Health care professional's relationships with those who self harm have been found to be failing, characterised by negative staff attitudes leading to a phenomenon termed 'terminal malignant alienation' prior to client suicide (Morgan, 1979). Greater understanding of attitude and care experience is vital to enhancing care process and its outcomes. A mixed method approach was required to examine both meanings given to care experience and attitudes of a large group of qualified nurses attending post qualification courses. The phenomenology of the care experience of six participants, carer, clients and their nurses is the focus of Study 1. Four essential themes (van Mannen 1990) were derived; Trying Hard Getting No where (Past relating) Time Strain and Apprehension, Incongruent Relating and Acceptant Engagement. A transition in ways of relating is emergent in these themes and sub themes which is marked by movement from nurse/carer focus on control of self harm and the repeated experience of strain apprehension, avoidance and disempowerment, to greater acceptance of client experience. Shared responsibility and more authentic relationships are accompanied by diminished belief that self harm is a direct reflection of carer effort and competence. Study 2 describes both the development of a thirty item Self Harm Antipathy Scale (SHAS) and six attitude dimensions derived using exploratory factor analysis and a survey of attitudes to self harm (n=153). Between groups analysis using the Mann-Whitney test showed that; previous study of self harm and contact with self harming clients was associated with more positive attitudes (p<.05) and general nurses held more negative attitudes than participants with mental health qualifications. Gender and years of experience and age were not found to be related to attitudes to self harm (p>.05). Qualitative content analysis of written responses in the questionnaire informed by Carper (1978), revealed three main themes describing attitudes and perspectives on care; 'Need for knowledge understanding and skill; 'Care Strain; reactions and feelings '; 'Therapeutic Approach and Treatability '. Analysis revealed tension and contrast between awareness of professional care values, perceived competence and personal feelings. Study 3 investigated the effect on attitude of a post qualification course on self harm. In a quasi-experimental design utilising an intervention and comparison group, participant's attitudes were measured immediately on course commencement and twice following course completion. Analysis using within groups Wilcoxon test on post course scores (n=65) revealed less antipathy in the intervention group; scores were significantly lower on both the SHAS scale and 4 attitudes dimensions derived from factor analysis (p<.05); Care Futility; Client Intent; Rights and Responsibilities; Needs Function. The intervention group demonstrated more belief in the value of care, less critical motivational attributions and more recognition of client responsibility and need. In a comparison group (N=22), (no teaching on self harm), no significant difference was found between pre and post test SHAS on 5 of the 6 attitude dimensions (p>.05). It was concluded that attitude, perceived competence can be positively influenced by the educational intervention and optimise the potential to restore caring and therapeutic qualities to alienated relationships. Clinical supervision is recommended as a resource for enhancing practice and a means of promoting learning for those who cannot access formal courses on self harm.

Thesis (M.Psyc.)--University of South Africa, 2001.

Thesis (M.Psyc.)--University of South Africa, 2001.

The purpose of this study is to provide descriptions of conversations with survivors of suicide, including their relationships with the persons who committed suicide, the relationships that followed these deaths, their experiences of suicide, and the way that they made sense of these deaths. The epistemological framework of this dissertation is ecosystemic and social constructionist. This study involved in-depth interviews with three suicide survivors, exploring personal and professional domains. Thematic analysis was the method used to generate patterns of meaning. The researcher recounted the research participants' stories and punctuated emergent themes and patterns according to what she deemed important. Each story was contextualised, and included reflections of the researcher. Themes both common and unique to each participant story were highlighted and discussed. The information yielded from this study could have value to survivors of suicide and psychotherapists whose clients commit suicide. / Psychology / M.A. (Clinical Psychology)

