Mary trained initially at the University of Liverpool (BSc) and then went on to undertake clinical training at North London Polytechnic now known as University of East London. On qualification she worked within children and young people's services initially in Kingston and then moved to Northampton to develop the service. Two years later she returned to London to work at St Georges Hospital within the behavioural medicine service for young people where she became a Consultant Clinical Psychologist.
Following a number of years of working with young people presenting with a variety of acute and chronic physical health problems as well as life limiting conditions she moved into clinical service development and management initially leading a Child Psychology Service in Kent and then taking on a number of roles within the Sussex area finally becoming Head of Psychology and Psychological services for West Sussex. Throughout this time she also contributed to the training of a wide variety of Health and social practitioners alongside a major contribution to the training of clinical Psychologists.
In 2004 she joined the University to become the Programme Director of the Clinical Psychology training course. Since that time she has worked with colleagues to develop supervision and consultation training, Cognitive Behavioural therapy practitioner training, Interpersonal psychotherapy training resulting in the development of a Surrey Sussex IPT Centre. In 2012-15 she became Deputy Head of School and Director of Teaching and Learning.
University roles and responsibilities
- Head of Department of Psychological Interventions
- Programme Leader for PsychD Clinical Psychology
- Senior Lecturer in Clinical Psychology
My research interests have become focussed on the impact of adversity on young people and how we understand the development of self- identity including well-being, resilience or psychological distress. Part of this strategy has been to develop measures of recovery from psychological distress, ReQUEST also other psychometric instruments examining shame and guilt ASA and GSA .These two self-conscious emotions have a significant impact on how young people appraise the world and how they form a world view of themselves. In a clinical context, the resulting consequences of developmental trauma can be present across the decades unless identified and addressed.
Currently I am working with CAMHS services on how we might effectively address this issue for young people. Looked after children are also at elevated risks of experiencing difficulties with emotion regulation, educational performance and inter-personal relationships. I am working with colleagues at Sussex University and the Rees Centre oxford to examine the impact of school transition on these young people's well-being. It is anticipated that we may be able to identify those most at risk of difficulties, provide profiles where specific intervention could be targeted.
Owing to my long term interest in chronic health condition I have recently begun working with Debbie Cooke, Laura Simonds and Gareth Morgan addressing the psychological needs of young people with who are experiencing difficulties controlling their diabetes.
The other area of particular interest is how adolescent boys and men become more emotionally self-aware of their emotional distress and seek adaptive methods to secure support. Currently girls and women are over represented in the utilisation of services whilst boys and men are over represented in police engagement, and probation and prison services.
During the course of this work I employ mixed method approaches as well as both specific Qualitative quantitative analytic strategies.
- Laura Simonds and I have been exploring personal centred recovery in young people both within the general population and also in clinical contexts. She and I also work together in the area of shame and Guilt.
- Linda Morison and I work together with Bob Patton, Jason Spendelow, Eli Joubert in this field of men and boys health.
- Debbie Cooke, Gareth Morgan and Laura Simonds on facilitating engagement with diabetes self care.
- I am also working with Professor Robin Banerjee at Sussex University and Dr Nikki Luke at The Rees centre Oxford. She is a reviewer for many journals and grant givers.
- Sussex Partnership NHS Trust Own account funding stream - Developing a Mindfulness App for young people. Collaboration with Prof Robin Banerjee Sussex University. 2013 Awarded.
- Sussex Partnership NHS Trust Own account funding stream- Development of a recovery measure for young people 2009 Awarded.
