Abstract Intimate partner violence (IPV) is highly prevalent in Pakistan. Social support is associated with a reduced risk for violence and adverse mental health. The purpose of this study was to investigate the association between social support and the occurrence of IPV and adverse mental health among Pakistani women exposed to IPV, along with exploring help-seeking behaviour using qualitative interviews. Data from a cross-sectional survey of 759 women, aged 25–60, were analyzed using logistic regression. The results demonstrated that informal social support was associated with fewer occurrences of all forms of IPV and less likelihood of adverse mental health when exposed to psychological violence, whereas formal social support was associated with more occurrences of all forms of IPV and more likelihood of adverse mental health when exposed to psychological violence. The qualitative result showed that fear of social stigma and low autonomy were, among others, obstacles for seeking help. Suggestions for future interventions include strengthening informal social networks and expanding formal resources, as well as raising awareness of IPV in order to address the issue. / This thesis was made possible by a Minor Field Study grant from the Swedish International Developmental Agency (SIDA) distributed by the department of Psychology at Stockholm University and we would like to express our gratitude for assisting us financially. / PhD project by Tazeen Saeed Ali, School of Nursing, Aga Khan University, called, “Living with violence in the home - a normal part of Pakistani women's life or a serious transgression of human rights.”

This study aimed to explore the relationship between ideas and practices of masculinity and help-seeking behaviour amongst young South African men. The need for this research has been motivated by both the limited amount of previous research in this area, and the importance of this kind of research. It was hypothesized that there would be a relationship between the intended and actual help-seeking behaviour, and the common ideas and practices of masculinity amongst the young men taking part in this research. It was hypothesized that where young men agreed with traditional conceptualizations of masculinity their intention and rate of actual help-seeking would be less. The sample included a diverse group of 100 young men attending the University of KwaZulu-Natal, Pietermaritzburg. Participants included young men from various religious, language, sexual orientation and faculty groups. The data for this research was collected using a questionnaire assessing intended and actual help-seeking behaviour, and participants‟ acceptance of traditional conceptualizations of masculinity. The findings of this study have shown that young men in this context have a low intention and rate of help-seeking behaviour from various help sources, but especially from formal sources such as mental health professionals and general practitioners. It has also found that there are differences in the common ideas and practices of masculinity between young men from different religious, faculty and sexual orientation groups. However, despite the initial hypothesis, this study has been unable to show a clear relationship between ideas and practices of masculinity and help-seeking behaviour. / Thesis (M.A.)-University of KwaZulu-Natal, PIetermaritzburg, 2008.

The use of coercion to induce entry to addiction treatment is controversial and a large body of research has accumulated considering ethical issues, benefits, and repercussions. However, development of evidence-based policy and practices is hampered by limitations of existing literature. Theoretical and empirical work on self-determination suggests that perceptions of coercion have negative implications for motivation, behaviour change, and psychological well-being; however, these insights have not generally informed research on coerced treatment. The present work seeks to further understandings of the meaning and effectiveness of coerced addiction treatment through a theory-based, prospective study of coercion and treatment processes. The sample includes 276 adults admitted to an outpatient counseling program for alcohol- and drug-related problems. At admission, participants completed questionnaires on motivation, perceived coercion, and pressures to enter treatment. Two months later, a second questionnaire assessed engagement in treatment and substance problem severity (follow-up rate = 74.3%). Retention was determined via self-report and agency records. Analysis was guided by a conceptual model based on Self-Determination Theory. Perceived coercion at admission was associated with greater pressures from legal and informal sources, and lower substance problem severity. Fewer than half (45.7%) of participants were still attending treatment at 2-month follow-up. Clients who reported greater coercion were more likely to leave treatment within the first 2 months, and to qualify that decision by statements indicating a lack of perceived need for continued treatment. Greater autonomous motivation was associated with higher client confidence in treatment, and lower perceived coercion and greater informal pressure were associated with greater resolution of substance problems in the weeks following admission. This work contributes empirical evidence to ongoing debates over the legitimacy of coerced addiction treatment by reframing relevant concepts in terms of client perspectives and evaluating the impact on treatment processes. Results raise questions about previous conclusions of the effectiveness of coerced treatment and suggest many future avenues for research. In particular, research is needed to evaluate the longer-term implications of coercion and the changing nature of perceptions and motivation during treatment.

