This study aims to ascertain the legal redress available to employees who suffer psychological harm as a result of workplace stress. On a general level, it identifies and assesses some of the available policy options, particularly as they relate to the interaction of statutory workers’ compensation schemes and the common law. On a more specific level, it examines and analyses various issues: the nature and extent of compensable psychiatric harm; the legal duty on employers to protect employees’ health and well being; the role of negligence; requirements specific to the Compensation for Occupational Injuries and Diseases Act 130 of 1993 (COIDA); and the causal nexus necessary to sustain a claim. The conclusion is reached that employees should utilise the workers’ compensation system as the primary vehicle to obtain redress if they suffer from occupational psychiatric harm. However, due to the law’s generally conservative approach to psychiatric harm and intimations that the Department of Labour intends setting strict requirements for claims for psychiatric harm in terms of COIDA, the common law of delict might continue to play an important role in claims for occupational psychiatric harm. The writer recommends that a hybrid system for compensation for stress-related psychiatric harm suffered in the course and scope of employment be adopted, with the statutory compensation scheme providing relatively limited benefits and the common law providing general damages if the claimant can prove negligence on the part of the employer; that the requirement of a recognised psychiatric illness be maintained for both statutory compensation and compensation in terms of the common law; that all parties’ interests are carefully balanced in delineating the employer’s legal duty to employers and that undue weight not be accorded to the terms of the contract of employment; that more attention be paid to factual causation and the development of lternatives/complements to the traditional conditio sine qua non test; that the validity of the circular instruction on post-traumatic stress disorder (PTSD) be tested on administrative-law grounds; and that the stringent prescription requirements set by the circular instruction on PTSD be reviewed.

The psychological sequelae of being involved in combat are only recently coming to be understood. Most of the available data are from research conducted on help-seeking Vietnam veterans in the United States, and very little work has been done in South Africa. There does not as yet appear to be any instrument designed specifically to detect combat-related psychopathologies amongst soldiers who are still in active service, either in the USA or in South Africa. Combat involvement has been shown to lead to a high incidence of combat stress reaction. This in turn has shown that it can predispose sufferers to the development of a Post-traumatic Stress Disorder. It is thus expected that there would be significantly higher incidences of reported symptoms of stress disorders amongst soldiers exposed to high levels of combat as compared with a similar group of soldiers who had no combat involvement. This study used a self-reporting questionnaire, developed in the USA but adapted for use in South Africa, to allow the soldiers in the study to rate the severity of various symptoms derived from the DSM-III criteria for Post-traumatic Stress Disorder. A Beck Depression Inventory was also administered to eliminate any persons who nay have been exhibiting symptoms of depression, as this would have confounded the results. Both questionnaires were administered to serving members of the Permanent Force of the South African Defence Force, with one group being members of various high-combat units based in what was then South West Africa, and the other group being non-combat or Headquarters elements. As a precondition of the study, absolute confidentiality of the respondents and their units was maintained. The study found the expected higher scores in the high-combat group, and also showed that the Keane questionnaire has a good coefficient alpha in South Africa. The study closes with several recommendations for further research, especially in the light of the new PTSD criteria in the DSM-IIIR.

Post Traumatic Stress Disorder (PTSD) is a psychiatric diagnosis receiving increased attention. Occupational therapists are becoming more involved with this diagnosis, particularly with Vietnam Veterans in Veteran Affairs Hospitals. Aerobic exercise is a treatment which has not been explored with this population. Depression and anxiety are symptoms commonly associated with PTSD. This study sought to determine whether aerobic exercise would reduce overall PTSD symptomatology, including depression and anxiety. Three psychological inventories: The Penn Inventory for PTSD, The Beck Depression Inventory (BDI), and The Beck Anxiety Inventory (BAI) and one physiological inventory: The Queens Step Test for VO2 Max were given to eighteen subjects before and after a four week period. Ten subjects engaged in no exercise, and eight subjects participated in an aerobic exercise program. Results indicate that aerobic exercise has a significant effect on reducing depression and anxiety and a marginal effect on their overall symptomatology.

