An exploration of the experience of codependency through interpretative phenomenological analysis

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonCodependency is a highly contested construct featuring in the popular, clinical and research literature. Within the academic literature, the voices and lived experience of individuals who consider themselves codependents are mostly unavailable. This Interpretative Phenomenological Analysis (IPA) study explored the lived experiences of 8 individuals self-identified as codependents, who chose 12-Step recovery groups to frame their recovery process. This research addressed the following research question: What is the lived experience of codependency among people who have sought support from a 12-step recovery group for codependents? The idiographic, phenomenological and hermeneutic aspects of the study captured how participants made sense of their experiences of codependency and the meanings of the support group. The information was collected over 3-6 months by means of three in-depth semi-structured interviews and a visual method in which participants selected and analysed objects or photographs which, for them, expressed the meaning of codependency. Four main themes emerged from the analysis of the interviews: (1) Codependency experienced as real and tangible: ‘Codependency explains everything’. (2) Experiencing an undefined sense of self: ‘Codependency helps me to discover my sense of self.’ (3) Seesawing through extremes in life: ‘Like a seesaw, I feel out of control’. (4) Finding meaning in codependency through exploring family experiences: ‘Down to childhood’. The findings revealed that the experience of codependency frames these individuals’ sense of identity, their lifeworlds and the way they view and experience life difficulties. It also provided a highly nuanced and fine-grained analysis of the lived experience of codependency. The study brings a new perspective on the lived experiences of this client group. Although the findings are not straightforwardly generalizable, they may inform clinical practice. It is hoped that this study will raise awareness about this controversial topic, bring a better understanding of codependency and inspire further research

The mental health associate practitioner pathway

Building and maintaining a qualified workforce of committed staff is one of the greatest challenges facing the NHS . Providing specialist care to people experiencing mental distress is difficult, demanding work and requires exceptionally dedicated, caring individuals. The Associate Practitioner role has been developed to address this demand. The Assistant Practitioner is defined as a worker who competently delivers health and social care to and for people, with the level of knowledge and skill beyond that of the traditional healthcare assistant or support worker ( Skills for Health 2009). A research project was undertaken to evaluate the Mental Health Associate Practitioner programme delivered by the Faculty of Health, Social Care and Education at Kingston University and St George’s, University of London. The programme was delivered full time over two years with 40/60 balance between theory and practice, with emphasis on work based learning. A longitudinal evaluation research study was undertaken, using mixed-methods concurrent triangulation design. Data was collected from the 7 learners through questionnaires, at three different points in time: pre-programme, at mid-point and at the end of the programme. The questionnaires included both quantitative and qualitative questions. SPSS version 23 and 24 was used to analyse the quantitative data of the questionnaires. Descriptive statistical analyses were conducted, reporting on frequencies of responses and means. Psychometric analysis of the questionnaires (measuring internal consistency using Cronbach’ Alpha) were also undertaken. Thematic analyses was used to analyse the qualitative data. Findings revealed learners’ engagement with the programme and its activities, the learners’ perceptions of the value of the programme, the impact of the programme on learners’ attitudes, knowledge and skills and the sustainability of the programme. Overall, learners reported good levels of satisfaction with the course and enhanced knowledge and skills, particularly around physical health care

The Lived Experience of Codependency: an Interpretative Phenomenological Analysis

Codependency is a complex and debatable concept, which has been used over the years by mental health professionals to inform their practices. Researchers have attempted to identify the main problems associated with codependency; however, their evidence is still inconclusive.This is the first time that interpretative phenomenological analysis (IPA) has been used to explore the lived experience of codependency from the perspective of self-identified codependents. Eight participants recruited from local support groups for codependency in the UK, offered in-depth information about their subjective experiences, and embedded in their lifeworld. Data was gathered through interviews and a visual method. The shared experienceof codependency was portrayed by the participants as a complex but tangible multidimensional psychosocial problem in their lives. It incorporated three interlinked experiences: a lack of clear sense of self, an enduring pattern of extreme, emotional, relational, and occupational imbalance, and an attribution of current problems in terms of parental abandonment and control in childhood

An examination of the lived experience of attending twelve step groups for co-dependency

