M.A. (Psychology) / This study set out to try and find some answers to questions pertaining to psychotherapy groups in the admissions ward of a psychiatric hospital. The questions were about the effect of group therapy on: * the system of the psychiatric hospital; * the therapists within the system of the psychiatric hospital; * the members of the groups (the patients). * which prosesses took place within the group therapy that can be regarded as therapeutic, and * which prosesses can be described as anti-therapeutic and destructive? The study is descriptive in nature and looks in turn to group therapy in the context of the psychiatric hospital and the efforts of two clinical psychology interns to run therapy groups in the admissions ward of a psychiatric hospital. The conclusion is made that the effectiveness of group therapy in a psychiatric hospital is limited as long as the epistemological differences between psychiatry and psychology are not attended to and as long as the status of psychologists in general, and interns in particular, stays as it is at present. With this in mind, recommendations are made regarding the context, organisation, goals and structure of group therapy as well as the role of the therapist, training of interns in group therapy and further research.

M.A. / The purpose of this study was to ascertain whether patients suffering from irritable bowel syndrome (IBS) differed from non-IBS clients in terms of their coping styles. Gastrointestinal disorders are among the most common of all illnesses; half of the population suffers from acute gastrointestinal illnesses every year (Read, 1985). More than 10% have chronic illnesses, and these illnesses are a major cause of absenteeism from work. In view of this it is surprising that there is such a faucity of psychological and psychophysiological research focusing on gastrointestinal activity. Perhaps one reason for this is that investigators conceptualise the gastrointestinal tract as a system that is unresponsive to psychological intervention. Another reason may be the widespread belief that adequate techniques are not available for studying gastrointestinal psychology and psychophysiology (Haynes & Gannon, 1981). Today there is consensus that IBS is a psychosomatic disorder that accounts for between 40 to 70% of referrals to gastroenterologists. Unfortunately, this is a very misunderstood disorder. Sufferers are often misinformed or poorly educated by their physicians. Misunderstanding and lack of patient education often results in increased anxiety and physical distress. There are cases in which unnecessary surgery, expensive diagnostic procedures and addictive pain killers are mistakenly employed. In addition, IBS patients represent an expensive group because they use up a considerable amount of medical resources in money and time (Moser, 1986).

M.A. / Parkinson's disease is a progressive neurological disorder. Symptoms such as tremor, muscular stiffness and slowness of bodily movement are prevalent in the disease. Early research studies have investigated emotional difficulties experienced by Parkinson's disease patients. Most research studies have focused on depression in Parkinson's disease. However few studies have investigated other emotional concomitants of Parkinson's disease, for example anxiety, self-esteem and impulse control. The aim of the present study was to investigate emotional concomitants of Parkinson's disease and to explore problematic emotional symptoms experienced by patients suffering from Parkinson's disease. The aim of the study was to compare a group of 10 male Parkinson's disease patients with a group of 10 healthy males (non-Parkinson's disease males) regarding the six subscales (Thought/Behaviour disorder, Impulse Control, Anxiety, Depression, Low Self-esteem and Total Pathology) of the Emotional Problems Scales (EPS). In the second part of the present study a group of six male Parkinson's disease patients completed the Millon Clinical Multiaxial Inventory (MCMI). The Millon Clinical Multiaxial Inventory consists of 22 clinical scales. The results indicated that there were statistically significant differences between the Parkinson's disease patients and the non-Parkinson's disease males regarding the Anxiety, Depression and Total Pathology subscales of the Emotional Problems Scales. The results further indicated that the Parkinson's disease patients had elevated scores above the 75 and 85 base rate scores of the Millon Clinical Multiaxial Inventory. The elevated scores were on the Schizoid, Compulsive, Self-defeating, Anxiety and Dysthymia scales. The results obtained in the present research study support previous studies regarding emotional concomitants in Parkinson's disease. Although effort has been made to ensure the present research study is methodologically sound, the study had a few shortfalls and limitations. The questionnaires (EPS and MCMI) used in the present study have not been standardised for the South African population. The present research study was interesting but a larger sample would be needed that would be more representative of the South African population. The present study did not discriminate between tremor dominant Parkinson's disease and rigid Parkinson's disease. Incidence of depression seems to be higher in Parkinson's disease patients with prominent features of bradykinesia and gait instability. It is recommended that future research studies distinguish between rigid Parkinson's disease and tremor dominant Parkinson's disease. Future research should also include measuring instruments that have been standardised for the South African population. Combined gender studies regarding emotional concomitants of Parkinson's disease will contribute to understanding the problematic emotional symptoms experienced by patients suffering from Parkinson's disease.

