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Motivational Interviewing is an effective treatment for a range of problematic behaviours. However, previous studies have revealed substantial variability in the effectiveness of clinicians. Curiously, the specific clinician behaviours which contribute to positive outcomes have rarely been studied. Previous studies have often focused on the impact of broad categories of clinician behaviour on outcomes; such outcomes have often been overt client behaviours. The current study represented a substantial shift from the dominant methodologies in the MI literature. It aimed to study the effect specific clinician behaviours had upon client’s preparatory talk and strong commitment talk, in the second-to-second interactions between clinicians and clients. A secondary analysis of Motivational Enhancement Therapy sessions was conducted, using recordings obtained during the United Kingdom Alcohol Treatment Trial (UKATT). Recordings were sampled from those clients who achieved and maintained positive changes in readiness to change following the UKATT study. Recordings were parsed and coded, with data being subjected to sequential and regression analyses. The findings revealed that clinicians’ complex reflections were associated with, and predictive of, significantly more strong commitments from clients. Open questions and complex reflections were both associated with significantly more preparatory talk. However, only complex reflections acted as a significant predictor of preparatory talk. It is concluded that complex reflections and open questions are necessary for the proficient practice of MI, and that clinicians should tailor their approach to match their client’s current motivational state. Moreover, the effectiveness of MI is likely attributable to a combination of the ‘spirit’ of MI and the proficient use of such skills, and possibly other specific skills. It is proposed that future research into MI and other psychological therapies should investigate the role of complex reflections, open questions and other specific clinician behaviours on client outcomes of interest.

Current treatments for cystic fibrosis (CF) have largely focused on symptom management. Consequently little attention has been paid to understanding the genetics of CF, in particular gene mutations and mutation classes. Advances in treatments for CF, the most recent development being Ivacaftor, are starting to become mutation specific. It is becoming increasingly important to understand what patients with CF and parents know about the genetics of CF, in particular whether they are aware of gene mutations and classes. Until now, research exploring parents’ knowledge of CF is almost absent. 30 parents of children with CF aged 5 or under participated in a survey that explored their knowledge about CF. They were asked to identify their child’s CF gene mutations, mutation classes, and how much of an impact that this has on their child’s health. The results of this survey found that most parents knew their child’s gene mutation, though only a significant minority correctly identified mutation class. A further 7 parents took part in semi structured interviews that explored their understanding of CF in more depth, their views of current and future treatments, and future outlooks. An understanding of how much they were aware about Ivacaftor, other treatments in clinical trials, and what this means to them was also explored. Using thematic analysis, five core themes and subthemes were identified: the arrival of CF; adjusting to CF; management of treatments; approaches to thinking about the future; and what I know and feel about new developments. The themes and implications for clinical practice are discussed.

This research explores the educational and employment experiences of young people with Cystic Fibrosis (CF) and was carried out as two separate studies. Study one consists of a small-scale survey examining the educational and employment history of 162 patients attending the Leeds regional Adult CF centre. Analysis of the data was conducted using non-parametric (Spearman‟s) correlations, t-tests and logistic regressions. Study two consists of qualitative analysis of interviews with six young people with CF discussing educational and employment experiences and their understanding of the factors that influenced the development and attainment of aspirations. Using Grounded Theory (GT) methodology, an overall theoretical model of participants‟ experiences has been developed, providing some speculations as to why many do not fulfil their potential. Study one found the educational attainment and employment of people with CF to be lower than those in the general population (OECD, 2011; 2008). Socioeconomic status was the factor most predictive of school leaving age, educational attainment at degree level and perceived impact of CF on education and career and disease severity and educational level the factors most predictive of employment. Findings from study two revealed several themes: physical and practical consequences of CF and in some cases the actions of others, illustrated many practical and prejudicial barriers that prevented many from attaining their educational and occupational aspirations. The reality of struggles to achieve and maintain educational and occupational performance because of CF, and worries about their health and life expectancy had a significant impact on self-belief and belief in educational and workplace providers. This lowered expectations of achieving educational and occupational success, resulting in a withdrawal from aspirations and subsequent educational and occupational attainment. It is hoped that the findings of this study will contribute to the wider CF literature and that of other chronic illnesses and disability.

