A thesis submitted in fulfilment of the requirement for the degree of Doctor of Philosophy, Faculty of Humanities; University of the Witwatersrand. June 2016 / This study explored the experiences of and interactions between speech-language therapists and interpreters in cross-linguistic mediated consultations with caregivers of children with severe disabilities within a health care setting. The objectives of the study included: to analyse the interactional characteristics and features of speech-language therapists and interpreters; and to identify speech therapists’ and interpreters’ perceptions of their competence and experiences in multicultural settings. Patients who do not speak the same language as the health care professionals receive limited health services when compared with people who speak the same language as the professionals who serve them, which may result in poor health outcomes. The research was conducted from an interpretive approach, which includes a respect for intra- personal values, beliefs and interests in the topic. The design included multiple data collection methods and analysis. The data was collected from consultation experience of thirteen caregivers of children with communication disabilities, five SLTs and one interpreter in two urban hospitals in Gauteng. The participants were recruited using purposive sampling procedures from two urban tertiary hospitals in Gauteng. And group Research instruments used were video recordings, individual interviews. The objectives were investigated through a qualitative study using ethnographic observations; video recordings of the interactions between speech therapists and an interpreter during interviews with caregivers of children with disabilities; audio recordings; and individual interviews with speech-language therapists and interpreters post-consultation. The data collected were analysed using thematic content analysis and conversational analysis. The findings highlighted the diversity challenges faced by SLTs working in multilingual and multicultural hospital settings. Language and translation issues had a marked impact on information received by caregivers. Despite the challenges that clinicians experienced in multilingual settings, they seemed to find that their working experience was an important leveller when they had an interpreter present during their consultations. The findings inform academic curricula and the clinical practice of speech-language and audiology students and professionals and will help improve application to transform the way in which they apply theoretical knowledge when treating speech and hearing disorders in a multilingual and multicultural context; thus enhancing the efficacy of management of communication disorders within this context. / MT 2018

As a paradigm of a wounded healer, parentified therapists may be gifted with therapeutic talents, but also with related vulnerabilities that may have a significant influence on their therapeutic practice. Therefore, the aim of the current study was to explore the impact of parentification on therapeutic practice, especially on the therapeutic skills of empathy and boundary settings. For this purpose, a mixed method design was employed in which 38 trainee psychologists provided self-report data on the constructs of parentification measured by parentification questionnaire (Jurkovic, 1997), empathy, measured by Interpersonal Reactivity Index (Davis, 1980), and boundary settings, measured by Exploitation Index (Epstein, 1990) in a survey study, while 4 trainee psychologists were interviewed in a separate study. First, the quantitative data were analysed to assess the existence of possible relationships among the variables of parentification, empathy and boundary transgressions by a regression analysis. The results offered significant suggestions for the predictive power of parentification in regard to empathy and boundary transgressions. Following this, a qualitative study analysed the interviews with the 4 trainees using thematic analysis to explore the above relationships and provided a deeper insight, especially for their therapeutic utility. Combining the findings, the current study supported that parentification may first of all catalyse the choice of a psychologist's profession, well as the choice of the psychotherapeutic approach. In regard to the interpersonal skills, parentification may positively impact the development of enhanced levels of empathy, boundary flexibility, and creativity. On the other hand, parentification may also negatively impact on practitioners by making them more vulnerable to enmeshed therapeutic relationships. Especially in the case of destructive parentification, professional support may be needed to minimise the risk for enmeshed relationships, by increasing self-care and self-other differentiation. Clinical implications for parentified therapists were also discussed.