M.A. / The purpose of the study was to ascertain whether patients suffering from irritable bowel syndrome (IBS) differed from non- IBS clients in terms of their defense mechanisms. Although irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders encountered by primary care physicians and gastroenterologists, it is one of the least well understood. Part of the reason for this is the lack of real consensus of opinion regarding the nature of the complaint (Read, 1985). Today it is widely agreed that irritable bowel syndrome is a psychosomatic disorder, that is, a disorder of physiological functioning and anatomical structure, which are determined for most part by psychological factors (Lachman, 1972; Moser, 1986). Evidence linking psychological variables to gastrointestinal disorders is surprisingly sparse, and all too often confusing and contradicting. Such conflicting results probably reflect the many methodological weaknesses common to all areas of study (Bennett, .1989). Although evaluation of the impact of psychological interventions on both symptomatic and psychological relief has been pursued, its findings provide tangential support for the importance of psychological disorders. Nevertheless, these studies have shown a consistency of positive results not found in the etiological research (Read, 1985). Using a variety of techniques, most with the therapeutic goal of stress reduction, psychological therapy has been shown to produce. symptomatic relief, increase periods of remission, and to reduce the impact of stress resulting from severe symptomatic flare ups in IBS (Bennett, 1989). In .addition, most IBS patients may not identify their gut symptoms in psychological terms. Therefore, they inappropriately and repeatedly subject themselves to unnecessary, expensive and harmful medical procedures in search of an organic cause. Further research into the psychological factors of IBS, including the defense mechanisms underlying it may lead to a reduction in type of anxiety (Folkman, Lazarus, Gruen & DeLongis, 1986). The ways in which people cope with intense emotions may have a significant effect on their psychological and physical health. StresS factors and the suppression of emotions, for example through defense mechanisms, are thought to be especially relevant in the etiology and exacerbation of psychosomatic illness (Ogden & Von Sturmer, 1984). The role that defense mechanisms play in the development of IBS forms the cornerstone of the present research.

M.A. / Die doel van hierdie studie was tweeledig van aard. Die eerste doelstelling was om 'n behoeftebepaling te doen ten einde vas te stel wat die pasiente se algemene behoeftes is ten opsigte van narkose. Die tweede doelstelling was om 'n streshanteringsprogram te ontwikkel, toe te pas op toepaslike proefpersone, en te evalueer aan die hand van vier afhanklike veranderlikes, naamlik angsvlak, pynvlak, irrasionele kognisies en lokus van kontrole. Hierdie streshanteringsprogram is ontwikkel om prakties uitvoerbaar en pasi ntvriendelik gerig te wees sodat die effektiwiteit. vir toekomstige volgehoue gebruik getoets kon word.

M.A. / HIV and AIDS are a growing problem with multiple implications on various fields in our society. It looks as if we are conscious only of the tip of the iceberg. This study commits itself to suggest alternatives other than medical support to ensure longevity in HIV and AIDS persons. From within a psychological framework certain psychological and social factors are identified that could possibly have an influence on immunology in the form of CD4 and CD8 counts. The results suggest that definite links exists between certain psychological factors and physical markers of immunology (CD4 and CD8 counts). A Factor analysis show that Social factors (measured with the FES scale) possibly lead to emotions that resort under psychological factors (Conflict, Course of illness and Independence). These factors unleash the need of self- expression. If this need to selfexpression are not relieved it leads to psychological factors (Anger, Depression and Tension). These factors have a marked short-term effect on CD4 count as well as a long-term effect on CD8 count. The result is a circular response comprising of psychological factors (Anger, Depression and Tension) that lead to feelings of avoidance and fatalism. In turn these factors lead to feelings of hopelessness resulting in a strengthening effect on another set of psychological factors (Conflict, Course of illness and Independence). OptimismNigor repeatedly played a leading role in the Course of illness, influencing the cognitive attitude of respondents. Initially 71 respondents took part in the study but comprehensive data over the sixmonth period could only be obtained for 40 respondents. The results suggest that a specific dynamic are concealed in the process between mind, body and illness and needs to be explored through further research. .