Simonds. L, John, M, Fifie-Schaw. C., Willis, S., Taylor, H., Hand, H., Rahim., Winstanley, H., and Winton,H ( 2015 )Development and Validation of an Adolescent Shame -proness Scale. Psychological Assessment
John, M (2015) Working with children chapter in Clinical Psychology (Topics in Applied Psychology) Routledge
Mulligan, B., John, M., Coombes, R., Singh, R., (2014) - Developing outcome measures for a Family Intensive Support Service for Children presenting with challenging behaviours. British Journal of Learning Disabilities March
John M, Jeffries F, Acuña-Rivera M, Warren F, Simonds L. (2014) 'Development of measures to assess personal recovery in young people treated in specialist mental health services'. Clinical Psychology & Psychotherapy, 21(3) 1063-3995 doi: 10.1002/cpp.1905
Simonds LM, Pons RA, Stone NJ, Warren F, John M. (2014) 'Adolescents with Anxiety and Depression: Is Social Recovery Relevant?'. Clin Psychol Psychother, 21 (4), pp. 289-298.doi: 10.1002/cpp.1841
Atkins, E., Colville., G and John. M. A 'biopsychosocial' model for recovery: a grounded theory study of families' journeys after a Paediatric Intensive Care Admission Intensive Crit Care Nurs. 2012 Jun;28(3):133-40
John, M. Shortlisting from the Clearing House Application form: Is it fit for purpose? A commentary Psychology Learning and teaching 9 (2) 37-39
Lee, K. Vandrevela,T and John A.M (2008). The challenges and experiences of Trainees pursuing Clinical psychology training straight from and undergraduate degree
Hewitt, O and Roose, G and John, M, Yazdani, A (2006) Young people with learning disability views on mental health. Young Minds
John, A.M. and Vetere, A It's Important, and Its' One Way of Helping, and One Way of Helping Only. Clinical Psychology Forum (2008)
Vandrevala, T, Hayward, M, Willis, J. and John, M. (2007). A move towards a culture of involvement: involving service users and carer in the selection of future clinical psychologists. Journal of Mental Health Training, Education and Practice.
Carlisle A. S., John A., Fife-Schaw, .C. and Lloyd. M (2006) The Self-Regulatory Model in Women with Rheumatoid Arthritis: Relationships between Illness Representations, Coping Strategies, and Outcome. J. Health Psychology.
Hewitt, O and Roose, G and John, M, (2004) View finder User consultation is seen as key to improving outline how children and young people view mental health services. Young Minds 71
Roose, G and John, A. (2003) Young children's understanding of mental health their help seeking behaviour and ideas for a mental health service. Child Health care and development
Adams, S., Dowdney, L., John, A, and Hill, V. (2003) Expanding the profession of clinical psychology- clinical psychologists views on providing training placements. Clinical Psychology 22- February
Bradford, R., Rutherford, D. L. and John, A. (2002) Quality of life in young people ratings and factor structure of quality of life profile-adolescent version. J of Adolescence Vol 25 no 23, 261-74
Bowen, A and John, A. M. (2001) Gender differences in presentation and conceptualisation of adolescent self-injurious behaviour: implications for therapeutic practice Counselling psychology quarterly vol. 14 357-379.
Spender. Q, and John, A. (2001) Psychological and psychiatric perspectives. In Legal concepts of childhood. Editors Fionda, J. Hart Publishing
John A.M, (2001) Psychological considerations in the child patient. Introduction to podopediatrics. Editors Thompson, P and Volpe, R Churchill Livingston
Skinner, C. John, M, and Hampson, S. (1999). Social support and personal models of diabetes as predictors of self care and well being A Longitudinal study of adolescents with Diabetes. J. of Pediatric Psychology.
Tomes, J and John, A. (1994). 'The Psychological Effects of Chronic Illness on Children and their Families.' In Paediatrics for Chiropodists. Edits. Thomson P. Harcourt Brace & Jovanovich.
John A, (1993) 'Emotional Problems of Children,' In: The Royal Society of Medicine. Child Health Guide. Edited West .R. Octopus.
John, A. & Bradford, R. (1991). Integrating Family Therapy into Paediatrics. A Model. Journal of Family Therapy. Vol. 13 p 207-223.
Bradford, R. & John, A. (1991). The Psychological effects on disaster work, implications for disaster planning. Journal of Royal Society of Health. Vol. 111 June, p 107-110
Recovery has become a central concept in mental health service delivery, and several recovery-focused measures exist for adults. The concept's applicability to young people's mental health experience has been neglected, and no measures yet exist.
The aim of this work is to develop measures of recovery for use in specialist child and adolescent mental health services.
On the basis of 21 semi-structured interviews, three recovery measures were devised, one for completion by the young person and two for completion by the parent/carer. Two parent/carer measures were devised in order to assess both their perspective on their child's recovery and their own recovery process. The questionnaires were administered to a UK sample of 47 young people (10?18 years old) with anxiety and depression and their parents, along with a measure used to routinely assess treatment progress and outcome and a measure of self-esteem.
