The experiences of working in an acute psychiatric unit were investigated in this research using multiple qualitative methodologies, particularly Reflective Topical Autobiography and Participatory Action Research. The Participatory Action Research was undertaken in an acute psychiatric unit of a major public hospital in Melbourne. The collaborative design focused on bringing staff and consumers of psychiatric services together with an aim to develop new work practices for mental health practitioners. Four consumer consultants including a Koori representative participated in this study. Consumer consultants and staff, working in collaboration with the researcher, informed the fluid and iterative research process. Data included thirty eight interviews with psychiatric health professionals (2 psychiatrists, 2 managers, 6 psychiatric registrars and 28 nurses, including two charge nurses). Horizontal violence, and its impact on the capacity for reflexive work practices, became a strong emergent theme. Other emergent and important themes included workplace hierarchy, values, power, and the impact of critical incidents and supervision. Ego-state theory was utilised to better understand the psychology of staff members, and Organisational Egostate theory was presented as an original concept to explore the psychiatric unit as an organism having its own personality characteristics. It was concluded that for there to be permanent and iterative change to the organisation that engrained automatic responses of the organisation need to be identified and new responses developed. The research resulted in a number of new work practice recommendations, including the establishment of non-discriminatory review processes where work practices that are viewed as inappropriate by staff and consumers can be assessed with consideration to the importance of all stakeholders. Specific insights and conclusions have been suggested in relation to the treatment of aboriginal (Koori) people in the psychiatric unit. A central conclusion from this study was that psychiatric staff and consumers need more inclusion in the design and review of work practices.

The social model of disability requires that research about disability should be controlled and managed by people with disabilities themselves. Traditional research has tended to marginalise people with disabilities, and the outcomes have been meaningless and irrelevant to them. Three years ago I approached a small disability advocacy organisation, and through six months of collaboration with Disability Justice Advocacy (DJA), the need for a strategic plan was identified. Developing a strategic plan for DJA became a vehicle for exploring the primary aim of my research, which was to conduct participatory action research with people with disabilities, and to examine its value as an empowering research practice. The literature indicates that while participation, and participatory action research in particular, has the potential to empower people with disabilities, it can also serve to disempower them. This study draws on the experiences of participation in this process, both from the perspective of the participants (six board and six staff members) and myself, as the researcher. Thematic analysis of the interview data identified barriers to participation at different levels of intervention. At an intrapersonal level, competence of people with disabilities emerged as a critical issue for DJA. This issue resonated with my own experience of the process and, through ongoing critical reflexivity, revealed that underlying ableist attitudes (i.e. attitudes based on non-disabled standards) reinforce the ongoing victimisation and oppression experienced by people with disabilities. This study builds on current knowledge regarding the role and tensions of a community psychologist working with a social justice agenda with people with disabilities.

This thesis reports research into referral and intake to child and adolescent mental health services intended to illuminate a largely unnoticed but potentially powerful clinical phenomenon in service provision. Referral and intake to child and adolescent mental health services was demonstrated to be a complex process that shapes subsequent clinical interactions. Three questions guided the present research. Why are the practices of referral and intake as they are and how have they been shaped, historically? What are the specific practices involved? What are the effects of these practices upon subsequent case consultations and outcomes? Four enquiries were conducted. An extensive and critical literature review was directed toward the first question and demonstrated the historical roots of child and adolescent mental health services, elucidated the phases of the referral and intake process, clarified the many images of the parent in such services, and postulated the existence of three categories of service applicants, namely committed, containable, and crisis-reactive parent referrers. A retrospective empirical enquiry addressed the second question and a prospective empirical enquiry addressed the second and third questions. A further, integrative and empirical enquiry addressed the practices, role, and clinical thinking of referral and intake workers. The empirical studies demonstrated that, when done well, referral and intake provides momentum toward change in subsequent clinical contact. The referral and intake worker was shown to perform nearly one hundred tasks within a 15 to 25 minute referral call. The committed parent referrer, who was distinguished from other referring parents, was characterized by hopefulness, determination, and often, emotional pain in gaining access or the active presence of another party opposed to the referral, in the xviii retrospective study. The findings have major implications for the conduct of psychotherapy research and for the efficient and personable management of child and adolescent mental health services.

