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Reflective Practice (RP) and Continuing Professional Development (CPD) have become key concepts in the post-qualification education and training of healthcare professionals, linked to maintaining and improving competence and fitness to practice in a modernised health service. There is little empirical research about this in relation to clinical psychologists. This qualitative study explored how clinical psychologists experience RP and CPD and apply this to their professional practice. A focus group generated the topics for 16 semi-structured interviews with a diverse range of qualified clinical psychologists practising in a Strategic Health Authority Region in England. Using Interpretative Phenomenological Analysis, four higher-order themes and associated sub-themes emerged: (1) clinical psychologists as reflective practitioners, including the understanding of reflection, influences on development, and reflection and professional identity; (2) the reflective space, including supervision, enablers and obstacles in reflective practice; (3) functions of CPD and reflection, including quality and enhanced service provision, safety and clinical governance, and professional requirements; and (4) linking reflection and CPD, including the link between reflection and action, reflective practice as CPD, and CPD and life-long learning. Seven second interviews were conducted for member-validation, and a final focus group was convened for triangulation and validation of the thematic analysis. The findings are related to the existing literature, and to learning theory and attachment theory. The relevance of this research is discussed in relation to clinical psychology practice and the implications for training and CPD. The importance of the present findings to the issue of the professional identity of clinical psychologists is outlined, and suggestions for future research are proposed.

Major life crises or traumatic events are frequently experienced as uncontrollable, overwhelming and significantly distressing. A sense of safety and predictability in the world is somewhat destabilised for victims of trauma as they struggle to make sense of the event. Whilst some go on to recover from trauma naturally, often many people experience long-term consequences. (van der Kolk, 2003). For decades, the impact of trauma has widely been associated with negative psychological consequences such as Post Traumatic Stress Disorder (PTSD), which was introduced as a clinical diagnosis following the delayed reactions of Vietnam veterans (APA, 1980). However, in recent years, there is growing investigation into the notion that there is personal gain to be found in suffering and, in fact, that traumatic life events can facilitate positive life change for some people. This has been coined as Post Traumatic Growth (PTG); positive change experienced as a result of the struggle with a major life crisis or a traumatic event (Tedeschi & Calhoun, 2004). However, it is suggested that opportunity for PTG, largely depends on individual perspectives and personality variables (Helgeson, Reynolds, & Tomich, 2006). This thesis is interested in the trauma responses of adult males who have experienced child sexual abuse (CSA). More specifically, in relation to their sense of male gender role identity and sexuality. Child sexual abuse can have long term profound effects on male victims (Walker, Archer, & Davies, 2005). In particular, males can struggle with their sense of masculinity and sexuality due to societal stereotypes that one should be strong and be able to physically resist a perpetrator (Javiad, 2015). Many male survivors blame themselves for not protecting themselves and, as a result, experience sexuality and gender role crises (Davies, Walker, Archer, & Pollard, 2010). However, it is recognised that opportunity for male survivors to experience PTG following CSA may be evident given research has found evidence of this for some female survivors of sexual victimisation (Stige, Binder, Rosenvinge, & TrÆen, 2013). In recent years there has been growing publicity in the area of male survivors, perhaps due recent exposure of high profile cases in the media (Alaggia & Mishna, 2014). However, there remains a scarcity of empirical research to provide insight into the lived experiences of male survivors. The systematic review (chapter 1) aimed to evaluate the qualitative literature that explored the impact of CSA on male survivors' gender role and sexuality. A systematic approach to identifying and screening empirical research enabled comprehensive coverage of the topic area. By synthesising the evidence, themes were derived to provide a narrative of male survivors identity experiences following CSA. Whilst negative experiences of masculinity and sexuality were evident, it was identified that further research using diversified samples of male survivors was warranted to strengthen the conclusions. The empirical paper (chapter 2) focused on the PTG experiences of male survivors. Third sector male survivor organisations supported the research and facilitated recruitment of male survivors who had experienced positive change following CSA. Male survivors generously provided rich interviews of their PTG experiences. Themes emerged that detailed the key processes involved in the redevelopment of their gender role and sexuality, contributing to the vital gap in the literature.

