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This thesis examines how the psychology of human relationships can be applied to the phenomenon of pet ownership. Current views on the origins of pet ownership and reasons for its popularity, and the application of concepts from the psychology of human-human relationships to human-pet relationships are reviewed. The most popular model, attachment theory, is critically evaluated and examined empirically in a preliminary study. Attachment seems not to provide a satisfactory model. A functional approach, investigating what human-pet relationships do rather than what relationships they resemble, was pursued in the remainder of the thesis. Individuals in a pet-owning family may all interact with the pet in quite different ways, yet are often all labelled equally as pet owners. Investigation of human-pet relationships in the family context facilitated an analysis of characteristics of owning a pet, such as exclusivity. Differences among human-pet relationships were examined according to family role of the owner, and pet species. Pets are frequently regarded as members of their owners' social network, and as a source of relational provisions at levels which are in some cases comparable to those from human relationships. For some pet owners, support from pets may have a buffering effect against stressful life events, and protect owners against adverse psychological symptoms. Important differences were found between species. Dogs provide higher levels of provisions than cats, and cats are rated more highly than other pet species. There is therefore a need for caution against generalising from one species to pets in general. The social provisions approach is shown to be productive, but it is not the only model from human social relationships that might be used, and alternative or complementary models should also be explored.

There are approximately 800,000 people in the UK with a diagnosis of dementia (Alzheimer’s Society, 2007). The ageing population is leading to increased pressures on dementia care facilities and acute hospital settings. As a result the care of patients with dementia is often suboptimal and staff tend to experience high levels of distress. Review of the literature examined the quantitative evidence base regarding the predictors of distress in staff working in 24 hour dementia care facilities. A narrative synthesis of 12 articles was carried out and identified three areas of predictors, these reflected intrapersonal, interpersonal and environmental predictors of distress. It was found that little attention was paid to environmental predictors of distress, most studies explored individual and relational factors, environmental predictors were often found to be linked to distress when research questions were broad and often investigating predictors of distress generally. Distress as a concept is ill defined, leading to many theories being applied and many tools being used, making synthesis of the results difficult. The findings are discussed in line with the existing evidence base on distress research. The research consisted of interviews with 21 acute care staff to explore how they experienced caring for those with dementia in acute medical units (AMU). Thematic analysis (TA) was used to develop four main themes and twelve subthemes, allowing for identification of the main concerns for staff caring for patients with dementia in their general practice. Findings inform changes that AMU could make to allow for staff to care for patients with dementia in a more effective way. The critical appraisal offers a reflective description of the experience of completing the research and its limitations.

Part 1: Literature review - Aim: To review the literature and examine factors which have been identified to contribute to the job satisfaction of formal caregivers working within dementia care. Method: 11 papers were included in the review following a systematic search of three databases. Results: Factors found to be associated with job satisfaction in caregivers include Person Centred Care, setting type, caregiver distress, support and exposure to aggression. Several methodological limitations of the reviewed studies were noted; namely a lack of consensus on the definition of job satisfaction and a wide variety of measures utilised. Conclusion: Due to the ambiguity of what constitutes job satisfaction precision regarding predictive factors was difficult; this is also reflected in wider healthcare literature. Future research with a qualitative design may elicit what job satisfaction means to caregivers working within dementia care. Part 2: Research report - Aim: This study set out to explore the experience of informal caregiver’s living and caring for someone with dementia who presents with Inappropriate Sexual Behaviour (ISB). Method: Interpretative Phenomenological Analysis was used to explore the lived experience of two caregivers. Results: Analysis across both cases revealed divergence and convergence. Three super-ordinate themes were identified: ‘What the behaviour means to me’, ‘The change in our relationship’ and ‘Making sense of outsiders’. Both caregivers seemed to adopt coping strategies such as minimisation and distancing their spouse from ISB by attributing the behaviour to dementia. Conclusion: This study provided a unique glimpse into the lives of spousal caregivers experiencing ISB and the importance of raising awareness of this behaviour. Further exploration is required to build on the current study and develop this under-researched topic. Part 3: Critical appraisal - A reflective account of the whole research process which highlights key aspects of the journey.