M.Cur. (Psychiatric Nursing) / The psychiatric nurse, as a member of the multiprofessional mental health team, utilises a goal directed approach to assist the psychiatric patient to mobilise resources to promote, restore and maintain his mental health as an integral part of his quest for wholeness. This goal directed approach is the nursing process which comprises assessment, planning, implementing and evaluation. All four steps of the nursing process and the nurse's interaction wi th the patient are dependent upon therapeutic communication between the nurse and the patient to elicit the necessary information so as to be able to formulate the nursing diagnosis, nursing actions and the patients' outcomes. Therapeutic communication remains important as the core of all nurse-patient interactions. Lack of therapeutic communication with the patient can cause conflict in the patient's internal and external environments since he will be unable to communicate his needs and problems and this will delay the mental health promotion, restoration and maintenance phases. Currently much attention is paid to the pharmacological treatment of the patient as more and more sophisticated psychotropic drugs are produced, and yet the other aspect of the patient's treatment which is equally important is neglected, namely his communication during hospitalisation, especially with the psychiatric nurse as she is the person in direct contact with him and should spend most of her time interacting with him.

D.Phil. / This thesis presents an intervention programme that aims to facilitate anger-expression and takes psychosocial and immunological variables into account. The present research argues that if the effects of the programme are validated, similar programmes may yield similar benefits for other participants in future intervention programmes in a South African context. The nature, course and effects of the HIV disease are described and include specific processes and mechanisms of influence in physical, mental and social terms. Biological processes that result from immunological deficiencies causing AIDS are analyzed and an explication of disease progression is offered. Psychological and social aspects related to immune-system deterioration carry implications for patients and influence their prognosis. The research was conducted in the context of a biopsychosocial conceptualization and was aimed at reducing levels of anger and helping establish recourses in the patients to manage infection and disease, as well as improve or at least retard decrements in immunological functioning. The goal of this intervention programme was to reduce levels of anger, anxiety, depression and social isolation. This would in turn increase the participant's personal sense of self-control, self-efficacy and self-esteem. Changes in these factors would help retard the overall HIV disease progression. An intervention programme was tailored to address the specific needs of HIV- infected patients. The group intervention was focused in such a way that relevant psychological, behavioural and social aspects were addressed. The programme borrowed and used aspects of different models and reformulated an intervention that would best address the specific needs of the participants. It was possible to isolate specific problems and focus the intervention on these specific areas, such as depression, anger, social isolation and hopelessness. For example, it was possible to take into account the participants' low self-efficacy and problems related to a lack of interpersonal coping skills and develop the participants' confidence and assertiveness (Antoni, 1991)

M.A. / Hubley (1990) notes that Acquired Immunodeficiency Syndrome (AIDS) is a relatively recently recognized disease. It is caused by infection with the Human Immunodeficiency Virus (HIV), which attacks selected cells in the immune system and produces defects in functioning. These defects may not be apparent for years. They lead, however, to a severe suppression of the immune system's ability to resist harmful organisms. This leaves the body open to an invasion by various infections, which are therefore called opportunistic diseases, and to the development of unusual cancers. The virus also tends to reach certain brain cells. This leads to so-called neuropsychiatric abnormalities or psychological disturbances caused by physical damage to nerve cells. Many of those infected with HIV may not even be aware that they carry and can spread the virus. Combating it is a major challenge to biomedical scientists and health-care providers. HIV infection and AIDS occur among the most pressing public policy and public health problems world-wide. Since the first HIV/AIDS cases have been reported in 1981, through mid-1993, more than 600 cases were reported in South Africa. This is only the tip of the iceberg of HIV/AIDS infection as it was estimated that between 2 and 2.5 million South Africans had been infected with the virus through the early 1990s but not yet developed the clinical symptoms. In terms of the historical data from previous surveys (ie. the results of the 1996 survey) in South Africa confirmed the trend of a growing HIV/AIDS epidemic. HIV infection has increased in all provinces, but Kwa-Zulu Natal and Mpumalanga had the highest HIV prevalence rates of 18,23% compared to 1994's '14,35% and 16-18%, compared to 12-16% respectively (see table 1).. Of particular concern are the pregnant women in South Africa under twenty years where a prevalence of 12,78% has been found. Thirty per cent of babies born to HIV positive women in South Africa are infected. Of the 3638 births in VVitbank — a rather small town in Mpumalanga-.Province — in 1996, 219 of the women were tested HIV positive (Masiphile Vol. 1: 1997).