Thesis (MA)--University of Stellenbosch, 2008. / ENGLISH ABSTRACT: Sometimes it is not entirely clear why certain clients improve. Critical clinical ingredients which may have led to this improvement or recovery are hard to identify and describe and decisions about therapeutic interventions often appear to be intuitive rather than following a strict modus operandi. This is true particularly if refractory or chronic cases start to improve and maintain this improvement. Refractory and chronic cases are the norm amongst clients suffering from complex, chronic trauma, also termed complex PTSD. Complex trauma is a multi-facetted, often multi-layered condition. It includes damage to the individuals’ self and to her ability to interpersonally relate, additionally to the DSM IV TR diagnosis of PTSD. Due to the manifold unique presentations of the syndrome, particular after long-term exposure and confounded by co-morbidities and rigid defenses, it is difficult to diagnose and treat the condition effectively. This study focuses on one such complex trauma case with an initially very poor prognosis, which improved significantly over a treatment period of eighteen months. The therapeutic intervention and progression of the case are closely examined, using the phenomenological method, with the aim of discerning and describing themes and patterns that could assist in understanding the healing process of this client during therapy and to promote further research in this regard. Integration of psychodynamic conceptualization, particularly self-psychology and intersubjectivity, and person-centered, supportive therapeutic methods were found helpful in the treatment of this case. The common factor to these approaches is their emphasis on the relationship between client and therapist. This therapeutic relationship was concluded to be the determining factor in the successful treatment of this client, because it addressed damage to self and to her relational ability. The research took place concurrent to the therapy with the client and this process led to a degree of integration on three levels: integration of the client’s self and interpersonal functioning, integration of the abovementioned approaches to form a creative synthesis in the therapist’s individual approach to trauma clients, and the integration of a phenomenological methodology with a psychodynamically conceptualized case study. It is noted that the theoretical explorations and therapeutic procedures described and explored in this study are but one way to conceptualize and treat complex trauma. / AFRIKAANSE OPSOMMING: Somtyds is dit nie duidelik hoekom sekere kliente se toestand verbeter nie. Dit is soms moeilik om die kritiese bestanddele wat tot hierdie verbetering of herstel gelei het, te identifiseer en te beskryf. Besluite met betrekking op therapeutiese intervensies blyk dikwels eerder intuitief, as die gevolg van ‘n streng modus operandi, te wees. Dit is spesifiek die geval wanneer chroniese en hardnekkige gevalle begin om te verbeter en die verbetering volhou. Hardnekkige en chroniese gevalle is nie ongewoon by kliente wat aan komplekse, chroniese trauma - ook genoem komplekse post-traumatiese stressversteuring - ly nie. Komplekse trauma is ‘n multi-fasettige toestand, wat dikwels ‘n verskeidenheid lae of vlakke van versteuring opwys. Dit sluit skade tot die individu se self in, asook verlies aan vaardigheid om met ander mense suksesvolle interpersoonlike verhoudings op te bou. Hierdie kenmerke is toevoegings tot die diagnose van die sindroom soos uitgevoer in die DSM IV TR. As gevolg van die meervoudige unieke voorstellings van die sindroom - in besonder na langtermyn blootstelling en verwarring deur co-ongesteldhede en rigiede verdedigings - is dit moeilik om die toestand korrek te diagnoseer en efektief te behandel. Hierdie studie fokus op die soort geval wat aanvanklik ‘n baie swak prognose gehad het, maar vervolgens oor ‘n tydperk van 18 maande ‘n beduidende verbetering getoon het. Die terapeutiese intervensie en die progressie van die geval is in hierdie studie noukeurig ondersoek, deur gebruik te maak van fenomenologiese ondersoekmetodes, met die doel om temas en patrone vas te stel en te beskryf wat die begrip van die genesingsproses van die klient gedurende terapie moontlik kan bevorder, en wat verdere navorsing op hierdie gebied kan stimuleer. Integrasie van psigodinamiese konseptualisering (spesifiek self-sielkunde en intersubjektiwiteit) asook persoongesentreerde, ondersteunende beradingsmetodes, is as waardevol bevind in die behandeling van hierdie geval . Die gemeenskaplike faktor tot hierdie benaderings is die klem op die verhouding tussen klient and terapeut. Die gevolgtrekking is gemaak dat hierdie terapeutiese verhouding die bepalende faktor in die sukkesvolle behandeling van hierdie klient was, omdat dit sowel die skade aan die self as die verlies aan die vaardigheid om verhoudings te bou, aangespreek het. Die navorsing en die terapeutiese intervensie met die klient het terselftertyd plaasgevind, en die proses het ten slotte tot ‘n mate van integrasie op drie vlakke gelei: integrasie van die klient se self en herstelling van interpersoonlike funksionering, integrasie van die bogenoemde benaderings wat tot ‘n kreatiewe sintese in die berader se benadering tot trauma behandeling gelei het, en die integrasie van fenomenologiese metodes en psigodinamies konseptualisering in ‘n gevallestudie. Dit is belangrik om in gedagte te hou dat die teoretiese navorsing en praktiese prosedures wat in hierdie studie beskryf en uiteengesit is, net een manier is om komplekse trauma te konseptualiseer en te behandel.