Children adopted from care are likely to have been exposed to similar adverse, early experiences as those suffered by looked after children, and therefore have an increased risk of developing complex emotional and behavioural difficulties. Consequently, parenting an adopted child may present significant challenges. Despite government commitments to improve support for vulnerable children and their caregivers, post-adoption support is often lacking and therapeutic interventions for adoptive families are currently offered in the absence of a robust evidence base. The current literature review aimed to explore the efficacy of therapeutic interventions for adopted children and their caregivers. Synthesis of eleven studies found limited support for a positive impact of interventions on children’s behavioural functioning and caregivers’ confidence and perceived competency. However there was a paucity of evidence for the benefits of interventions for children’s emotional and relational functioning, a key reason why adoptive families seek support. Methodological weaknesses indicated multiple evidence requirements would provide a more effective approach to evaluating the efficacy of interventions. The research study sought to understand the lived experiences of adoptive caregivers’ formal and informal help-seeking for their children’s emotional and behavioural difficulties. Qualitative interviews were conducted with six adoptive mothers whose children were currently accessing a child and adolescent mental health service (CAMHS). Interpretive Phenomenological Analysis (IPA) generated four super-ordinate and 12 sub-themes, which enabled convergence and divergence within respondents’ experiences to be accounted for. With a view to informing post-adoption intervention, themes were discussed in relation to existing theory including; parental help-seeking, stigma and attachment. Further qualitative research of particular populations of adoptive caregivers and issues highlighted by the current study was recommended. The critical appraisal presents a reflective account of the research process to maximise transparency and facilitate readers’ evaluation of the research process.

Literature Review: Qualitative research was reviewed to better understand how people cope with burns. Eleven articles were identified for inclusion with a total of 107 participants. A thematic synthesis was undertaken which resulted in two superordinate themes. These provided an account of how patients managed the burn (e.g. by maintaining a positive perspective and utilising pragmatic strategies), and how they distanced themselves from distress and pain (e.g. by using distraction). The findings reinforced the benefits of social support, which facilitated the use of coping strategies. Reviewing support and interventions during the process of recovery from burns is important, as patients’ needs may change over time. More research is needed to understand the use and effectiveness of avoidant coping at different times, and to understand what people need at different stages of recovery. Research Report: The experiences of using scar management interventions for burns were explored using Interpretative Phenomenological Analysis. Eight participants were recruited and data was collected using semi-structured interviews. Three superordinate themes were identified: ‘identity’, ‘functions of the pressure garment’ and ‘coping’. ‘Identity’ described the role of scar management in the developing identities of burn patients. ‘Functions of the pressure garment’ indicated the various personal and social functions of the garments. ‘Coping’ described the main strategies used to manage associated difficulties. Implications for healthcare professionals were discussed, which included appropriate assessment of trauma, providing information on managing social responses, and the facilitation of containment through their support. Recommendations for further research were to explore prior hospital experiences, and investigate the experiences of different demographic groups. Critical Appraisal: The process of conducting the research was reflected upon. This focused on developing good quality research in the face of dynamic challenges, formalising processes of reflexivity, and developing skills in utilising qualitative methodology.

Background: Chronic pain is a common aspect of many neurological conditions and often causes psychological distress. A scoping literature search revealed research was lacking in the area of Huntington’s disease (HD) and pain, therefore the empirical work focused on providing data on prevalence of pain and psychological predictors of pain in HD. There was insufficient research on HD and pain to form the basis of a review, however there was a body of literature on Parkinson’s disease (PD). The review focused on the relationship between pain and depression in people with PD. A critical appraisal of the experience of conducting the review and empirical work formed the final part of the thesis. Literature review: Fourteen articles were identified and reviewed in depth. Half of the studies, representing approximately three quarters of the participants in total, found a significant relationship between pain and depression in PD, with increased pain associated with increased depression. There was reasonable evidence to support an association between the severity of depression and the severity of pain in people with PD, although further research was recommended. Empirical report: A data-mining study was undertaken using data from 1474 participants of the European Huntington’s Disease Network (EHDN) REGISTRY study to examine the prevalence of pain in HD and to identify, using ordinal regression analysis, which psychological factors predicted severity of pain in people with HD. The prevalence of pain in HD was found to be 41%. Pain severity in HD was predicted by anxiety, depression and irritability. Caregivers and health professionals should consider the possibility that people with HD might be experiencing pain, particularly if there are signs of anxiety, depression or irritability. Recommendations were made for further research and limitations were discussed. Critical appraisal: The research process, methodology and main learning points were considered.

