This thesis follows a paper based format where papers 1 and 2 are stand-alone papers prepared for submission to the Journal of Pediatric Psychology. The relevant submission guidelines are included in the Appendix. Paper One: The purpose of this systematic review was to assess the effects of family-centred interventions for children and adolescents with Type 1 diabetes and review the bias associated with included studies. The review summarises the outcome measures which consisted of HbA1cs, hospital admissions for diabetic ketoacidosis (DKA), adherence, and family relationships including diabetes-related conflict. Research studies that were randomized controlled trials were selected to maximise the quality of information reviewed. Electronic searches of the OVID database using MEDLINE, PsycINFO, EMBASE, and CENTRAL were searched from their start dates until May 2012. Nine studies were located and assessed with the Cochrane risk of bias tool. Two studies were excluded from further analysis due to serious concerns about bias of their results. The remaining 7 had their findings summarised in a narrative statement, which indicated that family-centred interventions significantly improved HbA1cs, reduced DKA admission rates, improved adherence, and enhanced family relationships including reduced conflict. Family-centred interventions appear to be effective in enhancing health and psychological outcomes. The interventions however, were mainly in clinical settings and delivered by trained professionals. Given the importance of the family relationships in diabetes control, a need exists for interventions to have a more flexible setting and method of delivery, remain viable and demonstrate sustainability. Paper two: Clinic based interventions in type 1 diabetes have shown improvements in family relationships and metabolic control, but have limited reach. Therefore, a self-directed intervention was evaluated. Recruitment occurred through national advertising with diabetes charities, and the randomized controlled trial was conducted via online data collection. Parents of adolescents (aged 11-17) with diabetes were randomized to usual care (n = 37) or intervention (n = 42) using computerised block randomization, with researchers blinded to block size. The 10 week intervention involved the Self-directed Teen Triple P (Positive Parenting Program) workbook (10x1hour modules) and Chronic Illness tip sheet. Primary outcomes of diabetes-related family conflict and parenting stress were assessed pre and post-intervention. Intention-to-treat analysis was undertaken (n = 79), due to increased attrition from the intervention group. Intervention significantly improved diabetes related conflict, but not parental stress, compared to usual care. Followup analyses will assess maintenance effects and impact on metabolic control. Paper three: This paper was a Critical Evaluation, the purpose of which was to consider the findings from both papers, highlight additional and unexpected outcomes, place the research in the wider context, explore limitations of the thesis, and to discuss implications for future work.

Text in Afrikaans / During her theoretical training as an educational psychologist, the researcher became acquainted with the relations theory. The researcher became aware of the fact that persons who have experienced psychological trauma, commonly practice irrational inner dialogue/self talk. From her own experience, it also became clear that traumatized persons deal with their trauma more effectively when they have good relations with others. Due to the fact that these aspects are significant aspects of the relations theory, the researcher began to wonder whether this theory could possibly be of value in therapy with traumatized persons. On the basis of a qualitative study of limited scope, it was found that, with certain reservations, the educational psychological relations theory could be a workable theory in therapy and that relations therapy could make a valuable contribution to the success of therapy with traumatized persons. / In die loop van haar teoretiese opleiding as opvoedkundige sielkundige het die navorser kennis gemaak met die relasieteorie. Die navorser het bewus geword van die feit dat mense wat 'n sielkundige trauma in hulle lewens beleef het, oor die algemeen irrasionele selfspraak beoefen. Na aanleiding van haar eie ervaring, het dit ook duidelik geword dat getraumatiseerde persone meer effekttef deur hulle trauma kan werk indien hulle relasies toereikend is. Omdat hierdie aspekte juis baie gewig dra in die relasieteorie, het die navorser begin wonder of die relasieteorie nie moontlik van waarde kan wees in terapie met getraumatiseerdes nie. Op grond van 'n kwaiitatiewe studie van beperkte omvang is daar bevind dat, met sekere voorbehoude, die opvoedkundig-sielkundige relasieteorie wel 'n werkbare teorie in terapie kan wees en dat relasieterapie 'n waardevolle bydrae tot die sukses van terapie met getraumatiseerdes kan iewer. / Educational Studies / M.Ed. (Guidance and Counselling)

Text in Afrikaans / During her theoretical training as an educational psychologist, the researcher became acquainted with the relations theory. The researcher became aware of the fact that persons who have experienced psychological trauma, commonly practice irrational inner dialogue/self talk. From her own experience, it also became clear that traumatized persons deal with their trauma more effectively when they have good relations with others. Due to the fact that these aspects are significant aspects of the relations theory, the researcher began to wonder whether this theory could possibly be of value in therapy with traumatized persons. On the basis of a qualitative study of limited scope, it was found that, with certain reservations, the educational psychological relations theory could be a workable theory in therapy and that relations therapy could make a valuable contribution to the success of therapy with traumatized persons. / In die loop van haar teoretiese opleiding as opvoedkundige sielkundige het die navorser kennis gemaak met die relasieteorie. Die navorser het bewus geword van die feit dat mense wat 'n sielkundige trauma in hulle lewens beleef het, oor die algemeen irrasionele selfspraak beoefen. Na aanleiding van haar eie ervaring, het dit ook duidelik geword dat getraumatiseerde persone meer effekttef deur hulle trauma kan werk indien hulle relasies toereikend is. Omdat hierdie aspekte juis baie gewig dra in die relasieteorie, het die navorser begin wonder of die relasieteorie nie moontlik van waarde kan wees in terapie met getraumatiseerdes nie. Op grond van 'n kwaiitatiewe studie van beperkte omvang is daar bevind dat, met sekere voorbehoude, die opvoedkundig-sielkundige relasieteorie wel 'n werkbare teorie in terapie kan wees en dat relasieterapie 'n waardevolle bydrae tot die sukses van terapie met getraumatiseerdes kan iewer. / Educational Studies / M.Ed. (Guidance and Counselling)