SummaryBrain stem death may be a difficult concept for relatives to understand. Our ITU practice follows published recommendations that the use of explanatory leaflets showing CT scans and observing brain stem death testing in some cases may help relatives to understand that death has occurred. Using this strategy, we interviewed 27 relatives 12 months after bereavement following certification by brain stem testing, investigating their understanding of brain stem death, subsequent attitudes to organ donation, grief reactions and attitudes of those who had observed the tests. Most relatives understood that the brain stem death tests indicated that survival was not possible, although three relatives had not fully understood this and valued the opportunity to discuss it again. Only five relatives observed the tests, all were pleased that they had done so as this had confirmed their understanding that death had occurred; however, these relatives had more evidence of psychological distress. No relatives who agreed to organ donation regretted this but three who did not allow donation subsequently expressed regret. Several relatives thought that observing the tests would have helped them to understand that death had occurred, making easier the decision to allow organ donation.

Using Q-methodology and structured interviews, this preliminary study set out to explore how a diverse range of voice hearers construed their experience of hearing voices. Following factor analysis of 20 completed Q-sorts, six factors emerged. Pejorative media stereotypes about voice hearers were rejected, and despite the dominance of the biomedical model in our culture, on no factor did participants adhere to all of the biomedical concepts. All six factors endorsed some elements of psychological discourse on voice-hearing experiences. It is argued that attempting to understand voice hearers within a single theoretical framework may limit or adversely affect engagement and understanding of an individual. Consistent with previous research, users of mental-health services were more likely to find voices frightening and perceive them as negative experiences than non-users. However, some non-users found managing some of their voices difficult despite having seemingly positive beliefs about the experience of hearing voices. Comment is made on the potential therapeutic implications of this study along with some acknowledgement of its limitations.

This pilot study aimed to explore the clinical outcomes and therapeutic relationship for clients of an adult mental health service using Beating the Blues, a computerised cognitive behaviour therapy (CCBT) package. Sixteen participants completed the programme and reported a significant reduction in Beck Depression Inventory scores posttreatment. Participants' mean item ratings on the relationship measure were above the neutral midpoint, but no association was found between the therapeutic relationship and outcome. The results are discussed in terms of the utility of CCBT as part of a stepped-care model and how further research might usefully explore the nature of the relationship formed between clients and CCBT programmes.

JTC is a phenomenon common in many people in first-episode services. In this large cohort sample, no clear associations with symptoms or other psychological processes were evident. Hence, the reason people JTC is still unclear.

Service users reported that four main components of Early Intervention in Psychosis Services were helpful to them. These included a strong and effective therapeutic relationship, as well as medication, psychological therapies, and practical help and support. Services are valued both for the quality of the therapeutic relationship but also for their ability to deliver meaningful and valued treatments in this context.