All three measures had high internal consistency (alpha e 0.89). Young people's recovery scores were correlated negatively with scores on a measure used to routinely assess treatment progress and outcome (r = ?0.75) and positively with self-esteem (r = 0.84). Parent and young persons' reports of the young person's recovery were positively correlated (r = 0.61). Parent report of the young person's recovery and of their own recovery process were positively correlated (r = 0.75).
The three measures have the potential to be used in mental health services to assess recovery processes in young people with mental health difficulties and correspondence with symptomatic improvement. The measures provide a novel way of capturing the parental/caregiver perspective on recovery and caregivers' own wellbeing. Copyright © 2014 John Wiley & Sons, Ltd.
Key Practitioner Message
"No tools exist to evaluate recovery-relevant processes in young people treated in specialist mental health services.
"This study reports on the development and psychometric evaluation of three self-report recovery-relevant assessments for young people and their caregivers.
"Findings indicate a high degree of correspondence between young person and caregiver reports of recovery in the former.
"The recovery assessments correlate inversely with a standardized symptom-focused measure and positively with self-esteem.
This thesis aimed to explore the impact of experiential avoidance on the relationship between alexithymia and psychological wellbeing. Specifically, Part One of this portfolio contains a systematic literature review exploring the current evidence base pertaining to the question: how are alexithymia and experiential avoidance related? The findings of the review suggest that studies consistently report positive, significant relationships between alexithymia and experiential avoidance. Additionally, although there have been some mixed findings from mediation analyses, the weight of evidence currently appears in support of experiential avoidance being a critical mediator in the relationship between alexithymia and poorer psychological wellbeing.
Part Two presents an empirical paper that investigated the mediating role of experiential avoidance in the relationship between alexithymia and experiential avoidance in men. Findings supported experiential avoidance having a mediating role in this relationship, consistent across depression, anxiety and stress. Findings support the conceptualisation of alexithymia as a learned coping response, which develops alongside preferences for avoidant coping more generally i.e. psychological inflexibility.
Parts Three and Four of this portfolio contain details of the clinical experience and academic assignments also completed as part of this clinical doctorate programme.
Design: A cross-sectional, between-subjects? design was used. A clinical group of adolescents and one of their parents were recruited from a Child and Adolescent Mental Health (CAMH) service. A community group of adolescents and a parent were recruited as a comparison group. EE was assessed using the Five Minute Speech Sample (FMSS) with a coding scheme adapted for use with adolescent offspring. Parents completed the FMSS and a measure of psychopathology. Adolescents completed a questionnaire measure of their own anxiety and depression.
Results: Level of parental EE, Criticism and Emotional Over-Involvement was non-significant between the two groups. Level of Warmth and number of positive comments was significantly lower in the clinical group. Parental EE was significantly associated with higher adolescent self-reported symptoms of depression. Parental psychopathology was not associated with parental EE.
Conclusions: EE may be more normative in relation to adolescents compared to other studies. Lack of positive elements of EE may be more of a risk factor for adolescents. However, the cross-sectional design of this study means that causality cannot be inferred.
Key words: Expressed Emotion, Parents, Adolescents, Internalising disorders.
Part two presents an empirical paper of a feasibility study investigating the acceptability and effectiveness of a novel intervention for adolescent males with anger difficulties. The intervention was a short-term group programme based on Acceptance and Commitment Therapy (ACT), delivered in a school setting. Qualitative findings suggested that the participants experienced a number of benefits from the programme and found it acceptable. Quantitative findings suggested a more mixed picture of results; however, inferences made from the quantitative data were limited by the small sample and difficulties with measures. Suggestions for future research are provided.
Aims: The research aimed to understand what a group of parents thought about elements within current parenting programmes.
Method: A q-sort methodology was used to elucidate parental opinion about the parts of a programme that would have the most impact on their ability to parent effectively.
64 parents were asked to sort a number of statements about current parenting programmes on offer using an online tool.
Results: A principal components analysis was undertaken with 60 statements and 64 q-sorts. This yielded three factors that were interpreted to represent three different understandings of parenting programmes. ?A parenting toolkit of skills?, ?Fix me first? and ?Nurture the nurturer?. The factors shared some similarities of what parents report with current programmes on offer (e.g. therapeutic relationship, universal, childcare provision) but also highlighted areas where parents wanted different things. The results are discussed in light of the demographics of the individuals assessed and how this may impact on future parenting programmes.