Advances in medicine and healthcare have resulted in significant improvements for those children and adolescents living with a chronic health condition. However, the treatments prescribed will only work if they are taken. Rates of adherence to treatment in cystic fibrosis are low. This is especially true for adherence to aerosol therapy, a particular concern considering the reliance on aerosol therapy for the treatment of Pseudomonas aeruginosa. The advent of Adaptive Aerosol Delivery™ (AAD) technology has enabled accurate and objective measurement of adherence to aerosol therapy treatment. However, the factors which influence the process of adhering to aerosol therapy remain largely elusive. Therefore, the current study aims to qualitatively explore the process of adhering to aerosol therapy in a clinical sample of adolescents with CF from both a patient and parent perspective. In addition, objective data downloaded from an AAD device (the I-neb™, Respironics, Chichester, UK) will be used to cue reflections on actual events around adherence. 12 participants were interviewed (six parent-child dyads). The participating adolescents were all aged between 11 and 16 years and had a CF diagnosis. There were five mothers and one father who took part. The parent and adolescent data were analysed separately using the Grounded Theory Method. Nine core categories for the parent data and nine core categories for the adolescent data were developed into a coherent framework and represented as a theoretical formulation which described the process of adhering to aerosol therapy from both a parent and adolescent patient perspective. The theoretical formulation highlights the complexity involved and details the numerous interacting biological, psychological, social and environmental influences on adherence to aerosol therapy. These findings are discussed in relation to the existing literature and clinical implications are considered. The results of the current study complement and extend previous research on adherence in CF.

Healthcare for patients with a learning disability is an important topic; one that is receiving increased attention by the media, government, and NHS. Management of chronic illness is also an important topic, prioritised by the Department of Health. There is little research looking at chronic illness and learning disability, and contemporary models of coping and adjustment do not take into account the possible effects of having a learning disability. This research looked at how patients with a learning disability cope with chronic illness and focused specifically upon the experiences of patients with a learning disability diagnosed with stage V renal failure. This condition involves making a number of difficult decisions about treatment and adhering to difficult treatment regimes, and is amongst the most intrusive of illnesses in terms of impact upon quality of life. Five consultant nephrologists and five families/carers were interviewed. The data were analysed using grounded theory. The interviews from the two participant groups were analysed as two separate groups, and two models emerged from the data describing how individuals with a learning disability may cope with kidney disease. The results showed a complicated relationship between the level of learning disability and coping. Other factors unique to the individual (such as their previous experiences), the level and type of support the patient has, and their experiences of hospital care (including the role of the consultant) are all additional important factors that can affect coping. The research findings are related to the literature, and possible clinical implications are discussed. Future areas of research are suggested.

This study explored the factors involved in lifestyle decision making in young people with Cystic Fibrosis, specifically the role of infection risk. Certain pathogens present a high risk of infection to people with Cystic Fibrosis, and can significantly affect their health. It is therefore important that people with the disease attempt to minimise the risk of contracting these infections. There was limited literature relating specifically to infection risk and decision making in this population. However, this study drew on decision making literature from other areas, with regard to engaging in risktaking behaviours. The study employed a vignette methodology, presenting a series of lifestyle situations to eight participants and asking them to think aloud whilst deciding whether to engage in the activity. This was followed by a brief interview. An interview was also conducted with a Consultant Microbiologist, offering a detailed understanding of the level of risk presented in each vignette. Thematic Analysis was used to interpret the results, highlighting a number of important themes. Participants frequently chose to engage in activities that would present an increased risk of infection. It was often important to find a balance between maintaining their health and engaging in a fulfilling life. However, at times, participants lacked an adequate understanding of the level of risk or the nature of the infections to make an informed decision. Implications for future research and clinical practice are discussed.

Background: Clinical supervision is a central practice in the development of clinicians. The supervisory alliance is a key process within clinical supervision, amd may have a real impact of supervisee development. This may provide a rationale for the use of sessional measures to provide ongoing feedback on the supervisory alliance. Various measures of supervisory alliance exist. However these instruments are too long to be used on a sessional basis. Objectives: To develop a short-form measure (LASS) of the supervisory alliance from the perspective of the supervisee that has the clinical utility to be used on a sessional basis, and the psychometric properties to be a credible instrument for research. Study 1: Items from existing measures of the supervisory alliance were qualitatively analysed to produce a 25-item experimental measure. This was administered to 98 UK trainee Clinical Psychologists. Principal Components Analysis (PCA) of the data resulted in a 2-factor solution. Hierarchical Cluster Analysis led to the identification of 3 clusters measuring the supervisory alliance. Representative items were chosen, resulting in the 3-item LASS. Study 2: The LASS, and other related measures, were administered to 140 UK trainee Clinical Psychologists. Analysis of this data found that the LASS had acceptable internal consistency and test re-test reliability, but provided evidence that the LASS was sensitive to change. The results of the analysis investigating concurrent and convergent validity indicated that the LASS is a valid measure of the supervisory alliance. Conclusions: The LASS is a

