This study was aimed at exploring and describing the role of music as a medium in the Gestalt play therapy process with children who experience emotional distress and therefore suffer loss of healthy contact. The case study method was used as research strategy. A literature study of the Gestalt approach and Gestalt play therapy was carried out as well as a study of the child in middle childhood, the child experiencing emotional distress in the form of loss, and music as a medium. In implementing of this research study three case studies were described. The sampling method was based on a non-probability purposive sampling technique. The criteria for inclusion in this study were children who experience emotional distress in the form of loss and who, subsequently, do not make effective contact. Between seven and eight therapeutic sessions per child were conducted. The role of music was evident in all three cases. / SOCIAL WORK / MDIAC (PLAY THERAPY)

Thesis (MEdPsych (Educational Psychology))--University of Stellenbosch, 2005. / As a research-therapist-in-training I sought to document a young boys story of his struggle with enuresis. The purpose of the study was to explore the use of the narrative metaphor with this young boy who took a stand against enuresis after numerous attempts to resolve it. Enuresis is a medical diagnostic term and I attempted to seek alternatives to the diagnosis and treatment of what is sometimes viewed as pathology. I undertook to find an answer to the research curiosity: How could the narrative metaphor be used in working against the bedwetting? The narrative approach was utilized to guide the research journey in order to facilitate the client's preferred, alternative story of his life. I was interested in highlighting an alternative story to the diagnosis and treatment of enuresis as pathology. Looking at the positivist views on enuresis I became particularly interested how the narrative metaphor could be used against enuresis. I used the guidelines and questions suggested by Michael White's work (1995:201) on narrative therapy and bedwetting to strengthen Michael's voice. White described ways of externalising the problem and mapping the influence of the problem. Key concepts used during the research journey were: terms adopted from narrative therapy, enuresis and postmodernism.

Thesis (MEdPsych)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: High-risk behaviour among adolescents places heavy burdens on the public health, social welfare and criminal justice systems of many countries. Today, Equine-Assisted Learning (EAL) is increasingly used as an adjunct and experiential intervention programme to support the learning and personal development of adolescents at risk. It combines counselling and educational programmes with interactive activities involving horses (Thomas, 2009). The aim of this investigation was to conceptualize the experiences of these at-risk adolescents in residential care (AIRC), since gaps exist in both international and national research pertaining to studies which focus on exploring adolescents' experiences of taking part in EAL programmes (Holder, 2011). An interactive, qualitative and multiple case study design was employed in this study. The research was conducted at a Western Cape residential care facility with five adolescents between the ages of 12 and 18, after they had completed a three-week EAL programme. The programme comprised five sessions of one hour each. Data was collected through a projective technique (collage), semi-structured individual interviews, and a focus group interview. The research findings suggested that the at-risk adolescents experienced this Equine-Assisted Learning programme as positive and that it contributed to strengthening their relationships, enhancing attachment, self-esteem, empathy, communication, social competence, and a sense of mastery, as well as opening up future possibilities for them. As a relatively new field of study in South Africa, Equine-Assisted Learning can make a significant contribution to fostering the learning and development of adolescents in residential care. / AFRIKAANSE OPSOMMING: Die hoë-risiko gedrag van adolessente plaas 'n swaar las op lande se openbare gesondheid, maatskaplike welsyn- en kriminele regstelsels en sodoende word 'Equine Assisted Learning' (EAL) toenemend gebruik as 'n aanvullende en ervarings-intervensieprogram om die leer en persoonlike ontwikkeling van adolessente in nood te ondersteun. In EAL, word berading en opvoedkundige programme met interaktiewe aktiwiteite wat perde betrek, gekombineer (Thomas, 2009). Die doel van die studie was om hoë-risiko adolessente in residensiële sorg se ervarings van 'n EAL intervensieprogram te konseptualiseer, aangesien daar op beide internasionale en nasionale vlak 'n gebrek aan navorsing is wat fokus op die verkenning van adolessente se ervaring van deelname aan EAL programme (Holder, 2011). 'n Interaktiewe, kwalitatiewe en veelvuldige gevallestudie ontwerp is in hierdie studie ontplooi. Die navorsing is uitgevoer in 'n Wes-Kaapse residensiële sorg fasiliteit met die hulp van vyf adolessente tussen die ouderdomme van 12 en 18, nadat hulle drie weke lank aan 'n EAL program deelgeneem het. Die program het bestaan uit vyf sessies wat elk een uur geduur het. Data is ingesamel deur gebruik te maak van projektiewe tegniek (collage), semi-gestruktureerde individuele onderhoude asook 'n fokusgroep-onderhoud. Navorsingbevindings het voorgestel dat adolessente wat risiko beloop, die EAL program as positief ervaar. Dit blyk ook dat dit bygedra het tot die bevordering van sekere aspekte soos verhoudings, hegting, selfbeeld, empatie, kommunikasie, sosiale bevoegdheid, 'n gevoel van bemeestering en die daarstel van toekomstige moontlikhede. 'Equine Assisted Learning' is 'n relatiewe nuwe studieveld in die Suid-Afrikaanse konteks, en kan daarom betekenisvol bydra tot die bevordering van leer en ontwikkeling van adolessente in residensiële sorg.