M.A. / Despite the fact that the helping professions in the SAPS make use of a multi-professional team approach to provide a service with regards to trauma intervention, statistics confirm that there is still a high occurrence of stress-related problems amongst police officials'. The aim of this study is to explore and describe the police officials' experience of trauma and the trauma intervention programmes in the SAPS, in order to create guidelines and to make certain recommendations with regard to client-focussed programmes for police officials' attached to the high-risk units in the Eastern Cape. The aims of this study were best realised by the exploratory and descriptive goals of fundamental research as expounded by de Vos et al. (1998). The exploratory and descriptive goal ofthe problem is best achieved by combining the qualitative and quantitative approaches to research, as proposed by Cresswell (1994). For the purposes of this study, the researcher has first made use of a qualitative approach to research. The population with regards to this phase of the study consisted of the police officials' attached to the high risk units in Port Elizabeth. The researcher made use of the purposive sampling method in order to select the participants of the focus group. A semi-structured interview schedule, consisting of four pre-designed questions, was employed in order to obtain maximum information on the subject. The four questions are as follows: experience of trauma, impact on and reaction to trauma, coping with trauma and the experience of trauma intervention programmes. The themes arising from the findings are divided into eleven categories including the classification of their respective sub-categories. The categories are as follows: 1) the concept trauma, 2) traumatic incidents, 3) trauma reinforcers, 4) post traumatic events, 5) post traumatic stress disorder, 6) social support, 7) avoidance/denial, 8) problem-focussed coping, 9) consumer orientation, 1 0) consumer satisfaction and 11) a core marketing strategy. A quantitative approach was used during the second phase of the study, whereby the themes that resulted from the findings of the focus group interview, were distributed amongst the police officials' representing the high risk units in the Eastern Cape. The latter was done in order to explore the extent of the items arising from the focus group in the population. For the purposes of the second phase of the study, the researcher employed the simple random sampling method, whereby 10% of the population was selected. The researcher made use of the group administered method whereby respondents were involved in a group and were thereby provided with an opportunity to complete the questionnaire. The social workers responsible for the high risk units in the various areas in the Eastern Cape were trained as field workers in order to facilitate the completion of the questionnaire by means of the group administered method. The following conclusions were drawn from the findings. Firstly, it is concluded that the police officials' attached to the high risk units in the Eastern Cape are exposed to a variety of traumatic incidents. The latter vary with regards to occurrence and intensity. The nature, frequency and intensity of the incident have an influence on the extent to which police officials' experience these incidents as traumatic, and this also influences the cumulative impact thereof on the individual. The internal and external stress factors which police officials' are exposed to on a daily basis in the carrying out of their duties, also plays an important role in the extent to which police officials' are capable of coping with trauma. In some cases it is experienced so intensely that it leads to a traumatic reaction by some police officials'. Secondly, it is concluded that police officials' generally react differently, depending on their exposure to trauma. These reactions are generally similar to the symptoms of post-traumatic stress and post traumatic stress disorder. Thirdly, the conclusion is reached that police officials' reveal different coping styles. These vary with specific reference to social support, avoidance/denial and problem focussed coping mechanisms. Lastly, it is concluded that the trauma intervention programmes are not consumer orientated as a thorough needs assessment is not done and police officials' individual needs, expectations, perceptions and preferences are not taken into consideration most of the time. Police officials' are also greatly dissatisfied with the programmes because the elements of the marketing strategy, with specific reference to product, place, cost and promotion as expounded by Terblanche (1993), do not live up to their expectations and perceptions of the programme. Finally, the findings were compared with each other, whereafter certain conclusions were reached and a number of recommendations were made.

