Attention is an acknowledged component of the therapeutic relationship that is the heart of clinical work and the base of competence. The centrality of the therapeutic relationship itself has been recognized throughout the history of clinical work. The clinician’s work is based, in part, in attending to the client by actively and openly listening to the client with attention and engagement. However, attention has been lacking within mental health disciplines to what occurs within the process of clinical attention. As a result, little knowledge exists about the structure of clinical attention itself. This dissertation studied the structure of clinical attention to understand what occurs when clinicians attend to their clients in sessions. The thesis focused on the internal processes occurring within the clinician, not on actions or interventions taken in sessions. The literature review grounded the study theoretically in mind science and contemplative science, the study of reality grounded in both objective and subjective experience. The literature review also conceptualized attention in its sub processes of mindfulness, meditation, reflective practice and affect regulation, examining literature relevant to those constructs as well as to the history, philosophy and psychology of attention. The literature revealed a lack of knowledge of the structure and process of clinical attention. Using the extant literature, a new theoretical framework of attention was constructed. Attention was conceptualized as composed of levels of pre-reflective and reflective attention as related to the attention sub processes. A phenomenological methodology was used to study the structure of clinical attention in relation to holistic competence. Fourteen clinicians, all of whom met the criteria for attaining expertise in the use of attention in their clinical work, participated in an explicitation interview. Data analysis followed a modified phenomenological methodology in a series of steps as the data were grouped in invariant constituents, reduced to emergent themes and analyzed for a textural structural description from which a structural description was constructed. From the structural description was distilled the essence of clinical attention. Clinical attention was seen to consist of a dynamic and iterative process of intention and intuition. Intention and intuition were seen to be based in different attentional levels, both of which were recursively and iteratively related to attention’s construction as a process grounded in inner awareness providing the potential abilities to reflect on experience and regulate affective experience. The study concluded with a discussion of the relationship of the skill of clinical attention to a holistic competence based in levels of procedural capability focused on concrete behavioural action and meta competence focused on clinical judgment, self-awareness and self-reflection on the actions taken. The implications of the study’s findings for training clinicians in attention were discussed.

Reform as a social process is underresearched in the case of Tibet. This study addresses this gap using Social Movement Theory, which sees social change as a complex process involving various Tibetan social groups and external reformers, the Communist Party of China (CPC). This approach was applied by comparing recruitment and mobilization efforts of several key internal and external reform movements in 20th century Tibetan history. Findings include that internal reform failures can be explained by their narrow social and geographic basis and limited mass appeal. Moreover, initial CPC reforms succeeded through recruitment and mobilization across Tibetan regions and social groupings. Subsequent reforms failed due to decreased attention to recruitment and mass mobilization of Tibetans. A major implication of the study is that understanding social reform in today’s Tibet requires a SM Theory approach, which currently is lacking among scholars of the Tibetan question and political representatives of both sides.

The Canadian Incidence Study on Reported Child Abuse and Neglect (Trocme, 2001) found that structural factors such as poverty, poor housing and substance misuse contribute to the over-representation of First Nations children in child welfare care and yet there is very little information on the experiences of First Nations and Non-Aboriginal children after they are placed in care. The When Everything Matters study tracks First Nations and Non-Aboriginal chlidren removed from their families between 2003-2005 in Nova Scotia to the time of reunification or to the time of data collection if the child remained in care. The characteristics of children and their families are compared to the primary aims of child welfare services provided to children and their families. Results indicate that poor families living in poor housing are graphically over-represented among all families who have their children removed. Poverty-related services were not provided to families in proportion to its occurrence. Caregiver incapacity related to substance misuse was most often cited as the primary reason for removal and although substance misuse services were provided there is a need for further child welfare training, policy and services in this area given the scope of the problem presenting in both First Nations and Non-Aboriginal families. Study findings are nested in a new bi-cultural theoretical framework founded in First Nations ontology and physic's theory of everything called the breath of life theory. Implications for theoretical development as well as child welfare research, policy and practice are discussed.