This study investigated relationships between problem video game playing, self-esteem and social skills in an adult sample. Via the internet, 621 (560 male) primarily Australian participants completed three scales: the Rosenberg Self-Esteem Scale, the multidimensional Social Skills Inventory and Problem Video Game Playing Scale. Hypotheses were: that problem video game playing would be related to social skills and self esteem; that time spent playing online games would be related to social skills; and that social skills and self esteem would predict problematic play. Online game time commitment was not significantly related to social skills or self esteem, suggesting online environments are not distinctly socially enriching or erosive. Resonating with past studies that found links between gaming, introversion, and social anxiety, a pattern of significant (p < .001) correlations emerged between 3 social skills subscales, together representing social hesitancy, and problem video game playing; however the magnitude of relationships was minute. To explore whether problematic play is impelled by social difficulties, a multiple regression analysis was used to predict problematic playing scores with scores on the social skills and self esteem scales. A significant model was found: F (9, 611) = 15.051, p < .001, accounting for 16.9% of variance. Time commitment (B = .314, p < .001), one social skill subscale (B = .184, p < .001) and self esteem (B = -.103, p = .03) emerged as significant predictors. Results suggest a very small proportion of problematic play is related to social skills and self esteem, but considering the magnitude of relationships, other factors may better explain problematic play. More broadly, this study aligns with others that found little negative consequences of problematic or dependant electronic game play. Further analyses included a comparison of game genre choice on important variables, finding players who preferred Massively Multiplayer Online Role Playing Games had significantly higher problematic play scores, time commitment and age than other genres. Contrary to past studies, males did not show significantly higher time commitment, although the gender discrepancy in participants suggests electronic gaming is still a male-dominated arena.

Imatinib was successfully introduced into haematology-oncology practice in 2001 and rapidly endorsed as a first line treatment for chronic myeloid leukaemia (CML) in the chronic, accelerated, and blastic phases. The survival advantage demonstrated by this target kinase inhibitor has meant that patients are now treated with this agent on a long-term basis. There is a growing literature on the potential toxic effects of chronic imatinib use (Fruttiger et al., 1999; Grove et al., 2004). A safety sub-study undertaken by the Australasian Leukaemia and Lymphoma Group (ALLG) identified a range of subtle effects consistent with the inhibition of targeted kinases in the immunological, respiratory, endocrine, and reproductive systems (Seymour et al., 2004). To date, there has been no attempt to elucidate possible neuropsychological sequelae of chronic imatinib use. However concerns exist about the potential neurotoxic effects of this agent, given that the inhibition of protein kinase in animal studies has been associated with a range of deleterious consequences, such as impaired learning and memory, and reduced synaptic efficacy (Grove et al., 2004; Moresco et al., 2003). The purpose of the current study was to monitor the neuropsychological function of a group of adult CML patients’ newly prescribed imatinib.

Research on attachment in human relationships has flourished with the development and validation of measures of attachment for infants, small children and adults, and, more recently, adolescents. However, research on attachment in middle childhood has been limited by relatively less attention to the development of relevant assessment techniques for this age group. At the same time, despite recognition of the powerful impact of attachment on overall child functioning, its assessment in clinical work has been hampered. Existing techniques for this age group rely on direct observation of actual behaviour, parent or child self-report of actual or hypothetical behaviour, or the interpretation of doll play in response to suggested specific situations of stress or separation. The present research represents the development of a more versatile technique for assessing quality of attachment in middle childhood, the 'Child’s Experience of Attachment Technique (CEAT)'. Design and piloting of this projective tool involved a number of steps. First, an in-depth exploration of relevant literature, particularly that relating to internal working models of attachment, was undertaken. On this basis, a series of ten ambiguous pencil drawings of children in various social situations was devised. Employing a storytelling technique, these drawings were trialled with a non-clinical sample of five boys and five girls, aged 6-12 years of age. The data collected enabled the stimulus drawings to be evaluated and refined, and a scheme for coding responses in the stories elicited to be created. The development of a coding scheme that could reflect some of the complexity of coexisting internal working models of attachment was the main thrust of this research. A revised set of stimulus drawings and the coding scheme were designed and piloted with a non-clinical sample of 20 girls and 20 boys, and with a clinical sample of 10 boys receiving psychotherapy for severe behavioural difficulties. When the matched samples were compared using the CEAT, the clinical group was found to have significantly lower security of attachment scores than the non-clinical group, as hypothesised. These results gave a preliminary indication of appropriate concurrent validity of the CEAT and its coding scheme. In addition, the CEAT provided rich multifaceted qualitative information concerning participants’ internal representations of attachment. Overall, findings suggested that further investigation of the reliability and validity of the CEAT is warranted.