Há interesse crescente não só no estudo dos resultados de psicoterapias, mas também nos processos responsáveis pelos resultados obtidos. De uma perspectiva analítico-comportamental discute-se se o processo de mudança psicoterápica se dá por formulação (e seguimento) de novas regras ou pela conseqüenciação direta de comportamentos emitidos na interação terapêutica. Mudanças ocorridas devido a orientação do terapeuta seriam governadas por regras. Por orientação entende-se uma descrição do comportamento feita pelo falante a ser executada pelo ouvinte com descrição explícita ou implícita das conseqüências da ação. A auto-orientação seria uma descrição feita pelo o cliente a ser executado pelo próprio cliente. A pesquisa teve por objetivo analisar quatro variáveis sobre o comportamento de orientar: a) formação teórica comportamental; b) experiência; c) clientes; d) flutuações entre sessões. Participaram desta pesquisa seis terapeutas comportamentais pouco experientes e três experientes. Cada um gravou três sessões com três clientes adultos com diagnóstico variado. As sessões foram transcritas e categorizadas, tendo sido contados o número de palavras e de falas com orientação e auto-orientação e seus subtipos. Os terapeutas comportamentais experientes orientaram significativamente mais seus clientes que os pouco-experientes. No entanto os terapeutas experientes apresentaram maior variabilidade em relação ao uso dessa estratégia. Apenas um dos terapeutas experientes orientou bastante todos seus clientes em todas as sessões. Os clientes de outro dos terapeutas experientes se auto-orientaram significativamente mais que os clientes dos outros terapeutas experientes e pouco-experientes. Quanto aos subtipos de orientações tanto terapeutas experientes como pouco-experientes orientaram mais para ação específica do que para ação genérica, encobertos ou tarefas. Entre os experientes e pouco-experientes ocorreram diferenças significativas referentes aos subtipos orientação para ação específica e orientação para tarefa, mas não houve diferenças significativas para os subtipos orientação para ação genérica e orientação para encoberto. Os terapeutas experientes emitiram significativamente mais orientação para ação específica e os terapeutas pouco-experientes significativamente mais orientação para tarefa. Os resultados sugerem que terapeutas comportamentais tendem a ser diretivos, ou seja, utilizam a estratégia de orientar seus clientes, mas em média menos de 20% das sessões dos terapeutas experientes e menos de 10% das sessões dos terapeutas pouco-experientes são usados com a estratégia de orientação / Increasing interest is being evinced not only in the study of psychotherapeutic results but also in the processes responsible for those outcomes. From a behavior analytical standpoint, discussions are focusing on whether the process of psychotherapeutic change takes place through the formulation (and following) of new rules or through the consequences for behaviors occurring in therapeutic interaction. Changes that take place just the therapist´s orientation are assumed to be governed by rules. Orientation refers to a description of the behavior made by the speaker to be executed by the listener, with an explicit or implicit description of the consequences of the action. Self-orientation is a description made by the client to be executed by himself. The purpose of the research was to analyze the effect of four variables on the behavior of giving orientation: a) a behavioral theoretical education; b) experience; c) clients; and d) fluctuations between sessions. Six inexperienced and three experienced behavior therapists participated in this research. Each of these therapists recorded three sessions with three adult clients with varied diagnosis. The sessions were transcribed and categorized, counting the number of words and of dialogues containing orientation and self-orientation and their subtypes. The experienced behavior therapists oriented their clients significantly more than the inexperienced ones did, although the former displayed a greater variability in relation to the use of this strategy. Only one of the experienced therapists gave substantial orientation to all his clients in every session. The clients of another experienced therapist self-oriented themselves significantly more than the clients of the other two experienced and the inexperienced therapists. As for the subtypes of orientation, both experienced and inexperienced therapists gave more orientation for specific action than for generic action, covert behavior or tasks. The experienced and inexperienced therapists displayed significant differences regarding the subtypes of orientation for specific action and for tasks, but no significant differences in the subtypes of orientation for generic action and covert behavior. The experienced therapists gave more orientation for specific action while the inexperienced ones gave more task-related orientation than the experienced. The findings suggest that behavior therapists tend to be directive, i.e., they use strategies to orient their clients, but that, on average, less than 20% of the experienced therapists´ sessions and less than 10% of the inexperienced therapists´ sessions make use of orientation strategy.