Conclusion: the results indicated that the main theme overlapped with the typical concepts embedded in well-established programmes in services. There are however a small group of parents where these concepts did not meet their needs. Consideration needs to be given to more mature parents, single parents and fathers.
The assessment of children and young people with history of complex developmental trauma presents a significant challenge to services. Traditional diagnostic categories such as post-traumatic stress disorder (PTSD) are argued to be of limited value, and while the proposed ?Developmental Trauma Disorder? definition attempts to address this debate, associated assessment tools have yet to be developed. This review builds on a previous review of assessment measures, undertaken in 2005.
To identify trauma assessment tools developed or evaluated since 2004 and determine which are developmentally appropriate for children or adolescents with histories of complex trauma.
A systematic search of electronic databases was conducted with explicit inclusion and exclusion criteria.
A total of 35 papers were identified evaluating 29 measures assessing general functioning and mental health (N = 10), PTSD (N = 7) and trauma symptomatology outside, or in addition to, PTSD (N = 11). Studies were evaluated on sample quality, trauma/adversity type, as well as demographic and psychometric data. Distinction was made between measures validated for children (0?12 years) and adolescents (12?18 years).
Few instruments could be recommended for immediate use as many required further validation. The Assessment Checklist questionnaires, designed with a developmental and attachment focus, were the most promising tools.
looked after children : a thematic analysis.,
Background: A growing concern within the looked after community is that there is an over-representation of Black, Asian and minority ethnic young people in the care system; the largest group being children from Black and mixed heritage backgrounds. Aim: The purpose of this research is to contribute to our understanding of the processes involved in peer support development for Looked After Children (LAC) from minority communities
Method: The study gathered information through face-to-face multi-method, interviews informed by a topic guide. The sample comprised of eight young people, both male and female, with their ages ranged from 11- 16 (mean age = 12.88). Results: The three main themes emerged from the data were: learning about each other, levels of closeness, and a sense of belonging. It also found young people from back and dual heritage background hold fairly realist views of LAC by believing they feel sad, experience stigma, struggle with building trusting relationships but should be treated no differently to others. Discussion: This research has also highlighted the potential process used to inform their inclusive nature towards LAC and how this may be related to prosocial qualities and past experiences that are unique to black and dual heritage young people. Conclusion: This research has extended our knowledge on what the views and perceptions black and dual heritage young people have of LAC and can serve as a preliminary base for future studies.
Design: Sixty-four participants (49 female, 15 male, 84% Caucasian, mean age 36) were randomly assigned to either a mindfulness-instructed condition (MI) or non-mindfulness instructed condition (NI). Participants were instructed to colour in designs in a book on 10 occasions over a two-week period. Mindfulness, worry, perceived stress and work-related rumination were measured pre and post the colouring intervention and at one-month follow up. Perfectionism was measured once, prior to the two-week colouring period.
Results: Analysis of Covariance indicated no significant differences between conditions in post-colouring and follow up levels of mindfulness, perceived stress, worry or work-related rumination whilst controlling for pre-intervention scores. Oneway Repeated Measures Analysis of Variance for the whole sample indicated significant increases in acting with awareness and nonreacting mindfulness subscales, and a significant decrease in worry, affective rumination and problem-solving pondering pre-to post intervention. Changes in the nonjudging mindfulness facet pre-to post intervention were found to predict changes in worry from pre-intervention to follow up. There was little evidence of a relationship between perfectionism and change in wellbeing variables.
Conclusions: Colouring, with or without mindfulness guidance, appears to increase aspects of mindfulness and improve wellbeing. Replication of these results, and further research exploring whether colouring is intrinsically mindful is warranted
Background: Looked-after children (LAC) frequently experience greater mental health challenges than the general child population. There has been a call for greater focus on early preventative interventions and priority access to specialist mental health support for this population. Brief mental health screening tools often provide the gateway to services and yet there is a lack of suitable assessment tools available for LAC. The current study is the first to explore the perspectives of foster carers and CAMHS clinicians? in relation to the use of two brief screening tools; the Strengths and Difficulties Questionnaire (SDQ) and the Brief Assessment Checklists (BAC?s).