Text in Afrikaans / Selfmoord is 'n kontroversiele aangeleentheid wat beide omstanders en agterblywendes met onsekerheid vervul. 'n Belangrike rede hiervoor is dat dit 'n onnatuurlike afsterwe is wat teen baie mense se norme en waardes indruis. ldiografiese navorsing is onderneem om die belewenisse van agterblywende gesinslede te ondersoek aangesien hulle die eintlike slagoffers van 'n selfmoord is wat met 'n komplekse realiteit gelaat word. Die doel van die navorsing was om riglyne daar te stel vir die hantering en ondersteuning van hierdie mense. Vanuit 'n in-diepte literatuurstudie, het dit geblyk dat die grootste probleme waarmee agterblywendes gekonfronteer word, wentel random problematiese emosies, veroordeling deur omstanders en belewings van persoonlike onvermoe om te midde van intense rousmart selfaktualisering optimaal te volvoer. 'n Vraelys wat aspekte (socs dit uit die literatuurstudie geblyk het) inkorporeer, is opgestel en aan agterblywendes gegee om te beantwoord. Van die belangrikste elemente wat na vore gekom het, is dat intense verhoudingskomplikasies na 'n selfmoord figureer, dat agterblywendes 'n behoefte het om rouverwerking teen hul eie tempo te doen, dat agterblywendes verkies dat omstanders nie voortdurend die gebeure sal ontleed en soek na oorsake in die teenwoordigheid van agterblywendes nie en dat elke agterblywende persoon se roubelewing persoonlik en uniek is. 'n Hoofstuk is gewy aan 'n wye verskeidenheid terapeutiese tegnieke wat geimplementeer kan word tydens hulpverlening aan agterblywendes. Die studie beskryf ook 'n gevallestudie en die verloop van sestien individuele terapeutiese sessies. In die terapeutiese insette is daar hoofsaaklik gebruik gemaak van hipnoterapie as 'n vorm van ontspanningsterapie waartydens daar gelokus word op problematiese emosies en persepsies wat voortgesette kwalitatiewe selfaktualisering belemmer. In die studie word Opvoedkundige Sielkundige riglyne vir hulpverlening aan agterblywendes, wat benut kan word deur hulpverleners (soos sielkundiges, onderwysers en ander ondersteuningsisteme). verskaf. Die studie bevestig dat die agterblywendes as die werklike slagoffers na 'n selfmoord agtergelaat word, maar dat sinvolle intervensie hierdie persone in staat kan stel om ten spyte van die gebeure weer optimaal te selfaktualiseer. / Suicide is a controversial topic. It causes both bystanders and survivors to feel insecure. An important reason for this is that it is an unnatural death which directly opposes the norms and values of the majority of people. ldiografic research has been undertaken to closely examine the experiences of suicide survivors as they are the real victims who are left to cope with a complex reality after a suicide. The objective of this study was to provide guidelines to effectively manage and render assistance to survivors. From an in depth review of available literature it appeared that troubled emotions, being denounced by bystanders and the inability to proceed with continued qualitative self-actualization are some of the most important problems survivors have to cope with. A questionnaire, incorporating significant aspects reported in literature, was compiled and given to survivors to complete. From their responses certain facets seemed to be problematic. Among the more problematic aspects were complicated interpersonal relations, the basic need to grieve at their own pace, the preference that bystanders avoid analysing the suicide and possible contributing factors (especially in the presence of survivors) and the recognition that each survivor's grief is personal and unique. A chapter has been devoted to a wide range of therapeutic techniques that can be implemented to facilitate the support given to survivors. The study also describes a case study as well as the progression of sixteen individual therapy sessions. Therapeutic intervention was mainly based on hypnotherapy as a form of relaxation therapy during which the focus is placed on problematic emotions and perceptions which prevent continued qualitative self-actualization. Educational Psychological guidelines along which assistance can be rendered by psychologists, teachers as well as other support services are given. This study not only confirms that the survivors are the actual victims of a suicide, but also that it is possible to assist these people to achieve optimal self-actualization through meaningful intervention. / Psychology of Education / D. Ed. (Sielkundige Opvoedkunde)

The purpose of this study is to provide descriptions of conversations with survivors of suicide, including their relationships with the persons who committed suicide, the relationships that followed these deaths, their experiences of suicide, and the way that they made sense of these deaths. The epistemological framework of this dissertation is ecosystemic and social constructionist. This study involved in-depth interviews with three suicide survivors, exploring personal and professional domains. Thematic analysis was the method used to generate patterns of meaning. The researcher recounted the research participants' stories and punctuated emergent themes and patterns according to what she deemed important. Each story was contextualised, and included reflections of the researcher. Themes both common and unique to each participant story were highlighted and discussed. The information yielded from this study could have value to survivors of suicide and psychotherapists whose clients commit suicide. / Psychology / M.A. (Clinical Psychology)

