Doctorate in Clinical Psychology: Main Research Portfolio
: 1) A systematic review exploring therapist competence, adherence and therapy outcomes in individual CBT for children and young people. ; 2) How can we get better at recognising cases of fabricated illness? A service improvement project within a paediatric chronic fatigue service; 3) “I feel as though it will help me feel better, but it usually just makes things worse”. The role of self-harm material on the internet.

  • Hannah Rapley

Student thesis: Doctoral ThesisDoctor of Clinical Psychology (DClinPsy)


Critical Review of the Literature Objective: Whilst the evidence base for Cognitive Behavioural Therapy (CBT) with children and young people is growing, the mechanisms through which these beneficial effects occur is still unclear. This systematic review seeks to appraise the relationship between therapeutic outcomes in CBT and therapist adherence and competence, within the child and adolescent literature. Method: A systematic review was carried out, with seven studies identified as meeting the inclusion criteria. Results: The literature is currently small and inconclusive. Amongst the studies reviewed there were inconsistent findings, with minimal-to-no effect sizes found between adherence, competence, and outcomes. Conclusions: The current paucity of research in this area means that conclusions are currently limited. The role and impact of adherence and competence on therapeutic outcomes remains unclear within individual CBT in a child population. This is comparable with the current adult literature, where findings also remain inconclusive. Further research avenues are discussed. Keywords: CBT, adherence, competence, children, young peoplePublic health significance: Cognitive Behavioural Therapy has a growing evidence base for children. However, it is still unclear which mechanisms enable these beneficial effects. How well a therapist adheres to the model, and the competence with which they deliver the therapy, are two possible variables that may contribute to the outcome of therapy. This article reviews the state of the current literature. Service Improvement ProjectFabricated or induced illness by another is rare and poorly understood. Whilst some of the difficulties recognising and managing it have been addressed in literature and guidelines, to date there has been no published consideration of fabrication within the context of chronic fatigue syndrome, which itself is often poorly understood and recognised. This study seeks to understand staff’s experience and knowledge of fabricated or induced illness within a paediatric chronic fatigue setting. Whilst challenges in line with other health conditions are identified, additional challenges are also highlighted that may be unique to working within a chronic fatigue setting. Discussion of these and future improvements are considered. Keywords: fabricated illness, chronic fatigue syndrome, paediatrics Main Research ProjectObjective: This novel study sought to examine the prevalence of online self-harm activity amongst those who self-harm and how this impacts on self-harming practices and related distress. Method: A small innovative experimental study (N=3) sought to look at real-time effects of viewing self-harm material online. A cross-sectional study of young adults (N=126) compared differences between those who view self-harm material online and those who do not. The impact of appraisal of online content was explored in both studies. Results: 48% of the sample reported currently viewing self-harm material online, with an additional 23% reporting having previously viewed such material. Stronger desire to self-harm and greater psychological distress was found amongst those who view self-harm material online. Due to the small sample size in the experimental study causational inferences about the role of viewing self-harm material online cannot be made. Conclusions: Findings suggest that viewing self-harm material online is common amongst those who self-harm and that those who view self-harm material online may have stronger urges to self-harm and greater psychological distress than those who do not view such material online, thus indicating a higher risk group. Keywords: self-harm, self-injury, online, internet.Public Health Significance Statement: This study suggests that amongst young adults who self-harm, those who view self-harm material online have stronger urges to self-harm and greater psychological distress than those who do not view such material online.
Date of Award28 Sept 2017
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorCatherine Hamilton-Giachritsis (Supervisor) & Maria Loades (Supervisor)

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