Method: Qualitative data was collected via semi-structured telephone interviews and face-to-face focus groups with female foster carers (N=13) and clinicians working in a CAMHS setting (N=9).
Results: Thematic analyses generated six themes which were organised into three superordinate themes centred around: 1) relevance to LAC, 2) using measures to inform care planning and; 3) current problems when using psychometric measures within the LAC population. Foster carers and clinicians emphasised the need for a comprehensive understanding of LAC given the complexity of their difficulties. There was acknowledgement that psychometric measures could facilitate and contribute to this by highlighting difficulties, providing accurate feedback to carers and clinicians, and enabling access to support. However, both groups seldom felt that current measures were nuanced enough to adequately capture the needs of LAC.
Conclusion: Screening tools play a crucial role in identifying the mental health needs of LAC and facilitating access to services. Further research is needed to establish the ability of such measures to increase the sensitivity of the complex needs? assessment of LAC. A number of clinical recommendations are also discussed in relation to the assessment of mental health in the LAC population.
Fifteen participants showed an interest in the online mindfulness based intervention phase of the study. Four gave consent to participate, three dropped out, leaving one participant who was successfully recruited into the study. Reliable and clinically significant improvement was only demonstrated for negative repetitive thinking, at post-intervention and follow-up. Eight participants took part in the semi-structured interview, Thematic analysis demonstrated the following themes in relation to feasibility and acceptability Where I am in my HIV Journey Matters, Will it be Worthwhile? Trust is Key, Is it Accessible and Relatable to me, A human connection improves the online mindfulness experience.
The study indicated that an online mindfulness-based course for people recently diagnosed with HIV was not feasible, due to recruitment difficulties. Future studies may benefit from implementing adaptations to the focus and recruitment when conducting research within this population, suggestions of these adaptations can be considered within the themes that emerged.
Introduction: Teachers are often faced with incidences of young people who self-harm but can feel ill-equipped to offer support. The United Kingdom (UK) government state that all staff working in schools should be trained on how to deal with self-harm, yet a large proportion of teachers identify a lack of training as a barrier to supporting students. Barriers to receiving training are a lack of time and resource in schools.
Aim: This study seeks to investigate whether a bespoke eLearning module, designed for UK secondary school teachers, helps to increase knowledge and confidence in supporting young people who self-harm.
Method: Twenty-one schools across the West Midlands and South West of England were contacted via email and invited to complete a 30-minute web-based eLearning module on self-harm in schools. Participants were also invited to complete pre-and post-intervention measures and a follow-up questionnaire. The data was analysed using non-parametric statistics and the free-text comments using Thematic Content Analysis.
Results: 173 teachers completed the eLearning and pre-and post-measures and 16 completed a follow-up questionnaire. The eLearning significantly enhanced participants? perceived knowledge, actual knowledge and confidence in talking to and supporting young people who self-harm. 90.7% of participants felt that eLearning was a good way to receive training. The following themes emerged from the qualitative data: Learning about self-harm is important; eLearning is convenient and accessible; eLearning is less engaging than other modes of training delivery; Training improved my confidence and understanding; The module could be enhanced with further detail and guidance; Wanting ongoing support.
Background: Due to rising in rates in deliberate self-harm (DSH) and increasing pressure on NHS services, the government is looking to schools to provide a front-line response. Previous adolescents have indicated that more information on distress and alternative ways of coping would be helpful. However, teachers have raised concerns that talking about DSH in schools could lead to an increase in prevalence i.e. contagion. Therefore, this study aimed to explore student?s views of a classroom-based intervention on DSH and any potential consequences resulting from this teaching. It hoped to ascertain whether pupils had similar concerns to teachers around contagion following exposure to an intervention.
Method: Sixty-one students in England (years 7-10) participated in 11 focus groups which were conducted in three secondary schools. They discussed their thoughts on having teaching on DSH and what the potential consequences of any teaching might be. Only one of the schools already provided teaching on DSH in the classroom and wider school environments, and their ideas appeared to be informed their experiences of this teaching.
Results: Two themes emerged from the data which were ?Should we talk openly about DSH?? and ?How to talk to openly about DSH?.
