We used discourse analysis to study how mediators and parties negotiate competing priorities and values during the family mediation process. We drew on understandings of practical morality, specifically the concept of a moral order, to study UK mediation session talk. Our analysis highlighted the contradictory moral orders drawn on by parties and mediators. The saliency of moral categories and concerns in parenting is demonstrated, and we consider the problems this causes in the “no-fault” context of mediation.

the relationship between flexible working arrangements and the gender pay gap is explored in this article, based on a study of flexible working arrangements among Chartered Accountants in Britain. Individual interviews with 50 participants provided details on working patterns, flexibility policies and practices, and experiences of flexible working.The article considers whether gender-neutral discourses of flexible working succeed in encouraging more men and non-parents to use flexible working arrangements, thereby potentially reducing the gender pay gap. The study highlighted gendered patterns of take-up of flexible working. Women who worked flexibly or part time typically did so to combine working with caring commitments, in ways that damaged their career prospects. In contrast, men typically deferred working flexibly to a later stage when their career had progressed further. There was therefore a clear impact on current and future salary for women taking up flexible working arrangements, which was not equivalent for the men who did so. In this context, the promotion of flexible working arrangements is reinforcing the gender pay gap.

We used Discursive Psychology to study the claims and arguments which occur when “the child’s best interests” is produced as a resource in family mediation settings. Analysis draws on data from three pairs of separated or separating parents attempting to resolve child contact or residency disputes through mediation. Our analysis focuses on the tendency of claims to the abstract notion of the child’s best interests to exacerbate conflict, especially as parents drew on conflicting research in this area. Changing expectations of fathering could be observed in the men’s argumentative positioning, and this was taken up in different ways by ex-partners and by mediators. Participants aligned themselves with mediators’ statements by picking up details of mediators’ language, hampering mediators’ attempted neutrality. The problematic nature of acknowledging the intensity of emotions in this process was also highlighted.

In this article we explore how young adults became members and sustained membership in an online self-harm support forum, SharpTalk. We take a discursive approach to consider resources young people used to establish themselves, how others responded to their attempts, and how membership categories were developed and applied. Participants displayed expectations about appropriate ways of discussing self-harm, and about responses and advice. New posters made reference to other self-harm sites, provided biomedicalized narratives of their "story," and asked for help in particular ways. Participants were active in shaping interactions on the forum, requesting input from site moderators, and challenging each other both on perceived infringements of posting content, and on style of posting pertinent to membership. On the SharpTalk site, perceived deviance in posting behavior, and also the giving of health care advice, were most commonly addressed by other young people who self-harmed, rather than by the site moderators. We consider implications for creating sites that enable young people who self-harm to become members and sustain membership, and therefore access support.

OBJECTIVES: Self-compassion is the ability to be kind to oneself in adversity. This multidimensional construct is typically assessed by the Self-Compassion Scale (SCS). In Chinese samples, there have been inconsistent psychometric findings that impede cross-cultural research. This study aimed to explore the factor structure of the Chinese version (SCS-C). METHODS: Two samples of young Chinese adults were recruited (Sample 1, N = 465, 141 men, Mean age [Mage] = 20.26; Sample 2, N = 392, 71 men; Mage = 18.97). Confirmatory factor analyses and exploratory structural equation modeling (ESEM) were used to examine previously reported four- and six-factor structures of SCS-C. RESULTS: Although ESEM supported the six-factor structure when a problematic item was omitted, we found stronger evidence for a novel four-factor structure of the SCS-C revealed with self-kindness, common humanity, mindfulness, and uncompassionate self-responding. This suggests that Chinese individuals have a different understanding of the negative components of the original self-compassion definition, which was based on the United States and other mostly Western samples. Omega coefficients of the bifactor models suggested that using the SCS total score in Chinese samples is inappropriate. However, high factor determinacy and construct replicability indicated that the general factor of SCS-C could be used in a structural equation modeling context for both four-factor and six-factor structures. CONCLUSIONS: When using the existing SCS-C in path models, researchers should use a latent variable approach and establish the measurement construct rather than sum scores of the scale or subscales without checking the factor structure in future empirical studies. Also, the SCS-C needs to be revised, and we proposed directions forward for future research.

Abstract
. Objectives
. Recent
research has suggested that Chinese individuals from a collectivist culture may have a different understanding of self-compassion, which could differentially contribute to mental health. This study aimed to obtain an in-depth insight into Chinese adults’ understanding of self-compassion.
.
. Methods
. Four online focus groups in Chinese undergraduates discussed the construct of self-compassion based on self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification. Thematic analysis was used to analyse the data.
.
. Results
. Chinese participants valued benign self-criticism and self-reflection when contemplating their understanding of self-compassion. Similarly, participants’ view of self-compassion dimensions can be described as dialectical in that they reflected both negative and positive perceptions in each factor rather than suggesting separate and purely negative or purely positive dimensions. There was also an overlap in the interpretation of the negative dimensions (self-judgment, isolation, and over-identification).
.
. Conclusions
. The findings highlight particularities in the understanding of self-compassion in these Chinese students, which may be influenced by philosophical traditions promoting dialecticism and the dual focus on the transformation of the self and social participation. This suggests the importance of a cultural perspective when studying self-compassion and interpreting relevant research findings.
.

There has been recent emphasis on the assessment of competence in psychotherapy training courses to improve evidence-based practice and outcomes for clients. The Systemic Practice Scale (SPS) was developed as a structured way of evaluating systemic practice. There is, however, little research on the impact and experience of competence measures, particularly in the context of systemic practice. Five focus groups conducted with sixteen students and seven supervisors from systemic family practice (SFP) programmes explored their views of the SPS as an appropriate measure of systemic competence. Data was analysed using a discourse analysis with three dominant discourses identified: feedback as valuable but uncomfortable; measuring competence; and being systemic. The SPS was viewed as a valuable and useful measure of systemic competence when reflexivity and collaboration is maintained between the student and supervisor. Practitioner points: There is limited research exploring the use of competence measures in systemic practice the SPS was perceived as broadening perspectives of students’ practice and competence, reiterating the importance of feedback in a collaborative supervisory relationship Increasingly the SPS is being used across clinical psychotherapy training courses (including systemic IAPT course and Doctorate of Clinical Psychology) it has the potential to be used more widely with wider implications for the development of systemic training standards in systemic practice.