Rape survivors often have two traumatic events to deal with. In addition to the actual rape experience, survivors commonly need to deal with hearing the results of human immunodeficiency virus (HIV) testing (which is standard practice after rape in South Africa). The relationship between these two traumatic events in terms of the survivors specific traumatic stress symptoms have not been well explored in the literature. The primary aim of this study was therefore an exploration of the relationship between receiving an HIV test result and the traumatic stress symptoms of rape survivors. In order to contextualise the main aim, an exploration of the relationship between demographic variables, knowledge of HIV status and early traumatic stress symptoms was also completed. The initial sample consisted of 97 South African rape survivors, however, only 45 participants returned for the second part of the study. This quantitative study utilised an exploratory descriptive design using the Harvard Trauma Questionnaire-Revised (HTQ-R) to measure the traumatic stress symptoms of rape survivors. The results of the first part of the study indicated that there was no significant difference between participants’ demographic factors in relation to their knowledge of HIV status or their overall traumatic stress symptom severity. Significant differences on individual traumatic stress symptoms indicated a relationship between not knowing one’s HIV status and dissociation after a rape incident, as well as a relationship between rape survivors who knew their HIV status is positive and emotional dysregulation. The results of the second part (and main analysis) of the study indicated that most participants presented with less severe overall traumatic stress severity after receiving their HIV test results (irrespective of their status before and after hearing their results). However, participants whose HIV status was unknown and who received a positive test result reported more severe overall traumatic stress compared to those whose HIV status was unknown and received a negative test result. Some inter-group differences on individual symptoms were HIV TEST RESULT TRAUMATIC STRESS RAPE SURVIVORS noted that highlight the possibility that dissociative and an intrusion/hyperarousal subtypes may be at work to explain some of the differences seen.

Culture is important to an individual’s understanding of traumatic events and the symptoms that ensue after such events. Cultural understandings also inform how individuals cope with the traumatic stress symptoms they experience. A great deal is known about the understanding of traumatic experiences and effective coping mechanisms used in Western cultures, but non-Western cultures are generally understudied. Valuable lessons are learnt from conducting studies with understudied non-Western cultures. The research sought to explore and describe the culturally informed conceptions of traumatic experience and coping strategies in one such understudied population - the Mole-Dagbon of Ghana. The research used a qualitative exploratory descriptive interpretive methodology. Purposive nonprobability sampling was used to gain access to individuals who could comment on the knowledge objectives of the study. Data was collected using focus group discussions with cultural leaders, and semi-structured interviews with traumatized individuals. All interviews were audio-recorded, transcribed, translated and analyzed using interpretive phenomenological analysis. The findings indicated that traumatic experiences and the coping strategies are influenced by a number of cultural factors. Participants’ understanding of traumatic experiences and symptoms relied heavily on normative traditional African cultural understandings, but explanations also utilized monotheistic (from Islam and Christianity) worldviews. It was also evident that not all explanations were purely spiritual and events and symptoms were also explained using a natural/scientific framework. Some aspects of this system indicated parallels with the Western cognitive understanding of traumatic stress symptoms. The Mole-Dagbon did not focus naturally on explaining the events and symptoms and in the current sample such explanations were often deferred to authoritative individuals in the society (especially the soothsayers from the Traditional African Religion). However, there was an easy focus on coping with the symptoms after a traumatic event and in this last aspect there was a great degree of agreement between participants. A clear hierarchy of coping emerged with community and family social support being considered the most important aspect. Irrespective of religious affiliation, individuals also considered a visit to the soothsayer and completing prescribed rituals as important in the process. Even where an individual did not wish to include this practice from African Traditional Religion because of religious affiliation, they acknowledged the existence and effectiveness of these practices. Finally, it was thought important that a traumatized individual consult a religious leader for counselling (again irrespective of the actual religion). While there were elements of cognitive understanding and a recognition of counselling by religious leaders, Western based treatment modalities were not mentioned as options for the treatment of the symptoms of PTSD. Practitioners that come into contact with the Mole-Dagbon may need to use collaborative treatment strategies that respects and utilizes cultural treatment strategies for PTSD. One interesting element that needs further exploration is whether the cognitive understandings of the Mole-Dagbon can be used in a cognitive therapeutic paradigm. Even though these cognitive appraisals are present in explaining symptoms, there are no direct cultural remedies that rely on them.

