No description available.

Esta tese teve como objetivo geral analisar o fenômeno do abandono em psicoterapia psicanalítica (PP) através de metodologia qualitativa. Para tanto, três artigos foram realizados identificando características de inicio e término de tratamento de pacientes adultos classificados por seus psicoterapeutas como pacientes que abandonaram a PP, em um serviço de atendimento da cidade de Porto Alegre/Brasil, cujo objetivo principal é a formação de especialistas em PP. Foi utilizado em todos os estudos o método de Bardin (1995) para analisar o conteúdo das entrevistas iniciais de tratamento, encontradas no arquivo do serviço de atendimento, e das entrevistas pós-tratamento realizadas pela autora da tese. O primeiro artigo apresenta a análise do tratamento de seis mulheres que abandonaram a PP. Objetivos pouco claros de tratamento, fraca disposição para mudar, sinais precoces de transferência negativa e resistência, e ausência de reconhecimento da própria participação nos problemas são fatores que surgiram no início da psicoterapia. Ganhos terapêuticos, insatisfação e resistência durante o processo psicoterapêutico pareceram estar associados ao abandono. O segundo artigo revela os achados dos tratamentos de cinco pacientes que abandonaram a PP e de cinco que a completaram. Pacientes que abandonaram a PP apresentaram no início do tratamento: objetivos e expectativas focalizadas, fraca disposição para mudar, capacidade de insight diminuída, percepção negativa dos tratamentos anteriores, e manifestações significativas de transferência negativa e resistência. Por outro lado, pacientes que completaram a PP possuíam metas e expectativas de psicoterapia relacionada com aspectos mais amplos da vida, foram menos resistentes para começar o tratamento, apresentaram maior disposição de mudar, transferência mais positiva, e níveis mais elevados de percepção e de satisfação com o tratamento anterior. Durante o tratamento, pacientes que completaram a PP foram menos resistentes e estavam mais satisfeitos com a psicoterapia, referiram benefícios mais eficazes e alcançaram maior capacidade de continuar trabalhando em problemas psicológicos, em comparação com os pacientes que abandonaram a PP. E o terceiro artigo, mostra os dados encontrados nos tratamentos de pacientes que abandonaram a PP em diferentes momentos da psicoterapia. Sete pacientes de tempo de abandono médio (AM- dois a 11 meses após o início da psicoterapia) comparados com sete pacientes de tempo de abandono tardio (AT- mais de um ano após o início) foram identificados como aqueles que iniciaram o tratamento mais por indicação de terceiros do que por conta própria, apresentando maior resistência, com expectativas de mais apoio, menor transferência positiva, mais queixas depressivas e experiências negativas com tratamentos anteriores. Na entrevista pós-tratamento revelaram mais resistência durante o processo de psicoterapia. Abandonaram a psicoterapia com menor capacidade de insight, avaliaram mais negativamente o tratamento tanto nos aspectos gerais como nos específicos. Embora distinções tenham sido observadas, entende-se que a diferenciação das características dos grupos de AM e AT é tênue e necessita de mais investigações. Esta tese oferece algumas hipóteses ou explicações para o complexo fenômeno do abandono da PP. Sugere que as decisões de iniciar, abandonar ou completar a psicoterapia dependem de múltiplos fatores, tais como: definição de metas e objetivos estabelecidos em conjunto pela dupla paciente/psicoterapeuta, disposição para empreender mudanças, capacidade de insight que implica em reconhecimento da condição psíquica e da participação nos problemas, resistência, transferência e experiência vivenciada em tratamento anterior. Os resultados obtidos nesta tese são exploratórios necessitando mais estudos nessa área. / This thesis had as general objective to analyze the phenomenon of dropout in psychoanalytic psychotherapy (PP) through qualitative methodology. To do so, three articles were written identifying characteristics of beginning and end of treatment of adult patients who were classified by their psychotherapists as patients who dropped out the PP, in a service of attendance in the city of Porto Alegre/Brazil, whose main objective is the formation of specialists in PP. The Bardin’s method (1995) was used in all the studies to analyze the content of the initial interviews of treatment, which were found in the file of the attendance service, and of the post-treatment interviews accomplished by the authoress of the thesis. The first article presents the analysis of treatment of six women who dropped out the PP. Factors that came up in the beginning of the psychotherapy were: unclear objectives of the treatment, weak readiness to change, precocious signs of negative transference and resistance and absence of recognition about the own participation in the problems. Therapeutic gains, dissatisfaction and resistance during the therapeutic process seemed to be associated to the dropout. The second article reveals the findings of the treatments of five patients who dropped out the PP and other five who completed it. Patients