Accessible Summary The Circle of Security Parenting (COS‐P) programme can be helpful for some parents of children with learning disabilities to think about their relationship with their child. Parenting a child with learning disabilities is different, and COS‐P can highlight this difference. This can feel painful for parents and may stop them engaging with the programme. Abstract BackgroundBackground: The promotion of secure attachment relationships in childhood leads to better outcomes in later life (British Psychological Society 2017, Incorporating Attachment Theory into Practice: Clinical Practice Guideline for Clinical Psychologists Working with People who have Intellectual Disabilities). The Circle of Security Parenting Programme (COS‐P) provides a clear framework for reflecting on attachment relationships (Cooper et al 2009, Zero to Three, 37, 27). MethodsMethods: Semi‐structured interviews were conducted with parents of children with learning disabilities who attended a COS‐P programme to find out about their experiences of the course and how applicable it was to them. The data were analysed using thematic analysis. FindingsFindings: Four key themes were identified: these related to (1) COS‐P concepts are relevant to all children but (2) parenting a child with a learning disability is different and (3) COS‐P can create a focus on their child as different, which can be painful, and (4) changes recommended to make COS‐P suitable for parents of children with learning disabilities. ConclusionsConclusions: This paper outlines the benefits and challenges of COS‐P in sharing concepts related to attachment, whilst highlighting differences for parents of children and young people with learning disabilities, which can be painful.

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Depression and anxiety are major contributors to growing healthcare costs in the UK, particularly with an increasingly ageing population. However, identification of mental health needs in older adults has been overshadowed by a tendency to focus on physical health issues, despite the established co-morbidity of depression, anxiety and physical health conditions. When older adults seek psychological support, treatment options may vary and may be time limited, either because of protocol guidance or due to the resource constraints of psychology services. Time-limited treatment, common in many adult services, may not best meet the needs of older adults, whose physical, cognitive and emotional needs alter with age. It is, therefore, important to identify treatments that best meet the needs of older adults who seek psychological support, but who may arrive with complex mental and physical health histories. This paper aims to explore how a case formulation-driven approach that draws on the theoretical underpinnings of cognitive behavioural therapy (CBT) and compassion-focused therapy (CFT) can be used to reduce anxiety and depression in an older adult with a complex multi-morbid mental and physical health history. This study employs a single-case (A–B) experimental design [assessment (A), CBT and CFT intervention (B)] over 28 sessions. Results suggest the greatest reductions in depression and anxiety (as measured using PHQ-9 and GAD-7) occurred during the CFT phase of the intervention, although scores failed to drop below subclinical levels in any phase of the intervention. This case highlights the value of incorporating CFT with CBT in case formulation-driven interventions. Key learning aims (1) To consider the value of using case formulation approaches in older adult populations. (2) To demonstrate flexibility in balancing evidence-based interventions with service user needs by incorporating CBT and CFT to treat anxiety and depression in an older adult. (3) To present a clinical case to identify how assessment, formulation and treatment of anxiety and depression are adapted to best meet the needs of older adults with complex co-morbid mental and physical health conditions. (4) To appreciate the impact of contextual factors, such as austerity measures, on therapeutic work with individuals with long-standing mental and physical health difficulties.

Play as a concept is complex and often contested 1 despite the fact that it is claimed that we know play when we see it. 2 There have been considerable attempts by theorists to define play such as by: category, 3 typology, 4 criteria, 5 and continuum. 6 However, it has been stated that it is difficult to have a common conceptualisation or definition of play. 7 Whilst there is a considerable body of literature on defining play by theorists, there is far less literature on understanding play from the perspectives of different professionals, parents, adolescents, and children. There is a growing research base of early years practitioners' understanding of play and how this relates to practice; 8 however, there is a lack of research on the understanding of play from the perspective of other professionals. There is also limited research on parents' and adolescents' perspectives of play. There is, however, an emerging literature on children's perspectives of play but it is not yet known how their perspectives differ from the perceptions of adults. It is important to have a shared understanding of play for three reasons: so that there is a common language with which to talk about play, 9 so that the same phenomenon is investigated by researchers, 10 and so that there is clarity in relation to play practice. This chapter draws on a series of case studies which have employed a range of methodologies including: questionnaires, interviews and experiments to identify perceptions of play in relation to the aforementioned groups. As well as identifying similarities and differences in perceptions of play across the different groups, the implications for practice and future research are identified.