The increasing diversity of the United States creates a pressing public health need to investigate methods to increase the engagement, retention, and efficacy of mental health services for racial/ethnic minority (REM) youth. Evidence from the adult psychotherapy treatment literature suggests that enhancing therapist cultural competence leads to increases in client satisfaction, alliance, and retention (Constantine, 2002; Sodowsky, Kuo-Jackson, Richardson, & Corey, 1998; Worthington, Soth-McNett, & Moreno, 2007). However, this relationship has not been adequately explored in youth mental health services, due in part, to a lack of valid and reliable measurement. This research project included measure development and initial validation of the Youth Therapist Observational Cultural Competence Scale (YTOCCS) with the aim of creating an observer-rated measure of youth therapist cultural competence. The measure was developed from a review of the theoretical and empirical literature and integrated the surveyed opinions of practicing child therapists, caregivers of REM children involved in the mental health system, and experts in therapist cultural competence. The study used an extreme group design based on child-therapist alliance selecting 32 recordings of 8 unique child-therapist dyads. Three coders were trained using a standardized manual and independently double coded early treatment sessions from an effectiveness trial for individual child cognitive-behavioral therapy conducted in community clinics. The measure demonstrated good reliability as measured by intraclass correlation coefficient, adequate internal consistency, and evidence supported initial validity through demonstrated significant between-group differences. Future studies are warranted to refine the measure and to explore the factor structure of the measure.

Parent-infant psychotherapy is a small but growing field in South Africa. Its potential to contribute to mental health services in South Africa is, by contrast, vast. This thesis contributes towards much-needed research on the state of the field in the country and its potential applications across different sectors. Drawing on Daniel Stern’s concept of ports of entry, it is argued that an expansion of ports of entry offers an important integrating tool through which different aspects of parent-infant psychotherapy can be examined and adapted to the South African context. A history of parent-infant psychotherapy in South Africa is offered, together with an analysis of the experiences of current practitioners in the field. These aspects of the thesis draw on interviews with key stakeholders. The dominant context of private practice is then explored through two case study based papers. The first explores the meaning of symptoms in parent-infant psychotherapy. The second introduces the ‘grandmaternal transference’ as an important but under developed port of entry. These different aspects of parent-infant psychotherapy in South Africa are then considered through the prism of ports of entry in order to argue for a flexing of the psychoanalytic frame. Implications for the growth of the parent-infant psychotherapy field in South Africa are considered.