Este trabalho analisa o processo de institucionalização da medicina acadêmica em Belém, entre 1889 e 1925, envolvendo o período posterior ao processo de proclamação da república no Brasil e a formação da primeira turma da Faculdade de Medicina e Cirurgia do Pará. O objetivo principal deste trabalho é mostrar que a institucionalização da medicina acadêmica em Belém não ocorreu sem conflito. Estes emergiam do interior da própria classe médica e, também, relacionavam-se às disputas dos médicos acadêmicos com outros terapeutas (homeopatas, farmacêuticos, práticos de farmácia, curandeiros, espíritas, etc.), visando a conquista do monopólio da cura. Para a realização deste trabalho foram utilizados Relatórios, Falas e Mensagens de governo do estado do Pará, Relatórios da Junta de Higiene, do Serviço Sanitário, documentos da Sociedade Médico-Cirúrgica do Pará, da Faculdade de Medicina e Cirurgia do Pará, e periódicos diversos (jornais e revistas). Com base nesta documentação constatou-se que os médicos acadêmicos, para alcançar seus objetivos, recorreram a diversas estratégias, ocupando cargos na administração pública, defendendo suas ideias através da imprensa, criando instituições e combatendo seus concorrentes. Mesmo tendo criado suas instituições e fechado o cerco contra seus concorrentes, os médicos acadêmicos não conseguiram impedir a continuidade de outras práticas terapêuticas e precisariam percorrer outro caminho para, além de institucionalizar, legitimar suas práticas / This thesis analyzes the process of institutionalization of academic medicine in Belem, between 1889 and 1925, involving the posterior process of the proclamation of the Republic in Brazil and the graduation of the first class of the College of Medicine and Surgery from Para State. The main objective of this work is show that the institutionalization of academic medicine in Belem city occurred with some conflicts. These conflicts emerged from the medical profession itself and also were related to academic disputes with other therapists (pharmacists, spiritualists, healers and so on) with the aim of gaining the monopoly of healing through academic medicine. This thesis was written by consulting reports, speeches and messages from the Government of Para State, reports from the Hygiene Committee, Health Service, documents of Medical-Surgical Society of Para and from the College of Medicine and Surgery from Para State and many journals (newspapers and magazines). Based on this documentation was found that the medical students used various strategies to achieve their goals, such as: occupying positions in public administration, defending their ideas through the press, creating institutions and combating their competitors. Even having created its institutions and tighten the net against their competitors, medical students were unable to prevent the practice of other methods of therapy and need to change the strategy in order to legalize and institutionalize their practices

Este trabalho analisa o processo de institucionalização da medicina acadêmica em Belém, entre 1889 e 1925, envolvendo o período posterior ao processo de proclamação da república no Brasil e a formação da primeira turma da Faculdade de Medicina e Cirurgia do Pará. O objetivo principal deste trabalho é mostrar que a institucionalização da medicina acadêmica em Belém não ocorreu sem conflito. Estes emergiam do interior da própria classe médica e, também, relacionavam-se às disputas dos médicos acadêmicos com outros terapeutas (homeopatas, farmacêuticos, práticos de farmácia, curandeiros, espíritas, etc.), visando a conquista do monopólio da cura. Para a realização deste trabalho foram utilizados Relatórios, Falas e Mensagens de governo do estado do Pará, Relatórios da Junta de Higiene, do Serviço Sanitário, documentos da Sociedade Médico-Cirúrgica do Pará, da Faculdade de Medicina e Cirurgia do Pará, e periódicos diversos (jornais e revistas). Com base nesta documentação constatou-se que os médicos acadêmicos, para alcançar seus objetivos, recorreram a diversas estratégias, ocupando cargos na administração pública, defendendo suas ideias através da imprensa, criando instituições e combatendo seus concorrentes. Mesmo tendo criado suas instituições e fechado o cerco contra seus concorrentes, os médicos acadêmicos não conseguiram impedir a continuidade de outras práticas terapêuticas e precisariam percorrer outro caminho para, além de institucionalizar, legitimar suas práticas / This thesis analyzes the process of institutionalization of academic medicine in Belem, between 1889 and 1925, involving the posterior process of the proclamation of the Republic in Brazil and the graduation of the first class of the College of Medicine and Surgery from Para State. The main objective of this work is show that the institutionalization of academic medicine in Belem city occurred with some conflicts. These conflicts emerged from the medical profession itself and also were related to academic disputes with other therapists (pharmacists, spiritualists, healers and so on) with the aim of gaining the monopoly of healing through academic medicine. This thesis was written by consulting reports, speeches and messages from the Government of Para State, reports from the Hygiene Committee, Health Service, documents of Medical-Surgical Society of Para and from the College of Medicine and Surgery from Para State and many journals (newspapers and magazines). Based on this documentation was found that the medical students used various strategies to achieve their goals, such as: occupying positions in public administration, defending their ideas through the press, creating institutions and combating their competitors. Even having created its institutions and tighten the net against their competitors, medical students were unable to prevent the practice of other methods of therapy and need to change the strategy in order to legalize and institutionalize their practices

