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PURPOSE: To develop a grounded theory-informed model explaining the decision-making process professionals in multi-disciplinary teams go through in deciding whether to administer electroconvulsive therapy (ECT) or not. METHODS: A grounded theory informed methodology was used to analyse the data offered by ten participants who had all been involved in the process of deciding if someone has ECT or not. RESULTS: The core categories, described as 'layers' in this research, 'personal and professional identity'; 'subjective vs objective'; 'Guidelines or Clinical Instinct?'; 'Someone has to take Responsibility' and 'the decision in action', were constructed from the data. CONCLUSIONS: The study describes a useful insight into the layers of the decision-making process that could be further considered in clinical settings. The model highlights the decision to give ECT that has many different layers including professional identity, how a person understands the evidence base, past experiences, and the amount of power they have in the process. The consultant psychiatrist and the patient were seen as holding most power in the process depending on whether the Mental Capacity Act (2005) or Mental Health Act (2007) was being followed. Patients were seen to experience a very different decision-making process dependant on the personal views of the professionals in relation to ECT.

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Aims and method To establish an initial conceptualisation of how psychiatrists understand and use formulation within adult psychiatry practice. Twelve psychiatrists took part in semi-structured interviews. Transcripts were analysed using a constructivist grounded theory methodology. Results Formulation was conceptualised as an addition to diagnosis, triggered by risk, complexity and a need for an enhanced understanding. Participants valued collaborative formulation with psychologists. Multiple contextual factors were perceived to either facilitate or inhibit the process. Barriers to formulation led to a disjointed way of working. Clinical implications Findings contribute to an understanding of formulation within psychiatry training and practice.

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PURPOSE: Supervision is typically mandatory for therapists in training and plays an important role in their professional development. A number of qualitative studies have considered specific aspects of supervision. This systematic review aimed to synthesize these studies' findings and explore the experience and impact of supervision for trainee therapists. METHODS: A systematic search of the literature was conducted, and inclusion/exclusion criteria were applied. This led to a sample of 15 qualitative studies, with which a meta-synthesis was conducted. RESULTS: The meta-synthesis led to four key concepts: supervision as a learning opportunity, the supervisory relationship, power in supervision and the impact of supervision. These themes explored helpful and unhelpful aspects of supervision, including some concerns regarding the evaluation of supervision. CONCLUSIONS: Supervision can effectively support trainee therapists in their personal and professional development. However, it can also lead to feelings of distress and self-doubt. Supervisors need to consider the power differential within supervision and attend to different factors within the supervisory relationship. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Supervision can encourage personal and professional development, but it can also have a detrimental impact on trainee therapists' well-being, and consequently their clinical work and clients' experiences. Supervisees may not disclose unhelpful events or impacts from supervision, for fear of negative evaluation. Evaluation of supervisors should be facilitated and encouraged, to maintain good practice.

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We present the key issues to consider in therapy with Muslim families. Following a brief introduction, five themes are presented: self, family dynamics, causation, and coping strategies. The section on "self" includes a discussion of three terms which link the four Islamic models of "self" identified through the review. The family dynamics section pays particular attention to interconnectedness, family roles, and gender. Causation is discussed with reference to supernatural and spiritual causes. On the theme of coping strategies, religious responses are discussed as are the roles of religious leaders, and professional mental health services. Clinical implications from the key themes are also discussed in addition to limitations of the published literature in this area. This includes a discussion of the epistemological and paradigmatic issues related to the research. The review concludes by summarising these issues and presenting areas for further research.