Pesquisas de processo em psicoterapia utilizam categorização de sessões como uma maneira de compreender as relações terapeuta-cliente no contexto clínico, sistematizando a descrição da prática terapêutica e identificando variáveis críticas do processo e o impacto sobre sua efetividade. A presente pesquisa buscou relacionar resultados de categorização (molar) de objetivos analítico-comportamentais, estratégias (molares) para atendimento da criança e comportamentos de terapeuta e cliente (molecular), para análise da interação em sessões de atendimento analítico-comportamental. Participaram duas renomadas terapeutas infantis. Foram realizadas filmagens de oito sessões da díade Alice-Alex, seis da díade Bertha-Bia e de entrevistas com as terapeutas doutoras em análise do comportamento com mais de 30 anos de experiência clínica infantil. As sessões foram categorizadas segundo quatro sistemas, os dois primeiros elaborados na presente pesquisa: (1) Sistema de Categorização de Objetivos Terapêuticos (SICOT), (2) Sistema de Estratégias de Conversas e Atividade Terapêuticas (SECAT), (3) Functional Analytic Psychotherapy Rating Scale (FAPRS) e (4) Categorias do terapeuta e do cliente (SMCCIT), além da categorização do foco da fala (dentro ou fora da sessão). Foram obtidos índices Kappa satisfatórios de concordância entre observadores (K>0,630 em três sistemas, p<0,05 em todos) e realizadas análises de associação entre categorias nominais (chi-quadrado), intra e entre sistemas, e análise qualitativa sobre os dados, relacionando-os com os relatos das terapeutas nas entrevistas. Os resultados indicaram que as terapeutas enfatizaram estratégias diferentes, mas coerentes com o perfil das crianças e seus objetivos: no atendimento de Alex, buscou-se ensiná-lo a relatar, engajar-se em tarefas e seguir instruções como alternativa a opor-se e distrair-se; no caso de Bia, visou-se ensiná-la a se expressar de modo assertivo e aprimorar análises. As estratégias de Alice se basearam principalmente em: (1) fazer tarefas terapêuticas, manejando o comportamento de Alex na sessão, para ensino de leitura e escrita e (2) derivar conversas a partir de brincadeiras e fantasias, manejando o controle verbal para ensiná-lo a relatar. As estratégias de Bertha foram: (1) utilizar fantasia, manejando o comportamento de Bia na sessão, para ensino de outras formas de se relacionar com a família e (2) conversar derivado ou paralelo ao brincar e fantasiar, manejando o controle verbal para que as análises suplementassem as contingências fora da sessão. Os dois atendimentos tiveram maior porcentagem de interações com foco dentro da sessão, com ênfase em diferentes atividades para favorecer a adesão, manejar os comportamentos diretamente e conversar com as crianças. Discute-se que: (a) o uso dos diferentes sistemas, molares e moleculares, foi essencial para realizar diferentes níveis de análise e combiná-las entre si; (b) o uso de atividades não é terapêutico em si, mas auxiliar de intervenções com uma população cujo desenvolvimento verbal e seu controle por regras ainda é incipiente, em que as atividades auxiliam o manejo dos comportamentos em sessão e das conversas para a promoção do controle verbal. São apontadas algumas questões de pesquisa decorrentes deste estudo e, considerando a experiência das terapeutas, as implicações e questões práticas para a formação profissional em terapia analítico-comportamental infantil / Research process in psychotherapy use categorization of sessions as a way of understanding the therapist-client relationship in the clinical setting, systematizing description of the therapeutic practice and identifying critical process variables and the impact on their effectiveness. This research related the results of a molar categorization of behavior-analytic objectives, a molar system of strategies for treating the child, and therapist and client behaviors (molecular) for analysis of interaction in behavior analytic sessions. Filming was done in eight sessions of Dyad Alice-Alex and six of Dyad Bertha-Bia and of interviews with therapists, doctors in behavior analysis with more than 30 years of clinical experience with children. The sessions were categorized according to four systems, the first two developed in this research: (1) Categorization System for Therapeutic Objectives (SICOT) (2) System of Strategies of Conversations and Activities (SECAT), (3) Functional Analytic Psychotherapy Rating Scale (FAPRS) and (4) Categories of Therapist and Client Behavior (SMCCIT), besides the categorization of the focus of conversation (in or out of session). Satisfactory Kappa rates of agreement were obtained between observers ((K>0,630 in three of those, with p<0,05 in every system)) and correlation analysis was carried out among nominal categories (Chi-square), within and between systems, as well as qualitative analysis on the data, relating them to reports of therapists during the interviews. Results indicated that therapists have emphasized different strategies, but consistent with the profile of children and their therapeutic goals. In Alex case the therapist attempted to teach him to report, engage and follow instructions as an alternative to opposing and distracting himself. In case Bias case the therapist aimed to teach her to express herself assertively and improve analysis. Alices strategies were based primarily on: (1) assigning therapeutic tasks, managing behavior in the session for teaching to read and write, and (2) deriving conversations from fantasy and games, managing verbal control to teach him to report. The strategies with Bertha were: (1) using fantasy, managing the behavior of Bia in the session for teaching other forms of relationships with family and (2) talking derived from or parallel to playing and make believe, managing verbal control so that the analysis of B would supplement the contingencies out of the session. The two treatments had the highest percentage of interactions with focus on the session, an emphasis on different activities to promote adhesion, to manage behavior directly and converse with children. Conclusions: (a) the use of different systems, molecular and molar, was essential to achieve different levels of analysis and combine them together, (b) the use of activities is not therapeutic in itself, but helps interventions with a population whose verbal development - and its control by rules is still incipient. The activities are important for the management of behaviors in session and conversation for enhancing verbal control. Some research questions are raised considering the experience of participating therapists, and practical implications for professional training in child behavior analytic therapy are discussed