This research project aimed at obtaining an in-depth analysis of the experiences of self-identified co-dependents, who chose twelve-steps groups as a way for dealing with difficulties identified as co-dependency. Interpretative phenomenological analysis (IPA) was used as the methodology for the research. Eight participants volunteered from local support groups for co-dependency in the UK. Data were collected through 3 in-depth interviews with each participant over a period of 3–6 months. A visual method was used to gain a more in-depth phenomenological perspective. It included photographs, drawings and images chosen by the participants to describe their experiences. The analysis revealed 2 contradicting and complementary themes: (1) representations of the twelve-step group as a helpful tool and (2) representations of the twelve-step group as no longer meaningful. It demonstrated that the participants found their groups useful as an initial pathway for recovery; however, it did not feature as a central aspect in their recovery, as different levels of engagement were described. The results of this study provide a base for developing a more empathic and contextualised understanding of the experience of individuals who attend twelve-step groups for co-dependency, which in turn will enable health professionals to offer support which is relevant to these individuals’ experiences.Co-dependency is a contested psychological concept associated with addictive behaviours. It is a multifactorial problem characterised by a constellation of factors identified as differentiation of self, self-sacrifice, external locus of control, interpersonal conflict and control and emotional constraint (Lampis et al. 2017; Dear and Roberts 2005). Evidence suggests that these factors are typically found in the lives of adults who grew up in dysfunctional families, for example where substance abuse prevailed (Abadi, Maarefvand, Aghaei et al. 2017; Bortolon et al. 2017; Sarkar et al. 2015; Marks et al. 2012).A systematic review of literature in co-dependency offered a summary of various treatment perspectives based on individual and group therapy modalities (Ahmad-Abadi, Vand and Aghaee 2015). The twelve-step group appears to be the preferred pathway for helping individuals who identify with this problem (Askian et al. 2016, 2018; Sohrabnejad et al. 2018; Abadi et al. 2015).However, our review of literature in co-dependency demonstrated that to this date, to our knowledge, the voices and experiences of individuals who attend twelve-step groups have not been included in the discussion, therefore indicating the need for an in-depth analysis of the perspectives of self-identified co-dependents, who chose the twelve-step group as a way for dealing with difficulties identified as co-dependency. Their experiences of the twelve-step recovery groups will illuminate professionals who work in this field, suggesting ways to support people who consider themselves to be co-dependents and who chose the twelve-step group pathway for recovery

The Lady of Shalott: insights gained from using visual methods and interviews exploring the lived experience of codependency

Codependency is a complex human experience with many meanings. The experiences of self-identified codependent individuals, who attend 12 steps groups are largely missing from the literature. In this article, we present how a combination of a visual method and interviews assisted deeper exploration and analysis of the experience of living with codependency, in an Interpretative Phenomenological Analysis (IPA) study.A case example, entitled the ‘Lady of Shalott’, is offered as an illustration of the data collection and multilevel interpretative analytical process, highlighting how the ambiguity in the meanings of the imagery aided the interpretation. The case study, demonstrates how the visual method enriched the data collection and analysis process assisting the researcher to reach deeper layers of meanings, capturing a better understanding of the lived experience portrayed by the participant

The Arctic and the UK: Climate, research and engagement

• The Arctic has warmed by around 2°C since 1850, approximately double the global average. Even if the Paris Agreement successfully limits global warming to a further 0.5°C, the Arctic is expected to warm by at least another 1°C. • The United Kingdom’s (UK) weather is linked to conditions in the European Arctic. For example, high atmospheric pressure in the Nordic Seas divert damaging storms across the UK and mainland Europe, with the potential to cause societal disruption from flooding. • It is possible, although presently unconfirmed, that alterations in Arctic conditions provoked the ‘Beast from the East’ winter storm in 2018. • Scientists need to take observations and improve their understanding of climatic processes in the Nordic Seas and the Arctic Ocean to fill gaps in knowledge about the links between the Arctic climate and the UK’s weather; a risk identified by the Intergovernmental Panel on Climate Change (IPCC). • The UK has significant research expertise and experience to understand how global warming will change the Arctic’s environment and affect the UK. • This strength, allied with the capabilities of the UK’s new polar research ship the RRS Sir David Attenborough, warrants an integrated programme of research, including advanced numerical modelling, to improve predictions of future extreme weather events. • Such a programme must acknowledge that the Arctic is politically an increasingly congested and contested space. It should be designed in collaboration with key Arctic and near-Arctic nations to increase the UK’s influence and abilit

Ex vivo drug sensitivity screening predicts response to temozolomide in glioblastoma patients and identifies candidate biomarkers

Background: Patient-derived glioma stem-like cells (GSCs) have become the gold-standard in neuro-oncological research; however, it remains to be established whether loss of in situ microenvironment affects the clinically-predictive value of this model. We implemented a GSC monolayer system to investigate in situ-in vitro molecular correspondence and the relationship between in vitro and patient response to temozolomide (TMZ). Methods: DNA/RNA-sequencing was performed on 56 glioblastoma tissues and 19 derived GSC cultures. Sensitivity to TMZ was screened across 66 GSC cultures. Viability readouts were related to clinical parameters of corresponding patients and whole-transcriptome data. Results: Tumour DNA and RNA sequences revealed strong similarity to corresponding GSCs despite loss of neuronal and immune interactions. In vitro TMZ screening yielded three response categories which significantly correlated with patient survival, therewith providing more specific prediction than the binary MGMT marker. Transcriptome analysis identified 121 genes related to TMZ sensitivity of which 21were validated in external datasets. Conclusion:GSCs retain patient-unique hallmark gene expressions despite loss of their natural environment. Drug screening using GSCs predicted patient response to TMZ more specifically than MGMT status, while transcriptome analysis identified potential biomarkers for this response. GSC drug screening therefore provides a tool to improve drug development and precision medicine for glioblastoma.</p

Top-down contingent feature-specific orienting with and without awareness of the visual input

In the present article, the role of endogenous feature-specific orienting for conscious and unconscious vision is reviewed. We start with an overview of orienting. We proceed with a review of masking research, and the definition of the criteria of experimental protocols that demonstrate endogenous and exogenous orienting, respectively. Against this background of criteria, we assess studies of unconscious orienting and come to the conclusion that so far studies of unconscious orienting demonstrated endogenous feature-specific orienting. The review closes with a discussion of the role of unconscious orienting in action control

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes