This thesis comprises three main sections: a literature review, research report and a critical appraisal of the research process. The literature review is generic across a number of health professions and begins by placing supervision within its historical context followed by an attempt to clarify our current understanding of supervision. The literature relating to effective supervision is presented, with the supervisory working alliance being identified as potentially one of the most important common factors in the change process of supervision (Ellis, 1991). A review of supervision models suggests that they provide a structure for understanding the roles, relationships, responsibilities and processes integral to the practice of supervision. The review attempts to clarify the current state of supervision training, highlighting the lack of attention that has been paid to the process by which individuals learn to become effective supervisees and supervisors. It is concluded that there is a need for further research in the area of training for both supervisees and supervisors. The research report comprises a qualitative study using interpretative phenomenological analysis to explore the supervision experiences of six Chartered Counselling Psychologists. The thematic content that emerged indicated a lack of preparation for the role of supervisee and a lack of formal training for the supervisory role. The findings revealed that the participants relied upon self-directed learning, their previous experience and their therapeutic skills to inform their supervisory practice. The findings also highlighted the critical role of the supervisory relationship for both supervisee and supervisor in managing the anxieties generated by this lack of preparation and training as well as in supporting the learning and development of all involved in the relationship. The final section is the researcher’s critical appraisal of the research process.

The literature review produced for this thesis systematically analysed qualitative studies of cognitive therapy using a methodology checklist and a meta-synthesis technique. Ten papers which used qualitative analysis to look at clients’ experiences of Cognitive Behavioural Therapy (CBT) met the selection criteria. Seven themes emerged. Three were linked to a therapeutic relationships theme; the trusted listener, power and authority and others like me. Four were linked to the impact of cognitive therapy theme; empowering information, analysing the problem, thinking differently and doing things differently. It was concluded that future research should focus on the components of cognitive therapy and that differences in technique between CBT and Rational Emotive Behaviour Therapy (REBT) should be explored via a qualitative study of clients’ experiences of REBT. A qualitative approach was taken to look at clients’ experiences of REBT. Seven participants were interviewed using a semi-structured interview guide and the resulting transcripts were analysed using interpretive phenomenological analysis. Three themes emerged: one which looked at what it was like to have mental health problems; a second, which looked at clients’ expectations and experiences of the more technical aspects of therapy, and a third which examined the therapeutic relationship. All of the participants appeared to value therapy. However, the extent to which they knew about and used the theory and philosophy of REBT varied greatly. These results suggest that further research needs to be carried out which looks at how people benefit from therapy as clients views may differ from those of therapists. A critical appraisal of the research process was written using the REBT model to reflect the experience of producing the thesis.

“Prison self-injury rate accelerates at four times the rise in population” (The Howard League for Penal Reform; 2008a) The rise in self-harm figures in forensic settings in 2003 may largely be due to the improvement in the reporting of self-harm levels in prisons in December 2002. However it does not account for the continued rise in self-harm figures during the years that followed. Despite the increase, there have been few interventions to support prisoners who self-harm, particularly in remand settings. For this purpose the Carousel programme was designed by a counselling psychologist specifically to meet the demands of the female remand population. The aim of this study was to evaluate the effectiveness of Carousel. Forty women who had a history of deliberate self-harm entered and completed the programme through means of self-referral. The study employed both a quantitative and qualitative methodology to evaluate the programme. Participants were interviewed and assessed both at the start and completion of Carousel. This included monitoring levels of self-harm incidents, levels of anxiety and depression using the 14-item Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983), and coping levels using the 60-item Coping Styles Questionnaire (CSQ) (Roger, Jarvis & Najarian, 1993). Results showed a significant decrease in depression and anxiety, a reduction in self-harm levels and a change of coping styles in the desired direction. Qualitative methodology using content analysis was employed to ascertain the components of the programme which were deemed most helpful or unhelpful to the participants. Findings suggest that the most useful components within the programme are coping strategies, management of self-harm behaviours, antecedent, behaviour and consequence (ABC) sessions and the understanding of the brain and associated emotions with self-harm behaviours. Implications for counselling psychology and clinical practice are highlighted and limitations of the current study and directions for future research suggested within the report.

Objectives: Inclusion of sociopolitical context in therapeutic interventions is under-researched, largely limited to practitioners’ addressing diversity issues in therapy. Relevant studies have shown both trainees and qualified practitioners experience anxiety and discomfort associated with uncertainties about effectively incorporating diversity and sociopolitical context. Although various models exist to aid systematic case conceptualisation incorporating sociopolitical factors, these are not widely used. The majority of relevant literature continues to concentrate on idiosyncratic conceptual models specific to theoretical approaches. This study aimed to discover how qualified practitioners currently conceptualise and incorporate diversity and sociopolitical factors into practice. Design: Given the lack of research available to inform the area, a grounded theory study was conducted as an exploratory exercise. The qualitative approach was adopted to investigate practitioners’ subjective experiences of their current practice. Constructivist assumptions underpinned the approach to the data, leading to use of Charmaz’s (2006) version of the grounded theory approach. Method: Theoretical sampling was used to recruit the 13 participants. Two focus groups and 8 individual interviews were conducted. Analysis: Two models emerged, representing the processes practitioners engaged in to “find a comfortable fit”, and the range of contexts within which the processes took place. Personal and professional dissonance emerged as a central feature of practitioner development. Discussion: The study highlighted the contribution of dissonance and the situated nature of the practitioner as major contributors affecting how sociopolitical issues are conceptualised and addressed in therapy. Further research is needed to clarify how these factors may most usefully contribute to best practice. However, multiple ecological contexts cited as levels of influence add a degree of complexity that will require operationalizing by those wishing to investigate this area in the future.