During the researcher's work with looked after children for the past four years, it became clear that adolescent placements were much more likely to break down than others. Although there is some literature about foster placement breakdowns, the researcher did not really get an answer as to the causes of adolescent placement breakdowns. This study therefore explores causal factors of adolescent placement breakdowns as seen by foster carers, adolescents and professionals. It is evident from this study that there are no easy answers. Although the adolescent, as much as any other child, craves to belong, to be listened to and be respected, it seems that it is not always possible for foster carers to put this into practice, given the challenging behaviour that adolescents often display. Recommendations are based on relevant literature and the empirical study, in the hope that it might be useful to those with an interest in this field. / Social Work / M.Diac. (Play Therapy)

This study aimed to test the efficacy of the memory box as a medium in Gestalt Therapy, specifically within a therapeutic group with AIDS orphans in the middle childhood phase of development. The aim was to explore and describe the utilisation of the memory box, as a medium for telling one's story, within the safety of the Gestalt play therapy group. It was felt that the increased self-awareness fostered by belonging to a supportive group could enhance self-concept. The research included qualitative and quantitative data. Theoretical and the meta-theoretical assumptions affecting children, in the middle childhood phase, orphaned through HIV/AIDS, were reviewed. The group sessions were described and the data obtained from the pre and post-test was graphically illustrated. The information was then compared to ascertain whether the objectives had been met. Results show that the memory box, used in Gestalt play therapy groups, with AIDS orphans was effective. / Social Work / M.Diac. (Play Therapy)

Text in Afrikaans / In today's society our children are being incredibly exposed to trauma and death. Parents want to protect their children against hardship and loss and it is evident that todays society is characterized by social pathology. In view of the above the researcher studied literature extensively to investigate the affect of the phenomenon of death and trauma in the life of the young child. In order to establish the availability of therapy programs for the young child in childcare whose parents died in an unnatural way. It was evident that the present South African society is indeed characterized by conflict, homicide and violence. The death of a parent is a traumatic experience for the young child (aged two to seven years). VVhen death occurs suddenly it was found that the grief process is more complex. Through the process of literature study and empirical investigation it seems that many young children, who lost their parents through unnatural death, are placed in childcare institutions. In this study it was established that the fact that children were placed in childcare did not always imply that therapeutic intervention took place. Limited financial support and social services contributed to insufficient therapeutical intervention. Furthermore it was found that the investigated childcare institutions couldn't provide the researcher with therapeutic programmes. This study therefore indicates that there is a need for the development of therapeutic programmes for the young child in childcare. whose parents died in an unnatural way. / In die hedendaagse samelewing blyk dit dat kinders al hoe meer aan dood en trauma blootgestel word. Hoewel ouers graag hulle kinders wil beskerm teen hartseer en verlies, blyk dit dat vandag se samelewing gekenmerk word deur 'n vorm van sosiale patologie. In die lig van voorafgaande, het die navorser literatuurstudie onderneem om die teenwoordigheid en die fenomeen van dood en trauma in die lewe van die jong kind te ondersoek. 'n Verdere literatuurstudie is ook onderneem om die rou ervaring van die jong kind te ondersoek. Die navorser wou ook in hierdie studie vasstel of daar terapeutiese begeleiding aan die jong kind in kindersorg, wie se ouers op 'n onnatuurlike wyse gesterf het, beskikbaar is. Daar is in die studie gevind dat die huidige Suid-Afrikaanse samelewing inderdaad gekenmerk word deur konflik, moord en misdaad. Die afsterwe van 'n ouer is 'n traumatiese ondervinding vir die jong kind (twee tot sewe jaar). Wanneer die dood skielik en onverwags intree, is bevind dat die rouproses gekompliseerd is. Deur die proses van literatuurstudie en empiriese ondersoek blyk dit dat verskeie jong kinders wie se ouers op 'n onnatuurlike wyse gesterf het, in kindersorginstansies geplaas word. Daar is in hierdie studie bewys dat hoewel die kind in kindersorginstansies geplaas word, terapeutiese begeleiding nie altyd plaasvind nie. Hierdie gebrekkige terapeutiese begeleiding word toegeskryf aan die feit dat nie voldoende finansiele ondersteuning en maatskaplike dienste is nie. Daar is verder gevind dat kindersorginstansies, wat aan die studie deelgeneem het, nie oor traumaterapie programme vir terapeutiese begeleiding beskik nie. Hierdie studie toon dus dat daar 'n behoefte is vir die ontwikkeling van terapeutiese programme vir die jong kind in kindersorg wie se ouers op 'n onnatuurlike wyse gesterf het. / Educational studies / M. Ed. (Voorligting)

