The Visual Reproduction subtest of the Wechsler Memory Scale – Revised has been widely used in neuropsychological assessment as a measure of visual memory since its publication in 1987 by Wechsler. Mindful of practice effects in serial assessment, a potential limiting factor in assessing recovery or decline with this subtest is the absence of an alternative form. This study aimed to develop an alternative form and a scoring system for this form. The scoring system was modelled on a revised scoring system for the original version developed by Clark (2000). Additional procedures, namely a cued recall and recognition format, were included in the administration to improve the diagnostic utility of the subtest. Evaluation of the psychometric properties of the Alternative Form, based on the administration of both versions to an unselected adult non-clinical population (n = 44, aged 25-51) revealed high internal reliability, good convergent validity and satisfactory discriminant validity with other verbal and visual memory tests. Moreover, there was a good correlation between the Alternative Form and the Visual Reproduction subtest of the Wechsler Memory Scale – Revised, taking into account the test-retest reliability of the original version. Hence, this Alternative Form has the potential to be a useful addition to clinical practice with further refinement of the scoring criteria and development of normative data via administration to a larger sample that has a wider age range and intelligence.

Obstructive sleep apnoea (OSA) is a complex disorder of neural respiratory control and upper airway dysfunction that results in repeated complete and partial occlusion of the upper airway during sleep. Obstructive sleep apnoea has been linked to fatigue, increased rates of road and work-related accidents and deficits across a range of neurocognitive domains. The most widely used treatment for OSA is continuous positive airway pressure (CPAP). This study aimed to compare neurocognitive functioning, simulated driving performance, vigilance, objective and subjective sleepiness in patients with moderate to severe OSA with control participants before and after treatment with CPAP. It was hypothesised that patients with OSA would report higher levels of subjective sleepiness, perform poorer on a simulated driving task and neurocognitive tests, demonstrate reduced vigilance and reaction times, and show increased objective sleepiness in comparison to control participants. It was also hypothesised that performance in these tasks would improve in OSA patients following CPAP treatment. Fifteen patients (12 males and 3 females) with moderate to severe OSA between the ages of 40 and 71 were recruited from the Austin and Repatriation Medical Centre and 15 healthy controls (12 males and 3 females) aged between 37 and 70 matched for gender and closely matched for age and weight were recruited from the community. Participants were assessed on a driving simulator, psychomotor vigilance task and a battery of neurocognitive tests. The results showed that OSA patients displayed significant impairments related to daytime sleepiness and a novel finding of this study was that OSA patients demonstrated a lowered capacity for procedural learning. The current study also found that following CPAP treatment, OSA patients improved on measures of sustained attention, reaction time, simulated driving performance, memory and procedural learning. Findings of the present study indicate the importance of detecting impairments relating to performance in OSA patients in order to minimise the risk of accidental injury to themselves or others. Increased sleepiness and deficits in simulated driving and neurocognitive tasks may be alleviated with CPAP treatment. Continued research into this area is warranted so that significant consequences for the quality of life of patients and for other road users can be identified.

Mental illness including depression has been estimated to account for 11% of the world's disease burden with the expectation that this figure will rise to in excess of 15% by the year 2020 (AIHM, 2002; Australian Health Ministers, 1998). Women have been reported to be twice as likely as men to experience depression, making depression a significant public health issue for women. How individuals perceive themself to be at risk has important implications for understanding help seeking behaviour and in turn, diagnosis and treatment outcomes. A number of factors have been identified in the physical health literature that account for the way perception of risk is conceptualised. The present study was designed to explore perception of risk of depression from the perspective of optimistic bias. The work of Weinstein (1980) and Moore and Rosenthal (1996) identify factors such as perceived seriousness, perceived control, stereotyping, perceived commonness, knowledge of a sufferer, perceived knowledge of the illness and attitude to the illness, as potentially influencing a person's perception of personal risk. Weinstein (1980) developed a model for integrating these factors, called optimistic bias. This model has been studied in relation to perception of risk for cancer, sexually transmitted diseases and other physical illnesses, but not in relation to mental illness. Two conceptualizations of optimistic bias were tested in this study, i) as a series of semi-independent illness specific constructs, and ii) as a global personality construct. The value of the Weinstein model for predicting perception of risk of depression was explored in relation to three physical illnesses (HIV/AIDS, Diabetes and Breast cancer). In addition women's conceptualizations of depression were explored in relation to depressive status and ability to recognize typical symptoms of depression. A non- clinical sample of one hundred and five women over the age of 18 were recruited with each participant required to complete a series of questionnaires that were quantitatively analysed. The model of optimistic bias as a series of semi-independent (state) constructs did significantly predict perception of risk for depression, accounting for 27.8% of the variance. The personality model of optimistic bias was also significant for predicting perception of risk of depression, but significantly less powerful accounting for only 8.2% of the variance. Part of the analysis for this study involved a replication of the work by Moore and Rosenthal (1996) utilising both descriptive and inferential data analyses to determine which variables predicted perception of risk of depression with two factors, perceived control and knowledge about the illness, revealed to be most significant. This study found that the illness specific model was more applicable to depression than to physical illness. Perception of risk was demonstrated by the comparative profiles to be different for each illness with the women in this study able to list a number of categories of stereotypical sufferers. A frequency analysis was also conducted to explore the similarities and differences in conceptualisation of the illnesses. Results indicated that 57% of women within the sample reported levels of clinical depression. Evidence emerged that among those who reported clinical levels of depression a subset were unable to recognise depression. A woman's depressive status and her ability to recognise depression from a scenario appeared to influence perception of risk. These results highlight important theoretical and applied implications for health promotion as well as the treatment and management of depression.