Many children and their families who seek assistance for childhood behaviour disorders experience comorbid disorders, namely the presence of two or more disorders. Although comorbid disorders are recognized as a frequent clinical complication, minimal direction exists within the literature about the risk factors for comorbid conditions and how best to provide intervention services. In this study an ecological framework was used to compare the individual, family, and community environmental contexts of young girls who presented at intake at a children’s mental health centre with comorbid externalizing and internalizing disorders, and girls who presented at intake with externalizing disorders only. The treatment response to a cognitive-behavioural intervention for externalizing behaviour disorders was examined, by comparing externalizing scores over time between girls with comorbid externalizing and internalizing disorders and girls with externalizing disorders only. Additionally, internalizing scores over time for girls with comorbid disorders were examined. Results indicated that a history of abuse and a cluster of individual characteristics placed girls at higher risk to present with comorbid conditions. The results also indicated that girls with comorbid disorders experienced a reduction of both externalizing and internalizing symptoms. Only 1 in 7.4 girls, however, scored below the clinical range for both externalizing and internalizing disorders at the end of the treatment phase, in comparison to 1 in 5 girls scoring below the clinical range for externalizing disorders in the noncomorbid group.

This study uses institutional ethnography (IE) to address the question of how young women, considered to be “at risk” youth, make decisions about their working lives. Based on interviews with young women and program workers in housing, employment, young mothers’ and girls’ programs, field observations, and document analysis at Gen-Y (pseudonym for a women’s community-based social services agency), young women’s provisioning experiences are used to critique current program and policy models that feature notions of choice and risk. Provisioning is a concept that captures a wide range of work and work-related activities that young women perform for themselves and people they feel responsible for. IE is applied to understand how institutional processes and practices give rise to the conditions under which young women participants at Gen-Y make career and life decisions.

The impetus for this study came from my own history of being a single mother while completing my undergraduate degree and the struggles that entailed. The research uncovers both the barriers and facilitators experienced by single mothers in undergraduate programs in a Canadian context and utilizes a framework of access and equity in education. The co-participants belonged to diverse social and political identities in terms of age, race and ethnicity, sexuality, (dis)ability, and countries of birth. All the women attended universities in Southern Ontario. Twenty-five women agreed to be interviewed in either a group or individual interview. Co-participants were encouraged to contribute to the design and analysis of the study wherever possible. Previous research based in the United States conceptualized single mother students as social assistance recipients and explored their difficulties within this context. This study suggests using a wider lens to include other experiences identified by co-participants and the literature review. The study locates barriers both within the university as well as in the larger society such as interpersonal violence, stress, financial insecurity, racism and other forms of discrimination. However, it also identifies supports and strengths single mothers encountered such as family, friends, children as motivation, professors, on-campus supports, and critical pedagogy, all of which were largely missing from previous research. Many women challenged the often pathologizing dominant discourse and instead described single motherhood as empowering, independent, and liberating as compared to being a part of a traditional nuclear family. Co-participants also identified feeling isolated, discussions around which engendered a social group outside of the research project. By creating awareness of the needs of diverse single mother students, this project aims to disrupt the still-prevalent notion of the “traditional student” and accompanying policies and practices in institutions of education and the wider community. While much has been documented in Canada about the need for access, equity, and inclusive schooling, single mothers in particular have not been a main focus and included among other intersections of identity. The findings from this study address this gap and contribute to the literature.

Families who are dissatisfied with the nursing home care of their family member may supplement their care by hiring a private companion. Families who have the financial resources pay for extra care, while families who cannot afford a private companion receive the current standard of care. Anecdotal evidence suggests that private companion use has increased over time. However, there is no research that examines private companions. The goal of this mixed methods study was to provide empirical evidence about who private companions are, what they do, and why they are needed. Andersen and Newman’s Health Service Utilization Model was used to understand private companion use. This study used both survey research and grounded theory. A mailed survey was completed by 280 of 432 family members of nursing home residents in a Toronto nursing home, yielding a response rate of 65 percent. Grounded theory principles were used to conduct interviews with 10 family members to understand why private companions were hired. Almost two-thirds of nursing home residents had a private companion. Family members reported that they paid about $475 per week for private companions who provided about 40 hours of care per week. Private companions were mostly women and immigrants. Private companions performed many activities including assisting with activities of daily living, toileting, feeding, escorting to activities, and providing social support. In the survey, family members reported hiring a private companion for reasons related to families’ needs (e.g. quality of care concerns), residents’ needs (e.g. deteriorating health); and staff recommendations. The family members reiterated these reasons in the interviews. Quality of care was the overarching theme that captured the reason for private companion use, which encompassed the following themes: inadequate staffing, unmet residents’ needs, overburdened family members, and suboptimal nursing home environment. The qualitative data emphasized the importance of building relationships with nursing home residents. The predictors of private companion use in the multivariate analysis were longer duration of nursing home stay, higher resident dependency, and family members’ concerns with quality of care. This research is among the first to study private companions, and has implications for research, policy, and practice.