The use of coercion to induce entry to addiction treatment is controversial and a large body of research has accumulated considering ethical issues, benefits, and repercussions. However, development of evidence-based policy and practices is hampered by limitations of existing literature. Theoretical and empirical work on self-determination suggests that perceptions of coercion have negative implications for motivation, behaviour change, and psychological well-being; however, these insights have not generally informed research on coerced treatment. The present work seeks to further understandings of the meaning and effectiveness of coerced addiction treatment through a theory-based, prospective study of coercion and treatment processes. The sample includes 276 adults admitted to an outpatient counseling program for alcohol- and drug-related problems. At admission, participants completed questionnaires on motivation, perceived coercion, and pressures to enter treatment. Two months later, a second questionnaire assessed engagement in treatment and substance problem severity (follow-up rate = 74.3%). Retention was determined via self-report and agency records. Analysis was guided by a conceptual model based on Self-Determination Theory. Perceived coercion at admission was associated with greater pressures from legal and informal sources, and lower substance problem severity. Fewer than half (45.7%) of participants were still attending treatment at 2-month follow-up. Clients who reported greater coercion were more likely to leave treatment within the first 2 months, and to qualify that decision by statements indicating a lack of perceived need for continued treatment. Greater autonomous motivation was associated with higher client confidence in treatment, and lower perceived coercion and greater informal pressure were associated with greater resolution of substance problems in the weeks following admission. This work contributes empirical evidence to ongoing debates over the legitimacy of coerced addiction treatment by reframing relevant concepts in terms of client perspectives and evaluating the impact on treatment processes. Results raise questions about previous conclusions of the effectiveness of coerced treatment and suggest many future avenues for research. In particular, research is needed to evaluate the longer-term implications of coercion and the changing nature of perceptions and motivation during treatment.

In this study, an Implicit Association Test (IAT) was created to measure individuals attitudes towards seeking psychological help. The IAT was administered prior to the Beliefs About Psychological Services scale (BAPS; Ægisdóttir & Gerstein, 2009) to examine the relationship between the implicit and explicit measures of attitudes toward seeking psychological help. It was theorized that the implicit measure would be less affected by social desirability and unconscious attitudes than the explicit measure. Standardizing revealed that IAT scores reflected less belief in the expertness of psychology professionals than did BAPS scores. However, participants reported greater intent to seek psychological help on the BAPS compared to the IAT. BAPS scores reflected higher stigma towards psychological services compared to the IAT. Correlations between the implicit and explicit measure were moderate for stigma and perceived expertness of psychology professionals but low for intent to seek psychological help. / Department of Counseling Psychology and Guidance Services

The purpose of this study was to identify factors that may affect counseling psychology doctoral students' tendencies to seek professional psychological help for their personal problems. The study had the following specific goals: (a) to identify psychology students' reasons for seeking professional help, (b) to identify psychology students' reasons for hesitating to seek professional help, (c) to determine the incidence of personal distress among psychology students, (d) to determine the incidence of professional psychological help seeking, and (e) to begin to examine the impact that training environments have on the development of psychologists' attitudes toward seeking personal psychotherapy.The population of this study was doctoral students in APA-approved programs in Counseling Psychology during their internship phase of training. The sample consisted of 178 pre-doctoral interns. Students were mailed a survey developed by the researcher. The survey instrument consisted of questions about psychological problems experienced and the extent to which students had sought or would seek help for these problems. The survey also addressed students' perceptions about whether or not personal help seeking was advocated in their training programs and extent to which the topic of personal psychotherapy was included in their graduate curriculum.Data were analyzed using a combination of qualitative and quantitative procedures. Grounded theory analysis techniques, frequency distributions and multiple regression analyses were utilized.The study reveals that the decision to seek help is a complex one. While most students had sought or would be willing to seek help in the future, many would hesitate to do so. Conclusions drawn are that psychologists (in training) may prefer to turn to professional help as a last resort, and that there are barriers that prevent trainees from obtaining psychological services including finances, availability of therapists, and concerns about confidentiality. Trainees who have had positive experiences with therapy or who value it for personal or professional growth are more likely to seek help. Trainees who perceive that help seeking is normative among their peers are also more likely to seek help. The topic of "psychologists' seeking help for themselves" is not consistently addressed as a part of counseling psychologists' formal training. / Department of Counseling Psychology and Guidance Services

There is a significant gap between the numbers of college students who experience a diagnosable psychological problem and those who seek psychological treatment for these problems. One explanation for this gap may be that many college students may be unaware of free mental health services available at the university counseling center on campus. Thus, use of these resources is not a viable option. These concerns were addressed in the current study via a posttest-only experimental design by creating a video in line with the Theory of Planned Behavior (TPB; Ajzen, 1985; 1991) and assessing its effects on college students attitudes towards psychological help seeking (PHS), subjective norms associated with PHS, perceived behavioral control over PHS, and PHS intentions. Mixed support was found for the video’s impact on TPB variables in a PHS context. In addition, the utility of the TPB model for explaining PHS in college students was examined. Based on model fit statistics the TPB adequately explained PHS in college students, but only after modifications were made to the measurement model. / Department of Counseling Psychology and Guidance Services