who dropped out the PP presented in the beginning of the treatment: focalized objectives and expectations, weak disposition to change, decreased capacity for insight, negative perception of the previous treatments and meaningful manifestations of negative transference and resistance. On the other hand, patients who completed the PP had goals and expectations of psychotherapy related to wider aspects of life, were less resistant to begin the treatment, presented a bigger disposition to change, more positive transference and higher levels of perception and satisfaction concerning the previous treatment. During the treatment, patients who completed the PP were less resistant and were more satisfied about the psychotherapy, referred more effective benefits and reached a bigger capacity to continue working in psychological problems if compared to patients who dropped out the PP. And the third article shows the data found in treatments of patients who dropped out the PP in different moments of the therapy. Seven patients of medium time of dropout (MD - two to eleven months after the beginning of the psychotherapy) compared to seven patients of late time of dropout (LD - more than one year after the beginning) were identified as the ones who started the treatment by indication of others more than by their own, presenting more resistance, with expectations of more support, less positive transference, more depressive complains and negative experiences about the previous treatments. In the post-treatment interview they revealed more resistance during the process of psychotherapy. They dropped out the psychotherapy with minor capacity of insight, evaluated the treatment in a more negative way concerning its general aspects as well as the specific ones. Although distinctions have been observed, it is understood that the differentiation of the characteristics of the groups of MD and LD is tenuous and it needs more investigation. This thesis offers some hypothesis or explanations for the complex phenomenon of dropout of PP. It suggests that the decisions about initiate, dropping out, or completing the psychotherapy depend on multiple factors, such as: definition of marks and objectives established in partnership (patient/psychotherapist), disposition to undertake changes, capacity of insight which implies in recognition of the psychic condition and the participation of problems, resistance, transference and experience that were experienced in previous treatment. The results which were obtained in this thesis are exploratory and it is necessary to study more in this area.

Esta tese teve como objetivo geral analisar o fenômeno do abandono em psicoterapia psicanalítica (PP) através de metodologia qualitativa. Para tanto, três artigos foram realizados identificando características de inicio e término de tratamento de pacientes adultos classificados por seus psicoterapeutas como pacientes que abandonaram a PP, em um serviço de atendimento da cidade de Porto Alegre/Brasil, cujo objetivo principal é a formação de especialistas em PP. Foi utilizado em todos os estudos o método de Bardin (1995) para analisar o conteúdo das entrevistas iniciais de tratamento, encontradas no arquivo do serviço de atendimento, e das entrevistas pós-tratamento realizadas pela autora da tese. O primeiro artigo apresenta a análise do tratamento de seis mulheres que abandonaram a PP. Objetivos pouco claros de tratamento, fraca disposição para mudar, sinais precoces de transferência negativa e resistência, e ausência de reconhecimento da própria participação nos problemas são fatores que surgiram no início da psicoterapia. Ganhos terapêuticos, insatisfação e resistência durante o processo psicoterapêutico pareceram estar associados ao abandono. O segundo artigo revela os achados dos tratamentos de cinco pacientes que abandonaram a PP e de cinco que a completaram. Pacientes que abandonaram a PP apresentaram no início do tratamento: objetivos e expectativas focalizadas, fraca disposição para mudar, capacidade de insight diminuída, percepção negativa dos tratamentos anteriores, e manifestações significativas de transferência negativa e resistência. Por outro lado, pacientes que completaram a PP possuíam metas e expectativas de psicoterapia relacionada com aspectos mais amplos da vida, foram menos resistentes para começar o tratamento, apresentaram maior disposição de mudar, transferência mais positiva, e níveis mais elevados de percepção e de satisfação com o tratamento anterior. Durante o tratamento, pacientes que completaram a PP foram menos resistentes e estavam mais satisfeitos com a psicoterapia, referiram benefícios mais eficazes e alcançaram maior capacidade de continuar trabalhando em problemas psicológicos, em comparação com os pacientes que abandonaram a PP. E o terceiro artigo, mostra os dados encontrados nos tratamentos de pacientes que abandonaram a PP em diferentes momentos da psicoterapia. Sete pacientes de tempo de abandono médio (AM- dois a 11 meses após o início da psicoterapia) comparados com sete pacientes de tempo de abandono tardio (AT- mais de um ano após o início) foram identificados como aqueles que iniciaram o