Thesis (DPhil (Psychology))—University of Stellenbosch, 2009. / ABSTRACT: This study, within the fields of occupational therapy and occupational science, describes the occupations of isiXhosa-speaking individuals with longstanding histories of mental illness living in chronic poverty. Occupation refers to the daily tasks and purposeful activities which, in occupying people’s time, establish the patterns of their lives and give expression to their roles, identity, interests and abilities. The aim of this study was to describe how poor households and persons with psychiatric disability living in those households coped with their circumstances and how they viewed, orchestrated, drew meaning from and attributed purpose to the everyday things they did, in particular the self-identified, primary income generating occupation of the disabled person. The research questions elicited information about the genesis, characteristics, meanings and functions of occupation, in particular those occupations performed by the disabled member that contributed to the survival of the household. Using case study methodology, the research involved prolonged engagement with five households living in a peri-urban, informal settlement on the outskirts of Cape Town, South Africa. Qualitative data about occupation was derived through demographic screening, multiple interviews with key informants in each household, participant observation and focus group discussion. In addition, discussions were held with mental health professionals familiar with the context and the Xhosa culture. Four forms of data analysis and interpretation (Kavale, 1996; Stake,1995) were applied to develop substantive case studies: condensation (identification of major organising ideas); categorisation (thematic categorical aggregation); patterning (narrative structuring) and generalisation (naturalistic interpretation). In addition, discussions were held with mental health professionals familiar with the context and the Xhosa culture. Four forms of data analysis and interpretation (Kavale, 1996; Stake, 1995) were applied were applied to develop substantive case studies: condensation (identification of major organising ideas); categorisation (thematic categorical aggregation); patterning (narrative structuring) and generalisation (naturalistic interpretation). Thematic descriptions of the basics of occupation are used to illustrate the various ways participants negotiated the challenges of life at the margins of society through the ordinary things they did everyday. Cross case analysis provided insights into the financial and social costs of mental illness as well as the strategies, embedded in occupation, adopted by participants in dealing with their circumstances. The central thesis of this dissertation is that psychiatrically disabled people, as economic actors functioning in complex structural, social and occupational matrices, contribute in paradoxical ways to the survival of their households. While their illness behaviour may increase the vulnerability of the household from time to time, they nevertheless facilitate its functioning either as providers of a disability grant; as contributors of additional labour or as productive income generating agents. The individual, the social and the structural are co-constituted in what poor and disabled people are able to do everyday. The less resources that are available in the occupational form, the more effort is needed to perform occupations and the more reliance is placed on the informal relational economy. Relative mastery of constrained circumstances occurred by optimising the goodness of fit between occupational form and occupational performance through adaptive capacity, an under-recognised form of agency in the context of chronic poverty. Looking beyond the obscuring façade of psychiatric disability at the ordinary things people did everyday revealed their capacity to strategise practically and attitudinally in support of the household’s survival. The study heightens awareness of human