This qualitative study was designed to identify protective practices that mitigate risks of Vicarious Traumatization (VT) among trauma therapists. The sample included six peer-nominated experienced therapists, trained at the masters or doctoral level, who self-identified as having managed well in this work. Narrative data was collected through interviews with individual co-participants, who were asked, "How do you manage to sustain your personal and professional wellbeing, given the challenges of your work with seriously traumatized clients?" Data analysis was based upon Lieblich, Tuval-Mashiach, and Zilber's (1998) typology of narrative analysis, with a primary focus on thematic content analysis within and across participants' narratives. The research findings yielded twelve major themes that describe protective practices engaged by exemplary trauma therapists: countering isolation (in professional, personal and spiritual realms); developing mindful self awareness; consciously expanding perspective to embrace complexity; openness to the unknown; sustaining and renewing hope; active optimism and problem solving; holistic self-care; maintaining clear boundaries; invoking imagery, metaphor, and ritual; exquisite empathy; professional satisfaction; and creating meaning. The novel finding that empathic engagement with traumatized clients appeared to be protective challenges previous conceptualizations of VT and points to exciting new directions for research and theory, as well as applications to practice. Participants also described experiences of vicarious post-traumatic growth. The findings confirm and extend previous recommendations for ameliorating VT and underscore the ethical responsibility shared by employers, educators, professional bodies, and individual practitioners to create time and space to address this serious problem. Participants recommend opportunities for regular supervision, support and validation (including group-based interaction), self-care (including personal therapy, as needed), and developing self-awareness within and beyond the workplace. They think taking care of the caregivers is an organizational responsibility as well as a personal one. Although the research design precludes generalizing from the data, the knowledge generated herein may be helpful to others in the fields of psychology, psychiatry, social work, psychiatric nursing, and related health care disciplines, at the levels of education, training, and practice. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

The absence of clearly defined competencies to guide the development of educational programs for occupational therapy and physical therapy fieldwork instructors provided the impetus for this research. A primary objective of the study was to identify the competency categories and the competencies which occupational therapy and physical therapy fieldwork instructors, and occupational therapy and physical therapy students perceived to be important in determining the effectiveness of a student's fieldwork experience. A review of the literature in occupational therapy, physical therapy, and related health professions identified a pool of fieldwork instructor competencies from which 105 competencies were selected for the study questionnaire. The questionnaire was administered to 34 occupational therapy and 37 physical therapy students from the University of British Columbia, and to 59 occupational therapy and 76 physical therapy fieldwork instructors in British Columbia. A response rate of 87% was obtained. Respondents' ratings of importance of the competency categories and of the most important competencies were similar to previous research findings. Communication and supervisory behaviours were rated as most important in contributing to the effectiveness of a student's fieldwork experience. The majority of the competencies which were ranked as most important belonged to these two categories. Consistent with previous research, the professional competence category and the competencies which were assigned to it were deemed least important in contributing to the effectiveness of a student's fieldwork experience. Group differences in ratings of importance were tested using a factorial design. The two-way and three-way analyses of variance, a multivariate analysis of variance and subsequent multiple comparison tests revealed only one significant main effect. Physical therapy students' ratings of importance differed significantly from the occupational therapy and physical therapy fieldwork instructors (p< .05). While this significant difference was identified from the analysis, examination of the mean ratings of the competencies showed a consistent pattern of low, moderate or high ratings among all of the groups. Participants in the study confirmed that the competencies included in the questionnaire were important in contributing to the effectiveness of a student's fieldwork experience. However, the literature suggests that the most important outcome will be the use of the competencies to guide the development of standardized educational programs for occupational therapy and physical therapy fieldwork instructors. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

