigma, shame and anxiety if they test positive for the virus than women who are not aware of the mode of transmission and (2) women who are aware of the high prevalence of HPV infection will expect to experience lower levels of stigma, shame and anxiety than women who underestimate its prevalence.Methods: A web-based survey in which information about HPV was manipulated to generate a 2 x 2 design (awareness that HPV is sexually transmitted v no awareness; awareness of the high prevalence of HPV v no awareness). Participants (n = 811) were female students. They were asked to imagine that they had tested positive for HPV. Outcome measures were expected stigma, shame and anxiety.Results: Great differences were observed in emotional reactions to imagining testing HPV positive between the four groups based on knowledge of HPV. Knowledge of the prevalence was associated with lower levels of stigma, shame and anxiety. Knowledge that HPV is sexually transmitted was associated with higher levels of stigma and shame, but not anxiety. Women who knew that HPV is sexually transmitted but not that it is highly prevalent had the highest scores for stigma and shame.Conclusions: Raising public awareness of the sexually transmitted nature of HPV has the potential to increase women's feelings of stigma and shame if they test positive for the virus. However, our findings suggest that ensuring women's awareness of HPV being common may reduce these feelings and also reduce anxiety, perhaps by "normalising" the infection. [ABSTRACT FROM AUTHOR]

This essay explores the relationship between shame and honor in various texts and practices associated with medieval chivalry, and especially in The Order of the Carter. The meaning and significance of the motto of the Order--Honi soit qui mal y pense--is contested, but it emphasizes the close relationship between shame and honor in courtly society. The motto may not be an embedded coded reference to an unknown event; it may have been coined by Edward III to generate a sense of mystery appropriate to a courtly elite. An examination of selected literary texts (including Malory's Works and Shakespere's Henry VI, Part One) and historical documents describing the ceremonial rituals of heraldic degradation and courtly shame suggests a remarkable continuity in the understanding of courtly shame between the medieval and the early modern period in England. This continuity is ignored by several recent commentators on shame, who unconsciously rehearse and repeat the abjection of the medieval past in contrast to the renaissance understanding of shame. [ABSTRACT FROM AUTHOR]

In 1989, in the wake of the first operations to transplant fetal tissue into the brains of sufferers from Parkinson's Disease, the UK Code of Practice governing the use of the fetus for research was overhauled by an eminent committee under the chairmanship of the Reverend Dr John Polkinghorne. The Polkinghorne Report has, however, attracted remarkably little comment or analysis. This paper is believed to be the first to subject it to sustained ethical and legal scrutiny. The author concludes that, although the committee's recommendations meet the major objections to the Code of Practice, the report is nevertheless vulnerable to criticism in its treatment of at least three issues: the moral status of the fetus; paternal consent to fetal use, and the ethical inter-relation of fetal use and abortion. [ABSTRACT FROM PUBLISHER]

Effective communication forges the dentist-patient treatment alliance and is thus essential for providing person-centred care. Social rank theory suggests that shame, trust, communication and anxiety are linked together, they are moderated by socio-economic position. The study is aimed to propose and test an explanatory model to predict dental attendance behaviours using person-centred and socio-economic position factors. A secondary data analysis was conducted on a cross-sectional representative survey of a two-stage cluster sample of adults including England, Wales and Northern Ireland. Data were drawn from structured interview. Path analysis of proposed model was calculated following measurement development and confirmation of reliable constructs. The findings show model fit was good. Dental anxiety was predicted negatively by patient's trust and positively by reported dentist communication. Patient's shame was positively associated with dental anxiety, whereas self-reported dental attendance was negatively associated with dental anxiety. Both patient's trust and dentist's communication effects were moderated by social class. Manual classes were most sensitive to the reported dentist's communications. Some evidence for the proposed model was found. The relationships reflected in the model were illuminated further when social class was introduced as moderator and indicated dentists should attend to communication processes carefully across different categories of patients. [ABSTRACT FROM AUTHOR]

The ways in which inequality generates particular population health outcomes remains a major source of dispute within social epidemiology and medical sociology. Wilkinson and Pickett's The Spirit Level (2009), undoubtedly galvanised thinking across the disciplines, with its emphasis on how income inequality shapes the distribution of health and social problems. In this paper, we argue that their focus on income inequality, whilst important, understates the role of neoliberal discourses and practises in making sense of contemporary inequality and its health-related consequences. Many quantitative studies have demonstrated that more neoliberal countries have poorer health compared to less neoliberal countries, but there are few qualitative studies which explore how neoliberal discourses shape accounts and experiences and what protections and resources might be available to people. This article uses findings from a qualitative psycho-social study employing biographical-narrative interviews with women in Salford (England) to understand experiences of inequality as posited in The Spirit Level. We found evidence for the sorts of damages resulting from inequality as proposed in The Spirit Level. However, in addition to these, the most striking finding was the repeated articulation of a discourse which we have termed "no legitimate dependency". This was something both painful and damaging, where dependency of almost any sort was disavowed and responsibility was assumed by the self or "othered" in various ways. No legitimate dependency, we propose, is a partial (and problematic) internalisation of neoliberal discourses which becomes naturalised and unquestioned at the individual level. We speculate that these sorts of discourses in conjunction with a destruction of protective resources (both material and discursive), lead to an increase in strain and account in part for well-known damages consequent on life in an unequal society. We conclude that integrating understandings of neoliberalism into theorising about inequality enriches sociological perspectives in this area., (Copyright © 2014. Published by Elsevier Ltd.)

