In this thesis I contemplate the work that subjects perform when giving accounts of themselves, and the work that researchers might perform when working with those accounts. It is composed of a series of philosophical contemplations emergent from reflections upon my experience of conducting life-history narrative interviews with forty people aged between eighteen and sixty-five. It is motivated by questions about the practices through which subjects, their experiences and their accounts of that experience are constituted and articulated. It is motivated, too, by ethical questions related to the practices through which researchers engage with the accounts that subjects of research give of themselves. It is a reflexive project in which my presence as researcher and author is figured as an intellectual resource. This is accomplished through the inclusion of a self-conscious textual ‘I’ who gives an account of himself. I ask how we might understand biographical accounts of experience to have been constituted and performed as accounts, and their narrators to have been constituted and performed as narrating and narratable subjects. In pursuing these questions I trace and articulate those temporalised and spatialised practices and relations through which subjects are constituted, and constituted as intelligible to themselves and each other. I work to give an account of subjects as the play of possibilities within, and differences among, intersecting repertoires of regulatory and regularising technologies of subjectification. I resist, however, giving accounts of subjects that suggest that they are reducible to these technologies. I am, then, concerned with articulating a subject who is simultaneously, paradoxically, regulated and irreducible, knowable and not. These concerns are articulated and performed through contemplation of philosophical and ethical questions related to working with transcriptions of life-history narrative interviews. Rather than suppose the transcribed interview to be a patient text awaiting interpretation, I perform the act of approaching the text with patience. I work with transcriptions of narrative interviews as resources for the reflexive development of my theorising, and for the articulation and performance of patient theorising through deferral of close attention to one narrative until the final chapter. I work with theory in this way, not as if there is a hypothesis to be tested through research, but with research as a space through which questions of theory might be developed. I open the text to philosophical questions, propositions and concepts motivated more towards further openings rather than closures. It is an assemblage of thoughts, knowledges, relations, memories and forgettings which instantiate multiple trajectories that arc in multiple directions without necessarily meeting or arriving. It is a text of bits and fragments, absences and presences, inclusions and omissions, locutions and lacunae. / Doctor of Philosophy (PhD)

Thesis (Ph. D.)--University of Zürich, 1986. / Bibliography: p. [185]-195. Also issued in print.

Thesis (Ph. D.)--University of Texas at El Paso, 2008. / Title from title screen. Vita. CD-ROM. Includes bibliographical references. Also available online.

Thesis (Ph. D.)--University of Zürich, 1986. / Includes bibliographical references (p. [185]-195).

Thesis (Ph. D.)--University of Zürich, 1986. / Bibliography: p. [185]-195. Also issued online.

Proefschrift Maastricht. / Met lit.opg. - Met een samenvatting in het Nederlands.

Thesis (M.S.)--Boston University

This thesis presents an empirical research that aims to explore insight generation in discrete-event simulation (DES) studies. It is often claimed that simulation is useful for generating insights. There is, however, almost no empirical evidence to support this claim. The factors of a simulation intervention that affect the occurrence of insight are not clear. A specific claim is that watching the animated display of a simulation model is more helpful in making better decisions than relying on the statistical outcomes generated from simulation runs; but again, there is very limited evidence to support this. To address this dearth of evidence, two studies are implemented: a quantitative and a qualitative study. In the former, a laboratory-based experimental study is used, where undergraduate students were placed in three separate groups and given a task to solve using a model with only animation, a model with only statistical results, or using no model at all. In the qualitative study, semi-structured interviews with simulation consultants were carried out, where participants were requested to account examples of projects in which clients change their problem understanding and generate more effective ideas. The two separated parts of the study found different types of evidence to support that simulation generates insight. The experimental study suggests that insights are generated more rapidly from statistical results than the use of animation. Research outcomes from the interviews include descriptions of: the phase of a simulation study where insight emerges; the role of different methods applied and means used in discovering and overcoming discontinuity in thinking (for instance, the role of consultant s influence in problem understanding); how some factors of a simulation intervention are associated with the processes of uncovering and overcoming discontinuity in thinking (for example, the role of clients team in the selection of methods used to communicate results); and the role of the model and consultant in generating new ideas. This thesis contributes to the limited existing literature by providing a more in depth understanding of insight in the context of simulation and empirical evidence on the insight-enabling benefits of simulation based on an operational definition. The findings of the study provide new insights into the factors of simulation that support fast and creative problem solving.