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This study explores therapists' experience of working with suicidal clients. Using a Hermeneutic-phenomenological method informed by Heidegger [1889 – 1976] this study provides an understanding of the meaning of therapists' experiences from their perspective as mental health professionals in New Zealand. Study participants include thirteen therapists working as mental health professionals in District Health Boards from the disciplines of psychiatry, psychology and psychiatric nursing. Participants' narratives of their experiences of working with suicidal clients were captured via audio taped interviewing. These stories uncover the everyday realities facing therapists and provide an ontological understanding of their experiences working with suicidal clients in District Health Boards. The findings of this study identified three themes. All the participants experienced shock and surprise upon hearing their clients had committed suicide without presenting with signs and symptoms associated with suicidality in their assessment. All the participants experienced the responsibility of assessing suicidal clients and intervening to be a burden. Further, they suffered from guilt and fear of punishment in the aftermath of a client's suicide. They also found themselves in a professional and personal crisis as a result of their experiences and struggled to come to terms with events. This study has shown how these experiences could be understood by uncovering the perspectives therapists bring to working with suicidal clients. I have shown how mainstream prevention and intervention strategies follow on from the misrepresentation and misinterpretation of our traditional way of knowing what it means to be human. I show when therapists discover that phenomena are not necessarily what they appear to be they feel unsettled and confused about their responsibilities and what it means to live and die as a human being. The experience of being a therapist to a person who commits suicide has been revealed in this thesis to leave a profound legacy of guilt, doubt and fear. This thesis proposes that it may be time for the profession to care for its own that therapists in turn may not shy back from caring for and about the vulnerable other.

This study explores therapists' experience of working with suicidal clients. Using a Hermeneutic-phenomenological method informed by Heidegger [1889 – 1976] this study provides an understanding of the meaning of therapists' experiences from their perspective as mental health professionals in New Zealand. Study participants include thirteen therapists working as mental health professionals in District Health Boards from the disciplines of psychiatry, psychology and psychiatric nursing. Participants' narratives of their experiences of working with suicidal clients were captured via audio taped interviewing. These stories uncover the everyday realities facing therapists and provide an ontological understanding of their experiences working with suicidal clients in District Health Boards. The findings of this study identified three themes. All the participants experienced shock and surprise upon hearing their clients had committed suicide without presenting with signs and symptoms associated with suicidality in their assessment. All the participants experienced the responsibility of assessing suicidal clients and intervening to be a burden. Further, they suffered from guilt and fear of punishment in the aftermath of a client's suicide. They also found themselves in a professional and personal crisis as a result of their experiences and struggled to come to terms with events. This study has shown how these experiences could be understood by uncovering the perspectives therapists bring to working with suicidal clients. I have shown how mainstream prevention and intervention strategies follow on from the misrepresentation and misinterpretation of our traditional way of knowing what it means to be human. I show when therapists discover that phenomena are not necessarily what they appear to be they feel unsettled and confused about their responsibilities and what it means to live and die as a human being. The experience of being a therapist to a person who commits suicide has been revealed in this thesis to leave a profound legacy of guilt, doubt and fear. This thesis proposes that it may be time for the profession to care for its own that therapists in turn may not shy back from caring for and about the vulnerable other.

The personal characteristics of the therapist are strongly associated with therapeutic alliance and treatment outcome. Since treatment techniques are often shown to be equally effective, differential outcomes may be attributed to the therapist's early experiences and personality features. The purpose of this study was to determine the influence of childhood relational trauma in predicting specific components of mentalizing skills (i.e., affect consciousness, psychological mindedness, mindfulness, cognitive empathy and theory of mind) among therapists. Participants were 121 clinical psychology doctoral and master's in mental health counseling students (20 males, 101 females) aged 22 to 53 years old (M = 27.26, SD = 5.25). Measures included the Child Abuse and Trauma Scale (CATS), Kentucky Inventory of Mindfulness Skills (KIMS), Toronto Alexithymia Scale (TAS), Psychological Mindedness Scale (PMS), Reading the Mind in the Eyes Test-revised (RMET), Interpersonal Reactivity Index (IRI-PT/IRI-EC), Relationship Structures Questionnaire (RSQ) and a questionnaire assessing demographic information, graduate training and interests, personal therapy, objective childhood familial trauma and adult and peer support. Linear regression and hierarchical multiple linear regression analyses (HMLR) were conducted to assess the relationship between childhood relational trauma (CATS) and the various components of mentalization. HMLR was also used to determine whether relational style (anxious/avoidance) as measured through the RSQ moderated between childhood relational trauma and the mentalizing components. Finally, emotional empathy (IRI-EC) was examined as a potential mediator between childhood relational trauma and the mentalizing components using Andrew Hayes' SPSS macro. Post hoc analysis explored associations between the mentalization variables and demographic questionnaire items related to objective childhood familial trauma and support. Results revealed that childhood relational trauma significantly predicted lower levels of affect consciousness, psychological mindedness and mindfulness among therapists. Relational style was not found to be a significant moderator and emotional empathy was not found to be a significant mediator. Growing up with a parent who had a disability or physical illness was significantly associated with higher levels of emotional empathy in therapists. The implications of these results for the training and supervision of graduate level therapists are discussed.