Motivational Interviewing (MI) has been shown to be an effective treatment for substance abuse and other lifestyle and/or behavioural problems. However, mechanisms of change remain a topic of speculation. It has been hypothesised that MI works by eliciting and resolving a client's ambivalence, thereby enhancing their motivation and commitment to change. Research has supported the theory that enhancing commitment is an integral element of MI, however little is known about the role ambivalence plays in producing change. The aim of this project was to investigate this role, and the possible role of other relevant models from social psychology such as cognitive dissonance. First, the social psychology literature relating to the process of ambivalence and dissonance was reviewed to determine whether this was adequately reflected in the literature on MI. It was found that a comprehensive, contemporary view of these processes is largely absent from the literature on MI, and that this may be potentially valuable in furthering an understanding of the mechanisms of change. Second, a secondary analysis of data from a completed randomized controlled study (the United Kingdom Alcohol Treatment Trial - UKATT) on the effectiveness of Motivational Enhancement Therapy (MET), an adaptation of MI, was carried out. This used a thematic analysis with an a priori coding frame based upon constructs shown previously by research in social psychology to be important in ambivalence and dissonance. The aim was to explore the relevance of these constructs to understanding the processes within sessions of MI, and to determine whether either the model of ambivalence or cognitive dissonance offers an advantage in analysing the data. Application of the a priori coding frame developed, to MET transcripts revealed variations in the expression of ambivalence and cognitive dissonance in client language. Inconsistencies both within and between the different cognitive components outlined in both theories occurred in close proximity to one another, inferring an experience of inconsistent related discomfort within the client. The thematic analysis also enabled the identification of additional themes, relevant to both ambivalence and cognitive dissonance theories, in client language. In total fourteen themes were identified, five ambivalence and nine cognitive dissonance. Ambivalence themes were expressed on 107 occasions and cognitive dissonance on 205. Ambivalence and cognitive dissonance theories prove to be valuable in examining and interpreting client language, providing a discrepancy-related model to enhance understanding of MI's motivational processes. It is concluded that cognitive dissonance more adequately captures the motivational processes reflected in client language: however ambivalence theory provides a more specific model, guiding clinicians and researchers delivering and investigating the elicitation and resolve of the ambivalent experience.

INTRODUCTION: Men's health generally and testicular cancer in particular are neglected areas of research. This particular malignancy is the most common among young men in the western world (Champion, 1996), and its prevalence is on the increase, however, so too are cure rates. As a consequence there are an increasing number of young male survivors. Impact on sexual function of survivors is well documented in the literature, yet little is mentioned about the impact on the sexuality and masculinity of the young man following treatment. The objective of the research therefore was to explore the impact on survivor's self-perceptions,in particular focusing on the areas of sexuality, masculinity and body image. METHOD: The research followed a cross-sectional design, comparing men at four different stages post-illness. Repertory grid technique was utilised for data collection purposes, which combined qualitative and quantitative methods. Semi-structured interviews (n = 10) were analysed using content analysis, which formed the basis of a generic repertory grid. Quantitative data from subsequent grid completion (n = 37)were analysed using a beta version of SPSS to carry out 3-way 3-mode multidimensional unfolding. RESULTS: The results suggest that men's self-perceptions change as a consequence of testicular cancer, and that sexuality, masculinity and body image play a part in these changes for some, but not all men. The constructs rated in this study all contribute to the differences in patterns across groups. Results suggest the occurrence of an adjustment process, showing current perceptions of the self as more aligned with retrospective pre-illness perceptions by 24 months post-illness. The majority of men judged repertory grid technique to be a satisfactory means of evaluating self-perceptions relating to the illness experience. DISCUSSION: The results of the study have implications for the level of professional support received by men with testicular cancer, both generally and with specific reference to issues of sexuality, masculinity and body image. However the innovative style of this research and the absence of pre-existing evidence in support of the findings, mean that further research will be required to gain a thorough understanding of the psychological implications of surviving testicular cancer with regards to these issues. Specific recommendations are made for further research