The social model of disability requires that research about disability should be controlled and managed by people with disabilities themselves. Traditional research has tended to marginalise people with disabilities, and the outcomes have been meaningless and irrelevant to them. Three years ago I approached a small disability advocacy organisation, and through six months of collaboration with Disability Justice Advocacy (DJA), the need for a strategic plan was identified. Developing a strategic plan for DJA became a vehicle for exploring the primary aim of my research, which was to conduct participatory action research with people with disabilities, and to examine its value as an empowering research practice. The literature indicates that while participation, and participatory action research in particular, has the potential to empower people with disabilities, it can also serve to disempower them. This study draws on the experiences of participation in this process, both from the perspective of the participants (six board and six staff members) and myself, as the researcher. Thematic analysis of the interview data identified barriers to participation at different levels of intervention. At an intrapersonal level, competence of people with disabilities emerged as a critical issue for DJA. This issue resonated with my own experience of the process and, through ongoing critical reflexivity, revealed that underlying ableist attitudes (i.e. attitudes based on non-disabled standards) reinforce the ongoing victimisation and oppression experienced by people with disabilities. This study builds on current knowledge regarding the role and tensions of a community psychologist working with a social justice agenda with people with disabilities.

This thesis reports research into referral and intake to child and adolescent mental health services intended to illuminate a largely unnoticed but potentially powerful clinical phenomenon in service provision. Referral and intake to child and adolescent mental health services was demonstrated to be a complex process that shapes subsequent clinical interactions. Three questions guided the present research. Why are the practices of referral and intake as they are and how have they been shaped, historically? What are the specific practices involved? What are the effects of these practices upon subsequent case consultations and outcomes? Four enquiries were conducted. An extensive and critical literature review was directed toward the first question and demonstrated the historical roots of child and adolescent mental health services, elucidated the phases of the referral and intake process, clarified the many images of the parent in such services, and postulated the existence of three categories of service applicants, namely committed, containable, and crisis-reactive parent referrers. A retrospective empirical enquiry addressed the second question and a prospective empirical enquiry addressed the second and third questions. A further, integrative and empirical enquiry addressed the practices, role, and clinical thinking of referral and intake workers. The empirical studies demonstrated that, when done well, referral and intake provides momentum toward change in subsequent clinical contact. The referral and intake worker was shown to perform nearly one hundred tasks within a 15 to 25 minute referral call. The committed parent referrer, who was distinguished from other referring parents, was characterized by hopefulness, determination, and often, emotional pain in gaining access or the active presence of another party opposed to the referral, in the xviii retrospective study. The findings have major implications for the conduct of psychotherapy research and for the efficient and personable management of child and adolescent mental health services.