Domestic violence (DV) victims face significant barriers to accessing healthcare. This is particularly concerning in cases of brain injury (BI), which is difficult to diagnose and risks severe long-term consequences for DV victims. Police may be able to identify head injury (HI) and signpost victims to healthcare. This research investigated potential barriers to police supporting victim health needs by exploring police attitudes towards DV and considering how police interpret and respond to stories of HI in DV victims. Individual interviews were conducted with 12 police officers from forces in South and Central England. This included the use of a clinical vignette. Thematic analysis highlighted three global themes: ‘seesaw of emotions’, ‘police vulnerability’, and ‘head injury is fearful’. Police officers’ vulnerability to external blame was the predominant influence in their responses to HI.

Background: Attachment theory has made significant contributions to clinical psychology and there is an interest increasing in attachment-informed approaches to therapy. Attachment research suggests that successful psychotherapy relies on therapists’ attachment security and their ability to reflect on the therapist-client attachment interplay. However, therapists with insecure attachment often struggle with lower reflective function (RF). Personal therapy (PT) can develop RF and attachment awareness in clinical psychologists (CPs).
Aim: to study how reflecting about CPs’ relationships with their personal therapist contributes to their awareness and understanding of their own attachment and its implications for their practice.
Methods: from a social constructionist approach, 12 CPs were interviewed. Thematic analysis was used to analyse interview transcripts.
Results: Thematic analysis resulted in three main themes: constructing and understanding their own attachment; bringing in an emotional dimension into attachment; and the clinical implications of attachment awareness.
Conclusion: Through PT, CPs’ increased their awareness about their own attachment. The idea of attachment security was deconstructed, in support of a range of attachment responses that CPs can reflect about when interacting with others. This forged a sense of robustness in the self from where to work relationally with clients, raising clients’ awareness about their relational needs in the TR.

LITERATURE REVIEW
Abstract
Objectives: Research indicates that illness representations are associated with the management of health conditions. They are therefore important to understand when supporting people to best cope with their illnesses. This systematic review aims to summarise and synthesise the literature exploring illness representations and associated coping responses in people experiencing more than one chronic condition.
Methods: a systematic review of literature published prior to November 2018 on MEDLINE, Embase, CINAHL, Web of Science and PsycINFO databases. Search terms included three broad areas; multimorbidity, health and illness representations. Results are synthesised using a narrative approach.
Results: Eight papers are included in the review and comprise qualitative and quantitative research designs. Findings indicate that illness representations in those with multimorbidity vary across conditions and individuals, while people hold representations relating to both individual conditions and multimorbidity. These representations have been associated with medication adherence and self-management behaviours.
Conclusions: This narrative synthesis highlights that representations have a role in coping. There is a need to consider illness representations in clinical consultations and in the delivery of care to improve condition management. Further research is needed to establish how this may be best achieved and to consider other variables which may influence representations and coping. Developing a theoretical framework which may account for both single and multimorbid representations will be important for such future research.
Keywords: Multimorbidity, chronic condition, common-sense model, illness representation, systematic review, narrative synthesis.

EMPIRICAL PAPER
Abstract
Objectives: Research has highlighted an association between illness representations and coping responses, such as self-management, medication taking and treatment-seeking. However, illness representations for common mental health symptoms when experienced alongside multimorbidity are poorly understood. The current study aims to understand how people experiencing multimorbidity represent and respond to their common mental health symptoms.
Methods: Semi-structured interviews were conducted with thirteen participants experiencing mild to moderate symptoms of anxiety and/or depression alongside physical multimorbidity. Thematic analysis combined with deviant case analysis was used to analyse the data.
Results: the results provide an understanding of illness representations and coping responses for common mental health symptoms in those experiencing multimorbidity. Four key themes were identified; 1) interconnected conditions, 2) methods of responding to mental health difficulties, 3) relationships: the importance of connection and understanding, and 4) narrow treatment options.
Conclusions: Illness representations for common mental health symptoms appear to have a role in guiding coping responses, including treatment-seeking. Having an awareness of people’s illness representations will be useful in clinical practice to guide consultations and interventions. By understanding and working with illness representations and increasing primary care accessibility we may begin to improve coping and treatment-seeking within this population. The implications of this research will be useful in allowing health services to meet the needs of the growing multimorbidity population and close the mental health treatment gap.
Keywords: Multimorbidity, chronic conditions, mental health, illness representations, coping responses, treatment-seeking, qualitative research.

Paper One Abstract:

Background and aims. Social participation is a key determinant for health and wellbeing across the lifespan, and is a frequent goal for rehabilitation. Acquired brain injury (ABI) is a leading cause of death and disability worldwide that can result in persistent difficulties within cognitive, emotional, behavioural, physical, and social domains that contribute to chronic disability and restricted participation. Consequently, survivors are at higher risk of social isolation and reduced quality of life (QoL). The social participatory goals of rehabilitation are increasingly advocated for to support QoL and minimise disability post-ABI. The aim of this review was to explore the efficacy of interventions that facilitate social participation on outcomes of social participation and QoL in adult survivors of ABI. The synthesis of available evidence might support rehabilitation professionals to consider how to improve such outcomes in post-acute settings.

Methods. A systematic review was conducted to locate, appraise, and synthesise evidence relating to the review questions. Appropriate intervention studies were identified using a pre-determined search strategy. These were then assessed for inclusion against pre-defined eligibility criteria to investigate the efficacy of their interventions on the target outcomes for this review, social participation and QoL.