[pt] Dando continuidade aos estudos sobre o início do tratamento familiar, a presente pesquisa teve como objetivo investigar o período de entrevistas preliminares com famílias. Procurou-se focar a avaliação diagnóstica, assim como, as implicações da construção da demanda compartilhada e sua influência na adesão familiar ao tratamento. A demanda familiar compartilhada foi uma noção desenvolvida neste estudo, significando a motivação latente que conduziu o grupo à psicoterapia. Ou seja, corresponde aos conteúdos interpsíquicos que são ainda incompreensíveis para a família. Entende-se que no período de entrevistas seja importante problematizar a queixa inicial, centrada nos conflitos existentes com o paciente identificado. Estas intervenções iniciais visam à realização de uma transformação da posição de vítima da família, para um posicionamento conjunto responsável pela manutenção de seu sofrimento. Buscou-se também enfatizar a riqueza do uso de dispositivos diagnósticos, entendendo-os como um recurso que contextualiza as hipóteses do psicoterapeuta e promove uma ampliação na cadeia associativa da família. Nesta investigação descreveu-se a técnica Arte-Diagnóstico Familiar, a fim de difundi-la ainda mais no Brasil como um instrumento complementar à avaliação diagnóstica familiar. Para atingir os objetivos propostos, foram descritos três casos clínicos. Eles ilustraram o período de entrevistas e o trabalho de construção da demanda familiar compartilhada, cujas análises pretenderam contribuir para o enriquecimento do trabalho inicial da psicoterapia de família. / [en] Pursuing our studies about the beginning of the family treatment, the present research aimed at investigating the period of preliminary interviews with families. An effort was made to focus on the diagnostic evaluation of the family motivations to seek for psychotherapeutic help as well as on the implications of constructing the conjoint demand and its influence on the family adherence to the treatment. The conjoint family demand was a notion developed in this study, meaning the latent motivation shared by all the family members which led them, conjointly, to look for psychotherapy. In other words, it corresponds to the interpsychic contents that are still incomprehensible to the family. It is assumed that during the period of interviews it is important to raise the problematical issue of the initial complaint, focused on the existing conflicts with the identified patient. These initial interventions seek the transformation of the family’s position as victims to a conjoint positioning, responsible for the maintenance of their suffering. Special emphasis was also given to the value of using evaluation instruments, considering them as a resource that contextualizes the psychotherapist’s hypothesis and promotes an increase of the family’s associative chain. This investigation described exclusively the Family Art Evaluation in order to disseminate it even more in Brazil as a complementary instrument to the family diagnostic evaluation. To achieve the proposed objectives, three clinical cases, with different complaints and problematical issues, were described. They illustrated both the period of interviews and the work in constructing the family conjoint demand, whose analyses were intended to contribute to the enrichment of the initial work of the family psychotherapy.

There is growing evidence that the way patients and families relate to healthcare professionals influences their experience of illness and healthcare, and may affect their psychological and physical wellbeing. Relationships between professional groups may also have a significant impact on healthcare provision to children and families. Previous research has focused on dyadic relationships within paediatric healthcare (mother and child, nurse and parents, doctors and nurses), but little has been published concerning the complex inter-relationships and roles of family members, doctors and nurses. The aim of this research was to undertake a systemic analysis of the roles and relationships of nurses and doctors with children, adolescents and families. A qualitative methodology was used to explore how the three groups (nurses, doctors and families) understand their respective roles and relationships in the care of ill children within a tertiary paediatric hospital. While systemic and social constructionist theory informed the overall conception of the study, grounded theory was the method used for structuring data collection and analysis. Data collection involved semi-structured interviews with doctors, nurses and families. These were audio-taped and each set of transcripts analysed according to grounded theory principles. Theoretical coding then allowed comparisons to be made across each set of data. Two theoretical categories describing key processes involved in the care of ill children emerged from the analysis. These were: “Building emotional connections and focusing on medical goals: complementary or contradictory relationship discourses for families and staff?” and “Shifting relationships around expertise and power: the gains and losses associated with new positionings” The first category highlights that both professionals and families appear to draw on particular societal discourses to inform their roles and relationships. These discourses (about the therapeutic value of emotional connections between staff and families and the need for ‘medical professionalism’) can appear at odds with each other. creating tensions and dilemmas for each group. The second theoretical category highlights that power relationships between nurses, doctors and families are in a process of change. Fundamental change may be hard to achieve however, as each group may experience losses and well as gains in their emerging positions. It is further argued that changes in government policy relating to these core processes creates challenges for each participant group as they struggle to balance positive working relationships, the medical care of the child and status and power issues. Change in any one aspect of these professional and family roles and relationships may have both adverse and beneficial effects, which need to be recognised. These findings raise important questions about the feasibility and desirability of family centred care. The implications of this research for training, consultation and future research are explored. The research adds to a small but growing body of literature focusing on the interface between professionals, patients and families in healthcare settings.