This study investigated relationships between problem video game playing, self-esteem and social skills in an adult sample. Via the internet, 621 (560 male) primarily Australian participants completed three scales: the Rosenberg Self-Esteem Scale, the multidimensional Social Skills Inventory and Problem Video Game Playing Scale. Hypotheses were: that problem video game playing would be related to social skills and self esteem; that time spent playing online games would be related to social skills; and that social skills and self esteem would predict problematic play. Online game time commitment was not significantly related to social skills or self esteem, suggesting online environments are not distinctly socially enriching or erosive. Resonating with past studies that found links between gaming, introversion, and social anxiety, a pattern of significant (p < .001) correlations emerged between 3 social skills subscales, together representing social hesitancy, and problem video game playing; however the magnitude of relationships was minute. To explore whether problematic play is impelled by social difficulties, a multiple regression analysis was used to predict problematic playing scores with scores on the social skills and self esteem scales. A significant model was found: F (9, 611) = 15.051, p < .001, accounting for 16.9% of variance. Time commitment (B = .314, p < .001), one social skill subscale (B = .184, p < .001) and self esteem (B = -.103, p = .03) emerged as significant predictors. Results suggest a very small proportion of problematic play is related to social skills and self esteem, but considering the magnitude of relationships, other factors may better explain problematic play. More broadly, this study aligns with others that found little negative consequences of problematic or dependant electronic game play. Further analyses included a comparison of game genre choice on important variables, finding players who preferred Massively Multiplayer Online Role Playing Games had significantly higher problematic play scores, time commitment and age than other genres. Contrary to past studies, males did not show significantly higher time commitment, although the gender discrepancy in participants suggests electronic gaming is still a male-dominated arena.

Research on attachment in human relationships has flourished with the development and validation of measures of attachment for infants, small children and adults, and, more recently, adolescents. However, research on attachment in middle childhood has been limited by relatively less attention to the development of relevant assessment techniques for this age group. At the same time, despite recognition of the powerful impact of attachment on overall child functioning, its assessment in clinical work has been hampered. Existing techniques for this age group rely on direct observation of actual behaviour, parent or child self-report of actual or hypothetical behaviour, or the interpretation of doll play in response to suggested specific situations of stress or separation. The present research represents the development of a more versatile technique for assessing quality of attachment in middle childhood, the 'Child’s Experience of Attachment Technique (CEAT)'. Design and piloting of this projective tool involved a number of steps. First, an in-depth exploration of relevant literature, particularly that relating to internal working models of attachment, was undertaken. On this basis, a series of ten ambiguous pencil drawings of children in various social situations was devised. Employing a storytelling technique, these drawings were trialled with a non-clinical sample of five boys and five girls, aged 6-12 years of age. The data collected enabled the stimulus drawings to be evaluated and refined, and a scheme for coding responses in the stories elicited to be created. The development of a coding scheme that could reflect some of the complexity of coexisting internal working models of attachment was the main thrust of this research. A revised set of stimulus drawings and the coding scheme were designed and piloted with a non-clinical sample of 20 girls and 20 boys, and with a clinical sample of 10 boys receiving psychotherapy for severe behavioural difficulties. When the matched samples were compared using the CEAT, the clinical group was found to have significantly lower security of attachment scores than the non-clinical group, as hypothesised. These results gave a preliminary indication of appropriate concurrent validity of the CEAT and its coding scheme. In addition, the CEAT provided rich multifaceted qualitative information concerning participants’ internal representations of attachment. Overall, findings suggested that further investigation of the reliability and validity of the CEAT is warranted.

This thesis discusses the multiple narratives of Iranian migrants and refugees living in Melbourne, Australia. The narratives are constructed by men and women who left Iran immediately after the 1979 revolution; the Iran and Iraq war; and Iranians who are recent arrivals in Australia. The narratives of the participants are particularly influenced and contextualized by the 1979 revolution, the 1980 to 1988 Iran and Iraq War and the post 9/11 political framework. It is within these historical contexts, I argue that Iranian experiences of displacement need to be interpreted. These historical periods not only provide the context for the narratives of the participants but it also gives meaning to how they reconstruct their identities and the emotions of their displacement. This thesis also argues that Iranian migrant and refugee narratives are part of a holistic story that is united rather than separated from one another. These narratives are part of a continuum that are influenced by historical events that have caused their displacement. For Iranians in this thesis displacement and a traumatic past often creates many different forms of rupture that includes spatial, temporal, cultural and emotional experiences that are constantly being revaluated, renegotiated and changed. In the narratives of the participants we find people struggling to negotiate their identity; devising strategies to cope with displacement and a traumatic past; and they tell stories on the ways they are stereotyped and caricaturized in western discourse. The participants' recount stories about how the objectification of their cultural background fails to take into account the complexity of their experiences and their suffering. For the participants the simplistic notions about their identity and experience in the popular imagination of western culture they believe ignores how their narratives of home (Iran) are connected with the host (Australia) context. The narratives of the participants' have a lugubrious tone which tries to express the effects of the cultural, social, political ruptures they have experienced. The thesis addresses the theoretical issues underlying such experiences and focuses on a narrative methodology to bring to light the problems of identity, stigmatization, cultural trauma, and the significance of representation in the lives of Iranian migrants and refugees.