Conclusions: The majority of the students within the focus groups expressed a desire to learn about DSH in lessons, with a few expressing concerns about the potential for contagion. All groups discussed ways to reduce the likelihood of contagion occurring. Most felt teaching would have a protective element and reduce DSH. The results indicate teaching on DSH in an open manner in the classroom is warranted, although further research measuring contagion following any intervention would add to the evidence.
Background: There are growing numbers of smartphone apps to support the mental health of young people (YP). The NHS Long Term Plan outlines a key focus on the use of technology to support health and wellbeing. Mental health apps (MHapps) have potential to help YP, but the evidence base for their efficacy is not clear, and research exploring young people?s attitudes towards MHapps is lacking. Further in depth investigations and methodologically robust research are needed, where diverse populations of YP are included in research process, examining the development, content, safety, efficacy, and effectiveness of MHapps.
Objective: This study explores the attitudes of university students (age 18 ? 19) towards smartphone apps for mental health, and perspectives on their use. The purpose is to continue to inform effective design, engagement and evaluation of MHapps for YP.
Method: This study used a qualitative research design, conducting five focus groups with young people aged 18 - 19 years. The data was analysed using Thematic Analysis.
Results: Two major themes emerged: value and engagement ? each contained a number of subthemes. Findings are discussed in context of functionality and delivery of apps; help-seeking and engagement; evidence base; co-production and evaluation of apps; and universality. Implications for policy, practice and future research are discussed.
Conclusions: MHapps have numerous merits among young people, but concerns relating to app design, function and credibility need to be addressed. We should be cautious about a ?one size fits all? approach. There is a need to better understand how YP use MHapps, and it is essential that MHapps are co-designed with young people, clinicians and app developers, and are subject to evaluation.
Background: Eating disorders are most commonly diagnosed in adolescence and when left untreated cause serious psychological and physical harms. Early intervention is most effective at reducing negative outcomes, however there are delays to adolescents recognising a problem and seeking help for eating disorders (Beat, 2017).
Aims: The present study aimed to address a gap in the literature by investigating the gender differences in how young adolescents recognise early signs of eating disorders in their peers, and their intentions to seek help for the problem. The study also aimed to investigate whether a brief film intervention that is focused on adolescent males? experiences of body image concerns had a positive impact on problem-recognition and help-seeking intentions.
Methods: Participants (N=194, 12-13 years, 57% female) from two secondary schools in the UK completed online measures of their recognition of a mental health problem and help-seeking intentions at three time points: before and immediately after watching the film intervention, and at one-month follow up.
Results: Females recognised a mental health problem in a vignette at a higher rate compared to males. Recognition of a mental health problem improved for males and females after the film intervention but more so for males. Help-seeking intentions also improved after the film intervention. However, at one-month follow up much of the gains in recognition and help-seeking intentions were lost.
Conclusions: Adolescent males are poorer at recognising and intending to seek help for eating disorders compared to females, but males can catch up with females following a brief film intervention. More investigation is required into whether gender-sensitive interventions can help maximise the effectiveness of interventions particularly toward gender-related mental health inequalities.
Social and occupational functioning are important for psychological health. However, quantitative research has suggested that these areas can be adversely affected by multiple chemical sensitivity (MCS). This systematic review therefore sought to explore what qualitative research has suggested about how people with MCS perceive it to affect their social and occupational functioning.
Journal articles were included if they were 1) peer reviewed 2) qualitative or mixed methods 3) published in English 4) reported qualitative findings relevant to the review. Studies were excluded if they were 1) descriptive only 2) primarily concerned with environmental intolerances other than chemicals or 3) focussed on specific populations such as veterans. Quality was assessed using the National Institute for Health and Care Excellence (NICE, 2018) qualitative quality criteria. However, quality was not used to determine eligibility for inclusion. Six databases (CINAHL, Medline, PsychArticles, PsychInfo, Scopus and Web of Science) were searched between the 24th of February 2019 and 2nd of March 2019.
Having removed duplicates, database searches identified 388 potential articles. Thirteen of these articles were eligible for inclusion. Following review, no more articles were included from the reference lists of these studies. Meta-aggregation of the findings identified seven categories. These were synthesised into three themes; ?limited access?, ?loss & anxiety? and ?seeking engagement?.
The findings suggested that MCS limits some people's social and occupational functioning. The results warrant further research, and, the development of prevention and intervention strategies. Studies predominantly recruited United States and Canadian females and had several limitations.