Results. of the 1119 possible articles identified in the initial search, 12 studies met the inclusion criteria for this review. Data were then extracted and methodologies were critically appraised. Intervention programmes were grouped according to intervention methods, and included peer-mentoring, community integration, leisure activities, outpatient neuropsychological rehabilitation, intensive cognitive rehabilitation, and health-promotion. Seven of the 12 studies found statistically significant differences on at least one target outcome following intervention. Four of these identified efficacy on both social participation and QoL, and varied in methodological design and quality.

Conclusion. Currently, there is limited evidence for the efficacy of interventions that facilitate social participation on outcomes of social participation and QoL for adults with ABI. The varying objectives, quality, and potential bias of the 12 included studies limits the conclusions that can be drawn. Social participatory interventions appear to have objective and subjective benefits for adults post-ABI. Appropriate intervention methods (i.e. delivery and focus) to support target outcomes is uncertain from the limited literature included in this review. However, interventions that showed efficacy on both target outcomes (four of the 12) were multifaceted and intensive. Rehabilitation of social participation to support social participation and QoL post-ABI may benefit from supporting participants to develop the skills and self-belief needed to actively participate in social activities that are important to them, however, further evidence is needed. Considerations for future research and clinical implications are outlined.

Paper Two Abstract:

Background and aims. Adolescence is a time for significant social development, facilitated by successful peer relationships. Those with reduced social skills are at risk of being rejected or victimised by peers, and can face significant emotional ramifications and implications for quality of life (QoL). Peer relationships for adolescents with acquired brain injury (ABI) have been largely under-recognised in the paediatric neuropsychology literature. Previous interventions aiming to improve social skills (needed for peer relationships) in this population have shown inconsistent efficacy and the targets for intervention are unclear. The intervention mapping (IM) framework offers a systematic and iterative protocol for the co-production of interventions through engagement with key stakeholders. This consists of six steps for intervention design, implementation, and evaluation: (1) creating a logic model of the target problem; (2) stating programme objectives; (3) programme design; (4) programme production; (5) implementation plan; and (6) evaluation plan. This study aimed to: (a) develop a collaborative understanding of peer relationship difficulties for adolescents with ABI; and (b) seek the views of adolescents and other key stakeholders on what might be required to improve peer relationships post-ABI, and what intervention the goals might be. Qualitative methodology was used to support these aims. The findings of this study can inform the co-development of a meaningful intervention to support peer relationships and QoL in adolescents with ABI using the IM protocol in future research.

Method. Consistent with IM protocol, a planning group comprising four ABI clinical-researchers provided consultation at each stage of the study. First, the planning group completed a survey to develop an initial logic model. This is a framework for understanding peer relationship difficulties following ABI, the determinants (or contributing factors) for these, and the long-term impact on QoL for adolescents. Focus groups and semi-structured interviews were then conducted with four stakeholder groups to develop an in-depth understanding of peer relationship difficulties post-ABI, the impact of these, and the determinants contributing to such difficulties, and to further develop the initial logic model: (1) adolescents with ABI (n=4); (2) parents of adolescents with ABI (n=7); (3) adults who sustained an ABI in adolescence (n=2); and (4) specialist practitioners (n=3). Perspectives were also obtained from stakeholders concerning what might need to change to support peer relationships post-ABI and what the targets for intervention might be. Qualitative data from focus groups and interviews were analysed using thematic analysis.

Results. The analysis of stakeholder conversations yielded 11 themes, grouped into two domains: (1) understanding peer relationship difficulties (e.g. dropped and excluded, a need to belong, restricted independence); and (2) supporting peer relationships (e.g. building understanding, meaningful social connection). The logic model underwent six iterations following planning group and stakeholder feedback. This was provided by stakeholders in the focus groups and interviews, and by planning group members and stakeholders through further member-checking procedures following the analysis.

Conclusions. Adolescents with ABI were reported to experience difficulties with peer relationships. At an important time for social development, peer rejection can increase feelings of isolation, loneliness, shame, and hopelessness. This can have further implications for mental health, peer relationships, and QoL. The individual, psychological, behavioural, and environmental determinants for peer relationship difficulties are broad. A meaningful intervention would need to be multifaceted attempting to build understanding in others, facilitate meaningful social opportunities, offer early support post-injury, and help manage psychological wellbeing. A primary focus would be to empower adolescents post-ABI. The presented logic model provides a robust understanding of peer relationship difficulties for adolescents with ABI that can be used to guide intervention development in future research.

Objective: to examine the discourses used by therapist-client dyads when co-constructing therapy goals in Cognitive Behavioural Therapy and how these discourses influence the process of goal-setting.
Methods: Therapy tapes for five therapist-client dyads were examined and goal setting discourse were transcribed. From this, five representative excerpts were selected then analysed using a Discourse Analysis approach.
Results: Discourses related to power, collaboration, expectations of the CBT model and positioning of therapist and client with regards to the task of goal setting were identified. The use of language as a tool for both creation of shared understanding and as a way of undertaking social action was also identified. There was an emphasis within the excerpts on the micro-process within therapy such as positioning, alliance building and showing a shared understanding of different topics, while narratives on what goals should be or look like informing the macro-process within the co-construction process and forming a wider narrative shaping the process undertaken by therapist and client.
Conclusion: Ensuring that therapists have an awareness of the different discourses in use within goal setting and how they influence the process of goal co-construction is important in ensuring an effective goal setting process. Consideration of the different discourses in the goal setting process is not well represented in the research literature with the majority of research investigating the form and content of goals. Explicit discussion of therapy process in manuals of therapy and therapy teaching could be an important factor in ensuring effective goal setting. Future research could further investigate and how these may impact practice is important.

