Thesis (M.S.)--Boston University

This work describes the impact of personalisation on users and professional workers identities in four mental health care settings. The development and context of personalisation is identified and set within an emergent narrative of consumer choice and austerity. International personalisation research is compared and a discussion of UK mental health literature is presented. The social constructions of key participants are analysed through their narrative accounts as they undertook identity work while being involved with individual budget pilots, either as users, carers, brokers or mental health professionals. The work employs Stake’s collective case study as the method of combining semi-structured interview data taken from participants in four personalisation studies designed and led by this author between 2008-2011. Narrative social constructionist methods, positioning theory and story-line are used in the analysis to produce a framework of participants’ orientation to personalisation. The importance of nuance as opposed to binary construction towards personalisation is highlighted, as are the positioning actions of independent brokers for the success of personalisation. The importance of co-production and challenging professional asymmetry in health and social mental health care services is clearly made as are the implications for practice. The value of the proposed framework and possible future research are discussed.

Aim: This research project explored the relationship between borderline personality disorder, difficult to treat depression and treatment outcome. Method: The study used data collected in the course of the Tavistock Adult Depression Study (TADS). The TADS was a randomised controlled trial comparing Long Term Psychodynamic Psychotherapy (LTPP) to Treatment as Usual (TAU) for 129 patients whose depression has not been successfully treated by at least two previous interventions. The author of this project took part in rating all patients with the Shedler-Westen Assessment Profile (SWAP-II) – a 200-item personality measure – at the beginning and end of treatment. Statistical analysis explored the relationship between patients’ borderline personality scores at the beginning and end of treatment, and their progress in treatment in terms of decrease in depression severity, and psychological distress, and increase in general functioning. In addition, changes in borderline personality features were also explored in relation to changes on the three main outcome measures. The author included the rest of the SWAP-II personality scales in the analysis, too, as the SWAP-II generates an overall personality profile. Results: Only a small number of patients reached cut-off scores for borderline personality disorder or features. When the SWAP-II borderline scale was entered in analysis as a continuous variable, no significant link was found between borderline personality scores at the beginning of treatment, and treatment outcome. The way borderline features changed in the course of treatment, however, was significantly related to the outcome measures. This was particularly the case for SWAP-II items indicating insecure attachment and affect dysregulation. In addition, patients in the LTPP group who presented with borderline personality features or disorder at the end of treatment were more likely to still experience severe or very severe depression at the end of therapy.

This research comprises three linked projects stemming from the first project which aimed to define “long-term” pupil absence from school and discover the principal reasons for such absence. The second project focussed on the area of Child and Adolescent Mental Health Services (CAMHS), an issue emerging from the first project. The CAMHS 4-Tier Strategic Framework (or “CAMHS Concept”), including links between CAMHS providers were examined and referral pathways investigated and measured against published criteria. The third project explored the new CAMHS Strategic Framework and considered whether implementation problems were to blame for its lack of transformational impact.

<p> Musicians often feel the extremes of highs and lows based on the nature of their work. In order to effectively communicate with an audience, the performer needs to express his or her musical ideas. This form of expression leaves the performer vulnerable, since the audience may either enjoy or disapprove of the performer&rsquo;s interpretation. With each performance, musicians are evaluated or judged by their peers and audiences as to whether or not they have performed at a level expected. Additionally, to have a successful performance, a musician must put on a good show in order to communicate to the audience. If the performance is not positively received by the audience, the performer may feel ashamed or embarrassed, and may even think that the severe reception reflects the performer&rsquo;s lack of aptitude as a musician. Furthermore, since musicians dedicate so much of their lives and time to practicing, preparing, and performing, oftentimes their identity revolves around being a successful musician. To speak to the audience successfully, a musician must be vulnerable with his or her performance. However, vulnerability can lead to degradation, and thus, a breakdown of mental health. An unfavorable critique of their performance may also make them feel inadequate as a human and professional. Therefore, musicians often suffer different types of anxiety connected with their performances. Depression is one dominant mental health issue prevalent in many musicians. </p><p> Not only is it the professional nature of the musicians&rsquo; work that highlights their depression, it is also the creative component of their work that intensifies their depression. Such was the case with Christian Ferras, a French violinist born in 1933. Ferras was considered a prodigy as a violinist and performed with many well known conductors, orchestras, and accompanists. Unfortunately, he battled with his depression throughout his career. Ferras took some time off from performing and teaching from 1967&ndash;1975, but ultimately was not able to regain the career that he wanted. In 1982 at the age of forty-nine, Ferras committed suicide by jumping out of his Paris apartment window.</p><p>