Text in Afrikaans / Selfmoord is 'n kontroversiele aangeleentheid wat beide omstanders en agterblywendes met onsekerheid vervul. 'n Belangrike rede hiervoor is dat dit 'n onnatuurlike afsterwe is wat teen baie mense se norme en waardes indruis. ldiografiese navorsing is onderneem om die belewenisse van agterblywende gesinslede te ondersoek aangesien hulle die eintlike slagoffers van 'n selfmoord is wat met 'n komplekse realiteit gelaat word. Die doel van die navorsing was om riglyne daar te stel vir die hantering en ondersteuning van hierdie mense. Vanuit 'n in-diepte literatuurstudie, het dit geblyk dat die grootste probleme waarmee agterblywendes gekonfronteer word, wentel random problematiese emosies, veroordeling deur omstanders en belewings van persoonlike onvermoe om te midde van intense rousmart selfaktualisering optimaal te volvoer. 'n Vraelys wat aspekte (socs dit uit die literatuurstudie geblyk het) inkorporeer, is opgestel en aan agterblywendes gegee om te beantwoord. Van die belangrikste elemente wat na vore gekom het, is dat intense verhoudingskomplikasies na 'n selfmoord figureer, dat agterblywendes 'n behoefte het om rouverwerking teen hul eie tempo te doen, dat agterblywendes verkies dat omstanders nie voortdurend die gebeure sal ontleed en soek na oorsake in die teenwoordigheid van agterblywendes nie en dat elke agterblywende persoon se roubelewing persoonlik en uniek is. 'n Hoofstuk is gewy aan 'n wye verskeidenheid terapeutiese tegnieke wat geimplementeer kan word tydens hulpverlening aan agterblywendes. Die studie beskryf ook 'n gevallestudie en die verloop van sestien individuele terapeutiese sessies. In die terapeutiese insette is daar hoofsaaklik gebruik gemaak van hipnoterapie as 'n vorm van ontspanningsterapie waartydens daar gelokus word op problematiese emosies en persepsies wat voortgesette kwalitatiewe selfaktualisering belemmer. In die studie word Opvoedkundige Sielkundige riglyne vir hulpverlening aan agterblywendes, wat benut kan word deur hulpverleners (soos sielkundiges, onderwysers en ander ondersteuningsisteme). verskaf. Die studie bevestig dat die agterblywendes as die werklike slagoffers na 'n selfmoord agtergelaat word, maar dat sinvolle intervensie hierdie persone in staat kan stel om ten spyte van die gebeure weer optimaal te selfaktualiseer. / Suicide is a controversial topic. It causes both bystanders and survivors to feel insecure. An important reason for this is that it is an unnatural death which directly opposes the norms and values of the majority of people. ldiografic research has been undertaken to closely examine the experiences of suicide survivors as they are the real victims who are left to cope with a complex reality after a suicide. The objective of this study was to provide guidelines to effectively manage and render assistance to survivors. From an in depth review of available literature it appeared that troubled emotions, being denounced by bystanders and the inability to proceed with continued qualitative self-actualization are some of the most important problems survivors have to cope with. A questionnaire, incorporating significant aspects reported in literature, was compiled and given to survivors to complete. From their responses certain facets seemed to be problematic. Among the more problematic aspects were complicated interpersonal relations, the basic need to grieve at their own pace, the preference that bystanders avoid analysing the suicide and possible contributing factors (especially in the presence of survivors) and the recognition that each survivor's grief is personal and unique. A chapter has been devoted to a wide range of therapeutic techniques that can be implemented to facilitate the support given to survivors. The study also describes a case study as well as the progression of sixteen individual therapy sessions. Therapeutic intervention was mainly based on hypnotherapy as a form of relaxation therapy during which the focus is placed on problematic emotions and perceptions which prevent continued qualitative self-actualization. Educational Psychological guidelines along which assistance can be rendered by psychologists, teachers as well as other support services are given. This study not only confirms that the survivors are the actual victims of a suicide, but also that it is possible to assist these people to achieve optimal self-actualization through meaningful intervention. / Psychology of Education / D. Ed. (Sielkundige Opvoedkunde)