This thesis discusses the multiple narratives of Iranian migrants and refugees living in Melbourne, Australia. The narratives are constructed by men and women who left Iran immediately after the 1979 revolution; the Iran and Iraq war; and Iranians who are recent arrivals in Australia. The narratives of the participants are particularly influenced and contextualized by the 1979 revolution, the 1980 to 1988 Iran and Iraq War and the post 9/11 political framework. It is within these historical contexts, I argue that Iranian experiences of displacement need to be interpreted. These historical periods not only provide the context for the narratives of the participants but it also gives meaning to how they reconstruct their identities and the emotions of their displacement. This thesis also argues that Iranian migrant and refugee narratives are part of a holistic story that is united rather than separated from one another. These narratives are part of a continuum that are influenced by historical events that have caused their displacement. For Iranians in this thesis displacement and a traumatic past often creates many different forms of rupture that includes spatial, temporal, cultural and emotional experiences that are constantly being revaluated, renegotiated and changed. In the narratives of the participants we find people struggling to negotiate their identity; devising strategies to cope with displacement and a traumatic past; and they tell stories on the ways they are stereotyped and caricaturized in western discourse. The participants' recount stories about how the objectification of their cultural background fails to take into account the complexity of their experiences and their suffering. For the participants the simplistic notions about their identity and experience in the popular imagination of western culture they believe ignores how their narratives of home (Iran) are connected with the host (Australia) context. The narratives of the participants' have a lugubrious tone which tries to express the effects of the cultural, social, political ruptures they have experienced. The thesis addresses the theoretical issues underlying such experiences and focuses on a narrative methodology to bring to light the problems of identity, stigmatization, cultural trauma, and the significance of representation in the lives of Iranian migrants and refugees.

Research studies have found that pregnant adolescents and adolescent mothers differ from their older counterparts on a number of psychological factors. Differences have been noted in the level of antenatal bonding to the foetus, the presence of depressive and/or anxious symptomatology during the pregnancy, the woman’s own attachment experiences and the amount of social support received. These variables have also been found to influence the development of maternal bonding after the baby is born. The primary aim of this research was to examine these antenatal factors and to assess their relative contribution to maternal bonding at six weeks postpartum. A further aim was to explore how different cultural and religious beliefs held by the adolescent and her family impact on the adolescent. The sample comprised pregnant adolescents aged between 13 and 19 years who attended either the Women’s Clinic at Sunshine Hospital or the Young Mothers’ Clinic at the Royal Women’s Hospital in Melbourne, Australia. The participants completed a number of standardised questionnaires during their pregnancy to measure antenatal bonding, retrospective perceptions of their own experiences of being parented by their mother (care and control), depression, anxiety and social support. The adolescents also participated in a semi-structured interview regarding religious and cultural beliefs. At six weeks and three months postpartum the adolescents completed another set of questionnaires to measure postnatal bonding, depression and anxiety. The proposed model to predict post-natal bonding was tested using hierarchical multiple regression. Results of the multivariate analyses indicated that the proposed regression model did not fit the data. Antenatal bonding was the only antenatal factor that was significantly related to postnatal bonding at six weeks. There were other significant correlations noted among the antenatal factors of care, control, depression, anxiety and social support received, but none of these appeared to be significantly related to postnatal bonding in this sample. However, strong relationships were noted between all postnatal factors (postnatal bonding, postnatal anxiety and postnatal depression) at both six weeks and three months postpartum. Information from the interviews on the influence of cultural and religious beliefs was presented and case studies were provided to highlight some of the experiences of these young women. The results of this research were compared and contrasted to the limited number of previous studies that have been carried out in the area. The lack of support for some hypotheses was discussed in the context of the limitations of the study. Other hypotheses were generated and discussed with recommendations made for future research.