Research studies have found that pregnant adolescents and adolescent mothers differ from their older counterparts on a number of psychological factors. Differences have been noted in the level of antenatal bonding to the foetus, the presence of depressive and/or anxious symptomatology during the pregnancy, the woman’s own attachment experiences and the amount of social support received. These variables have also been found to influence the development of maternal bonding after the baby is born. The primary aim of this research was to examine these antenatal factors and to assess their relative contribution to maternal bonding at six weeks postpartum. A further aim was to explore how different cultural and religious beliefs held by the adolescent and her family impact on the adolescent. The sample comprised pregnant adolescents aged between 13 and 19 years who attended either the Women’s Clinic at Sunshine Hospital or the Young Mothers’ Clinic at the Royal Women’s Hospital in Melbourne, Australia. The participants completed a number of standardised questionnaires during their pregnancy to measure antenatal bonding, retrospective perceptions of their own experiences of being parented by their mother (care and control), depression, anxiety and social support. The adolescents also participated in a semi-structured interview regarding religious and cultural beliefs. At six weeks and three months postpartum the adolescents completed another set of questionnaires to measure postnatal bonding, depression and anxiety. The proposed model to predict post-natal bonding was tested using hierarchical multiple regression. Results of the multivariate analyses indicated that the proposed regression model did not fit the data. Antenatal bonding was the only antenatal factor that was significantly related to postnatal bonding at six weeks. There were other significant correlations noted among the antenatal factors of care, control, depression, anxiety and social support received, but none of these appeared to be significantly related to postnatal bonding in this sample. However, strong relationships were noted between all postnatal factors (postnatal bonding, postnatal anxiety and postnatal depression) at both six weeks and three months postpartum. Information from the interviews on the influence of cultural and religious beliefs was presented and case studies were provided to highlight some of the experiences of these young women. The results of this research were compared and contrasted to the limited number of previous studies that have been carried out in the area. The lack of support for some hypotheses was discussed in the context of the limitations of the study. Other hypotheses were generated and discussed with recommendations made for future research.

Much research has been conducted that explores the process of psychotherapy and psychoanalysis; however, there is little that provides an illustration of what actually occurs between patient and therapist. This research is an explanatory and descriptive study of testing, which Weiss (1993; Weiss et al. 1986) links to the transference. An analysis of the process of testing is presented from two theoretical perspectives drawn from the theories of Joseph Weiss (Control-mastery theory (CMT)) and Sigmund Freud and Jacques Lacan (Freudian-Lacanian theory). The primary research question asked: what is testing? CMT, based on the higher mental functioning hypothesis (HMF), proposes that testing is a phenomenon based on an assumption that the unconscious can think, plan and make decisions in the same way as the conscious mind. Freud’s later theory relating to the ego provides a theoretical framework for CMT and Freud’s early theory is used by Joseph Weiss as an alternative theoretical hypothesis to the HMF hypothesis. This thesis presents a comparative analysis of both theoretical positions, which revealed that testing was consistent with an unconscious transference demand. Two propositions were examined at a clinical level using data from a multiple-case study in which transcripts of the first ten sessions of each of three patients’ psychotherapy were analysed. The propositions were examined according to Yin’s rival theory and analysed according to the logic of pattern matching. The first proposition stated: (1) The Freudian-Lacanian theory of the transference would provide a fuller explanation of testing episodes than CMT. The second proposition related to what the patient wants of the therapist in testing and proposed that: (2) The patient wants the therapist to occupy the position of his parental object, which is the position of an identificatory object. Theoretically, testing in control-mastery theory is consistent with the Freudian preconscious but inconsistent with the Freudian unconscious. At a descriptive level testing was consistent with aspects of the psychoanalytic processes of acting out, projective identification, and repetition but inconsistent with these processes at a theoretical level due to differing conceptualisations of the unconscious. Clinically, testing as an unconscious process was most consistently explained in the case studies by Freudian-Lacanian theory in which it was viewed as the patient’s demand that the therapist occupy the position of the parental objects. This finding opposes the CMT assumption that in testing, the patient does not want the therapist to occupy the position of the parental objects. The opposing positions were explained by the different formulations of the unconscious, either admitting or omitting the drives, which underpinned different therapeutic aims in the two theories. As a theory of conscious and preconscious functioning CMT has merit, but the thesis concludes that it is not a theory of unconscious functioning. The implications of these findings for clinical practice and research are discussed.