The relationships among counseling expectations, attitudes toward seeking psychological help, psychological distress, and intention to seek counseling have only been examined in one previous study (Vogel, Wester, Wei, & Boysen, 2005). The primary purpose of the current study was to replicate and address the limitations of the Vogel et al. (2005) study. First, a mediation analysis of attitudes on the relationship of expectations and intention to seek therapy was performed. Next, path analyses were used to test a model of the relationship among counseling expectations, attitudes toward seeking psychological help, psychological distress, and the intent to seek counseling, for men and women separately. In the hypothesized model, two separate paths were predicted to impact intentions to seek psychological help. First, three distinct expectations about counseling (personal commitment, facilitative conditions, and counselor expertise) were expected to influence attitudes toward seeking psychological help, which in turn, predicted intention to seek counseling. Second, psychological distress was expected to relate to the intent to seek therapy. Because the hypothesized model for both genders did not fit the data, exploratory path analyses were completed. In the final path model for men, additional paths from the expectancy factors personal commitment and counselor expertise to intent to seek therapy resulted in a well-fitting model. For women, an additional path between psychological distress and attitudes improved the model significantly. Impact of these findings for research and practice are discussed. / Department of Counseling Psychology and Guidance Services

This study was designed to explore the relationship between attitudes toward help seeking, the ethnicity of the psychological help provider, and the level of cultural mistrust toward Jews. A sample of 102 Israeli Arab undergraduate students from Haifa, Israel, participated in this study. It was hypothesized that attitudes toward help seeking, as measured by Attitudes Toward Seeking Professional Psychological Help-Short Form (ATSPPH-S) and the Beliefs About Psychological Services (BAPS), will be related to the ethnicity of the psychological help provider and to the level of cultural mistrust toward Jews. A 2 x 2 between subjects multivariate analysis of variance (MANOVA) was employed. No significant relationship was found between attitudes toward help seeking, the ethnicity of the psychological help provider, and the level of cultural mistrust toward Jews. However, ANOVAs revealed that Freshmen had more favorable attitudes toward seeking professional psychological help as measured by ATSPPH-S than fourth and fifth year students and that sophomores had more favorable attitudes toward seeking psychological help as measured by BAPS than fourth and fifth year students. The results of the logistic regression indicated that Muslim and Christian participants are three times more likely to choose an Arab help provider than Druze participants. Further, the probability of choosing an Arab psychological help provider increased significantly as the participant’s level of cultural mistrust, in the domains of Politics and Law and Interpersonal Relations increased. On the other hand, the probability of choosing an Arab psychological help provider decreased significantly when participants had previous psychological help, and when their level of cultural mistrust increased in the domain of Business and Work. Results indicated strong significant correlations between attitudes toward help seeking and variables such as father’s highest level of education, previous psychological help, age, and year in school. Significant correlations between beliefs about psychological help and year in school and gender were found. The level of cultural mistrust correlated significantly with religion, ethnicity of psychological help provider, previous psychological help, age, and gender. Limitations and implications for future research and practice are presented. / Department of Counseling Psychology and Guidance Services

Mental illness is common, and usually starts early in life. However, the majority of those affected never seek mental health care. The overall aim of this thesis was to increase knowledge about help-seeking young adults with mental illness in order to improve diagnostic procedures in clinical psychiatry. A group of young adult psychiatric out-patients (n=217) were consecutively invited to participate in the study between October 2002 and September 2003. Altogether 200 (92%) agreed to participate. Among them, there were 161 (80%) women and 39 (20%) men. Participants’ mean age was 22.4±1.9 years. All participants were carefully and comprehensively assessed with respect to axes I, II, IV and V in the DSM-IV. Psychiatric disorders and personality disorders were assessed using the Structured Clinical Interview for DSM-IV for axis I disorders and the Structured Clinical Interview for DSM-IV for axis II disorders. Psychosocial and environmental problems (axis IV) were evaluated through structured interviewing by a social worker and by self-assessment with a questionnaire. Professional and patient ratings on the Global Assessment of Functioning scale were compared before and after treatment. Patients also reported on the Swedish universities Scales of Personality, the Child and Adolescent Psychiatric Screening Inventory-Retrospect and the Coddington’s life event scale. Taken together, the young adult, psychiatric outpatients were characterized by an early onset of their mental disorders, by co-morbidity, by being female and by having mood or anxiety disorders. There were no significant differences between self-referred and those referred by medical professionals according to either number of current or lifetime diagnoses. Childhood onset of depression was associated with more severe symptoms, more psychosocial risk factors, and more childhood developmental delays. Axis IV psychosocial stress categories were related to the presence of axis I disorders, personality disorders, co-morbidity, and impaired functioning. Agreement between patients’ and professionals’ ratings on the GAF scale was good before treatment and excellent after treatment. In summary, the findings suggest that direct self-referral to specialized psychiatric care does not seem to be associated with overutilization of such care. Childhood onset of depression is associated with a more complex illness. The revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability. And finally, the results support the usefulness of the self-report GAF instrument for measuring outcome in psychiatric care.