During this research project, an attempt was made to understand the role of ecotherapy as a therapeutic model in post conflict healing. The aim was to evaluate the application and significance of ecotherapy as an intervention strategy for post conflict healing for individuals who were exposed to violent encounters during the liberation struggle. Eight respondents (involved in the arms struggle) from Mdanstane Township in the Eastern Cape, were taken through a series of workshops as part of an ecotherapy healing process. The research concluded that all the participants had suffered from some form of traumatic stress because of their exposure to violence and violent experiences. Moreover, on closer examination the situation of ex-combatants proved to be more complex and often volatile, due to the absence of social support, loss of social status, absence of economic, employment opportunities, and the dislocation from their families and communities. Subsequent to the ecotherapy intervention, a positive outlook amongst the participants was recorded. Furthermore, there was an indication of a significant increase in their sense of self-worth and personal development, which influenced the manner in which the participants viewed the world, related to their families or communities and responded to life in general. Essentially, the research findings, conclusions, and recommendations contributed towards a better understanding of ex-combatants and the value that could be derived from ecotherapy as a post conflict healing method for individuals and groups exposed to violence and trauma.

This study assessed the extent to which exposure to traumatic events affected the traumatic stress response of male and female police officers. A convenience sample of male and female police officers (N = 66: n Male=46, n Female=20) was surveyed at an Eastern Cape police station. The following instruments were used: 1) Biographical questionnaire 2) PTSS-10 scales 3) The 39-item stress incident scale. Findings of this study indicate that the frequency of exposure to stressful incidents especially for more serious events is significant higher than that of Peltzer (2001) study. The four most frequent stressful incidents experienced by all participants were 1) Finding a corpse after murder (86.4 percent), 2) Responding to a scene involving accidental injury of a child (84.8 percent), .3) Finding a corpse (died of natural causes) (84.8 percent), 4) Duty related violence (non-shooting) (84.8 percent ).The four least frequent incidents experienced by participants were: (1) Response to the depressing social situation (71.2 percent), (2) Dragging of a corpse (74.2 percent), (3) Taking a life in the line of duty (75.8 percent), (4) Violent death of a colleague (77.3 percent ).Female participants results indicated a positive relationship between frequency of stressful incidents and total threat, anxiety, helplessness and PTSS-scale , where male participants’ results indicate no significant relationship between frequency of stressful incidents and total threat, anxiety, helplessness and PTSS-scale. Findings on male participants however indicate a positive relationship between years of service in police, age of police officers and PTSS-scale, while female participants’ results indicated no relationship between years of service in the police, age of police officer and PTSS-scale.

Background: The aim of this study was to explore the experience and sense making oftherapists working with clients who present with a PTSD diagnosis. The study engaged with therapists experience and understanding of predisposing factors to PTSD and how they incorporate this understanding into the therapy process. Further to this the experience of the therapists understanding of the influence of predisposing factors on the expression of PTSD was explored. Literature Review: A literature review is presented identifying core research relating to PTSD, predisposing factors to the development of PTSD and the treatments used when working with PTSD as a presenting issue. Methodology: To address the aims of the study 9 therapist participants were interviewed. Semi-structured, one to one, in-depth interviews were utilised to elicit participant’s experience of the issues outlined within the aims. Interpretative Phenomenological Analysis (IPA) was used to identify re-current themes across the interviews and analyse the data, which emerged. Findings: The main findings present thirteen sub-ordinate themes that reflect the essence of the participant’s experience of the phenomenon under investigation. These were based around eight Super-ordinate (master) themes of Previous history, Therapy relationship, Psychoeducation and Normalisation, Identity, Culture, Attachment, Presenting Therapy Themes, and Support Systems. Discussion and Conclusion: The study identified the participant’s experience of predisposing factors on the expression of PTSD. There was consensus from the participant’s in relation to the significant impact of client’s previous life experience on their expression of PTSD. The participants further identified that the client’s previous life experience influenced their formulation and treatment of PTSD. Significant issues that were described by all of the participants regardless of their theoretical or therapeutic perspective were (1) the central importance of the therapeutic relationship, (without a strong, trusting and safe relationship the participants would not engage the therapy work), (2) the importance of in-depth history taking (identification of previous life experience and its impact on the current response to the trauma), (3) the impact of previous trauma(s), and (4) the impact of support systems, environment and identity. These issues are discussed alongside the existing literature around this topic. Additionally, suggestions for future directions of research and recommendations for practice are presented.