<p> In the United States, recidivism rates among juvenile offenders continue to grow year after year, despite decades of research to understand the problem, including more recent efforts by the courts to focus on alternatives to incarceration. More contemporary research efforts have suggested that targeting specific risk factors, particularly mental health issues, in juvenile offenders is an effective method for not only reducing recidivism, but the successful completion of probation programs. In virtually all juvenile justice systems across the country, offenders are given a mental health assessment when entering the system, although utilizing the results is neither mandate not nor consistently applied in many cases. This study sought to understand, from the perspective of probation officers in one county in Arizona, why the assessments are not more widely and consistently used. Specifically, this study sought to answer the following research question: How do probation officers for juveniles describe the barriers to implementation of mental health assessments in case planning? This study used a generic qualitative methodology, interviewing current juvenile probation officers. Interviews were recorded, transcribed, analyzed, and ultimately identified three primary themes: lack of training, overwhelming caseloads, and an overall problem with the perceived value of the assessments. Subsequently, these themes are indicators of barriers that probation officers face in their jobs when it comes to implementing mental health assessment results in case planning. Ultimately, this study provided new insight into why juvenile probation officers do not more consistently utilize mental health assessment results and offers implications for future research to expand the population, scope, and understanding of this research topic.</p><p>

This study explored the reliability and discriminant validity of a new narrative measure, the Teddy Bear's Picnic (Mueller, 1996), in a small non-clinical community sample of 5 year olds (n=35). The measure is designed for use with young children, and reveals internally represented psychosocial themes through the use of a story telling technique. The Teddy Bear's Picnic measure consists of nine incomplete story stems which are administered to children individually, using a range of age appropriate toys and props. Each story is based on an imaginative scenario involving a family of toy bears. Children are presented with the stories in a specific order, each of which poses an unresolved hypothetical conflict; following which they are asked to complete the unfinished story in response to the prompt "what happens next? " Concurrent parent and teacher measures were gathered as part of a larger ongoing study in the same community. Parents and teachers were asked to complete a brief 25 item rating scale, the Strengths and Difficulties Questionnaire (SDQ: Goodman, 1997), and one categorical question asking them to rate level of concern about the child's behaviour (based on the work of Stallard, 1995). The study aimed to examine the associations between coded thematic material generated from the Teddy Bear's Picnic, and parent and teacher rated behaviour problems and global concern about behaviour. Associations were all in the expected direction, but not statistically significant. Inter-rater reliability was acceptable for total positive theme scores (r = . 91, p < . 001), and approached acceptability for negative total theme scores(r = . 58, p < . 05). Problems were particularly apparent in the use of TBP composite total scores. Internal consistency of total theme scores and factor based subscale scores (derived from Mueller, 1996), revealed low alpha coefficients (alpha = . 42 -. 59). Discriminant function analysis demonstrated that in this study, the TBP was unable to correctly classify children into parent and teacher rated groupings, based on both measures. Further studies would benefit from larger samples than were available to Mueller (1996) and the present study. However, the measure appears promising as a method for eliciting psychologically relevant themes from young children, but findings suggest that further work is required in developing its psychometric properties.

<p> The purpose of this study was to explore the experience of healing and transformation that occurs for wounded healers who brings their ancestral story and related traumas and resiliencies to consciousness. The primary research questions guiding the study were: What is the journey of healing that occurs for wounded healers exploring their ancestral story and related intergenerational traumas and resiliencies? What is the transformation that happens in the course of this healing? </p><p> Using narrative and art-based methodologies, the study involved interviewing six healing professionals who had consciously addressed the wounding passed down to them from previous generations. Themes of healing and transformation were identified using Riessman&rsquo;s (2008) coding and narrative analysis, Lieblich&rsquo;s (1998) holistic-content approach to narrative, and art-based inquiry. </p><p> The findings indicate that on the journey of bringing ancestral story to consciousness the participants experienced healing and transformation in the following ways: breaking ancestral patterns, receiving support from the ancestors, reclaiming ancestral heritage, deepening awareness of the healing power of nature, acquiring a new sense of identity, and finding purpose. Additional research comparing the particular types of modalities involved in healing and transforming ancestral trauma would be of benefit.</p><p>