tratamento mais por indicação de terceiros do que por conta própria, apresentando maior resistência, com expectativas de mais apoio, menor transferência positiva, mais queixas depressivas e experiências negativas com tratamentos anteriores. Na entrevista pós-tratamento revelaram mais resistência durante o processo de psicoterapia. Abandonaram a psicoterapia com menor capacidade de insight, avaliaram mais negativamente o tratamento tanto nos aspectos gerais como nos específicos. Embora distinções tenham sido observadas, entende-se que a diferenciação das características dos grupos de AM e AT é tênue e necessita de mais investigações. Esta tese oferece algumas hipóteses ou explicações para o complexo fenômeno do abandono da PP. Sugere que as decisões de iniciar, abandonar ou completar a psicoterapia dependem de múltiplos fatores, tais como: definição de metas e objetivos estabelecidos em conjunto pela dupla paciente/psicoterapeuta, disposição para empreender mudanças, capacidade de insight que implica em reconhecimento da condição psíquica e da participação nos problemas, resistência, transferência e experiência vivenciada em tratamento anterior. Os resultados obtidos nesta tese são exploratórios necessitando mais estudos nessa área. / This thesis had as general objective to analyze the phenomenon of dropout in psychoanalytic psychotherapy (PP) through qualitative methodology. To do so, three articles were written identifying characteristics of beginning and end of treatment of adult patients who were classified by their psychotherapists as patients who dropped out the PP, in a service of attendance in the city of Porto Alegre/Brazil, whose main objective is the formation of specialists in PP. The Bardin’s method (1995) was used in all the studies to analyze the content of the initial interviews of treatment, which were found in the file of the attendance service, and of the post-treatment interviews accomplished by the authoress of the thesis. The first article presents the analysis of treatment of six women who dropped out the PP. Factors that came up in the beginning of the psychotherapy were: unclear objectives of the treatment, weak readiness to change, precocious signs of negative transference and resistance and absence of recognition about the own participation in the problems. Therapeutic gains, dissatisfaction and resistance during the therapeutic process seemed to be associated to the dropout. The second article reveals the findings of the treatments of five patients who dropped out the PP and other five who completed it. Patients who dropped out the PP presented in the beginning of the treatment: focalized objectives and expectations, weak disposition to change, decreased capacity for insight, negative perception of the previous treatments and meaningful manifestations of negative transference and resistance. On the other hand, patients who completed the PP had goals and expectations of psychotherapy related to wider aspects of life, were less resistant to begin the treatment, presented a bigger disposition to change, more positive transference and higher levels of perception and satisfaction concerning the previous treatment. During the treatment, patients who completed the PP were less resistant and were more satisfied about the psychotherapy, referred more effective benefits and reached a bigger capacity to continue working in psychological problems if compared to patients who dropped out the PP. And the third article shows the data found in treatments of patients who dropped out the PP in different moments of the therapy. Seven patients of medium time of dropout (MD - two to eleven months after the beginning of the psychotherapy) compared to seven patients of late time of dropout (LD - more than one year after the beginning) were identified as the ones who started the treatment by indication of others more than by their own, presenting more resistance, with expectations of more support, less positive transference, more depressive complains and negative experiences about the previous treatments. In the post-treatment interview they revealed more resistance during the process of psychotherapy. They dropped out the psychotherapy with minor capacity of insight, evaluated the treatment in a more negative way concerning its general aspects as well as the specific ones. Although distinctions have been observed, it is understood that the differentiation of the characteristics of the groups of MD and LD is tenuous and it needs more investigation. This thesis offers some hypothesis or explanations for the complex phenomenon of dropout of PP. It suggests that the decisions about initiate, dropping out, or completing the psychotherapy depend on multiple factors, such as: definition of marks and objectives established in partnership (patient/psychotherapist), disposition to undertake changes, capacity of insight which implies in recognition of the psychic condition and the participation of problems, resistance, transference and experience that were experienced in previous treatment. The results which were obtained in this thesis are exploratory and it is necessary to study more in this area.