The transition period from on- to off-treatment has been described as one of the major stressors faced by children and young people with cancer. Few UK studies, however, have explored this stressful period with a particular focus on identity. A grounded theory study of 9 children and young people going through this transition period was conducted. Findings revealed the core theme of ‘stepping into the unknown’ and reflected the continued process of role and identity changes that participants faced. During treatment participants adopted a ‘cancer identity role’, which was managed by ‘adapting’ and ‘increasing support’. After treatment they adopted a ‘survivor identity role’. Finally, an integration of their pre-cancer identity, ‘cancer identity role’ and ‘survivor identity role’ took place, forming a ‘new identity’, however this pathway appears to be age and condition dependent. Understanding of this process may help to prepare patients for the impact and challenges that finishing treatment may pose.

INTRODUCTION: Paediatric acquired brain injury is a leading cause of mortality in children in the UK. Improved treatment during the acute phase has led to increased survival rates, although with life-long morbidity in terms of social and emotional functioning. This is the protocol for a feasibility randomised controlled trial with an embedded qualitative study and feasibility economic evaluation. If feasible, a later definitive trial will test the effectiveness and cost-effectiveness of an online intervention to enhance problem solving ability versus treatment as usual. METHODS AND ANALYSIS: Twenty-five adolescents and their families identified by primary or secondary care clinicians at participating UK National Health Service Trusts will be recruited and individually randomised in a 1:1 ratio to receive the online intervention or treatment as usual. Participants will be followed up by online questionnaires 17 weeks after randomisation to capture acceptability of the study and intervention and resource use data. Qualitative interviews will capture participants' and clinicians' experiences of the study. ETHICS AND DISSEMINATION: This study has been granted ethical approval by the South West-Exeter Research Ethics Committee (ref 17/SW/0083). Results will be disseminated via peer-reviewed publications and will inform the design of a larger trial. TRIAL REGISTRATION NUMBER: ISRCTN10906069.

Clinical supervision is a key factor in the professional development and competence of the supervisee. The recent shift towards competence-based practice has highlighted a need to understand the relationship between supervision and supervisee competence further. A systematic review following PRISMA-P guidelines aimed to summarise and synthesise the literature across five databases exploring the impact of supervision on supervisee competence and the factors that may contribute to effective supervision. Eleven papers met the search criteria and were included within the review. A narrative synthesis of the findings provided some evidence of a positive relationship between supervision and supervisee competence with feedback and the supervisory relationship shown as important factors. The implications for future research and practice are discussed.

Aims: the aim of the research was to explore healthcare staff members’ perceptions and experiences of reflective practice groups (RPGs) that had been conducted in a learning disability service. The research also aimed to gain the perspective of both RPG attendees and non-attendees (people who did not engage in the groups). Obtaining the perspective of non-attendees provided a valuable and often overlooked insight into the social processes occurring outside the RPGs.

Methods: a qualitative grounded theory method was adopted to address the research aims. The study took place within a learning disability service that had implemented RPGs for five months. Observational data (including audio-recordings and field notes) were collected on three RPGs planning meetings and two facilitator supervision sessions. Semi-structured interviews were conducted with the RPG facilitators (N=3) attendees (N=5) and non-attendees (N=5). The observation and interview data were analysed using a social constructionist approach to grounded theory.

Results: Three main themes emerged from the analysis. Theme 1 described the collective process occurring within the RPGs that attended to unmet needs and resulted in the development of shared connections, restorative experiences, as well as mutual support. Theme 2 illustrated how the RPGs led to the enhancement of personal, professional and team identities. The social processes occurring within the group also created conflicts in how people navigated their multiple identities. Theme 3 identified the divisions and differences that existed beyond the RPGs that may have impacted upon people’s engagement in the group.

Conclusion: Social identity theory and social capital theory offered useful frameworks to understand the collective processes occurring with and beyond the RPGs in a learning disability service. The findings suggest that RPGs could represent a significant team-based intervention that promotes collaborative working, solidarity, and commitment. Further research is needed to explore the relevance and strength of these theories to the implementation of and staff engagement with RPGs.

Literature review:
Objectives: Historically most qualitative research on the couple experience of stroke has focused on the negative impact, including reviews that outline challenges for couple’s communication, roles and intimacy. The current review aims to examine the perceived positive impact of stroke on couple relationships from the perspective of stroke survivors and spouses.
Methods: Relevant qualitative literature was identified through systematic searching of the databases Medline, PsycInfo and EMBASE. Thirty-two articles met the inclusion/exclusion criteria. The articles were appraised using the Critical Appraisal Skills Programme tool and a thematic synthesis was conducted on the findings from these articles.
Results: Ten descriptive and three analytical themes were identified. The analytical themes showed a strengthening of the couple bond, an enhanced way of couple’s relating and empowerment of the spousal caregiver in the stroke survivor’s recovery.
Conclusions: the review identifies that couples can engage with dyadic coping and enhance their pre-stroke relationship through the experience of stroke. Rehabilitation staff, inclusive of clinical psychologists, can play an important role in engaging and empowering couples to recognise and utilise their strengths and resilience. Future research could examine how rehabilitation can utilise these findings in practice and the efficacy of couple’s therapy in this population.

Empirical paper:
Abstract
Objectives: to explore the impact of relational dynamics on couples impacted by malignant brain tumour, with the aim of expanding the knowledge we have about the impact of brain tumour from the perspective of the patient, carer and couple. The current research gives a different perspective of the relational impact of this illness through use of discourse analysis and joint interviews.
Methods: Six heterosexual couples took part in the research which involved conducting joint semi-structured interviews with the couple in their homes. The interviews were analysed using a discourse analysis approach to observe how the couples constructed meaning about their shared experience of a brain tumour and its impact on the couple relationship.
Results: Couples used rhetorical strategies, such as humour and deflection, to ease discomfort and navigate the sensitive topic. Discourses used by both partners highlights that the journey can be one of isolation, despite the presence of a partner. In contradiction, the couple were often positioned together, against the brain tumour itself, in a position of dyadic coping.
Conclusions: Conversations about the impact of brain tumour are highly sensitive. As a result, couples implement strategies in order to communicate their difficulties, their distress and challenging elements such as death and uncertainty of the future. Clinical implications are offered for how health care professionals facilitate discussions between couples and how the dynamic between a couple can be supported in hospitals, rehabilitation and in the community.