experiences that have been overlooked in the occupational science and occupational therapy literature, in particular how the basics of occupation operate in resource constrained environments. This contribution to knowledge about human occupation will inform mental health occupational therapy practice and community based psychiatric services concerned with the inclusion of disabled people in promoting social development. / OPSOMMING: Hierdie studie val binne die gebied van arbeidsterapie en ‘occupational science’. Dit beskryf die ‘occupations’ van Xhosa-sprekende individue met ‘n geskiedenis van geestesongesteldheid wat in kroniese armoede in informele nedersettings aan die buitewyke van Kaapstad, Suid-Afrika woon. ‘Occupation’ verwys na die daaglikse take en doelgerigte aktiwiteite wat mense se tyd in beslag neem; die patrone en ritmes van hul lewens bevestig en wat uitdrukking gee aan hul verskeie rolle, identiteit, belangstellings en vermoëns. Die doel van die studie was om inligting te verkry oor die oorsprong, eienskappe, betekenis en funksies van ’occupation’ in die konteks van armoede en veral met betrekking tot die psigiatries gestremde lid se belewenis en bydrae tot die huishouding se oorlewing deur sy of haar self-geidentifiseerde, primêre winsgewende ‘occupation’. Verlengde verbintenis met vyf huishoudings en sleutel informante as gevalstudies het die verkryging van kwalitatiewe data oor ‘occupation’ deur onderhoude, waarneming en fokusgroepe moontlik gemaak. Onderhoude met geestesgesondheidspesialiste vertroud met die konteks en die Xhosakultuur is ook gevoer. Vier tipes data-analise en interpretasie (Kavale, 1996; Stake, 1995) is toegepas om die ontwikkeling van substantiewe gevallestudies moontlik te maak: kondensasie (identifisering en organisasie van belangrike idees); kategorisering (tematiese sorteering van eenhede van betekenis); motief (narratiewe strukturering) en veralgemening (naturalistiese interpretasie). Kruisgevalanalise is toegepas om inligting oor die finansiële en sosiale kostes van ‘n psigiatriese stoornis in die konteks van armoede te bekom asook die ‘occupational’ strategieë waarvan informante in die hantering van hul omstandighede gebruik gemaak het. Die slotsom van hierdie verhandeling is dat psigiatries gestremde persone wat in die konteks van kroniese armoede ‘n bestaan probeer voer, op paradoksale maniere ‘n bydrae tot die voortbestaan van hul huishoudings lewer. Terwyl hulle siektegedrag die kwesbaarheid van die huishouding van tyd tot tyd laat toeneem, maak hulle nieteenstaande die oorlewing van die huishouding moontlik deur ‘n kombinasie van die volgende bydraes: die verskaffing van bykomende arbeid; die beskikbaarstelling van ‘n ongeskiktheidstoelaag en die produktiewe uitvoering van winsgewende ‘occupations’ in die sogenaamde ‘tweede’ of informele ekonomie. Die individuele, die sosiale en die strukturele is aan mekaar verbonde en beinvloed sodanig wat arm en gestremde mense daagliks in staat is om te doen. Hoe minder materiele komponente en hulpbronne in die ‘occupational form’ beskikbaar is, hoe groter is die inspanning wat benodig word om ‘occupation’ uit te voer en hoe meer afhanklik word die gestremde persoon op die informele sosiale ekonomie. Die teenoorgestelde is ook waar. Die kapasiteit vir aanpasbaarheid, ‘n miskende vorm van agentskap in die konteks van kroniese armoede, maak die bemeestering van beperkte omstandighede moontlik. Die kapasiteit vir aanpasbaarheid is geleë in die vermoë om strategies, prakties en sielkundig te funksioneer. Die studie vergroot die bewustheid van menslike ervarings wat oor die hoof gesien is in die arbeidsterapie en ‘occupational science’ literatuur, veral hoe die basiese beginsels van ‘occupation’ funksioneer in omgewings wat gekenmerk word deur deprivasie en beperkte materiële besittings. Hierdie bydrae tot kennis oor ‘occupation’ sal arbeidsterapiepraktyk en gemeenskaps-gebaseerde psigiatriese dienste toelig asook die insluiting van psigiatries gestremde persone in maatskaplike ontwikkeling bevorder.