A Psicoterapia Analítica Funcional (FAP) é uma abordagem clínica que objetiva a melhora dos relacionamentos do cliente por evocação e reforçamento de progressos terapêuticos em sessão. O transtorno de oposição desafiante (TOD) é um problema disruptivo, manifestado pela primeira vez na infância, sendo caracterizado por um padrão de humor raivoso e irritável, um padrão de comportamento de desafio e oposição a normas sociais e figuras de autoridade e uma índole vingativa. Está associado ao desenvolvimento posterior de outros transtornos mentais e carece de tratamentos com resultados satisfatórios para crianças acima de oito anos. O objetivo deste trabalho foi avaliar os resultados de uma aplicação da FAP para o tratamento de crianças com TOD. Para isso, foi realizada uma pesquisa de intervenção com delineamento experimental de caso único com linha de base múltipla entre participantes. Fizeram parte do estudo Carlos, Brandão e Júlio, com respectivamente nove, 10 e 11 anos e com diagnóstico de TOD, sendo os dois primeiros com nível clínico de sintomas e o terceiro, limítrofe. Júlio recebeu um tratamento de 32 sessões com a FAP, Carlos, 10 sessões de Análises de Contingências Externas (ACE) seguidas de 28 de FAP, e Brandão, 20 de ACE e 29 de FAP. As sessões foram agendadas com frequência semanal e duração estimada de 50 minutos. No tratamento ACE, as análises de contingências não deveriam envolver os comportamentos ocorridos durante a sessão, além de serem realizadas também orientações e brincadeiras livres. A frequência de comportamentos clinicamente relevantes (CCRs) durante as sessões foi verificada com a Escala de Avaliação da Psicoterapia Analítica Funcional (FAPRS); o funcionamento global e o nível de estresse com o Questionário Infanto-Juvenil de Resultados (Y-OQ 30.2); e os sintomas de TOD com o Inventário de Comportamentos da Criança e do Adolescente de 6 a 18 anos (CBCL). Os resultados demonstram aumento de CCRs de melhora relacionados à aplicação da FAP. Também foi registrada melhora no funcionamento global e no nível de estresse ao longo do tratamento para todos os clientes, mas não foi possível identificar efeitos diferenciais da ACE ou da FAP sobre estes resultados. A avaliação da mudança no nível de sintomas de TOD apresentou resultados inconsistentes, isto é, Júlio manteve o nível limítrofe nas avaliações anterior e posterior ao tratamento; Carlos mudou de nível clínico para normal; e Brandão de clínico para limítrofe. Ainda, foi verificado que as intervenções que caracterizam a FAP ocorreram com maior frequência na fase correspondente do que na ACE, indicando adesão ao protocolo. Também foram incluídas vinhetas clínicas com transcrições de falas do terapeuta e dos clientes destacando as intervenções centrais / Functional Analytic Psychotherapy (FAP) is a clinical approach that aims to improve client relationships by evoking and reinforcing therapeutic progresses in session. Oppositional defiant disorder (ODD) is a disruptive problem manifested with onset at infancy characterized by an angry and irritable mood pattern, a pattern of challenging behavior and opposition to social norms and authority figures, and a vindictive nature. It is associated with the further development of other mental disorders and lacks treatments with satisfactory results. The objective of this study was to evaluate the results of an application of FAP to the treatment of children with ODD. Thus, a single-case intervention research with multiple baseline design between participants was done. Participated Charles, Brandon and Julian, respectively aged nine, 10 and 11 year-old, all diagnosed with ODD, being the first couple boys at clinical level of symptoms and the third, at borderline level. Julian received a treatment with 32 sessions of FAP, Charles, 10 sessions of External Contingency Analysis (ECA) followed by 28 of FAP, and Brandon, 20 of ECA and 29 of FAP. Sessions were scheduled on a weekly basis and with estimated duration of 50 minutes each. In ECA treatment, contingency analyzes should not mention behaviors occurred during session, being also delivered counseling and free play. Frequency of clinically relevant behaviors (CRBs) during sessions was evaluated with Functional Analytic Psychotherapy Rating Scale (FAPRS); overall functioning and level of stress were also evaluated, using the Youth Outcome Questionnaire (Y-OQ 30.2); and ODD symptoms, with Child Behavior Checklist (CBCL). Results demonstrated increasing in behavioral progresses (i.e., CRB2s) related to FAP condition. Also, improvement in overall functioning and stress level were observed for all clients throughout treatment, however it was not possible to identify differential effects of ECA or FAP to these results. ODD symptoms level registered inconsistent results; that is, Julian maintained a borderline level of symptoms at assessments pre and post-treatment; Charles changed from clinical to normal level; and Brandon from clinical to borderline. Furthermore, it was verified that FAP defining interventions occurred more frequently at the proper condition than in ECA, indicating adherence to the protocol. Clinical vignettes with transcriptions of therapist and client interactions highlighting central interventions were included