Background:
Given the enhanced life expectancy of individuals with learning disabilities, siblings are increasingly adopting caregiving responsibilities when parents are no longer able. Therefore, future care planning in families is significantly important; however, previous research highlights challenges with this process. To date, research has primarily focused on future planning from parents’ perspectives. This study explores how siblings talk about the future care planning process within the family context, attending specifically to taboo discourses.
Materials and Methods:
Twelve siblings of individuals with learning disabilities were interviewed about planning the future care of their brother and/or sister. The data were subsequently subject to discourse analysis.
Results:
Siblings were reluctant to engage in explicit future planning discussions, which drew on several taboo topics including death, conflict and obligation. Consequently, siblings employed multiple discursive strategies to evade, manage and negotiate troublesome talk.
Conclusions:
In addition to parents, siblings also pose a barrier to future planning. Avoidance of discussion may shield them from criticism and vulnerability, whilst also protecting familial relationships. Professionals need to recognise the challenges these conversations raise for siblings. They should endeavour to involve siblings, in order to facilitate open dialogue and collaborative future planning.

"The ancient prescription of Hippocrates (400 BC) that the obese should ‘eat less and exercise more’ is still today, and for the foreseeable future, the cornerstone approach to treat obesity despite its well-documented failures." (Dulloo, 2012 p1418)

There is considerable research into bariatric surgery as a treatment for the purposes of weight-loss and reduction of co-morbidities associated with obesity, but very little of it is written from the patient’s point of view. This study is a contribution towards remedying that lack.

Twenty participants, who were both pre- and post-surgery, were recruited from self-help support groups and asked to talk about their experience of WLS. A critical narrative-discursive approach is used to analyse the transcriptions of the interviews informed by my experience as a reflexively practising psychoanalytic clinician.

Participant’s identity construction is explored with regard to the discourses chosen to account for their weight which enabled them to avoid being stigmatised as morally failing to fulfil the neo-liberal task of personal responsibility for their health. The concept of positioning over time is used to demonstrate the shift from being blameless for their past size, to one of being blameworthy were they to put on weight post-surgery. This facilitated a fattist discourse when those who had regained weight after WLS were othered as failing to use the ‘tool’ of WLS, which in turn made it necessary to locate control, or to account for the lack of it. It was expected that participants would express feelings of loss with regard to food, and some disturbance in their experience of their rapidly shrinking bodies, but neither manifested significantly.

We used discourse analysis to study how mediators and parties negotiate competing priorities and values during the family mediation process. We drew on understandings of practical morality, specifically the concept of a moral order, to study UK mediation session talk. Our analysis highlighted the contradictory moral orders drawn on by parties and mediators. The saliency of moral categories and concerns in parenting is demonstrated, and we consider the problems this causes in the “no-fault” context of mediation.

This paper contributes to debates in the broad area of generational differences at work. Specifically, we locate this study within the literature of the work values and expectations of the ‘Millennial generation’, also known as ‘GenMe’. Much has been made in the media and popular practitioner literature about how the latest generation of workers have a ‘sense of entitlement’ and therefore expect more from the workplace than previous generations. In this paper, we argue that this mainstream view of the sense of entitlement as a concept is problematic and requires a more critical examination. We consider two divergent bodies of literature on the sense of entitlement in relation to generational differences at work – a managerialist approach, which conceptualises sense of entitlement to work–life balance as a negative trait, and a second body, based on the seminal work by Sue Lewis and colleagues, that treats sense of entitlement as a situated process rather than an internal characteristic. We use data from a study of young adults leaving university in the UK, inspired by Sue's work. Our analysis challenges the notion of today's younger workers as more ‘entitled’ than previous generations. This study extends existing research by providing a contextualised analysis of young people's situated accounts of sense of entitlement at work.

the relationship between flexible working arrangements and the gender pay gap is explored in this article, based on a study of flexible working arrangements among Chartered Accountants in Britain. Individual interviews with 50 participants provided details on working patterns, flexibility policies and practices, and experiences of flexible working.The article considers whether gender-neutral discourses of flexible working succeed in encouraging more men and non-parents to use flexible working arrangements, thereby potentially reducing the gender pay gap. The study highlighted gendered patterns of take-up of flexible working. Women who worked flexibly or part time typically did so to combine working with caring commitments, in ways that damaged their career prospects. In contrast, men typically deferred working flexibly to a later stage when their career had progressed further. There was therefore a clear impact on current and future salary for women taking up flexible working arrangements, which was not equivalent for the men who did so. In this context, the promotion of flexible working arrangements is reinforcing the gender pay gap.

Working in groups is increasingly regarded as fruitful for the process of analyzing qualitative data. It has been reported to build research skills, make the analytic process visible, reduce inequalities and social distance particularly between researchers and participants, and broaden and intensify engagement with the material. This article contributes to the burgeoning literature on group qualitative data analysis by presenting a worked example of a group data analysis of a short extract from an interview on serial migration from the Caribbean to the UK. It describes the group's working practices and the different analytic resources drawn upon to conduct a narrative analysis. We demonstrate the ways in which an initial line-by-line analysis followed by analysis of larger extracts generated insights that would have been less available to individual researchers. Additionally, we discuss the positioning of group members in relation to the data and reflect on the porous boundary between primary and secondary analysis of qualitative data.

in this article, we critically evaluate a conversation analytic approach to the study of the links between gender and language from a feminist perspective. In so doing, we engage in the recent series of exchanges about conversation analysis (CA) and other strands of discourse analysis that have been published in Discourse & Society. We consider talk from two sets of discourse data, focusing on participants' orientation to gender categories as they crop up in the interactions. We suggest that a CA approach produces a rich understanding of the links between discourse and gender. However, we are critical of several, often unexamined aspects and conundrums of conversation analytic methodology. First, we consider the extent to which the `analytic stances' of feminism and conversation analysis are compatible. Second, we question whether, as Schegloff (1997) suggests, it is fruitful to rely on descriptions of and orientations to gender solely in participants' terms, as well as problematizing the notion of `orienting to gender' itself. Finally, while we propose CA is a useful tool for making claims about the relevance of gender in conversational interaction, and that such claims are grounded in speakers' orientations, we suggest that culture and common-sense knowledge, of both members and analysts, are largely unacknowledged and unexplicated resources in CA.