Thesis (DPhil (Psychology))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Major Depressive Disorder is a prevalent psychiatric illness that poses critical risk factors to families. Risk factors associated with depression are widely researched, but limited South African and international research exists with regard to family resilience factors and intervention programmes associated with these high-risk families. The aim of the present study was to address these limitations by (a) identifying and describing the qualities of resilience in families in which a parent had been living with Major Depressive Disorder, (b) developing a family intervention programme for parents to strengthen and enhance a quality of resilience and, finally, following the intervention programme, (c) to evaluate the impact of the intervention programme on the identified resilience quality. The research was divided into two phases in order to address the above-mentioned, namely the descriptive phase (Phase 1) and the intervention phase (Phase 2). The results of the descriptive phase revealed various statistically significant correlations between the independent variables and the dependent variable, namely family adaptation, as measured by The Family Attachment Changeability Index 8 (FACI8) (McCubbin et al., 1996). The strongest statistically significant correlation was found between family problem solving and communication, and family adaptation. This steered the development of the intervention programme, aiming it at enhancing family problem solving and communication as a family resilience quality. An experimental design was used to evaluate the impact of the intervention programme. Analysis 1 revealed a trend (not statistical significant on a 5% level), suggesting that negative communication decreased over a three-month period after the intervention programme. Analysis 2 supported this trend on a 5% level. The qualitative post-test data reveal that the participants perceived the intervention programme in a very positive light, namely as a beneficial and educational experience. Furthermore, the three-month follow-up assessment showed that the majority (81%) of the participants indicated that the intervention programme impacted positively on their family’s communication. / AFRIKAANSE OPSOMMING: Major Depressiewe Steuring is ‘n bekende psigiatriese siekte wat gesinne met kritiese risikofaktore uitdaag. Hierdie risikofaktore is wyd nagevors, maar beperkte Suid-Afrikaanse en internasionale navorsing bestaan met betrekking tot gesinsveerkragtigheidsfaktore en gepaste intervensieprogramme wat met hierdie hoë risiko gesinne geassosieer word. Die doel van die huidige studie was om hierdie beperkings aan te spreek, deur (a) veerkragtigheidsfaktore te identifiseer en te beskryf in gesinne waar ‘n ouer met Major Depressiewe Versteuring leef, (b) om ‘n gesinsintervensieprogram vir ouers te ontwikkel wat ‘n spesifieke veerkragtigheidsfaktor kan versterk en ontwikkel, en (c) om die impak van die intervensieprogram op die geïdentifiseerde veerkragtigheidsfaktor te evalueer. Die navorsing is in twee fases verdeel, naamlik die beskrywende fase (Fase 1) en die intervensie fase (Fase 2) om bogenoemde aan te spreek. Die resultate van die beskrywende fase het verskeie statisties beduidend korrelasies getoon tussen die onafhanklike veranderlikes en afhanklike veranderlike, naamlik familie aanpasbaarheid, wat deur The Family Attachment Changeability Index 8 (FACI8) gemeet is (McCubbin et al., 1996). Die sterkste statisties beduidende korrelasie was tussen gesin probleemoplossing en kommunikasie en gesin aanpasbaarheid. Hierdie verhouding het die ontwikkeling van die intervensieprogram bepaal wat ten doel gehad het om gesin probleemoplossing en kommunikasie as ‘n gesinsveerkragtiheidskwaliteit te ontwikkel. ‘n Eksperimentele ontwerp is gebruik om die impak van die intervensieprogram te evalueer. Analise 1 het ‘n tendens (nie statisties beduidend op ‘n 5 % vlak) uitgelig wat daarop dui dat negatiewe kommunikasie verminder het oor ‘n periode van drie maande na die intervensieprogram. Analise 2 het hierdie tendens ondersteun op ‘n 5% vlak. Die kwalitatiewe na-toets data het aangedui dat die deelnemers die intervensieprogram in ‘n baie positiewe lig ervaar het en as voordelig en opvoedkundig beskou het. Die drie-maande opvolgassessering het ook aangedui dat die meerderheid (81%) van die deelnemers gevind het dat die intervensieprogram ‘n positiewe impak op hulle gesinskommunikasie gehad het.