Esta tese teve como objetivo geral analisar o fenômeno do abandono em psicoterapia psicanalítica (PP) através de metodologia qualitativa. Para tanto, três artigos foram realizados identificando características de inicio e término de tratamento de pacientes adultos classificados por seus psicoterapeutas como pacientes que abandonaram a PP, em um serviço de atendimento da cidade de Porto Alegre/Brasil, cujo objetivo principal é a formação de especialistas em PP. Foi utilizado em todos os estudos o método de Bardin (1995) para analisar o conteúdo das entrevistas iniciais de tratamento, encontradas no arquivo do serviço de atendimento, e das entrevistas pós-tratamento realizadas pela autora da tese. O primeiro artigo apresenta a análise do tratamento de seis mulheres que abandonaram a PP. Objetivos pouco claros de tratamento, fraca disposição para mudar, sinais precoces de transferência negativa e resistência, e ausência de reconhecimento da própria participação nos problemas são fatores que surgiram no início da psicoterapia. Ganhos terapêuticos, insatisfação e resistência durante o processo psicoterapêutico pareceram estar associados ao abandono. O segundo artigo revela os achados dos tratamentos de cinco pacientes que abandonaram a PP e de cinco que a completaram. Pacientes que abandonaram a PP apresentaram no início do tratamento: objetivos e expectativas focalizadas, fraca disposição para mudar, capacidade de insight diminuída, percepção negativa dos tratamentos anteriores, e manifestações significativas de transferência negativa e resistência. Por outro lado, pacientes que completaram a PP possuíam metas e expectativas de psicoterapia relacionada com aspectos mais amplos da vida, foram menos resistentes para começar o tratamento, apresentaram maior disposição de mudar, transferência mais positiva, e níveis mais elevados de percepção e de satisfação com o tratamento anterior. Durante o tratamento, pacientes que completaram a PP foram menos resistentes e estavam mais satisfeitos com a psicoterapia, referiram benefícios mais eficazes e alcançaram maior capacidade de continuar trabalhando em problemas psicológicos, em comparação com os pacientes que abandonaram a PP. E o terceiro artigo, mostra os dados encontrados nos tratamentos de pacientes que abandonaram a PP em diferentes momentos da psicoterapia. Sete pacientes de tempo de abandono médio (AM- dois a 11 meses após o início da psicoterapia) comparados com sete pacientes de tempo de abandono tardio (AT- mais de um ano após o início) foram identificados como aqueles que iniciaram o tratamento mais por indicação de terceiros do que por conta própria, apresentando maior resistência, com expectativas de mais apoio, menor transferência positiva, mais queixas depressivas e experiências negativas com tratamentos anteriores. Na entrevista pós-tratamento revelaram mais resistência durante o processo de psicoterapia. Abandonaram a psicoterapia com menor capacidade de insight, avaliaram mais negativamente o tratamento tanto nos aspectos gerais como nos específicos. Embora distinções tenham sido observadas, entende-se que a diferenciação das características dos grupos de AM e AT é tênue e necessita de mais investigações. Esta tese oferece algumas hipóteses ou explicações para o complexo fenômeno do abandono da PP. Sugere que as decisões de iniciar, abandonar ou completar a psicoterapia dependem de múltiplos fatores, tais como: definição de metas e objetivos estabelecidos em conjunto pela dupla paciente/psicoterapeuta, disposição para empreender mudanças, capacidade de insight que implica em reconhecimento da condição psíquica e da participação nos problemas, resistência, transferência e experiência vivenciada em tratamento anterior. Os resultados obtidos nesta tese são exploratórios necessitando mais estudos nessa área. / This thesis had as general objective to analyze the phenomenon of dropout in psychoanalytic psychotherapy (PP) through qualitative methodology. To do so, three articles were written identifying characteristics of beginning and end of treatment of adult patients who were classified by their psychotherapists as patients who dropped out the PP, in a service of attendance in the city of Porto Alegre/Brazil, whose main objective is the formation of specialists in PP. The Bardin’s method (1995) was used in all the studies to analyze the content of the initial interviews of treatment, which were found in the file of the attendance service, and of the post-treatment interviews accomplished by the authoress of the thesis. The first article presents the analysis of treatment of six women who dropped out the PP. Factors that came up in the beginning of the psychotherapy were: unclear objectives of the treatment, weak readiness to change, precocious signs of negative transference and resistance and absence of recognition about the own participation in the problems. Therapeutic gains, dissatisfaction and resistance during the therapeutic process seemed to be associated to the dropout. The second article reveals the findings of the treatments of five patients who dropped out the PP and other five who completed it. Patients who dropped out the