The research deals with the losses the 7-11 year old child in die single parent family may experience. The research has been conducted from a practical theological (pastoral) perspective. The goal of the study was to investigate and elaborate upon the various losses the child may experience on a physical, cognitive, social, spiritual and an emotional level. In order to complement and verify the literature study, empirical methods of research were utilised. Focus groups were conducted within the framework of Gestalt Play Therapy. Parent interviews were used as an additional method of research. It became apparent, as a result of the literature and empirical studies, that the loss of a parent (whether by divorce/ abandonment/unmarried status/ death) affects the child on all levels of his/her development. Guidelines for the support of such a child are suggested. / Die navorsing handel oor die verlies(e) wat die 7-11 jarige kind in die enkelouergesin mag beleef. Die navorsing geskied vanuit 'n prakties-teologiese (pastorale) perspektief. Die doel van die studie was om die verliese wat die kind op fisiese, kognitiewe, emosionele, sosiale en geestelike vlak mag ervaar, te ondersoek en omskryf. Om die literatuurstudie aan te vul en te verifieer, al dan nie, is daar van empiriese navorsing gebruik gemaak. Fokusgroepe het plaasgevind binne 'n gestalt spelterapeutiese raamwerk. Oueronderhoude was as nog 'n wyse van ondersoek gebruik. Vanuit die literatuurstudie en empiriese navorsing het dit duidelik geword dat die verlies aan 'n ouer (vanwee egskeiding/ verlating/ongetroude status/ sterfte) die kind op al die vlakke van sy/haar ontwikkeling beinvloed. Riglyne tot ondersteuning aan hierdie kind is voorgestel. / Social work / M.Diac. (Youth Work)

The US Bureau of the Census (1999) projected that by 2004, 14 million people in sub-Saharan Africa will develop full blown AIDS, making this region by far the largest disease burden in the world (World Health Organization, 2002). The United Nations AIDS Programme judged South Africa to have the leading number of people living with HIV/AIDS worldwide (World Health Organisation, 2002). To date there has been extensive research conducted on the socio-economic impacts of HIV/AIDS on families in Africa. However an area of investigation that has remained largely underreported is the inquiry into the psychological impacts of HIV/AIDS on elderly caregivers. In African families older women increasingly have to provide care to their adult children with AIDS and their orphaned grandchildren. However few research studies have assessed the experience of parental caregiving and its psychological impacts on these women. This qualitative research study hypothesised that the role of primary parental caregiver in fact causes a range of psychologically distressing states, which serve to compromise the psychological well-being of these caregivers. To investigate this hypothesis three Xhosa speaking women living in informal settlements in Grahamstown, in the Eastern Cape Province of South Africa were selected for the study. The women were interviewed by means of semi-structured interviews, which consisted of questions related to their caregiving experiences, their experiences of loss, their choice of coping strategies, the role of support networks and their experiences of foster care responsibilities. The interviews were transcribed and analysed using a grounded hermeneutic approach. The research results confirmed the working hypothesis. The research revealed that although it was considered culturally appropriate for older women to care for their children and grandchildren, their caregiver roles caused significant psychological distress. Their distress was related to: emotional and physical exhaustion, complicated grief reactions and ongoing emotional and physical upheaval related to foster care responsibilities. Based on the results, the research recommendations emphasised the need for continual awareness of the psychological implications of caregiving for older African women with the aim to preserve their capacity to function as the primary caring resource to families struck by HIV/AIDS.