Thesis (DPhil (Psychology))--Stellenbosch University, 2008. / The literature in psychology repeatedly hints at identity representation as important in transforming the discipline of psychology in contemporary South Africa. It simultaneously names curriculum, race and gender as areas of silence within the discipline. These literatures coexist with the reality that few psychologists work in public health services, where approximately eighty six percent of South Africa’s population who cannot afford private health care, receive their services. Community psychology is generally viewed as the area of study that prepares practitioners to work in public health service. Thus the intersections of identity, community, psychology and community psychology become important. Yet no contemporary studies that systematically and empirically examine community psychology and identity, exist in South Africa. The current study therefore aims to examine identity and community psychology from a multi-levelled perspective in the Western Cape Province of South Africa. This work draws on multiple theoretical strands, broadly united under a social constructionist framework, to examine community psychology in the organisation of the university, in terms of student and practitioner perceptions (and therefore constructions) of community psychology and in the everyday talk of psychologists about their professional identities. The four studies of which this project consists use complementary quantitative and qualitative methodologies. A survey of all psychology departments, combined with interviews with one community psychology teacher in each department, examines teaching, learning and research practices in community psychology. The second study constitutes a survey of all psychology Honours students in the Western Cape whereas the third study surveys the perceptions about community psychology among senior psychologists in the Western Cape. The fourth and final study in this series uses three focus groups where senior psychologists, based in the greater Cape Town area, talk about their professional identity. The quantitative data were analysed using the descriptive statistics of frequencies and cross-tabulations. The qualitative data were analysed using thematic analysis and discourse analysis as analytical tools. While the quantitative data do not consistently suggest a link between community psychology, race and gender, there are some areas, such as community work, in which this link is apparent. The nature of such a link is not clear. However, in the qualitative work, the link between community, psychology and identity is centrally situated in the constructions and practices of universities, students and practitioners. Community psychology is constructed as psychology for black people in terms of both who delivers services and who clients are. This represents parameters of inclusion and exclusion not only for community psychology but for psychology, as a whole. The implications of these findings are discussed, particularly in relation to organisational transformation in universities.

Thesis (DPhil (Psychology))—University of Stellenbosch, 2009. / ABSTRACT: The aim of this study was to identify and enhance specific resilience qualities that help protect and support families in overcoming the adversity of having a child with a hearing impairment. The study was divided into two phases, namely (a) the descriptive phase, which aimed to identify and explore the resilience qualities that foster better adaptation in these families and (b) the intervention phase, which aimed to develop, implement and evaluate an intervention programme that enhances the utilisation of social support, one important resilience quality identified in the descriptive phase of the study. The study was essentially exploratory and descriptive in nature and was directed at developing scientific knowledge and theory in the field of family resilience. Using the Resiliency Model of Family Stress, Adjustment and Adaptation (McCubbin & McCubbin, 1996) as the theoretical framework, the resilience process was mapped in terms of stressors, risk and protective factors, and family adaptation. The 54 participating families in the descriptive phase were identified according to the nature of the crisis (hearing impairment) and the developmental phase of the family. The participants were obtained by means of a non-probability, purposive sampling procedure and were drawn from the black, coloured and white cultural subgroups residing in the Western Cape, South Africa. Both quantitative and qualitative measures were used for data collection. The results were analysed predominantly according to correlation and regression analyses techniques, while the qualitative data was categorised according to themes and frequencies. Results showed that family time