Attention is an acknowledged component of the therapeutic relationship that is the heart of clinical work and the base of competence. The centrality of the therapeutic relationship itself has been recognized throughout the history of clinical work. The clinician’s work is based, in part, in attending to the client by actively and openly listening to the client with attention and engagement. However, attention has been lacking within mental health disciplines to what occurs within the process of clinical attention. As a result, little knowledge exists about the structure of clinical attention itself. This dissertation studied the structure of clinical attention to understand what occurs when clinicians attend to their clients in sessions. The thesis focused on the internal processes occurring within the clinician, not on actions or interventions taken in sessions. The literature review grounded the study theoretically in mind science and contemplative science, the study of reality grounded in both objective and subjective experience. The literature review also conceptualized attention in its sub processes of mindfulness, meditation, reflective practice and affect regulation, examining literature relevant to those constructs as well as to the history, philosophy and psychology of attention. The literature revealed a lack of knowledge of the structure and process of clinical attention. Using the extant literature, a new theoretical framework of attention was constructed. Attention was conceptualized as composed of levels of pre-reflective and reflective attention as related to the attention sub processes. A phenomenological methodology was used to study the structure of clinical attention in relation to holistic competence. Fourteen clinicians, all of whom met the criteria for attaining expertise in the use of attention in their clinical work, participated in an explicitation interview. Data analysis followed a modified phenomenological methodology in a series of steps as the data were grouped in invariant constituents, reduced to emergent themes and analyzed for a textural structural description from which a structural description was constructed. From the structural description was distilled the essence of clinical attention. Clinical attention was seen to consist of a dynamic and iterative process of intention and intuition. Intention and intuition were seen to be based in different attentional levels, both of which were recursively and iteratively related to attention’s construction as a process grounded in inner awareness providing the potential abilities to reflect on experience and regulate affective experience. The study concluded with a discussion of the relationship of the skill of clinical attention to a holistic competence based in levels of procedural capability focused on concrete behavioural action and meta competence focused on clinical judgment, self-awareness and self-reflection on the actions taken. The implications of the study’s findings for training clinicians in attention were discussed.

No description available.

This study was based on the premise that most people made funeral arrangements only after a death had occurred and within a setting of emotional turmoil. The desire of the study was to make available material, and instruction which would help to prepare the practical materials, providing information for the survivors of the deceased listing the desires of the deceased for his or her bodily disposal. When this material had been completed it was found that over seventy percent of those who used the material, made their actual funeral arrangements or consciously made known their desires for their funeral arrangements, either in writing or verbally, before any time of trauma or crisis, and made others significantly more alert to the planners real desires for such a time. The over sixty-five (65+) age group is closer in years to the time of death when time is considered in the biological development of life. This age group will naturally have a larger percentage of deaths per thousand of population than any other age group in America. Florida contains the largest number of persons within this age group of any state. Our ministry location presents added problems in death crisis times because of location and problems of relationships to other geographic locations. Age, also, opens a door to the awareness of the need for pre-preparation that is usually ignored at other times of life. This same 'age' provides for the opportunity for an unusual ministry of pre-preparation. It is this ministry which was planned for and evolved from this study project. The average age and health conditions of the membership of the congregation to which the study was directed, provided a sense of urgency and emphasized the need for this act of ministry. This program resulted in financial outlay decrease. Emotional upset was seemingly eased for each participant. The study reflects information that could be available to any group that shows elements of interest for such a ministry. Although the study deals with an emotionally sensitive area, it also helps to remove the concept of morbidity which is found ingrained into the minds of many of the people who are approached on this subject. This study is, above all, a report of what is (in age and death) and what can or should be accomplished through a ministry of pre-preparation. Chapter VI stands alone as the focus of this study. It contains the goals toward which and from which the act of ministry evolved.