Indiana University-Purdue University Indianapolis (IUPUI) / African Americans' tendency to choose life-prolonging treatments (LPT) over comfort focused care (CFC) at end-of-life is well documented but poorly understood. There is minimal knowledge about African American (AA) perceptions of decisions to continue or discontinue LPT. The purpose of this study was to examine AA family members' perceptions of factors that influenced end-of-life care decision-making for a relative who recently died from serious illness. A conceptual framework informed by the literature and the Ottawa Decision Support Framework was developed to guide this study. A retrospective, mixed methods design combined quantitative and qualitative descriptive approaches. Forty-nine bereaved AA family members of AA decedents with serious illness who died between 2 to 6 months prior to enrollment participated in a one-time telephone interview. Outcomes examined include end-of-life treatment decision, decision regret, and decisional conflict. Quantitative data were analyzed using descriptive statistics, independent-sample t-tests, Mann-Whitney U tests, chi-square tests, Spearman and Pearson correlations, and linear and logistic regressions. Qualitative data were analyzed using content analysis and qualitative descriptive methods. Family members' decisional conflict scores were negatively correlated with their quality of general communication (rs = -.503, p = .000) and end-of-life communication scores (rs = -.414, p = .003). There was a significant difference in decisional regret scores between family members of decedents who received CFC versus those who received LPT (p = .030). Family members' quality of general communication (p = .030) and end-of-life communication (p = .014) were significant predictors of family members' decisional conflict scores. Qualitative themes related to AA family members' experiences in end-of-life decision-making included understanding (e.g., feeling prepared or unprepared for death), relationships with healthcare providers (e.g., being shown care, distrust) and the quality of communication (e.g., being informed, openness, and inadequate information). Additional qualitative themes were related to perceptions of the decision to continue LPT (e.g., a lack of understanding, believe will benefit) or discontinue LPT (e.g., patient preferences, desire to prevent suffering). In conclusion, this study generated new knowledge of the factors that influenced AA bereaved family members' end-of-life decision-making for decedents with serious illnesses. Directions for future research were identified.