and routine, social support, affirming communication, family hardiness, problem-solving skills, religion, a search for meaning and accepting the disability were factors promoting resilience in these families. A randomised pretest-posttest control group design was applied in the intervention phase of the study. The 31 participants were identified in the initial phase of the study and belonged to the coloured cultural subgroup. Data was again collected using quantitative and qualitative measures and was analysed using repeated measures analysis of variance and grounded theory analysis. The results did not indicate a statistically significant change in the utilisation of social support following the implementation of the workshop. The qualitative data, however, highlighted that the participants reported greater support from the immediate and extended family, increased family time and routine, as well as improved communication and problem-solving skills following the workshop. The study generally offers valuable knowledge that can be incorporated in psychological and social training programmes, preventative community interventions and therapeutic settings. The positive and pragmatic approach adopted in the study ensures that families are empowered by bringing them hope, helping them develop new competencies and building mutual support. The study has opened various new avenues for future research in the field of family resilience and hearing impairment. / OPSOMMING: Die doel van hierdie studie was om spesifieke veerkragtigheidskwaliteite te identifiseer en versterk wat gesinne met ’n kind met ‘n gehoorgestremdheid teen teenspoed beskerm en ondersteun. Die studie is in twee verdeel, naamlik (a) die beskrywende fase, met die doel om die veerkragtigheidskwaliteite wat beter aanpassing in hierdie gesinne gekweek het, te identifiseer en ondersoek, en (b) die intervensiefase, met die doel om ’n intervensieprogram te ontwikkel, implementeer en evalueer wat die gebruik van sosiale ondersteuning, een van die belangrike veerkragtigheidskwaliteite wat in die beskrywende fase van die studie geïdentifiseer is, te verhoog. Die studie was in wese ondersoekend en beskrywend van aard en daarop gerig om wetenskaplike kennis en teorie in die veld van gesinsveerkragtigheid te ontwikkel. Met die gebruik van die Veerkragtigheidsmodel van Gesinspanning, Verstelling en Aanpassing (Resiliency Model of Family Stress, Adjustment and Adaptation) (McCubbin & McCubbin, 1996) as teoretiese raamwerk, is die veerkragtigheidsproses uitgestippel in terme van die oorsake van die spanning, risiko- en beskermende faktore, en gesinsaanpassing. Die 54 gesinne wat aan die beskrywende fase deelgeneem het, is op grond van die aard van die krisis (gehoorgestremdheid) asook die ontwikkelingsfase van die gesin geïdentifiseer. Die deelnemers is deur middel van ’n doelgerigte nie-waarskynlikheidsteekproefnemingsprosedure verwerf vanuit swart, kleurling en blanke gesinne wat in die Wes-Kaap, Suid- Afrika woon. Beide kwantitatiewe en kwalitatiewe metings is vir data-insameling gebruik. Die resultate is hoofsaaklik aan die hand van korrelasie- en regressieontledingstegnieke geanaliseer, terwyl die kwalitatiewe data volgens temas en frekwensies gekategoriseer is. Die resultate het getoon dat gesinstyd en -roetine, sosiale ondersteuning, bevestigende kommunikasie, gesinsgehardheid, probleemoplossings-vaardighede, geloof, ’n soeke na betekenis en die aanvaarding van die gestremdheid faktore was wat die veerkragtigheid van hierdie gesinne bevorder het. ’n Ewekansige voor- en natoets kontrolegroep-ontwerp is tydens die intervensiefase van die studie toegepas. Die 31 deelnemers is tydens die aanvanklike fase van die studie geïdentifiseer en behoort tot die kleurling kulturele groep. Data is weereens deur middel van kwantitatiewe en kwalitatiewe metings ingesamel en is aan die hand van herhaalde metingsvariansieontleding en gegronde teorie-analise geanaliseer. Die resultate het geen statisties beduidende verskil in die gebruik van sosiale ondersteuning ná die implementering van die werkswinkel getoon nie. Die kwalitatiewe data het egter beklemtoon dat deelnemers ná die werkswinkel meer ondersteuning van hulle onmiddellike en uitgebreide familie geniet het, sowel as meer gesinstyd en -roetine, verbeterde kommunikasie en probleemoplossingsvaardighede. Oor die algemeen bied die studie waardevolle kennis wat by sielkundige en sosiale opleidingsprogramme, voorkomende gemeenskapsingryping en in terapeutiese raamwerke ingelyf kan word. Die positiewe en pragmatiese benadering in die studie verseker dat gesinne bemagtig word deur hulle hoop te bied, nuwe bekwaamhede te help ontwikkel en wedersydse ondersteuning op te bou. Die studie het talle nuwe weë vir toekomstige navorsing op die gebied van gesinsveerkragtigheid en gehoorgestremdheid gebaan.