patterns, severe personality patterns, depressive constructs, other clinical syndromes, severe clinical syndromes and dissociation following EMDR treatment. Thirty-two people, ranging from 23 to 65 years old, underwent the full EMDR protocol treatment for up to three traumas. The findings regarding clinical personality patterns revealed that EMDR is most effective in reducing the symptoms of dependent personality pattern because 76% of participants with clinically significant dependent personality pattern before EMDR treatment no longer had a clinically significant score (>75) on the MCMI-III at the end of EMDR treatment; compared to 75% with masochistic personality pattern, 77% with negativistic personality pattern, 69% with avoidant personality pattern, 40% with depressive personality pattern and 29% with schizoid personality pattern. These gains were maintained on the MCMI-III at follow-up by 76% with dependent personality pattern, 64% with masochistic personality pattern, 46% with negativistic personality pattern, 38% with avoidant personality pattern, 30% with depressive personality pattern and 29% with schizoid personality pattern. The analysis of the severe personality patterns at the end of EMDR treatment revealed that the scores on the MCMI-III reduced from within one standard deviation above the mean (60-74) to below the mean (<60) for 84% of participants with borderline personality pattern, compared to 68% with paranoid personality pattern and 52% with schizotypal personality pattern. These gains were maintained on the MCMI-III at follow-up by 84% with borderline personality pattern, 68% with paranoid personality pattern and 48% with schizotypal personality pattern. The analysis of the depressive constructs revealed that EMDR is most effective in reducing symptoms of major depression as 86% of participants with clinically significant major depression before EMDR treatment no longer had a clinically significant score (>75) on the MCMI-III at the end of EMDR treatment; compared to 73% with dysthymia and 40% with depressive personality pattern. These gains were maintained on the MCMI-III at followup by 86% with major depression, 58% with dysthymia, and 33% with depressive personality pattern. The findings regarding the other clinical syndromes revealed that 91% of participants with clinically significant post traumatic stress before EMDR treatment, no longer had a clinically significant score (>75) on the MCMI-III at the end of EMDR treatment, compared to 75% of participants with anxiety. These gains were maintained on the MCMI-III at followup by 91% of participants with post traumatic stress and 69% of participants with anxiety. The analysis of the severe clinical syndromes at the end of EMDR treatment revealed that the scores on the MCMI-III reduced from within one standard deviation above the mean (60-74) to below the mean (<60) for 78% of participants with delusional disorder, compared to 67% with thought disorder, 32% with bipolar (manic), 28% with alcohol dependence and 28% with drug dependence. These gains were maintained on the MCMI-III at follow-up by 67% of participants with delusional disorder, compared to 63% with thought disorder, 53% with bipolar (manic), 48% with alcohol dependence and 57% with drug dependence. The analysis of the effects of EMDR on dissociation revealed that there was a significant decrease in symptoms of dissociation on the DES at the end of EMDR treatment and these gains were maintained at the follow-up measurement at the end of the study. Whilst the findings of the present study cannot be generalised due to the small sample size, the findings do suggest that EMDR is successful in the treatment of a number of clinical conditions in addition to post traumatic stress; with further research being strongly indicated in order to further explicate the efficacy of EMDR across different psychiatric conditions. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

The #MeToo movement was established as a grassroots initiative in Brooklyn by Tarana Burke, as a way to bring awareness to the commonality of sexual violence towards African American women. Despite the awareness brought by the movement, it was virtually not inclusive of men who have experienced sexual violence. This study intends to provide educators an understanding of this phenomenon, as well as provide practitioners, scholars, and organizations supporting gay male rape survivors a qualitative perspective beneficial to enhance support systems in order to foster post-traumatic growth. This study answered questions of how participants described their experience of having been raped; how learning revealed itself during the participants’ journey towards post-traumatic growth; and what factors participants described that helped and/or hindered their ability to manage the experience, learn, and develop towards post-traumatic growth. Six individual in-depth cases are presented; each participating in a two-hour interview. Using Lifelines and Nohl’s (2015) five phase analysis of the unfolding of deep learning over time, this study demonstrated that Transformative Learning revealed itself throughout each of these cases. As described by O’Sullivan et al. (2002), Transformative learning is “[an] experiencing [of] a deep, structural shift in the basic premises of thought, feeling, and actions. It is a shift of consciousness that dramatically and permanently alters our way of being in the world. Such a shift involves our understanding of ourselves and our self-locations; our relationships with other humans and with the natural world; our understanding of relations of power in interlocking structures of class, race, and gender; our body-awareness; our visions of alternative approaches to living; and our sense of the possibilities for social justice and peace and personal joy.” The study provides insight into the various systems and social relationships that help and/or hinder the interviewees’ learning experience, as well as how they managed their lives along the way. Moreover, this study demonstrates that Transformative Learning can take over 20-years, as well as that the process requires recalibration after encountering obstacles as learners journeyed towards post-traumatic growth.