This article explores young European women and men’s expectations of support - from the state and employers - for reconciling paid employment and family life. It is based on a qualitative study employing focus groups with young women and men in Norway, Sweden, Portugal, Ireland and the UK. Drawing on the concept of sense of entitlement, derived from social justice theory, it was expected that the type of welfare state and ‘gender contract’ that young adults have experienced will influence their sense of entitlement to support for work and family life. Findings indicate that participants perceived their entitlement to state and employer support differently across national context. However this is moderated by gender, parental and occupational status, and particularly by awareness of provisions in other countries in the case of state support, while perceived entitlement to employer support varies according to the specific policy considered, gender and perception of benefits to employers. Some implications for public policy makers and employers are discussed.

This qualitative study used semi-structured interviews to explore how six people talked about their difficulties before and after a dementia diagnosis. Participants' accounts of their memory problems were analysed in terms of the verbal Markers of Assimilation of Problematic Voices Scale. This analysis indicated that after diagnosis some participants were able to integrate aspects of their illness that had previously been too painful, and which had been warded off. The process by which individuals were able to integrate a dementia diagnosis into their sense of self-involved stepping in and out of awareness, with both acceptance and denial featuring in their accounts as they approached and then retreated from addressing the diagnosis. In contrast, other participants resisted moving towards explicitly acknowledging their dementia but were instead able to express concerns about what this movement would entail, for instance voicing their fears that it would mean that they had surrendered. Social support seems to have been crucial in enabling participants to sustain a positive sense of self in the face of this adjustment.

in this article I explore the ways in which people talk about part-time work, with a particular focus on links which people make between working time, gender and professional identity. I investigate how women and men working part-time in financial sector organizations talk about their career, and their orientations to paid and unpaid work, and also how colleagues of these people talk about them. The analysis shows the links which participants routinely make between full-time work, professional commitment and gender. I demonstrate the ways in which participants negotiate with difficulty the category of ‘part-timer’, and in particular the problematic use of this category for men. The constructions of work, time and gender raised by the researchers are compared with the way participants themselves orient to categories, and implications for the research interview context are considered.

BACKGROUND: Online communities are known to break down barriers between supposed experts and non-experts and to promote collaborative learning and 'radical trust' among members. Young people who self-harm report difficulties in communicating with health professionals, and vice versa. AIM: We sought to bring these two groups together online to see how well they could communicate with each other about self-harm and its management, and whether they could agree on what constituted safe and relevant advice. METHODS: We allocated 77 young people aged 16-25 with experience of self-harm and 18 recently/nearly qualified professionals in relevant health-care disciplines to three separate Internet discussion forums. The forums contained different proportions of professionals to young people (none; 25%; 50% respectively) to allow us to observe the effect of the professionals on online interaction. RESULTS: the young people were keen to share their lived experience of self-harm and its management with health professionals. They engaged in lively discussion and supported one another during emotional crises. Despite registering to take part, health professionals did not actively participate in the forums. Reported barriers included lack of confidence and concerns relating to workload, private-professional boundaries, role clarity, duty of care and accountability. In their absence, the young people built a vibrant lay community, supported by site moderators. CONCLUSIONS: Health professionals may not yet be ready to engage with young people who self-harm and to exchange knowledge and experience in an anonymous online setting. Further work is needed to understand and overcome their insecurities.

In the context of a Professional Doctorate in Psychoanalytic Research, we examined how a group of psychoanalytic therapists responded to the ethos and methods of qualitative research. Although experienced therapy practitioners, the students were mostly new to qualitative research. We were interested in the extent to which students found psychoanalytic training and qualitative research compatible or in conflict. The data for the study was a focus group in which students discussed the experience of becoming researchers. The focus group was recorded, transcribed and analysed using Discursive Psychology but also informed by psychoanalytic analysis, in an iterative process including the participants. We concentrate here on some of the main discourses emerging, including intrinsic and extrinsic motivations for the course – bound up with life stage, sense of previous unfulfilled aspirations and the current challenges of working in UK mental health services. We also focus on tensions with the concept of developing a researcher identity, both concerning clinician identities and other roles. The sense of an uncomfortable ‘assimilation’ into a ‘foreign territory’ was explored, both in the focus group and the analysis. We use this to highlight some of the expectations and taboos of both psychoanalytic and research communities.

We used Discursive Psychology to study the claims and arguments which occur when “the child’s best interests” is produced as a resource in family mediation settings. Analysis draws on data from three pairs of separated or separating parents attempting to resolve child contact or residency disputes through mediation. Our analysis focuses on the tendency of claims to the abstract notion of the child’s best interests to exacerbate conflict, especially as parents drew on conflicting research in this area. Changing expectations of fathering could be observed in the men’s argumentative positioning, and this was taken up in different ways by ex-partners and by mediators. Participants aligned themselves with mediators’ statements by picking up details of mediators’ language, hampering mediators’ attempted neutrality. The problematic nature of acknowledging the intensity of emotions in this process was also highlighted.