Thesis (DPhil)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: It is a general assumption in psychology that past social relationships and experiences influence present social behaviour. With attachment theory and current social-cognitive theory as conceptual basis, the present study focused on the association between past experiences with significant others and the current processing of interpersonal information. By means of a 2x3x4 experimental design the study investigated the influence of chronic accessibility and subliminal priming (of significant other representations) on the accuracy and speed of processing scripted interpersonal information. One hundred and thirty seven university students took part in two sessions no more than two weeks apart. In session one they completed the Attachment Style Questionnaire (ASQ; Feeny, Noller & Hanrahan, 1994), and provided the names of positive and negative significant others. According to a median split of the Confidence Scale of the ASQ, they were assigned to a chronic positive or a chronic negative group, assuming that the information based on predominantly positive or negative experiences with positive or negative significant others will be chronically more accessible. In session two, in an individual computer task, they were subliminally primed (33 ms) with a control word or the name of the positive or negative significant other to increase the accessibility of the appropriate memory structures. They were then asked to read a positive, negative, mixed or ambiguous script of an interpersonal event and complete a memory test of 36 interpersonal statements (nine positive, nine negative, nine ambiguous and nine filler statements). The accuracy and response time for every statement was recorded, and the response times of accurate responses for positive and negative scripts were included in the main analysis. Separate univariate analyses of the differences between positive and negative priming per polarity of chronic group and script supported the priming hypothesis. The average response time of the chronic negative group was fastest when they received a negative prime (p = .039), and the positive group was fastest when they received a positive prime (p = .000). The results of a two-way analysis of variance for chronic group and script showed a highly significant interaction effect between chronic group and script (p = .000). When the primes were congruent to the scripts, the chronic groups were significantly faster in recognising statements from a congruent script. The results supported the conjunctive model of priming. The implications of these findings for the understanding of the cognitive structures and processes involved in processing interpersonal information are discussed, with specific reference to relational schemas and attachment working models. Possible directions for future research as well as the application of the results are also described. / AFRIKAANSE OPSOMMING: Dit is ‘n algemene aanname in die sielkunde dat sosiale verhoudinge en ervarings uit die verlede ‘n invloed het op huidige sosiale gedrag. Vanuit die bindingsteorie en die huidige sosiaal-kognitiewe teorie as konseptuele uitgangspunt, fokus die huidige studie op die assosiasie tussen ervaringe met betekenisvolle persone in die verlede en die huidige prosessering van interpersoonlike inligting. Met behulp van ‘n 2x3x4 eksperimentele ontwerp is ondersoek ingestel na die invloed van chroniese toeganklikheid en subliminale opwekking (van geheuevoorstellings van betekenisvolle ander) op die akkuraatheid en spoed waarmee interpersoonlike tekste verwerk word. Eenhonderd-sewe-en-dertig universiteitstudente het deelgeneem aan twee sessies wat nie meer as twee weke na mekaar plaasgevind het nie. Tydens sessie een het die deelnemers die Attachment Style Questionnaire (ASQ; Feeny, Noller & Hanrahan, 1994) voltooi en die name van positiewe en negatiewe betekenisvolle persone voorsien. Op grond van die mediaan-verdeling van die Selfvertroue Skaal van die ASQ is die deelnemers toegewys aan ’n chronies positiewe of chronies negatiewe groep, met die veronderstelling dat inligting gebaseer op oorwegend positiewe of negatiewe ervarings met positiewe of negatiewe betekenisvolle ander deurlopend meer toegankilk sal wees. Tydens sessie twee, wat ’n individuele rekenaartaak behels het, is ’n subliminale stimulus (33 ms) van ’n kontrole-woord, of die naam van ’n positiewe of negatiewe betekenisvolle ander aan hulle aangebied om die toeganklikheid van die toepaslike geheue-strukture verder te verhoog. Daarna is hulle versoek om ‘n positiewe, negatiewe, gemengde of dubbelsinnige teks van ’n interpersoonlike gebeurtenis te lees en ’n geheuetoets van 36 stellings te voltooi wat bestaan het uit nege positiewe, nege negatiewe, nege dubbelsinnige en nege neutrale stellings. Die akkuraatheid en reaksiespoed van elke stelling is gemeet en die reaksietyd van die akkurate response op stellings uit positiewe en negatiewe tekste is in die primêre ontleding ingesluit. Die resultate van onafhanklike eenveranderlike ontledings van die verskille tussen positiewe en negatiewe opwekking per polariteit van chroniese groep en teks, het die hipotese van opwekking ondersteun. Die gemiddelde responstyd van die chroniese negatiewe groep was die vinnigste wanneer hulle die negatiewe stimulus ontvang het (p = .039) en die van die positiewe groep was die vinnigste wanneer hulle die positiewe stimulus ontvang het (p = .000). Die resultate van ’n tweerigting variansieontleding van chroniese groep en teks het ‘n beduidende interaksie tussen chroniese groep en teks aangedui (p = .000). Wanneer die opwekkingstimuli kongruent met die tekste was, was die chroniese groepe betekenisvol vinniger in die herkenning van stellings van die kongruente teks. Die resultate ondersteun ’n konjunktiewe model van opwekking. Die implikasies van die bevindinge vir die verstaan van die kognitiewe strukture en prosesse betrokke by die verwerking van interpersoonlike inligting word bespreek, met spesifieke verwysing na verhoudingskemas en die gebruiksmodelle in bindingsteorie. Riglyne vir toekomstige navorsing op die gebied word verskaf, en die implikasies vir die praktiese toepassing van die resultate word bespreek.