Literature Review : Contemporary qualitative evidence exploring the adjustment experiences of young people treated for a brain tumour was synthesised. A systematic search of the literature was undertaken and eight papers met the criteria for inclusion in the review. A thematic synthesis of the findings revealed two superordinate themes: (a) no longer playing well; and (b) mastering the game of life. The findings from the review demonstrated the range and extent of difficulties experienced by survivors. However, the survivors showed resilience in adapting to the effects of their illness and developed a number of effective coping strategies. The findings also suggested that some survivors may experience post-traumatic growth. The review highlighted the need for multidisciplinary support and liaison between healthcare services and schools. Further implications for clinical practice and directions for future research are considered. Research Report : Young people’s experiences of reintegrating into school following treatment for a brain tumour were explored using an Interpretative Phenomenological Analysis (IPA) approach. Four girls (ages 14 to 16) were interviewed and the transcripts were analysed. Three superordinate themes emerged across the cases, relating to experiences of identity, relationships and reengaging with schoolwork. The subthemes retained the complexity of how these overarching themes were experienced differently for the individuals. The present study provided insight into the lived experiences of these young people as they returned to school following treatment for a brain tumour. The study highlighted the challenging nature of this experience, and implications for future research and clinical practice are discussed. Critical Appraisal : The processes involved in conducting a research project are discussed reflectively in the critical appraisal section. This includes personal reflections, a critique of the research, and a consideration of future research opportunities.

Female sexual pain is a common problem affecting women worldwide yet remains a poorly researched area of women’s sexual health. Dyspareunia and vaginismus are two types of sexual pain disorder each having psychological and physical health consequences for women and their partners. Part 1: A literature review of the qualitative research literature exploring women’s experiences of sexual pain disorders and their treatment was conducted adopting a narrative synthesis approach. Searches of psychological and medical electronic databases highlighted the paucity of research exploring women’s experiences of sexual pain disorders. Ten studies met the inclusion criteria for the review. The type of qualitative method and quality varied. Findings highlighted the complexity of women’s experiences of sexual pain. Positive experiences of treatment identified alternative benefits of treatment in addition to the traditional outcome of vaginal penetration and penetration without pain. Existing literature has focussed on dyspareunia, and further research is needed on vaginismus. Part 2: The research study used an Interpretative Phenomenological Analysis (IPA) of women’s experiences of vaginismus. Three women were interviewed about their experiences of vaginismus and the treatment they received. Interview transcripts were analysed using IPA. The findings identified the complexity of experiencing vaginismus, the struggle the women faced when trying to make sense of their vaginismus and the wider impact of these experiences on their identity. The findings highlight the value of psychological therapy with this client group and of the need to raise awareness amongst primary care professionals whom women with vaginismus are likely to consult in the first instance. Part 3: A critical appraisal of the research process is presented with focus on the experience of conducting qualitative research as a trainee clinical psychologist. A discussion of the findings is presented in the context of critical reflections on both the strengths and limitations of the study.

Literature Review: Emotional eating is being increasingly considered in the understanding of obesity and weight change (Ganley, 1989; Buckroyd, 2011). This review examined qualitative research grounded in emotional eating being a key factor of obesity and weight change. Six electronic databases were searched between August 2012 and January 2013. Included articles were published between 2000 and 2013 from the USA and Western Europe. Twenty-one articles were analysed using thematic analysis to integrate findings and generate relevant themes. Four core themes were identified: Vulnerability; Triggers; Function; and Emotional Aftermath. The findings indicated how emotional eating formed a cyclical pattern of behaviour with weight gain implicated as a primary consequence. Implications for future research and clinical practice are discussed. Research Report: Emotional eating was defined as van Strien et al. (2007) by 'the tendency to overeat in response to negative emotions such as anxiety or irritability' (p.106). The study aimed to explore women’s experiences of comfort eating, a form of emotional eating which provides self-comfort or self-soothing. Seven semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA), finding three superordinate themes: ‘The private experience of comfort eating’; ‘My emotional relationship with comfort eating’; and ‘Mind-body connection’. Themes linked to comfort eating being used to mask (Polivy & Herman, 1999) or escape (Heatherton & Baumeister, 1991) negative emotion. Vulnerabilities to comfort eating included restrained eating (Herman and Mack, 1975) childhood eating patterns and critical parental rules around food. Implications for research and clinical practice are discussed. Critical Appraisal: The processes involved in conducting a research project are discussed reflectively in the critical appraisal section. This includes: personal reflections; limitations in terms of data collection and analysis; and implications for research and clinical practice.

South Asians are at a greater risk of developing dementia due to also having a higher incidence of diabetes than the UK population as a whole (Department of Health, 2002). However little is known about this ethnic groups understanding of dementia. A review of the literature on the understanding of dementia in South Asian’s living in the community suggests that differences in the perceptions of the causes and treatment of dementia exist within South Asians. Further research has been suggested to explore minority groups within the umbrella term ‘South Asian’. NICE guidelines require treatment for dementia to be culturally, religiously and spiritually sensitive. However, the South Asian population is not an homogenous group, and there may be differences on what constitutes a sensitive approach for different sub-groups. This study sought to focus on one section, the Sikh community. A focus group design was used to explore how culture and religion influences the conceptualisation of dementia in the Sikh community. Six focus groups were undertaken, consisting of 28 participants and data was analysed using constant comparative methodology (Charmaz, 2006). Four themes emerged including awareness and interpretation of the characteristics of dementia, multiple perspectives of the same symptoms, cause of dementia and coping. The findings have been discussed in the context of existing research and provide an introductory insight into informing culturally appropriate interventions for dementia awareness in the Sikh community. The final section, the critical appraisal, reports an account of the researcher’s reflections throughout the research process.