Sandtray can be incorporated with diverse theoretical orientations and provides an interactive and engaging way to involve supervisees and students. This presentation will cover the use of sandtray in play therapy supervision and teaching play therapists, with a focus on multicultural competence.

Historically, African American lesbians (AALs) experiencing intimate partner violence (IPV) have received little or no support from therapists due to stigmas concerning the same-sex relationships of AALs in particular, who have been racially marginalized. The purpose of this study was to explore the experiences, attitudes, and perceptions of therapists who provide counseling for AALs who have experienced IPV. The findings of this study may help to better understand the challenges, perceptions, and attitudes of therapists regarding their experiences in working with AALs in domestic violent relationships because existing research was limited on mental health therapists' perceptions of working with AALs who are experiencing IPV in their relationships. Attribution theory provided a framework through which to explore and describe this topic. A phenomenological research design was used to explore the perceptions and lived experiences of 10 mental health professionals who have worked with AALs in IPV relationships. Data collection, using semistructured continued until data saturation was attained. Moustakas' phenomenological steps for data analysis were used to identify 4 themes in the data: challenges, IPV, resources available, and outcomes. Understanding the attitudes and experiences of therapists working with AALs in abusive relationships may result in positive social change through increasing knowledge of the issues involved. This may result in improved counseling and other services to AALs.

<p>Posttraumatiskt stressyndrom (PTSD) kännetecknas av tre huvudsymptom: undvikande, förnekande och hyperspändhet. Även koncentrationssvårigheter, ångest, depression, flashbacks och mardrömmar är vanligt förekommande hos individer med PTSD. Flyktingar i Sverige som har varit med om krig kan uppvisa dessa symptom. Syftet med denna studie är att undersöka terapeuters upplevelser av arbete med patienter med krigsrelaterat PTSD. Intervjuer med åtta terapeuter utfördes. Gemensamma mönster i deltagarnas svar var att det är fördelaktigt att skapa en bra relation till patienter. Det är viktigt att prata om krigstrauma och de som får behandling mår bättre. Patienter är präglade av sorg och skuld och det är viktigt för dem att känna tillit och trygghet. Kropp och själ hänger ihop och det är olika och beroende på många faktorer hur individer drabbas av krig. Ofta är det andra svåra upplevelser som förvärrar krigstrauma. Terapeuter upplever sitt arbete som roligt samtidigt som tungt och anser att det är viktigt med teamarbete.</p>

Posttraumatiskt stressyndrom (PTSD) kännetecknas av tre huvudsymptom: undvikande, förnekande och hyperspändhet. Även koncentrationssvårigheter, ångest, depression, flashbacks och mardrömmar är vanligt förekommande hos individer med PTSD. Flyktingar i Sverige som har varit med om krig kan uppvisa dessa symptom. Syftet med denna studie är att undersöka terapeuters upplevelser av arbete med patienter med krigsrelaterat PTSD. Intervjuer med åtta terapeuter utfördes. Gemensamma mönster i deltagarnas svar var att det är fördelaktigt att skapa en bra relation till patienter. Det är viktigt att prata om krigstrauma och de som får behandling mår bättre. Patienter är präglade av sorg och skuld och det är viktigt för dem att känna tillit och trygghet. Kropp och själ hänger ihop och det är olika och beroende på många faktorer hur individer drabbas av krig. Ofta är det andra svåra upplevelser som förvärrar krigstrauma. Terapeuter upplever sitt arbete som roligt samtidigt som tungt och anser att det är viktigt med teamarbete.

Thesis (M.Sc.)--Flinders University, School of Medicine, Dept. of Speech Pathology and Audiology. / Typescript bound. Includes bibliographical references: (leaves 237-249) Also available electronically.