This paper explores the use of focus group methodology as part of a life course approach building on Julia Brannen's pioneering work in these two areas. Much life course research uses individual interviews, including biographical interview techniques. It is less usual to find focus groups used within the life course perspective. This paper draws on a PhD study of young British and Asian adults' experiences of the transition from university to full-time employment, using focus groups as part of a multi-method approach, within a life course perspective. The study drew explicitly on Julia Brannen's approach to life course transitions. Three focus group excerpts are presented and discussed to illustrate how focus group data can further the understanding of the ways in which a group of peers discuss the transition to work and especially future work-life balance. We show how focus group discussions about individual choice for future work and 'life' or 'lifestyle' can highlight shared assumptions of this birth cohort group as well as areas of disagreement and contention, rooted in both individual experiences and societal and socio-cultural expectations. We relate this to Julia Brannen's conceptualisation of the three different modalities which young people draw on to talk about the future. © 2014 © 2014 Taylor & Francis.

Background: There is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction. Methods. We ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice. Results. MHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions. Conclusions. The anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one. © 2012 Smithson et al; licensee BioMed Central Ltd.

Within a context of concern about inappropriate advice-giving online, we examined how young people who self-harm behave online, and how professionals might engage with them. We use Discourse Analysis to focus on participant interactions (posts) from a forum's crisis/support rooms, and highlight the prevalence of disclaimers, hedges, questions and tags in the young people's online interactions. We use the concept of facework as a framework to help understand interactions in the forum SharpTalk. The findings demonstrate the use of a range of mitigation devices, and suggest that the young people orientate to a 'protective' line in their supportive interactions. These findings echo Goffman's (1967) 'supportive interchanges' in that the young people's online interactions may help to preserve face, in an emotionally complex setting, whose vulnerable members also need 'protective' and sensitive support. Taking this 'line' may enable members to create a more open and trusting context for support, and to remain in a forum which they find both helpful and challenging. In light of concerns about online support, the findings provide a new perspective on online peer-support for young people who self-harm. © Equinox Publishing Ltd.

This article describes a qualitative synthesis of published research on cancer patients' experiences of complementary therapies. We conducted a systematic search for qualitative studies on this subject published between 1998 and 2007. Twenty-six refereed journal articles met the inclusion criteria. These 26 articles were repeatedly read by the research team and key concepts emerging from them were identified. Differences and variations were examined in association with treatment, therapy type and by stage of cancer (early stage, mid-treatment, advanced cancer, palliative care and long term 'survivors'). Six overarching concepts were located, which describe the key aspects of patients' experiences of the use of complementary and alternative medicine after a diagnosis of cancer: Connection; Control; Well-being; Transformation; Integration; and Polarization. These are described in a 'line of argument' synthesis, and differences associated with treatment type and stage of disease are noted. The findings are presented in a table showing the six concepts according to treatment type and stage; as a composite story; and in a diagrammatic model showing the individual, practitioner and organizational levels. The synthesis identified various specific ways in which complementary therapies supported cancer patients, as well as occasional negative effects. The most notable barrier was the perceived polarization of complementary therapies and biomedicine; patients reported better experiences in integrated settings.

BACKGROUND: This review considers barriers to, and facilitators of, success for interventions to reduce unintentional injury to children in the home through supply and/or installation of home safety equipment, and looks at risk assessments. METHODS: a systematic review of qualitative research. Bibliographic databases were searched for studies on interventions to reduce unintentional child injury in the home, or on related attitudes and behaviours. Studies were quality appraised, findings extracted, and a conceptual framework was developed to assess factors affecting the success of interventions. RESULTS: Nine peer-reviewed journal articles were included. Barriers and facilitators were highlighted at organisational, environmental and personal levels. Effective provision of safety equipment involves ongoing support with installation and maintenance. Take up and success of interventions depends on adjusting interventions according to practical limitations and parents' cultural expectations. A particular barrier was parents' inability to modify rented or shared accommodation. CONCLUSIONS: the review highlights ways in which health inequalities affect the take up and success of home safety interventions, and how health workers can use this knowledge to facilitate future interventions.

The internet is widely used for health information and support, often by vulnerable people. Internet-based research raises both familiar and new ethical problems for researchers and ethics committees. While guidelines for internet-based research are available, it is unclear to what extent ethics committees use these. Experience of gaining research ethics approval for a UK study (SharpTalk), involving internet-based discussion groups with young people who self-harm and health professionals is described. During ethical review, unsurprisingly, concerns were raised about the vulnerability of potential participants. These were dominated by the issue of anonymity, which also affected participant safety and consent. These ethical problems are discussed, and our solutions, which included: participant usernames specific to the study, a closed website, private messaging facilities, a direct contact email to researchers, information about forum rules displayed on the website, a 'report' button for participants, links to online support, and a discussion room for forum moderators. This experience with SharpTalk suggests that an approach to ethics, which recognises the relational aspects of research with vulnerable people, is particularly useful for internet-based health research. The solutions presented here can act as guidance for researchers developing proposals and for ethics committees reviewing them.

In this article we explore how young adults became members and sustained membership in an online self-harm support forum, SharpTalk. We take a discursive approach to consider resources young people used to establish themselves, how others responded to their attempts, and how membership categories were developed and applied. Participants displayed expectations about appropriate ways of discussing self-harm, and about responses and advice. New posters made reference to other self-harm sites, provided biomedicalized narratives of their "story," and asked for help in particular ways. Participants were active in shaping interactions on the forum, requesting input from site moderators, and challenging each other both on perceived infringements of posting content, and on style of posting pertinent to membership. On the SharpTalk site, perceived deviance in posting behavior, and also the giving of health care advice, were most commonly addressed by other young people who self-harmed, rather than by the site moderators. We consider implications for creating sites that enable young people who self-harm to become members and sustain membership, and therefore access support.

Aims and method: to explore what young people who self-harm think about online self-harm discussion forums. SharpTalk was set up to facilitate shared learning between health professionals and young people who self-harm.We extracted themes and illustrative statements from the online discussion and asked participants to rate statements. Results: of 77 young people who participated in the forum, 47 completed the questionnaire. They said they learned more about mental health issues from online discussion forums than from information sites, found it easier to talk about self-harm to strangers than to family or friends, and preferred to talk online than face-to-face or on the telephone. They valued the anonymity the forums provided and reported feeling more able to disclose and less likely to be judged online than in 'real life'. Clinical implications: Mental health professionals should be aware of the value of anonymous online discussion forums for some young people who self-harm, so that they can talk about them and assess their use with their patients. Declaration of interest: None.