Background. Numerous clinical trials demonstrate the efficacy of medication and behavioral treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) in children, but provision of behavioral treatment for ADHD is limited in community clinics and only the pharmacological treatment is the standard care for children with ADHD. The current study evaluated the treatment effectiveness of combining psychosocial treatment to methylphenidate and to compare this combined treatment with medication alone in treating ADHD in children of a community mental health center in Hong Kong. Psychosocial treatment consisted of parent training and child intervention. The treatment group for children was a 24-week problem solving, anger coping, and social skills training program. Parent training consisted of 18 weekly sessions, highlighting parenting as an integration of elements of cognition, emotion, and behavior, as well as introducing effective parenting techniques based on social learning principles. Method. A group of 146 consecutive child patients with ADHD symptoms attending Yaumatei Child Psychiatric Center were invited for screening their eligibility of participating in this study. A randomized group comparison design was used with two treatment conditions (medication-only; combined medication and psychosocial treatment) and four assessment time points. Ninety eligible child-parent dyads were randomly allocated to the combined treatment condition or medication-only condition. Treatment outcomes were assessed in multiple domains at pre-intervention and post-intervention, and at 6-month and 12-month follow-ups. Data was analyzed through intent-to-treat mixed-effects regression model. / Conclusions. The combined treatment condition not only yielded significantly greater benefits than the medication-only condition on primary ADHD symptoms, but also other advantages in terms of conduct problem and adaptive functioning outcomes. / Results. Regarding ADHD symptoms, children in combined treatment condition showed significantly greater improvement than those given medication alone at post-treatment assessment. Combined treatment also proved better than medication alone in several other domains, such as oppositional behavior, a child's performance on computerized test, parenting behavior, and parental accurate knowledge of ADHD. Parental treatment-related attributions were also found to be changing over the course of treatment. Follow-up assessments revealed that children in the combined treatment condition maintained greater reduction in oppositional behavior one year after the completion of psychosocial treatment. / So Yuk-chi. / "May 2005." / Adviser: Patrick W. L. Leung. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 4119. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 222-247). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

<p>Parallell barn- och föräldrabehandling är idag det vanligast praktiserade sättet att bedriva behandlingsarbete med barn och familjer. Det har sin grund i ett psykoanalytiskt förhållningssätt där man traditionellt betonar arbetet med barnet, med en möjlig risk att föräldraarbetet och föräldrarnas roll i barnets terapi kommer i skymundan. Följande studie lyfter fram föräldrarnas egna berättelser kring att medverka och vara en del av en parallell behandling tillsammans med sitt barn. Syftet var att belysa föräldrars upplevelse av delaktighet i sina barns terapier när familjen deltagit i en parallell barn- och föräldrabehandling. Det är en kvalitativ intervjustudie med en tolkande ansats ur ett psykodynamiskt och systemiskt perspektiv. Resultatet visade att föräldrarna överlag upplevde det som att de fått tillräcklig inblick och att de känt sig delaktiga i behandlingen, dock framkom en aspekt av ambivalens i att de både velat och inte velat ha mer inblick och insikt i barnets behandling. Det visade sig vidare att föräldrarnas behov av inblick och insikt i barnets terapi var relaterat till upplevelsen av tillit till behandlingen. Författarens slutsatser är att tillit, inblick och insikt är tre viktiga interagerande aspekter av föräldrarnas upplevelse av delaktighet i barnets behandling.</p>

Parallell barn- och föräldrabehandling är idag det vanligast praktiserade sättet att bedriva behandlingsarbete med barn och familjer. Det har sin grund i ett psykoanalytiskt förhållningssätt där man traditionellt betonar arbetet med barnet, med en möjlig risk att föräldraarbetet och föräldrarnas roll i barnets terapi kommer i skymundan. Följande studie lyfter fram föräldrarnas egna berättelser kring att medverka och vara en del av en parallell behandling tillsammans med sitt barn. Syftet var att belysa föräldrars upplevelse av delaktighet i sina barns terapier när familjen deltagit i en parallell barn- och föräldrabehandling. Det är en kvalitativ intervjustudie med en tolkande ansats ur ett psykodynamiskt och systemiskt perspektiv. Resultatet visade att föräldrarna överlag upplevde det som att de fått tillräcklig inblick och att de känt sig delaktiga i behandlingen, dock framkom en aspekt av ambivalens i att de både velat och inte velat ha mer inblick och insikt i barnets behandling. Det visade sig vidare att föräldrarnas behov av inblick och insikt i barnets terapi var relaterat till upplevelsen av tillit till behandlingen. Författarens slutsatser är att tillit, inblick och insikt är tre viktiga interagerande aspekter av föräldrarnas upplevelse av delaktighet i barnets behandling.