Thesis (PhD)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The aim of the current study was to investigate factors that help single-parent families cope with the news that a family member has been diagnosed with HIV. The theoretical model that underpinned the study is the Resiliency Model of Family Stress, Adjustment and Adaptation of McCubbin and McCubbin (1996). A salutogenic perspective offers a view of human suffering that moves away from pathology to focus on factors that support successful coping, hence the focus of the current study on resilience. A cross-sectional survey research design was used, incorporating a combination method inclusive of both a qualitative and quantitative component. A total of 109 families, represented by an adult and a child, answered a qualitative question about what they considered to have helped them cope, and completing a biographical questionnaire and five questionnaires based on the theoretical model. Analyses included the Grounded Theory Method, a qualitative analysis method of Strauss and Corbin (1994; 1998), Pearson correlations and ANOVAs (for a categorical independent variable – employment status) to compute the significance of correlations between a dependent variable and a number of independent variables, and regression analysis. The results of the qualitative investigation revealed that families considered internal strength (or hardiness), social supports, communication, a sense of hope, using denial (both positive and negative behaviours to get on with life despite the presence of hardship), changing or reframing thoughts about the stressor, and material support to have been helpful. The quantitative results supported the qualitative results and showed that family hardiness (working together, viewing stressors as challenges and having a belief in own coping abilities), the availability of social support, supportive communication, use of reframing, accepting help from others and spiritual support all contributed to families functioning well under adverse conditions. It was also shown that inflaming types of communication, such as fighting and doing nothing about a crisis situation, negatively influenced the family functioning. It was interesting to note that family size had a significant, positive correlation with the parents’ views of family functioning, and that the higher the children’s level of education, the lower they rated their family functioning to be. Recommendations for further studies include a focus on resilience in various family types, a focus on families successfully coping with HIV diagnoses in their families, and the development of intervention programmes, inclusive of Cognitive Behaviour Therapy and Acceptance and Commitment Therapy. / AFRIKAANSE OPSOMMING: Die doel van die huidige studie was om ondersoek in te stel na faktore wat enkelouer gesinne met ‘n MIV-gediagnoseerde gesinslid ondersteun het. Die studie is teoreties gebou op McCubbin en McCubbin (1996) se Resiliency Model of Family Stress, Adjustment and Adaptation. Salutogenese bied ‘n siening of waardering van die manier waarop mense terugslae hanteer wat weg beweeg van die tradisionele fokus op patologie om te fokus op faktore wat suksesvolle aanpassing ondersteun ten spyte van die teenwoordigheid van genoemde krisis. Hierdie benadering bepaal dus die fokus op veerkragtigheid of gesinsveerkragtigheid wat hierdie studie rig. ’n Deursnee- steekproefontwerp is vir die navorsing gebruik en het ‘n kwalitatiewe en kwantitatiewe komponent ingesluit. ‘n Totaal van 109 gesinne is bestudeer, elk deur een volwassene en een kind verteenwoordig. Die deelnemers het ‘n kwalitatiewe vraag beantwoord oor wat hulle as ondersteunend ten opsigte van hulle eie krisishantering beskou het, en het ook ‘n biografiese vraelys en vyf vraelyste wat verskillende aspekte van die teoretiese model gemeet het, voltooi. Die deelnemers se response is ontleed deur middel van Strauss en Corbin (1994; 1998) se Grounded Theory