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PURPOSE: Research suggests psychological therapy as the treatment of choice for individuals diagnosed with NEAD. This study explored the experience of adjusting to a diagnosis of NEAD and engagement with therapy through a qualitative methodology. METHOD: Semi-structured interviews were conducted with 6 people with a diagnosis of NEAD and analysed using thematic analysis. RESULTS: Six master-themes were generated, with four discussed. Two themes were not discussed due to previous coverage in the literature and their less direct relevance to the service context. Theme 1: 'understanding NEAD' incorporated participants' evolving understanding of the diagnosis and their reflections on this. Theme 2: 'I can't deal with you' centres on participants' accounts of relationships with professionals in the context of NEAD. Theme 3: 'experiences of psychological therapy' reflected participants' experience of being referred to psychology and gaining a deeper understanding of themselves through therapy. Theme 4: 'adjusting to life with NEAD' explores participants' views on living with NEAD and their expectations for the future. CONCLUSION: This study extended previous research by highlighting the impact of how the diagnosis is received and understood on engagement in therapy. Improving awareness of NEAD amongst healthcare professionals is of key importance in reducing stigma and encouraging engagement in therapy.

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It has been recognised for several decades that a moderate to severe acquired brain injury frequently causes a high level of psychological stress within the immediate family, who often provide long-term care and support. However, although there is an abundance of research evidence for family burden and stress following brain injury, research into the effectiveness of psychological interventions designed to support such families is relatively scarce. This paper will summarise some of the existing research literature and examine the clinical process of working with families following acquired brain injury. After a brief and selective review of the evidence for caregiver stress following brain injury, we will consider some theoretical models and concepts relevant to family work, and the existing research evidence regarding family interventions. We will then focus on our experience of working with families in clinical practice and our approach will be illustrated using a case study...

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Huntington's disease (HD) is a hereditary, late onset, neurodegenerative disorder. Children of affected parents have a 50 % chance of inheriting HD. Research into the psychological consequences of HD for the family has focussed on individual family members, but little is known about the ways in which its impact is jointly experienced by members of these families. This is particularly important due to the hereditary nature of HD. To address this, the current study examined the experiences of dyads within affected families. Seven parent/adult child dyads were interviewed jointly about their experiences and relationships with their family and each other and interpretative phenomenological analysis was used to analyse the resultant data. Identified themes were: "A spectre hanging over us": HD as a presence within the family, "Us against the world": Protection, knowledge and control, and "That could be me in 50 years": Cyclical changes in identity and role. These findings are examined in relation to previous research and indicate the need for an increased understanding of the needs of HD families. Clinical implications and suggestions for further research are discussed.

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OBJECTIVE: The aim of this paper was to synthesize the findings of qualitative studies examining the experience of individuals with mental health difficulties attending mindfulness-based interventions. METHOD: A meta-synthesis of 15 qualitative studies was carried out, using a thematic synthesis approach. RESULTS: The meta-synthesis identified eight analytical themes: 'prior experiences and expectations', 'normalising and supportive process of the group', 'relating differently to thoughts and feelings', 'acceptance', 'a sense of control and choice', 'relationship with self and others', 'struggles', and 'awareness'. CONCLUSIONS: A conceptual framework is presented which accounts for the participants' experiences and suggests a process through which they renegotiate their relationship with their mental health difficulties.

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OBJECTIVES: The aim of this research was to explore with a heterogeneous Muslim population their understanding of the concept of mental health and how any mental distress experienced by an individual can best be addressed. DESIGN: A qualitative approach was taken. Participants were interviewed, and data analysed thematically. METHODS: A sample of 14 Muslims was interviewed according to a semi-structured interview schedule. Participants were recruited via electronic mailing lists, and communications with local Muslim organizations. Interviews were transcribed verbatim, and data were analysed using thematic analysis. RESULTS: Thematic analysis identified seven operationalizing themes that were given the labels 'causes', 'problem management', 'relevance of services', 'barriers', 'service delivery', 'therapy content', and 'therapist characteristics'. CONCLUSIONS: The results highlight the interweaving of religious and secular perspectives on mental distress and responses to it. Potential barriers are discussed, as are the important characteristics of therapy, therapists, and service provision. Clinical implications are presented along with the limitations of this study and suggestions for future research.

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