To date, research examining psychological adjustment to cleft lip and/or palate (CL/P) has produced conflicting findings. As a consequence, large gaps in our understanding of CL/P remain, ultimately impacting the ability to implement and evaluate psychological support for this population. The work presented in this DPhil discusses the conceptual and methodological challenges associated with this field in accordance with three key underlying themes: outcomes, methods and neglected groups, in an attempt to explain why these conflicting findings occur and to offer an alternative perspective. Specifically, this doctoral thesis proposes the need for an approach which is holistic rather than narrow, inclusive rather than exclusive, normalising rather than pathologising, appreciative of the patient perspective and encompassing of patient strengths and positive growth.