Much research has been conducted that explores the process of psychotherapy and psychoanalysis; however, there is little that provides an illustration of what actually occurs between patient and therapist. This research is an explanatory and descriptive study of testing, which Weiss (1993; Weiss et al. 1986) links to the transference. An analysis of the process of testing is presented from two theoretical perspectives drawn from the theories of Joseph Weiss (Control-mastery theory (CMT)) and Sigmund Freud and Jacques Lacan (Freudian-Lacanian theory). The primary research question asked: what is testing? CMT, based on the higher mental functioning hypothesis (HMF), proposes that testing is a phenomenon based on an assumption that the unconscious can think, plan and make decisions in the same way as the conscious mind. Freud’s later theory relating to the ego provides a theoretical framework for CMT and Freud’s early theory is used by Joseph Weiss as an alternative theoretical hypothesis to the HMF hypothesis. This thesis presents a comparative analysis of both theoretical positions, which revealed that testing was consistent with an unconscious transference demand. Two propositions were examined at a clinical level using data from a multiple-case study in which transcripts of the first ten sessions of each of three patients’ psychotherapy were analysed. The propositions were examined according to Yin’s rival theory and analysed according to the logic of pattern matching. The first proposition stated: (1) The Freudian-Lacanian theory of the transference would provide a fuller explanation of testing episodes than CMT. The second proposition related to what the patient wants of the therapist in testing and proposed that: (2) The patient wants the therapist to occupy the position of his parental object, which is the position of an identificatory object. Theoretically, testing in control-mastery theory is consistent with the Freudian preconscious but inconsistent with the Freudian unconscious. At a descriptive level testing was consistent with aspects of the psychoanalytic processes of acting out, projective identification, and repetition but inconsistent with these processes at a theoretical level due to differing conceptualisations of the unconscious. Clinically, testing as an unconscious process was most consistently explained in the case studies by Freudian-Lacanian theory in which it was viewed as the patient’s demand that the therapist occupy the position of the parental objects. This finding opposes the CMT assumption that in testing, the patient does not want the therapist to occupy the position of the parental objects. The opposing positions were explained by the different formulations of the unconscious, either admitting or omitting the drives, which underpinned different therapeutic aims in the two theories. As a theory of conscious and preconscious functioning CMT has merit, but the thesis concludes that it is not a theory of unconscious functioning. The implications of these findings for clinical practice and research are discussed.