The present study presents three individual cases; all three clients had endured a traumatic event, namely rape, and all three met the criteria for PTSD. Despite the fact that each of the clients was initially assessed as being a suitable candidate for psychological treatment, none of the cases proceeded to the therapy phase of treatment. A number of obstacles, both personal and contextual, were encountered during treatment implementation, preventing or limiting a successful outcome of psychological treatment in each case. An examination of these cases highlights a few of the many obstacles frequently faced when delivering psychological treatment to the South African context. In so doing, this research provides an opportunity to consider the possible reasons for the limited documentation of treatment efficacy within the South African context, as well as to enhance our understanding of and sensitivity towards the cultural and contextual factors playing a role in psychological treatment.

This study explores the possible use of digital media as an effective psychotherapeutic aid in art psychotherapy, specifically in addressing the effects of trauma experienced by adolescents. A literature review provides evidence on what exactly can be understood under the concepts 'art psychotherapy' and 'digital media'. The literature study further investigates trauma, its treatment and how art psychotherapy can be used as a psychotherapeutic tool with adolescents who have been exposed to trauma. An empirical study including six participants, chosen through a specific sampling process, and whose background information regulates the appropriate methods of intervention demonstrates the practicality of digital media in art psychotherapy. Data gathered from pre-assessment activities, art psychotherapy sessions and post-assessment activities are analysed, interpreted, and reduced through a systematic process. The empirical findings are then presented in a detailed, concise manner From the empirical investigation, it is determined that digital media can be used as a successful tool in art psychotherapy, specifically with adolescents who have experienced trauma. The researcher gained experience in the implementation of digital media in art psychotherapy and was able to provide valuable information about this practice, specifically for professionals interested in the field of art psychotherapy. The researcher was also able to identify limitations and further areas for research in this field. / Psychology of Education / M. A. (Guidance and Counselling)--University of South Africa --2013

This study explores the possible use of digital media as an effective psychotherapeutic aid in art psychotherapy, specifically in addressing the effects of trauma experienced by adolescents. A literature review provides evidence on what exactly can be understood under the concepts 'art psychotherapy' and 'digital media'. The literature study further investigates trauma, its treatment and how art psychotherapy can be used as a psychotherapeutic tool with adolescents who have been exposed to trauma. An empirical study including six participants, chosen through a specific sampling process, and whose background information regulates the appropriate methods of intervention demonstrates the practicality of digital media in art psychotherapy. Data gathered from pre-assessment activities, art psychotherapy sessions and post-assessment activities are analysed, interpreted, and reduced through a systematic process. The empirical findings are then presented in a detailed, concise manner From the empirical investigation, it is determined that digital media can be used as a successful tool in art psychotherapy, specifically with adolescents who have experienced trauma. The researcher gained experience in the implementation of digital media in art psychotherapy and was able to provide valuable information about this practice, specifically for professionals interested in the field of art psychotherapy. The researcher was also able to identify limitations and further areas for research in this field. / Psychology of Education / M. A. (Guidance and Counselling)

The purpose of this study was to investigate whether a psycho-educational intervention program could support traumatised people to increase their mental toughness. Mental toughness is a well proven phenomenon in sports psychology as well as in leadership in the corporate world. I wanted to apply the use of mental toughness in trauma. Literature was consulted to understand the phenomena of mental toughness and trauma respectively. The corresponding aspects of mental toughness and trauma were selected for the literature review and many similarities between mental toughness and trauma were discovered. The corresponding aspects included action taking, the importance of the “self”, facing negativity and adversity, the importance of support systems, flexibility and adjustment, dealing with guilt and self-blame, the role of self-talk, people’s perceptions, goal-setting, commitment, helplessness / learned helplessness and dealing with stress. I used the corresponding aspects to compile a psycho-educational intervention programme to support traumatised persons to develop increased mental toughness that will support them to better deal with trauma. A valid and reliable psychometric instrument, the MTQ48 (Mental Toughness Questionnaire 48), has been successfully used to determine people’s mental toughness in sports psychology and in corporate management, but has never been tested before in supporting traumatised people. An action research design was employed, where both qualitative as well as quantitative methods were used. This is also known as a mixed research design. Eight traumatised people took part in the research which was presented weekly, as individual sessions, over eight weeks. Data collection methods included questionnaires, observation and individual therapy. The results of the study indicated that seven of the eight participants’ overall mental toughness increased after the intervention program, and four of the eight participants’ mental toughness components increased. As an additional benefit, all respondents indicated that they could better deal and cope with their trauma after the intervention program. The conclusion could be drawn that the psycho-educational intervention program was successful in supporting the traumatised participants to increase their mental toughness. / Psychology of Education / D. Ed. (Psychology of Education)