Aim: To explore patients' and nurses' views on their experience of nursing care in mixed-sex bays., Method: Using a descriptive exploratory method, tape-recorded semi-structured interviews were conducted with a purposive sample of patients and nurses drawn from wards where mixed-sex bays were located. The resulting transcripts were analysed to identify shared themes., Findings: The key themes identified were: communication from nursing staff, first reactions, relationships in the bay, reactions of others, awareness of organisational issues and nursing in a mixed-sex ward., Conclusion: While some individuals felt that the attitudes and behaviours displayed by their fellow patients were of greater significance than their gender, there was a general view that mixed-sex bays were less than ideal. Nurses also struggled to maintain patient dignity in mixed-sex bays.

With the exception of specialized units, adults have historically been cared for in single-sex hospital wards in the UK. However, over the past two decades, concerns about mixed-sex wards have been reported. Respect and dignity are essential to provide high-quality health care. The issue of whether patients' privacy and dignity are compromised by mixed-sex wards is addressed in this article. Qualitative data were obtained from both nurses and patients on a mixed-sex surgical ward specializing in urology, to obtain individual perspectives relating to factors affecting dignity on the ward. Nurses tried hard to keep bays single-sex but, due to bed shortages, they were under continual pressure to mix the bays. Some patients of both sexes and varied ages perceived that a mixed-sex care environment threatened their dignity. They experienced a lack of privacy, worried about bodily exposure and felt uncomfortable. Nurses used various strategies to reduce patients' discomfort. Mixed sex accommodation is an unacceptable solution to bed shortages.

Background: There is considerable variation in service use, with overuse in conditions such as upper respiratory tract infections and high levels of unmet need in older patients with embarrassing conditions such as incontinence. The reasons for this situation are varied but to facilitate appropriate accessing of services the decision processes involved in help-seeking require greater understanding., Objectives: This study aimed to describe the decision making process for help-seeking in middle and older aged people with urinary storage symptoms., Methods: In-depth qualitative interviews were carried out with 33 men and women who had sought medical care for urinary symptoms. Respondents were recruited from an epidemiological study of the prevalence of urinary symptoms in community dwelling adults aged 40 years and over. Questions were directed at help-seeking for urinary symptoms as well as help-seeking in general. Interviews were audio-taped and a thematic analysis carried out according to grounded theory methods., Results: The steps in the decision process to seek medical care were drawn from the data. These consisted of appraisals of the presence and cause of symptoms, treatment options and the severity of symptoms and their impact on quality of life. Once the level of threat of the symptom was established, the costs and benefits of treatments and services were balanced against the perceived impact of symptoms on quality of life. These results were considered in relation to available models of health behaviour., Conclusions: Interventions that increase individuals' active involvement in their health care and which encourage greater knowledge of symptoms and outcomes will facilitate appropriate help-seeking and service use.

This article describes the results of a qualitative study that explores how religion and culture influence Muslim women's decisions to seek healthcare for urinary incontinence.

The growth of early intervention in psychosis services (EIPS) has prompted needed research to provide a robust evidence base to underpin practice. The typical service model embraces key psychosocial interventions, including family interventions. A literature review revealed a number of relevant studies that recognized the role of siblings in families affected by severe mental illness or mental impairment, but little was found about the impact of first-episode psychosis on siblings. To address this apparent oversight, we conducted a study to gain an understanding of sibling experiences. Ten siblings (ages 16 to 30) with a brother or sister diagnosed with first-episode psychosis took part in individual semi-structured interviews. The key findings were grouped in regard to emotional impact, relationships in the family, and siblings' roles and coping patterns. The study also revealed that families are able to identify positive gains out of a fundamentally negative experience.

Background: Undertreatment of depression in primary care is common. Efforts to address this tend to overlook the role of patient attitudes. Our aim was to validate and describe responses to a questionnaire about attitudes to depression and its treatment in a sample with experience of moderate and severe depressive episodes., Method: Cross-sectional survey of 866 individuals with a confirmed history of an ICD-10 depressive episode in the 12 months preceding interview, recruited from 7271 consecutive general practitioner (GP) attendees in 36 general practices in England and Wales. Attitudes to and beliefs about depression were assessed using a 19-item self-report questionnaire., Results: Factor analysis resulted in a three-factor solution: factor 1, depression as a disabling, permanent state; factor 2, depression as a medical condition responsive to support; and factor 3, antidepressants are addictive and ineffective. Participants who received and adhered to antidepressant medication and disclosed their depression to family and friends had significantly lower scores on factors 1 and 3 but higher scores on factor 2., Conclusions: People with moderate or severe depressive episodes have subtle and divergent views about this condition, its outcome, and appropriate help. Such beliefs should be considered in primary care as they may significantly impact on help seeking and adherence to treatment.

Background: Obesity has become a major public health issue and there is concern about the response of health services to patients who are obese. The perceptions of obese patients using primary care services have not been studied in depth., Aim: To explore obese patients' experiences and perceptions of support in primary care., Design of Study: Qualitative study with semi-structured interviews conducted in participants' homes., Setting: Five general practices contrasting in socioeconomic populations in Sheffield., Method: Purposive sampling and semi-structured interviewing of 28 patients with a diverse range of ages, backgrounds, levels of obesity and experiences of primary care services., Results: Participants typically felt reluctance when presenting with concerns about weight and ambivalence about the services received. They also perceived there to be ambivalence and a lack of resources on the part of the health services. Participants showed a strong sense of personal responsibility about their condition and stigma-related cognitions were common. These contributed to their ambivalence about using services and their sensitivity to its features. Good relationships with primary care professionals and more intensive support partly ameliorated these effects., Conclusion: The challenges of improving access to and quality of primary care support in tackling obesity are made more complex by patients' ambivalence and other effects of the stigma associated with obesity.