<p> This study examined the potential healing aspects of a psychosocial intervention using street theatre with those suffering from schizophrenia in Rio de Janeiro, Brazil. Qualitative research was conducted to explore how art, culture and public health can provide a comprehensive approach to promote mental health within communities. The sample consisted of eight men and women who were active members of DyoNises Theatre group for at least one year. Participants were either staff at Municipal Institute of Health Care Nise da Silveira or volunteers. A qualitative design methodology based on Heidegger&rsquo;s interpretive phenomenology was used. The data revealed nine major themes, 18 subthemes, 48 categories within subthemes, which were divided into three sections: a) Performance; b) Manifestations of Health; and c) Cultural Identities. Major themes in the Performance section included: 1) Play: from spectator to protagonist; 2) Ritual: providing structure; and 3) Theatre: development of social consciousness. Major themes in the Manifestations of Health section included: 1) Body in action: strengthening self-other boundaries; 2) Embodied Learning: practical actions to promote knowledge; and 3) Externalizing the Shadow: what within you kills you, out of you can save you. Major themes in the Cultural Identities section included: 1) Community Dialogue: rethinking perspective; 2) Experiential Knowledge as an Exercise of Power: expanding our models of thinking and behavior; and 3) Historical Heritage: reconnecting with ancestral knowledge. Clinical implications were related to reconstructing cohesive body boundaries, deepening the range of emotional responses to the environment, promoting autonomy, leadership, and community, educating the public, and redefining our cultural practices. </p><p>

Made available in DSpace on 2014-06-11T19:29:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-14Bitstream added on 2014-06-13T20:38:08Z : No. of bitstreams: 1 ferrazza_da_me_assis.pdf: 979464 bytes, checksum: 588a7035d40ca9b58068b18623e46852 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Atualmente, qualquer sinal de sofrimento psíquico pode ser rotulado como uma patologia cujo tratamento será a administração de psicofármacos. Com o advento dos modernos psicofármacos e com a ênfase preventiva que assumiu o atendimento psiquiátrico após a II Guerra Mundial, a psiquiatria modificou suas práticas e deixou de ser um saber voltado exclusivamente ao tratamento da loucura para dedicar-se a medicar qualquer mal-estar cotidiano. Essa tendência tem-se ampliado de tal modo que é possível perceber a ocorrência de uma generalizada “medicalização do social”. Neste trabalho, desenvolvemos dois movimentos de pesquisa distintos para estudar o tema da medicalização social e da atual expansão da prescrição de psicofármacos. O primeiro desenvolve um enfoque histórico-social de contextualização geral do processo de medicalização do social. Nele procuramos percorrer a trajetória da constituição do saber e das práticas médico-psiquiátricas desde a fundação manicomial do alienismo até a atual ênfase psicofarmacológica da psiquiatria contemporânea. O segundo movimento busca aproximar-se da capilaridade do processo de medicalização por meio do desenvolvimento de um estudo exploratório amostral sobre a prescrição de psicofármacos no âmbito de um serviço de atendimento à saúde mental de uma pequena cidade do interior paulista. Nossa pesquisa mostra que todos aqueles que passaram pelo atendimento psiquiátrico receberam prescrição de psicofármacos... / Currently, any sign of distress can be labeled as a pathology which treatment will be the administration of psychotropic drugs. With the advent of modern psychiatric drugs and with the preventive emphasis that psychiatric care assumed after World War II, psychiatry has changed its practices and no longer is a knowledge exclusively turned to madness but has been devoted itself to medicate any daily discomfort. This trend has been expanded in such way that is possible to notice the occurrence of a generalized medicalization of society. In the present work we developed two distinct research movements to study the issue of medicalization and social expansion of the current psychotropic drugs ´prescription. The first develops a historical-social emphasis at the general process of contextualization in the social medicalization. For that, we sought to travel through knowledge´s constitution and medical-psychiatric practices going through the asylum alienisms foundation to the current emphasis on psychopharmacology of contemporary psychiatry. The second movement seeks to approximate itself to the capillarity of the medicalization process by developing an exploratory sample of psychotropic prescription in a mental health service care from a small town in São Paulo. Our research shows that everyone who went through psychiatric treatment received psychotropic prescription... (Complete abstract click electronic access below)