The purpose of this study was to investigate whether a psycho-educational intervention program could support traumatised people to increase their mental toughness. Mental toughness is a well proven phenomenon in sports psychology as well as in leadership in the corporate world. I wanted to apply the use of mental toughness in trauma. Literature was consulted to understand the phenomena of mental toughness and trauma respectively. The corresponding aspects of mental toughness and trauma were selected for the literature review and many similarities between mental toughness and trauma were discovered. The corresponding aspects included action taking, the importance of the “self”, facing negativity and adversity, the importance of support systems, flexibility and adjustment, dealing with guilt and self-blame, the role of self-talk, people’s perceptions, goal-setting, commitment, helplessness / learned helplessness and dealing with stress. I used the corresponding aspects to compile a psycho-educational intervention programme to support traumatised persons to develop increased mental toughness that will support them to better deal with trauma. A valid and reliable psychometric instrument, the MTQ48 (Mental Toughness Questionnaire 48), has been successfully used to determine people’s mental toughness in sports psychology and in corporate management, but has never been tested before in supporting traumatised people. An action research design was employed, where both qualitative as well as quantitative methods were used. This is also known as a mixed research design. Eight traumatised people took part in the research which was presented weekly, as individual sessions, over eight weeks. Data collection methods included questionnaires, observation and individual therapy. The results of the study indicated that seven of the eight participants’ overall mental toughness increased after the intervention program, and four of the eight participants’ mental toughness components increased. As an additional benefit, all respondents indicated that they could better deal and cope with their trauma after the intervention program. The conclusion could be drawn that the psycho-educational intervention program was successful in supporting the traumatised participants to increase their mental toughness. / Psychology of Education / D. Ed. (Psychology of Education)

In 2009, South African police statistics revealed that more than 68 332 women were raped in the country. The evidence from independent researchers has shown that SAPS statistics are highly susceptible to under-reporting and the actual figure is more than double this amount. One pervasive feature of the phenomenology of rape is post-traumatic stress disorder (PTSD). PTSD is a highly debilitating condition with severe individual and societal costs. The condition takes a critical toll on occupational functioning, schooling and personal relationships and is associated with depression, suicide risk, self-harming behaviours and alcohol-abuse problems. The Ehlers and Clark (2000) cognitive model represents the most efficacious treatment for PTSD but the approach is severely under-utilised by South African practitioners working with sexual trauma. The reasons for such under-utilisation relate to a lack of exposure and training surrounding the model and concerns about the transportability of the treatment to a multi-cultural context. One method of addressing these barriers to treatment delivery is through systematic case-based research. Systematic case-based research offers a complementary means of refining theory and developing evidence-based practice in the context of a developing country. The method offers an intensive analysis and description of the particular phenomena under study within its real-life context. It allows the researcher to intensively examine and identify the specific aspects of the therapist’s responses and client’s reactions that contributed to significant change. Unlike efficacy studies, generalisability in case-study research is based on replication on a case-by-case basis and the creation of case law. This research study uses a systematic-case study approach to investigate the applicability of the Ehlers and Clark (2000) model in the treatment of rape-related PTSD in South Africa. The study aims to demonstrate the transportability of the model and develop a needed evidence base for service providers in the country. Seven women participated in the project and lent their treatment process to the research. The participants varied in terms of age, race, culture, socio-economic status and the nature of their sexual trauma. Through synoptic thematic analysis of their therapy process specific client-related personal aspects, client-related contextual factors and state-level factors were found to impede treatment delivery and implementation. The implications of these aspects for clinical practice and social policy are comprehensively discussed.