PP presented in the beginning of the treatment: focalized objectives and expectations, weak disposition to change, decreased capacity for insight, negative perception of the previous treatments and meaningful manifestations of negative transference and resistance. On the other hand, patients who completed the PP had goals and expectations of psychotherapy related to wider aspects of life, were less resistant to begin the treatment, presented a bigger disposition to change, more positive transference and higher levels of perception and satisfaction concerning the previous treatment. During the treatment, patients who completed the PP were less resistant and were more satisfied about the psychotherapy, referred more effective benefits and reached a bigger capacity to continue working in psychological problems if compared to patients who dropped out the PP. And the third article shows the data found in treatments of patients who dropped out the PP in different moments of the therapy. Seven patients of medium time of dropout (MD - two to eleven months after the beginning of the psychotherapy) compared to seven patients of late time of dropout (LD - more than one year after the beginning) were identified as the ones who started the treatment by indication of others more than by their own, presenting more resistance, with expectations of more support, less positive transference, more depressive complains and negative experiences about the previous treatments. In the post-treatment interview they revealed more resistance during the process of psychotherapy. They dropped out the psychotherapy with minor capacity of insight, evaluated the treatment in a more negative way concerning its general aspects as well as the specific ones. Although distinctions have been observed, it is understood that the differentiation of the characteristics of the groups of MD and LD is tenuous and it needs more investigation. This thesis offers some hypothesis or explanations for the complex phenomenon of dropout of PP. It suggests that the decisions about initiate, dropping out, or completing the psychotherapy depend on multiple factors, such as: definition of marks and objectives established in partnership (patient/psychotherapist), disposition to undertake changes, capacity of insight which implies in recognition of the psychic condition and the participation of problems, resistance, transference and experience that were experienced in previous treatment. The results which were obtained in this thesis are exploratory and it is necessary to study more in this area.

No description available.

While there is a large body of research demonstrating that Asian-Americans underutilize mental health services compared to other ethnic groups, little is known about how Vietnamese-Americans use formal mental health services. The traumatic war, post-war and refugee journey contributed to incidences of PTSD and other mental disorders. This mixed-method study aims to understand how multigenerational Vietnamese-Americans view their serious mental illness and how past experiences, family structure, and social networks influence mental health and use of mental health services. The theories that guided the research were the Network-Episode Model and Social Network Orientation Theory. Quantitative analyses using data from the National Latino and Asian-American Study (NLAAS) examined the relationship of variables assessing acculturation, social support, cultural identity, and health/mental health status with formal mental health service use for the Vietnamese-American subsample (N=520). The qualitative study explored how Vietnamese-Americans in multigenerational households experience severe mental illness and the reasons that influenced their mental health help-seeking and service use. Semi-structured interviews with 17 members of six multigenerational Vietnamese families from the greater Boston and Los Angeles area were conducted in English, transcribed, and analyzed using thematic analysis. Findings from the study highlight the differences between 1st and 2nd generation Vietnamese respondents and provide insight into how generational culture – the prevailing attitudes, values, and beliefs of each generation – influences the social network support of Vietnamese-Americans and affects their mental health help-seeking behavior. The forced migration severed social networks, restricting 1st generation respondents to rely on small family networks for information and support. The traditional matriarchal hierarchy limited access to treatment as younger 2nd generation Vietnamese-Americans were unable to convince their parents to seek help for serious mental health problems or to get their approval to seek treatment. Cultural values such as belief in spiritual healers and self-reliance also insulated families from seeking professional help. The study found that the types of interactions respondents had with their social networks—whether positive or negative in orientation—shaped their beliefs about who and where they could go to for help with serious mental health problems and was instrumental in creating pathways to mental health service use.