My interest in the process and effects of the witnessing act guides the purpose of this study. Here, I initiate a deeper understanding of the vicarious witnessing experience from the perspective of the witnessing participant. My central question is: How do individuals make sense of vicariously witnessing trauma through narrative, visual, and evidence-based representations of traumatic events in the concentration camps of Europe? Vicarious witnessing begins with abstract representations of the event. The evidence is witnessed firsthand, but the event itself is represented through various perspectives such as photographic or artistic images, survivor stories, or physical remnants. Witnessing the evidence evokes a potent embodied experience, so that a person can make the statement, "I have imagined what another has experienced, hence I believe I know." It is through the imagination that a witness forms a picture of the trauma. Undoubtedly, there is immense power in meeting another's experience in the realm of imagination. Compassionate action and social justice is based in this area of human empathy. To best achieve my purpose, I use a narrative method that involves two types of analysis, interpretive readings and narrative instances, as an approach to understand the participant's experience of vicarious witnessing. Participants in this study construct three types of narrative texts-written, spoken, and visual. Each textual perspective shapes the meaning that the participant attempts to express. As a first level of analysis, interpretive readings of the texts include general, specific, visual, and relational readings. Secondly, through exploring the interaction between various parts of these texts, and between the texts themselves, I explore three types of narrative instances--single-text, intratextual, and intertextual. Each analysis of a narrative instance is matched specifically to each participant, and I believe, is uniquely adequate for understanding the experience of vicarious witnessing. My inquiry outlines how individuals make sense of vicariously witnessing trauma, clarifies the meaning that participants make of the vicarious witnessing experience, shows the risks and coping involved in vicarious witnessing, and presents the kinds of social action that vicarious witnessing evokes. In the field of counselling psychology, the witnessing experience is an important aspect of trauma theory that has been left unexplored by psychologists. My research enlarges the social and theoretical conversation concerning the vicarious witnessing experience. / Arts, Faculty of / Psychology, Department of / Graduate

Two-hundred and twenty-four participants who reported a history of child abuse trauma were recruited from the internet, clinical (community outpatient) and prison settings and completed a battery of assessment measures, including Briere's Child Maltreatment Interview Schedule (CMIS) (slightly modified), Detailed Assessment of Traumatic Stress (DAPS), Cognitive Distortion Scale (CDS), and Inventory of Altered Self Capacities (IASC); van der Kolk's Self Inventory of Disorders of Extreme Stress (SIDES-SR); Nijenhuis's Somatoform Dissociation Questionnaire (SDQ-20); and a modification of the CMIS to assess for adult victimization experiences (Adult Victimization Survey or AVS; Dietrich, unpublished instrument). It was hypothesized that Posttraumatic Stress Disorder (PTSD), Affect Dysregulation, and Problems with Interpersonal Relatedness would be associated with later revictimization experiences during adulthood with this sample, and that disturbances in ability to regulate self capacities and other complex posttraumatic sequelae would be associated with perpetration of physical or sexual violence during adulthood. Data were analyzed for 207 individuals who reported childhood maltreatment per the CMIS. Results provide partial support for the hypotheses. Women were significantly more likely to report revictimization, and male inmates were significantly more likely to perpetrate against others. Whereas PTSD and Somatoform Dissociation are the strongest dynamic predictors of any sexual or physical revictimization, Impaired Self Capacities are more often associated with revictimization by intimate partners in particular. Trauma-specific dissociation was associated with a decreased risk of revictimization, whereas peritraumatic and trait dissociation did not enter predictive models. Posttraumatic sequelae were not associated with increased risk of physical perpetration with these samples; however, IASC scores were associated with an increased risk of sexual perpetration and victim-based cognitive distortions were associated with decreased odds of sexual violence. These findings provide partial support for the Complex PTSD (Herman, 1992a) construct. Results are discussed in terms of implications for treatment, further study, and classification. Limitations are noted. / Arts, Faculty of / Psychology, Department of / Graduate