The impetus for this enquiry came from two experiences with an Aboriginal Other, which prompted the initial research questions: “Why does the existence of an Aboriginal Other threaten a white sense of belonging?” and; “What are the mechanisms and purposes of aggression towards, or exclusion of, that which represents otherness in the Australian context?” In the introductory chapters, the author’s experiences at Lake Mungo and Legend Rock are presented as case studies to illustrate Wittgenstein’s (1953/1968) concept of the ways that subject positions are constructed through language games and hegemonic discourses. Psychodynamic theories of identity formation have been applied to the analysis of these cases to argue that the unconscious construction of Australia as a good, white and Christian nation has acted to overwrite Aboriginal perspectives and to position Aboriginal people at the margins of society. In Chapter One the case of Lake Mungo was presented to illustrate the ways that language games function as cultural frames, through which all experience is filtered. As well, Buhler’s (1934/1990) conception of the deictic and symbolic fields, and the role of the proper noun in allowing or disallowing individuals to occupy a position in the symbolic order as subjective agents was discussed. Here, a relationship between cultural framing and the construction of hegemonic discourses which act to position all that is Other outside positions of enunciation was posited. This was followed by a brief exploration of the concept that the lives of Aboriginal people are organized according to an ontological position that differs in fundamental ways from the world view of the white mainstream. Specifically, it was argued that the social realities of Aboriginal people are embedded within their relation to land and the kinship obligations associated with belonging to a particular community in a particular place. A series of hypothetical indices of difference, based on Margaret Bain’s (1992) research into a semi-remote Aboriginal community at Finke, in Central Australia, was presented. The centrality of whiteness as an organizing principle in Australia was illustrated by Barton’s (1901) “A White Australia” speech, made at the time of Federation. In the ensuing investigation of the way that the dominant culture has constructed an ideal image of the typical Australian, it was suggested that white Australians identify with a mythical Good Australia though white discourses of enlightened nation building and Empire, in which Aboriginal culture has been “mapped and managed” into a museum context and Aboriginal people have been rendered as “metonymically frozen into an extinct past” (Hemming, 2003, pp. 1-3). In Chapter Two, a case study approach, based on Freud’s model of analysis as an archaeology of the present, was used to explore the mechanisms behind the occlusion of Aboriginality as a presence in the case of Legend Rock. The Freudian (1919) concept of the uncanny was critical to the investigation of the particular anxieties around belonging that are evoked for white Australians when confronted with the unfamiliar Aboriginal presence in familiar spaces. In this section of the thesis, Gelder and Jacob’s (1999) characterization of the overturning of the legal fiction of terra nullius after Mabo as the return of the repressed was discussed. In Chapter Three, the rationale for using a case study approach to address the guiding hypothesis and the propositions to be investigated in the current study are outlined. Chapter Four introduces Lacan’s (1949/2002) conceptualization of the mirror stage, during which identifications are formed and the ego, or “I” is first recognized, as well as Klein’s (1937/1964) theory of primitive defence mechanisms. The ideas of these clinicians were used to explore the function of the Other in both normal development and in pathological states. This literature was then applied to an investigation of the process of othering as it has manifested in the Australian context in more general terms. Rutherford’s (2000) thesis: that an Australian ego-ideal has been based on the identification with a mythical being-without-lack, provided a starting point for analysis of the ways that white Australia has constructed a veil around cultural difference in order to defend against acknowledging the fact that Aboriginal peoples have been profoundly damaged by the practices and processes of colonization, and that these practices and processes continue to damage current generations of Aboriginal people. In Chapter Five, it was argued that, after Mabo, white Australians have had no choice but to adopt one of two defensive positions with respect to Aboriginal Australia. Following Money-Kyrle’s (1951) reading of Klein, these positions were nominated as being characterized by either persecutory or depressive guilt. The rejection of the Aboriginal story of Legend Rock was posited as representing the persecutory position, which was discussed in terms of the phenomenon of the rise of Pauline Hanson and One Nation. It was argued that the denial of Aboriginal rights, and attacks on Aboriginal people as the recipients of special treatment, could be explained as representing the manic defence of a large minority of the white mainstream in response to perceived threats to identifications with the Good Australia evoked by the recognition of Native Title. As Klein has explained, the manic defence is driven by anxiety and functions through the primitive psychological process of splitting, whereby internalized good (ego syntonic) objects are retained and internalized bad (ego dystonic) objects are projected onto the scapegoated Other. In the case of One Nation, Aboriginal people were represented as “greedy” people who wanted to take away “our backyards”. By contrast, it was argued that many white Australians had adopted the more difficult depressive position, which was best exemplified by Paul Keating’s (1993) Redfern Park Speech. The processes of splitting and projection that characterize the persecutory position enable us to repress the knowledge that we have inflicted harm, and thereby escape feelings of guilt. Depressive guilt, on the other hand, is associated with the painful awareness that harm has been done and a desire to make reparation to the damaged psychic object. This desire was manifest in the emergence of grass roots movements, such as Australians for Reconciliation, comprised mainly of white Australians, who organized their own responses to the stance taken by Pauline Hanson’s One Nation Party. Australians who wished to amend past wrongs were frustrated by the inertia of the Wik debate, the failed referendum for a republic, the Treaty debate, and the dismantling of the Aboriginal Tent Embassy in Canberra. Ordinary citizens walked over bridges and contributed to the Sea of Hands in their tens of thousands to show their solidarity with Aboriginal people. The “Sorry” books were in answer to the Howard administration’s steadfast refusal to make an apology and offer compensation to the Stolen Generations, as had been recommended by Wilson and Dodson’s (1997) Bringing them Home Report. Chapter Six outlined the epistemological and methodological framework within which the research was conducted. In this section, the ethics of conducting research with indigenous communities has been presented, and the reasons for adopting a critical approach to psychological research are explained. The primary data from the interviews was presented in Chapters Seven, Eight and Nine. Data was organized into sections according to the main themes that were raised by the indigenous participants, accompanied by relevant commentary from the non-indigenous contributors. The analysis of the emergent themes has been presented alongside the data within each section. In Chapter Seven, the guiding hypothesis that Bain’s (1992) indices of difference would be salient for a cohort of Aboriginal people living in urban and regional environments was partially supported. The Aboriginal participants’ subjective experience of their Aboriginal identity was explored In Chapter Eight. In Chapter Nine, Lacan’s concept that the unconscious is structured like a language, together with his emphasis on the role of metaphor in creating the illusion of fixed meanings, was used to investigate how Aboriginal narratives of identity have been influenced by representations of Aboriginality in both mainstream and indigenous communities. In Chapter Ten, a summary of findings, conclusions and recommendations has been presented.