These findings highlight the importance for screening by clinicians during inpatient hospital stays and for monitoring to be ongoing following discharge. For the subgroup of patients who experience auditory hallucinations, future research should seek to explore the relationship between self-harm and beliefs about voices.

This project was completed as a PhD dissertation by the first name author. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. AbstractThis investigation aimed to examine how specific client characteristics of individuals with chronic, complex trauma are associated with the type coping strategies they employ and the quality of the therapeutic alliance. Fifty-nine adult participants with diagnostic levels of posttraumatic stress disorder (PTSD) and who attended therapy for complex trauma in Northern Ireland were obtained via opportunity sampling. Participants completed self-report measures of client attachment style, alexithymia, coping strategies, and the therapeutic alliance. Preoccupied attachment factors such as "Need for Approval" and "Preoccupation with Relationships" were related to use of maladaptive coping strategies. In contrast, the adaptive coping strategies of "Acceptance" and "Instrumental Support" were significant predictors of a positive therapeutic alliance, whereas established psychological and traumatogenic factors (e.g., attachment, number of traumatic events) did not significantly predict the therapeutic alliance. The findings have implications for understanding the relationship between client characteristics and the therapeutic alliance within complex trauma populations, as well as developing protocols to assist this process.Keywords: Therapeutic Alliance, complex trauma, client factors, coping CLIENT FACTORS, THERAPEUTIC ALLIANCE, AND TRAUMA 3 Client characteristics, coping strategies, and the therapeutic alliance in a chronic, complex trauma sample Defined broadly as the collaborative and affective bond between therapist and client, the therapeutic alliance has long been considered an essential element of the therapeutic process. Research has consistently found a substantive relationship between the alliance and therapeutic effectiveness, regardless of therapeutic orientation, presenting problem, or problem severity (Goldsmith, Lewis, Dunn, & Bentall, 2015;Martin, Garske, & Davis, 2000). The capacity to engage in an effective therapeutic alliance, however, is thought to require concomitant implementation of certain coping strategies by clients (e.g., reflection, active coping, openness), which can prove challenging (Stiles, Agnew-Davies, Hardy, Barkham, & Shapiro, 1998).One clinical group in which this area of study is particularly relevant is individuals who have experienced chronic, complex or childhood trauma. Herman (1992) proposed the concept of 'Complex PTSD', or 'Complex Trauma' as it is also known, to describe the multifaceted clinical presentation of individuals experiencing protracted, recurring trauma, particularly of an interpersonal nature (e.g., childhood sexual abuse, sectarian violence).Compared to clients with a discrete or 'simple' PTSD presentation, individuals with complex PTSD have a more severe and comprehensive sympt...

The psychological impact of living with congenital heart disease in adulthood was explored using semi-structured interviews with seven adults. Participants described living with congenital heart disease as a constant and limiting presence, which impacts upon the relationship with self and others. Psychological and emotional reactions ranged from depression, shame, trauma, lack of control and an ongoing struggle with issues of uncertainty and life expectancy. Various coping strategies were identified such as denial and overcompensation. Participants reported that they were not psychologically supported by health professionals. Implications of findings are discussed with regard to service provision.

In order to examine for features of posttraumatic growth, this preliminary and exploratory study adopted a case study method with three individuals who had endured a traumatic event, as a consequence of the political violence in Northern Ireland. Most of the extant research carried on this topic has focused on the pathogenic effects that result from the conflict. Little is known about whether growth following political adversity in Northern Ireland has occurred or even likely, given the ongoing political violence, which serves as a constant reminder of what has happened before and what may still occur, regardless of the peace process. Employing Tedeschi and Calhoun's model of growth, findings reveal that certain features of growth are evident in the domains of a greater appreciation of life and changed relationships, which has lead to new possibilities. Two of the three participants reported change in the domain of personal strength and all reported ongoing psychological distress, which served to temper the degree of growth experienced. Differences in the growth domain relating to religion and spirituality set the three cases apart. Findings may serve as a springboard for future research in this neglected area within trauma research in the Northern Irish context.

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