In this article we investigate the nature of problem presentation and responses on an online forum for young people who self-harm. Previous studies have raised concerns about the peer encouragement of self-harming behaviours in online forums, and this analysis considers the nature of peer interaction on a specific forum, ' SharpTalk'. This was a research forum which explored the potential of online communities to foster engagement and shared learning between NHS professionals and young people who self-harm. This analysis draws on conversation analysis methods to study problem presentation and responses, and nature of advice given. Analysis highlighted both the tendency to offer advice where it was not asked for, and the mundane 'safe' nature of advice. This awareness of how young people interact and provide support online is important for those setting up online interventions to support young people who self-harm. © the Author(s) 2011.

BACKGROUND: Researchers using forums and online focus groups need to ensure they are safe and need tools to make best use of the data. We explored the use of metrics that would allow better forum management and more effective analysis of participant contributions. OBJECTIVE: to report retrospectively calculated metrics from self-harm discussion forums and to assess whether metrics add to other methods such as discourse analysis. We asked (1) which metrics are most useful to compare and manage forums, and (2) how metrics can be used to identify the participative stances of members to help manage discussion forums. METHODS: We studied the use of metrics in discussion forums on self-harm. SharpTalk comprised five discussion forums, all using the same software but with different forum compositions. SharpTalk forums were similar to most moderated forums but combined support and general social chat with online focus groups discussing issues on self-harm. Routinely recorded time-stamp data were used to derive metrics of episodes, time online, pages read, and postings. We compared metrics from the forums with views from discussion threads and from moderators. We identified patterns of participants' online behavior by plotting scattergrams and identifying outliers and clusters within different metrics. RESULTS: in comparing forums, important metrics seem to be number of participants, number of active participants, total time of all participants logged on in each 24 hours, and total number of postings by all participants in 24 hours. In examining participative stances, the important metrics were individuals' time logged per 24 hours, number of episodes, mean length of episodes, number of postings per 24 hours, and location within the forum of those postings. Metric scattergrams identified several participative stances: (1) the "caretaker," who was "always around," logged on for a much greater time than most other participants, posting but mainly in response to others and rarely initiating threads, (2) the "butterfly," who "flitted in and out," had a large number of short episodes, (3) two "discussants," who initiated many more discussion threads than anybody else and posted proportionately less in the support room, (4) "here for you," who posted frequently in the support room in response to other participants' threads, and (5) seven "people in distress," who posted many comments in the support room in comparison with their total postings and tended to post on their own threads. CONCLUSIONS: Real-time metrics may be useful: (1) by offering additional ways of comparing different discussion forums helping with their management, and (2) by identifying participative stances of individuals so allowing better moderation and support of forums, and more effective use of the data collected. For this to happen, researchers need to publish metrics for their discussion forums and software developers need to offer more real-time metrics facilities.

OBJECTIVE: the use of complementary therapies by people with cancer is commonplace. In a recent synthesis of 26 qualitative studies of patients' experiences of complementary therapy use after a diagnosis of cancer, the emergent theme of 'polarization' was the most notable barrier to a positive experience of complementary therapies. In this paper, we explore the two synthesis concepts of 'polarization' and 'integration', and their relationship to health service policies and guidelines on integrated services. METHODS: a systematic literature search and a meta-ethnography to synthesize key concepts. RESULTS: the majority of patients who used complementary therapies after a diagnosis of cancer wanted to be certain that the therapies were not interfering with their conventional cancer treatment. They valued the therapies in wider terms including: taking 'a niche of control', relieving symptoms, improving wellbeing, and promoting reconnection and social interaction. The emergent theme of 'polarization' suggested that conventional physicians who are perceived to be poorly informed or negative about complementary approaches induce patient anxiety, safety concerns, and difficulties in access. They may compromise their therapeutic relationship and, rarely, they may trigger patients to abandon conventional medicine altogether. In contrast, integrated advice and/or services were highly valued by patients, although some patients preferred their complementary health care to be provided in a non-medicalized environment. CONCLUSIONS: Our findings suggest that the current polarized situation is unhelpful to patients, detrimental to therapeutic relationships and may occasionally be dangerous. They indicate that complementary therapies, in a supportive role, should be integrated into mainstream cancer care.

Recent studies have shown that British women, especially mothers of young children, spend a particularly large amount of time online. Many are logging on to parenting websites. This chapter investigates Mumsnet, a large British parenting site, and evaluates how members use and conceptualise the site. A combined method of a questionnaire survey with open and closed-ended questions, and discourse analysis of discussions on the site, was used to explore this. The analysis considers how membership and expertise are displayed and acknowledged in online groups, how people view their involvement with the site, how online and "real life" are segregated or integrated in various ways. The positioning of "lurkers" (those who read but do not post) and of "trolls" (those who post false information or fake identities) is explored within the context of how power is reproduced and challenged in the type of discourse produced in an online discussion forum. © 2010, IGI Global.

This paper investigates how differences in national and organisational welfare policies and in cultural norms on national, organisational, and familial levels influence work-family reconciliation for mothers. Drawing on case study and interview data gathered through a large European study of parenthood and organisations, we compare experiences of transition to motherhood in three organisations in Norway, the UK, and Portugal. The specific question which is considered in this paper is how mothers manage the reconciliation of work and family in the period of time following parental leave. Our case analyses highlight the differences in organisational, national policy, and family support in the three contexts, and show that having a child is still conceptualised as a predominantly 'private problem' in the UK and Portugal, while it has come closer to having the status of a 'public issue' in Norway. © 2008 Taylor & Francis.