Obesity is a growing problem throughout the world and accompanies many physical and psychological issues. Increasingly Bariatric Surgery is being turned to as a means of losing weight, often after many failed attempts to use diet and exercise. The focus of this project is on the experiences of patients who opt for Bariatric Surgery. The literature review explored the qualitative studies on experiences after Bariatric Surgery. It adopted a Narrative Synthesis approach and the findings were analysed for themes. A total of twelve papers were included and three main themes emerged. They were titled “Transformation”, “Adjustment & Coping” and “The Paradoxes”. The review highlighted clinical recommendations regarding patients unmet needs after surgery and suggested topics for further research. The research report explored the longer term experiences of patients who had undergone Gastric Bypass Surgery (GBS), which is a frequently used procedure for weight loss. The study utilised Grounded Theory techniques to collect and analyse the data. Seventeen participants were interviewed, all of whom had undergone GBS three to eight years ago. A core category titled “The Battle for Control” was found to permeate the majority of experiences pre and post surgery. A theoretical model was devised to propose factors that enabled the participants to develop self-control after surgery, such as viewing the bypass as a tool and learning to self monitor. It also outlined circumstances that impeded this process, such as finding ways to cheat the bypass. Issues relating to food addiction and body image also emerged from the data. The findings are discussed in relation to existing literature, along with theories relating to self-efficacy and locus of control. Further recommendations for clinical practice and research are also given. The critical appraisal is a reflective, personal account that discusses some of the important issues relating to quality in qualitative research.

The literature review explored adolescents‟ experiences of psychological therapies. Sixteen studies were reviewed and a narrative synthesis found that therapist characteristics, the wider context of mental health and personal feelings were important aspects of the therapeutic encounter for the adolescent population. Synthesis of the evidence was limited by methodological weaknesses. Further research regarding what hinders engagement in therapy and macro-level influences on the therapeutic encounter was suggested. The research study utilised a qualitative, semi-structured interview design to explore adolescents‟ experiences of psychological therapy. The accounts of eight adolescents were analysed using Grounded Theory methodology (Glaser & Strauss, 1967). The findings suggested that adolescents‟ attitudes towards psychological therapy were affected in a complex and dynamic manner by their experiences of the therapeutic process, their experiences of the therapist and their views about what others‟ think. The research also suggested that adolescents represent a high risk group for disengagement from psychological therapy. The findings were discussed in the context of existing research and it was suggested that professionals providing psychological therapy should consider taking an active political role in shaping future service developments to enable services to engage better with this client group. Further research exploring whether these findings are more widely generalisable was suggested. A personal account of the researchers‟ reflections on the research process is provided in the critical appraisal.

Pain is both a medical problem and also an everyday experience for chronic pain patients. Attending to the biomedical aspects is important, but the emphasis on this can result in a failure to consider how the patients perceive and live with their chronic pain. The management of sensation over understanding emotion in traditional medical and psychological approaches has resulted in the lack of attention to the lived experience of chronic pain therefore neglecting broader issues of how culture and social factors influence pain. The UK is becoming more culturally diverse therefore there is a growing necessity to understand any influences of culture and ethnicity in pain management. The aims of this study were to address what is the patient’s experience of living with chronic pain followed by an appraisal of how or if ethnicity (White British or South Asian) influences the experience of living with chronic pain. The empirical work undertaken comprised of qualitative analysis of thirty-seven semi-structured interviews with patients attending a pain clinic in a culturally diverse city. The qualitative methodology used was Grounded Theory therefore a review of the literature was conducted after the initial empirical work. The literature itself was subjected to qualitative analysis and a narrative review was produced. The final element involved generating a synthesis of the narrative review and a theoretical model was produced from the empirical work. Important constructs of living with chronic pain were identified as affect, participants‟ expectations of the consultation, the reality of living with chronic pain and legitimization of chronic pain, and relationships between them were discussed. This thesis explored patients’ narratives with a view to uncovering differences between the pain experience for different demographic groups (e.g. age, gender and ethnicity). However, the data suggest that there are more similarities than differences between groups; this may be partly explained by acculturation. Research into newly arrived ethnic groups in the UK might reveal more differences in their perception of health, illness and pain.