A Spinal Cord Injury (SCI) is considered to be one of the most life changing injuries that an individual can experience (Van Leeuwen, Kraaijeveld, Lindeman, & Post, 2012). An SCI not only impacts on an individual's physical health (McDonald & Sadowsky), but also on their psychological wellbeing (Craig, Tran, & Middleton, 2009). SCIs are predominantly caused by a fracture in the spinal column causing motor neuron damage, which can result in paraplegia (loss of physical sensation and ability in the lower extremities) or tetraplegia (loss of functionality and sensation in all four limbs and torso). The most common causes of an SCI are road traffic accidents, violent assaults or through sport (McDonald & Sadowsky, 2002). A growing body of literature has highlighted that individuals can experience positive life changes in the form of posttraumatic growth (PTG) following an SCI (Byra, 2016; Davis & Novoa, 2013; January, Zebraki, Chlan, & Vogel, 2015; Kalpakjian et al., 2014; Kennedy, Lude, Elfström, & Smithson, 2012; Kortte, Gilbert, Gorman, & Wegener, 2010; Kunz, Joseph, Geyh, & Peter, 2017; McMillen & Cook, 2003; Min et al., 2013; Pollard & Kennedy, 2009; Wang, Xie, & Zhao, 2018). Tedeschi and Calhoun (1996) described PTG as benefits that are perceived to have arisen through the struggle that ensues as the individual attempts to make sense of and adjust to their new reality following a traumatic life-event. To date, few SCI studies have been systematically reviewed and, when they have, they have been part of wider traumatic health conditions. However, it has been suggested that PTG may differ across health conditions (Barskova & Oesterreich, 2009; Bostock, Sheikh, & Barton, 2009). The first research paper therefore systematically reviews the literature on PTG following an SCI to narrow this gap in knowledge. Quantitative literature has suggested that PTG reported in the early phase of recovery from trauma may represent coping mechanism rather than true growth, and therefore PTG may be influenced by the passing of time (Helgeson, Reynolds, & Tomich, 2006). To date, qualitative research has provided valuable understanding on PTG following an SCI (Chun & Lee, 2008; Chun & Lee, 2010; Chun & Lee, 2013; de Roon-Cassini, de St. Aubin, Valvano, Hastings, & Brasel, 2013; Crawford, Gayman, & Tracey, 2014; Griffiths & Kennedy; 2012; Kennedy, Lude, Elfström, & Cox, 2013; Khanjani, Younesi, Khankeh, & Azkhosh, 2017; Wang et al., 2017; Weitzner et al., 2011). However, none have used Interpretative Phenological Analysis (IPA) (Smith, Flowers, & Larkin, 2009) to explore how individuals in the long-term phase of an SCI experience PTG or how they make sense of the PTG they have experienced over the years. The second study therefore employs IPA to explore how individuals in the long-term phase of their SCI experience and make sense of their positive growth.

Reader groups involve the reading aloud of complex literature by a skilled facilitator in a group setting, followed by group discussion in relation to the text. They are delivered to a wide variety of populations within both physical and mental health and social care services, across community, residential and inpatient settings. A limited body of existing literature indicates that reader groups can produce positive therapeutic effects to enhance mental health and well-being, but research thus far is largely based on pilot studies with small samples. Further investigation is warranted to explore the experience of reader groups from the perspective of individuals with mental health problems and to consider possible psychological mechanisms underpinning potential therapeutic effects, since this is the first psychological study to be conducted in this area. The aim of the current research was to explore the experience of being in a community reader group for people with mental health problems, and to consider how participation relates to making sense of life experiences and relationships, both inside and outside the group. Eight participants took part in semi-structured interviews, which were transcribed and analysed using Interpretative Phenomenological Analysis. Five master themes pertaining to participants’ experience of reader groups emerged: ‘Literature as an Intermediary Object’, ‘Boundaries and Rules of Engagement’, ‘Self as Valued, Worthy, Capable’, ‘Community and Togetherness in Relational Space’, and ‘Changing View of Self, World, Others’. The findings were discussed in relation to existing literature, to provide an indication of possible psychological mechanisms underpinning participants’ experiences of reader groups. Clinical implications of the current research were considered, particularly in terms of mental health service provision and access to alternative therapeutic activity, and suggestions were made for future research.