Doctor of Philosophy / Department of Family Studies and Human Services / Sandra M. Stith / This dissertation presents an emerging inquiry about family therapists’ lived experiences as they work with families in situations that may also require the therapist to act as agents of social control whether through implementation of therapy, treatment, or programs. I used a grounded theory approach, informed by feminist qualitative research, to address the following three questions: 1) How do therapists experience their role as agents of social control? 2) What processes and strategies do they use as they navigate that role when working from a social justice perspective and 3) what implications does this have for family therapists as they conceptualize and plan treatment for their cases? This study used purposeful sampling: Eleven professional family therapists who have researched, taught and written about social justice issues were interviewed. The results of this study provide a preliminary map clarifying how family therapists navigate that role of working as an agent of social control while maintaining a social justice perspective. This research clarifies family therapists’ recognition of their role as agents of social control through the context, meaning, and expectations of therapy. The navigation of this role from a social justice perspective is accomplished through the therapists’ framework of therapy, their understanding of the lived experiences of their client systems, and their therapeutic approach to therapy. These participants also addressed the supervision and development of beginning therapists. These results are intended to provide a foundation for further discussion and research on the topic of therapists as agents of social control.

Student Number : 9001367H - MPh research report - School of Public Health and Oral Health Sciences - Faculty of Health Sciences / Introduction: Compulsory Community Service (CS) for health professionals has been introduced in South Africa since 1997. Some of the aims for its introduction were to: 1) address the maldistribution of health service providers, 2) prevent qualified health professionals from emigrating and 3) improve clinical skills and knowledge of newly qualified medical graduates. The Oral Hygiene (OH) and Dental Therapy (DT) professions have as yet not been included in the performance of CS. However the Department of Health (DOH) is planning to introduce CS for these groups of health professionals in the near future. The role of the oral hygienist and dental therapist in South Africa (SA) cannot be over emphasized. Given the high caries levels, low oral hygiene education levels, large unmet oral health needs and the preventative approach of the DOH at all levels, the oral hygienist and dental therapist can provide invaluable human and technical resources that are currently required to address these concerns. Aims: To assess the attitudes of OH and DT students registered during 2004 at the five dental schools in South Africa regarding the introduction of CS. Objectives: 1) To obtain the demographic data of the OH and DT students, 2) to determine whether their current training programme prepares these students for CS, 3) to identify the provinces in which the OH and DT students would prefer to be placed for CS and 5) to identify the different types of professional activities that the OH and DT students would like to perform whilst completing CS. Methods: A self administered questionnaire was jointly developed between the Kwa- Zulu Natal Department of Health and the Division of Public Oral Health at the University of Witwatersrand, Johannesburg. The questionnaire was sent to all OH and DT students who were registered at each of the five dental schools in SA during 2004. Results: There were a total of 163 students (68%) who responded to the questionnaire. Of the respondents, 109 (70%) were OH students and 54 (64%) were DT students. There were 132 (81%) females and 31 (19%) males. The average age of the student’s was 21 years (17-37; mode 19; median 20 and SD 3.2). There were 59 (36%) Whites, 53 (33%) Black, 31(19%) Asian and 18 (11%) Coloured students. The majority of OH students (63%) were against the introduction of CS. There was a significant number (p<0.05) of White students who were registered for the OH degree that did not want to perform CS. A significant number of respondents (p<0.05) felt that they were adequately trained to perform all the necessary duties that may be required of them during their CS. Most of the respondents chose Kwa-Zulu Natal (26%), Western Cape (26%) and Gauteng (22%) provinces respectively as their first choice province for carrying out their CS. The majority of students (p<0.05) chose their resident province as their first choice province in which they would prefer to perform their CS. Students indicated a preference to perform oral health promotional activities (56%), health educational activities (21%) and clinical work (18%) in their CS programme. Conclusion: The majority of DT students supported the concept of CS. This was in contrast to the OH students where less than half of them supported its introduction. Overall, most of the students chose the more urban provinces (Kwa-Zulu Natal, Western Cape and Gauteng) to complete their CS.