Thèse de doctorat présenté en vue de l'obtention du doctorat en psychologie - recherche intervention, option psychologie clinique (Ph.D) / La mort assistée ou aide médicale à mourir étant débattue et légalisée dans de plus en plus de pays et régions, notamment au Québec, le contexte du mourir en Occident semble en mouvance. Puisque la légalisation de cette pratique introduit un nouveau soin de fin de vie, de nombreuses personnes doivent désormais faire le choix entre mourir « naturellement » ou par aide médicale à mourir; un choix important susceptible de teinter le deuil des proches du défunt. La présente thèse porte un regard sur ces expériences de deuil en contexte d’aide médicale à mourir ou de mort naturelle accompagnée de soins palliatifs, et ce afin de déterminer les similitudes et différences dans le vécu des endeuillés, ainsi que le rôle des influences interpersonnelles (des relations avec autrui) dans ce même vécu. Dans le premier article de la thèse, les expériences de deuil sont directement comparées par l’entremise d’une recherche à devis mixte. L’échantillon se compose de 60 endeuillés ayant rempli des questionnaires mesurant des symptômes de deuil (25 endeuillés en contexte d’aide médicale à mourir et 35 en contexte de mort naturelle), desquels 16 ont pris part à des entrevues de recherche individuelles. Les résultats quantitatifs mettent en lumière l’absence de différences statistiquement significatives entre les deux populations. Les conséquences des deux contextes de fin de vie sur l’intensité du deuil s’avèreraient donc similaires. De plus, les scores ne suggèrent pas de complications du deuil, ce qui peut sous-entendre que l’aide médicale à mourir et la mort naturelle ne contribuent pas de prime abord à rendre l’expérience du deuil davantage éprouvante. Les résultats qualitatifs sont nuancés : des « empreintes » négatives et positives (concernant la distance temporelle et le symbole du héros) peuvent colorer l’expérience dans les deux contextes. Bien que les morts naturelles et médicalement assistées semblent généralement toutes deux ne pas avoir un impact foncièrement négatif sur le processus de deuil, il demeure qu’elles peuvent produire des vécus plus difficiles lorsqu’en interaction avec d’autres facteurs de risques. Dans le deuxième article, le concept du paysage relationnel est utilisé afin d’informer des conclusions à l’égard des facteurs interpersonnels à l’œuvre dans le deuil. Les résultats présentés sont basés sur les 16 entrevues individuelles conduites auprès d’endeuillés et prennent la forme d’un modèle interprétatif permettant de décrire cinq types d’acteurs dans l’environnement de l’endeuillé (le défunt, les co-endeuillés, les aidants, les antagonistes et les personnages secondaires) et leurs manières « d’être avec » et de « laisser seul ». Le modèle comprend également quatre paysages vécus décrivant la manière dont le deuil se vit en lien avec l’environnement social (se sentir entouré, se sentir seul et loin, se sentir assiégé et se sentir investi d’un message). Le modèle interprétatif du paysage relationnel permet de s’attarder aux similitudes entre les défis relationnels du deuil par aide médicale à mourir et du deuil par mort naturelle, ainsi qu’au rôle d’autrui. L’intégration des différents résultats nourrit des réflexions sur la création de sens, la compréhension de la souffrance en fin de vie, la temporalité, la culture, de même qu’à l’égard du poids relatif des circonstances d’une mort anticipée dans l’expérience du deuil des proches. L’accompagnement de la mort et du deuil en Occident à l’ère de la mort assistée est abordé sur la base des différents constats issus de la thèse. Ces réflexions permettent de songer à de futures avenues de recherche et de penser la clinique du deuil. / With assisted dying being debated and legalized in more countries and regions, including Quebec, the context of death in the Western world seems to be in flux. Since the legalization of this practice introduces a new type of end-of-life care, many individuals must now choose between dying “naturally” or with medical assistance in dying, an important choice that may affect the grief of the deceased’s loved ones. This thesis examines grief experiences in the context of medical assistance in dying or natural death with palliative care to determine the similarities and differences in the experiences of the bereaved persons and the role of interpersonal influences (relationships with others) on bereavement. In the thesis’ first article, grief experiences are directly compared through a mixed design research study. The sample consists of 60 bereaved persons who completed questionnaires measuring grief symptoms (25 bereaved individuals in the context of medical assistance in dying and 35 in the context of natural death), of whom 16 participated in individual research interviews. The quantitative results show no statistically significant differences between the two populations. The consequences of the two end-of-life contexts on grief intensity would therefore appear to be similar. Furthermore, the scores do not suggest grief complications, which may imply that medical assistance in dying and natural death do not prima facie contribute to a more distressing grief experience. Qualitative findings are nuanced: negative and positive “imprints” (regarding temporal distance and the hero symbol) may colour the grief experience in both contexts. Although both natural and medically assisted deaths generally appear not to have an inherently negative impact on the grieving process, they can still produce more difficult experiences when interacting with other risk factors. In the second article, the relational landscape concept is used to inform conclusions regarding the influence of interpersonal factors at work during bereavement. The results presented are based on the 16 individual interviews conducted with bereaved persons and take the form of an interpretive model describing five types of actors in the bereaved individuals’ environment (the deceased, co-bereaved, caregivers, antagonists, and secondary characters) and their ways of “being with” and “leaving alone”. The model also includes four lived landscapes describing how grief is experienced relative to the social environment (to feel open and visited, to feel alone and far away, to feel besieged, and to feel invested with a message). The relational landscape interpretive model allows us to focus on the similarities between the relational challenges of bereavement after a medical assistance in dying and after a natural death. It also sheds light on the role of others on one’s grief experience. The different results are integrated to provide insights into meaning-making, the understanding of suffering at the end of life, temporality, culture, and the relative weight of an anticipated death’s circumstances on the grief experience. End-of-life and grief support within Western societies in the era of assisted dying is also discussed based on the thesis’ various findings. These reflections allow us to consider future research avenues and to elaborate on grief intervention.

No description available.

The research is about African women living with HIV and women grieving the death of loved ones as a result of AIDS. We discuss the women's preferred care for the ill person and for the family as well as for the bereaved family. We consider together the effects of HIV/AIDS in the community: the stigma attached to the disease and the fears of people that they may contract HIV. The women and I acknowledge the closely woven relationships between faith and culture in a predominantly Xhosa community. Participatory action research is used and contextual feminist theology within a postmodern social construction approach to narrative pastoral therapy. / Philosophy, Practical and Systematic Theology / M.Th. (Practical Theology)

The research is about African women living with HIV and women grieving the death of loved ones as a result of AIDS. We discuss the women's preferred care for the ill person and for the family as well as for the bereaved family. We consider together the effects of HIV/AIDS in the community: the stigma attached to the disease and the fears of people that they may contract HIV. The women and I acknowledge the closely woven relationships between faith and culture in a predominantly Xhosa community. Participatory action research is used and contextual feminist theology within a postmodern social construction approach to narrative pastoral therapy. / Philosophy, Practical and Systematic Theology / M.Th. (Practical Theology)