My dissertation examines the depression prevalence, symptom patterns and dimension, and mental health service use among Chinese Americans. The purpose of this research is to, 1) provide epidemiological data on the prevalence of depression among Chinese Americans, 2) examine sociocultural impacts on the prevalence and specific symptoms patterns of depression, and 3) generate implications for more culturally-sensitive approaches in psychiatric diagnosis and treatment. I use secondary data from the Collaborative Psychiatric Epidemiology Studies (CPES). The CPES consists of three nationally representative surveys conducted between 2001 and 2003. Each of three substantive chapters attempts to a set of issues, and together they contribute to the literature on generational differences in mental health status and help-seeking behaviors among Chinese Americans. The first substantive chapter examines depression prevalence and correlates among different generations of Chinese Americans, using non-Hispanic whites as a comparison group, using weighted multinomial logistic regression. Results of the study indicate that Chinese Americans in general have a lower risk of depression than do non-Hispanic whites. Moreover, the prevalence and correlates of depression do not show a linear trend of difference from first to second to third-or-higher generation Chinese Americans, and then to non-Hispanic whites; rather, the risk of depression and its associated with social relational factors present distinct patterns for first and second generation Chinese Americans, compared to third-or-higher generation Chinese Americans and non-Hispanic whites. Specifically, friend network and extended family network play different roles in their influence on depression risk for different generations of Chinese Americans. In the Chapter Four, I conduct exploratory factor analysis to examine two subgroups of Chinese Americans, the foreign-born and the US-born, and compare them to the non-Hispanic whites. I also conduct weighted binary logistic regression to examine the patterns of depressive symptoms for Chinese Americans (separate by nativity status) and compare the two groups to non-Hispanic whites. I also examine how demographic characteristics and social factors are related to different dimensions of depressive symptoms for each group. I also find very similar factors structures of DSM-IV depressive symptoms among foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. For all three groups, suicidal ideation or attempt is a construct that is distinct from the rest of the symptoms items. The three groups have different social correlates, yet there are only minor differences in the social correlates for each one of the four depression dimensions within each group. Chronic physical condition is the most consistently significant predictor, for the negative affect, somatic symptoms, and cognitive symptoms among the two Chinese groups, and for all four dimensions of depression among non-Hispanic whites. Finally, in Chapter Five, I find significant heterogeneity of exclusive complementary and alternative medicine (CAM) use by race/ethnicity and generational status, as well as English proficiency, gender, age, marital status, education, employment status, having insurance, and having any probably psychiatric disorder. Specifically, first generation Chinese immigrants lag behind second, third-or-higher generation Chinese Americans, and non-Hispanic whites in the likelihood of using exclusive CAM services, as well as any services in general. In addition, this chapter finds that exclusive CAM service use was more popular than the use of only conventional Western medicine or a combination of both, among all Chinese Americans except for the second generations. The findings provide a more nuanced understanding of the pattern of mental health service use among Chinese Americans. / Sociology

O objetivo deste estudo foi compreender os conceitos e estratégias que norteiam a assistência dos profissionais que atuam em um Centro de Atenção Psicossocial para atendimento de pacientes com transtornos, decorrentes do uso e dependência de substâncias psicoativas, na tentativa de subsidiar as ações dos demais serviços de saúde que atendem tais pacientes. Optou-se pela pesquisa qualitativa, seguindo a metodologia de estudo de caso; assim, nove profissionais foram entrevistados e o eixo norteador das questões foi referente à concepção de serviço e as ações assistenciais ali desenvolvidas. Os dados foram analisados à luz do conceito da representação social. Valendo-se dos temas emergentes foram elaboradas duas representações centrais da pesquisa: Concepção sobre o serviço de atenção psicossocial. Ações assistenciais aos pacientes com transtornos decorrentes de uso prejudicial e ou dependência de álcool e outras drogas. A análise final orienta-se para a compreensão de que o uso prejudicial do álcool e outras drogas decorrem de fatores multifacetados, propondo nessa linha de raciocínio a assistência psicossocial / The purpose of this