Surviving moment to moment is characterized by a state of emotional flux and uncertainty about one's destiny, where the person has not fully committed to either life or death. Within this state, there are two interlinked subprocesses, whereby the person is leaning more towards death or life. A critical feature in working with this client group is to recognize their ambiguity and the fragility and temporality of their decisions about their destiny. The practitioner has an opportunity to be a catalyst in the momentum towards life by demonstrating understanding of this survival struggle and tailoring intervention to fit with the nuanced processes within this state.

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Background:The mental health of university-level students has become a global concern due to the increased level and complexity of mental health presentations among students and the rise in demand for university-level counselling services, often the primary source of support for these students. However, to date, few studies have explored counsellors' experiences of working in this context. Aim:To explore counsellors' experiences of providing counselling to students in university-level institutions in Ireland. Method:This interpretative phenomenological analysis (IPA) study used one-to-one semi-structured interviews to capture the lived experience of qualified counsellors who were actively providing counselling in university-level institutions (N = 8). Data were analysed following the six stages of the IPA analytic method.Findings: Two superordinate themes were identified: 'fighting for recognition' captures participants' struggle to gain and/or maintain a sense of value in their professional identity and to explain the complexity of their role to others; and 'zigzagging' describes how they need to respond flexibly and creatively to meet student needs in a context that is unpredictable and evolving. Conclusion:The study highlights the growing complexity of the university-level student counsellor role and identifies the challenges and rewards associated with working in this context. It suggests the importance of role recognition and counsellor capacity to adjust to protect their well-being and ultimately the quality of the service provided to students.

This qualitative study explored how the process of becoming an integrative psychotherapist is experienced, understood and facilitated during psychotherapy training. Semistructured individual interviews were used to capture the perspectives of students undergoing integrative training, recent graduates, and current trainers of integrative psychotherapy programs in Ireland and the United Kingdom (N = 12). Thematic analysis revealed 2 major themes, “finding meaning” and “the right ingredients.” The first theme describes how becoming an integrative psychotherapist was experienced as a complex and challenging yet rewarding journey that involved coming to an understanding about the meaning of integration and forming an identity as an integrative psychotherapist in a context of uncertainty. The second theme captures the view that this process may be smoother for students with an open-minded and reflective disposition, and that integration is facilitated by having a clear integrative focus early in student development, using integrative teaching methods, and having a dedicated integrative teaching team. Understanding this process may help trainers to anticipate and explicitly address the challenges faced by students, and provide students with a framework to understand and map their own developmental process. It is suggested that the various definitions of integrative psychotherapy may contribute to the challenges in coming to an understanding of this approach and developing an identity as an integrative psychotherapist. Thus, promoting the field of integration as an integrated whole might prove a fruitful endeavor in the future.

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Apolipoprotein E (apoE) belongs to a large heterogeneous family of lipid-binding proteins and is produced by a variety of tissues including the brain and liver where it subserves a diversity of functions. The primary metabolic role of apoE is as a key regulator of cholesterol and triglyceride transport between cells. It has three isoforms, E2, E3 and E4, and genetic variation in the distribution of these isoforms are associated with plasma lipid levels and atherosclerosis; the E4 isoform is also associated with increased risk for Alzheimer's disease, impaired cognition and decreased neurite outgrowth. As both lipid metabolism and synaptic connectivity are disturbed in schizophrenia and bipolar disorder, the role of apoE has been investigated in these disorders. The majority of studies have focused on the association between the genetic polymorphisms of apoE and schizophrenia with inconsistent results; however, measurement of protein apoE levels in the brain report changes in both disorders. We report here the fi rst study to our knowledge of measurement of plasma apoE levels in subjects with schizophrenia and bipolar disorder in a medication-free state and following 6 weeks of treatment. In both medication-free schizophrenia and bipolar disorder subjects, plasma apoE levels were signifi cantly decreased compared with control subjects and although there were increases in both groups following treatment, levels were still signifi cantly less than for the control group. These results will be discussed in reference to their implications for altered lipid metabolism in these two disorders and the potential for the development of therapeutics to rectify these defi cits leading to improved health outcomes for people with schizophrenia and bipolar disorder. Identifying Gene-brain Markers of Cognition and Emotion: Implications for Psychiatric Disorders L WilliamsThe Brain Dynamics Centre, Westmead Millennium Institute, Westmead Hospital and Discipline of Psychological Medicine, University of Sydney, Australia OverviewThis symposium reviews the biological underpinnings of particular genes and will examine biological markers of emotional and cognitive dysfunction in healthy samples. The data presented will be drawing from a standardized integrative database that includes measures of neural and autonomic activity, and behaviour. In particular, the interacting effects of environmental infl uences (stress) will be examined, as well as moderating effects of gender. This work was supported by an ARC-linkage grant (LP0455104).