study is to understand concepts and strategies that orient the assistance to professionals working in a Center of Psychosocial Attention to assist patients with disorders due to use and addiction of psychoactive substances, in the attempt to support actions of other health services which assist these patients. A qualitative research was our choice following the methodology of a case study. Nine professionals were interviewed and the interviews were based on questions aiming service and the assistance actions developed in the same institutions. Data were analyzed under the point of view of the social representation. Considering the emergent issue, two central representations of the research were elaborated: conception on the service of psychosocial attention. Assistance actions to patients with disorders due to the harmful use and/or addiction to alcohol and other drugs. The final analysis is oriented towards the comprehension that the harmful use of alcohol and other drugs are caused by varied factors, proposing a psychosocial assistance

Transitional care is an important process for professionals to consider, particularly as recent studies have shown how a mental health difficulty in adolescence will persist into adulthood. This indicates that a number of those seen in Child and Adolescent mental health services are likely to make the transition into Adult services. For professionals from both services, barriers can arise when supporting young people across service boundaries and recent studies have stated that the current practice of transitional care in mental health is deemed to be problematic. However at the time of conducting this study, there was a paucity of literature, therefore the aim of the study was to add to the existing knowledge. The study followed a Social Constructivist grounded theory (Charmaz, 2014) approach to explore the experience of stakeholders of the transition process. Semi-structured interviews were conducted with professionals, young people and parents. There were a total of eight interviews which were transcribed and analysed. The findings present the core category as Facing the transition, with three sub- categories: Changing status, Manoeuvring the boundaries and Reflections on the process. The tentative theory explains how facing the transition involves stakeholders adjusting to the changing status of the service user. This category triggers the service transition but also describes how societal perceptions about adulthood influence the expectations placed on young people. Manoeuvring the boundaries describes and explains service transition, identifying a range of barriers and strategies to overcome these. One of the most significant barriers was identified as cultural differences between the two services. The third category describes how stakeholders make sense of their experiences, and how these are managed within the therapeutic relationship.

An examination of developments between 1970-1990 demonstrate a substantial restructuring of relations between the state and nonprofit societies within Vancouver's mental health system. While helping to establish and support the growth of nonprofit societies, the state, during the 1970's, maintained a "hands off" relationship with the nonprofit sector. Throughout the 1980's and early 1990's, state intervention into the affairs and aspirations of nonprofit societies dramatically increased, primarily through the establishment of corporatist arrangements. Such arrangements necessitated the establishment of non-aligned intermediary organizations to regulate and monitor activities within the nonprofit sector. The establishment and development of nonprofit societies and the subsequent restructuring of relations between the state and nonprofit societies is explored through an examination of corporatism. This examination includes a detailed case study of two nonprofit societies operating in the city of Vancouver between 1972 to the present, the Coast Foundation Society and The Greater Vancouver Mental Health Services Society. The methodology utilized includes analysis of secondary data, archival and documentary materials, and personal interviews with a number of key informants previously or currently employed within the mental health system. Analytic themes from the literature on pluralism and corporatism, along with Claus Offe's theoretical examination of state-interest group relations, are used to explain the construction of corporatism during this period. While the inquiry provides a detailed account of developments within Vancouver's mental health system through a case study approach, broader issues are also explored. The impact of macro economic changes, especially the effect of the recessionary period during the 1970's, is crucial in understanding changing state priorities and the subsequent construction of corporatism. An understanding, therefore, of the way in which corporatism relates to the broader reconstruction of consensus within late capitalist societies is an important focus of this study.