Method vir die kwalitatiewe komponent; Pearson se korrelasies en ANOVA’s (ten opsigte van ‘n katogoriese onafhanklike veranderlike – werkstatus) is gebruik om die korrelasies tussen die afhanklike en ‘n aantal onafhanklike veranderlikes te bereken en regressie-ontledings is gedoen. Die kwalitatiewe resultate het aangedui dat die volgende faktore deur die gesinne beskou is as ondersteunend van hulle vermoë om krisisse te hanteer: innerlike sterkte, sosiale ondersteuning, kommunikasie, ‘n gevoel van hoop, die gebruik van ontkenning (beide positiewe en negatiewe gedrag om met die lewe aan te gaan ten spyte van die swaarkry), verandering van of herbesinning oor die stressor, en materiële ondersteuning. Die kwantitatiewe bevindinge het die kwalitatiewe resultate ondersteun en getoon dat gesinsgehardheid (saamwerk, beskouing van stressors as uitdagings en ‘n vertroue in eie vermoëns), die beskikbaarheid van sosiale ondersteuning, ondersteunende kommunikasie, die gebruik van herbesinning, aanvaarding van hulp van ander en geestelike ondersteuning almal gehelp het om die gesin onder ongunstige toestande goed te laat funksioneer. Daar is ook gevind dat opruiende soorte kommunikasie, soos baklei en niks oor ‘n krisissituasie te doen nie, ‘n negatiewe invloed op gesinsfunksionering gehad het. Dit was interessant om te vind dat gesinsgrootte positief met die ouers se beskouing van gesinsfunksionering gekorreleer het, terwyl ‘n hoër vlak van opvoeding onder die kinders gekorreleer het met ‘n laer skatting van gesinsfunksionering. Aanbevelings vir verdere navorsing sluit in ‘n fokus op gesinsveerkragtigheid in verskillende gesinstipes, ‘n fokus op gesinne wat ‘n MIV-diagnose in die gesin suksesvol hanteer, en die ontwikkeling van ingrypingsprogramme gebaseer op die beginsels van Kognitiewe Gedragsterapie en Acceptance and Commitment Therapy.

Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Despite the high prevalence of chronic kidney disease, renal narratives are under-reported. Much of what is written on kidney failure is written by health care professionals for health care professionals and about patients. While medical experts and health care practitioners have one type of knowledge, their patients have another type of knowledge acquired through their experience of their own condition. From within the disability and patients’ rights movements urgent calls have been made for the authentic voices of disabled people and patients to be heard without the mediation of professional lenses. In response to this my dissertation combines personal and academic writing to explore my own experience of end-stage renal disease, dialysis, transplantation and the life after transplant. I have used autoethnography as a methodology. Autoethnography is a relatively new, somewhat postmodern form of inquiry that developed from the reflexive turn in anthropology and narrative studies in the latter part of the twentieth century. It is very useful in writing about the experience of illness and reflecting on illness narratives because, in autoethnographic writing, the observer and observed, the narrator and narrated, insider and outsider are the same person. This allows scope for exploring the problematics of representation and for finding alternatives to already existing ways of telling certain stories. Engaging with autoethnography’s postmodern aspects has allowed me to conceptualize experiences that, until I undertook this research, I have never been able to articulate, because the traditional (static) illness narrative forms did not speak to my experience or my understanding of my condition. The central issue in my dissertation lies in the question: How do I tell the story of chronic illness once I have had an organ transplant? Flowing from this are a number of sub-issues: Can my story change? How do I describe myself: The well, the ill, the impaired, the disabled, the afflicted? Do I describe myself living in no man’s land? In my narrative, do I oscillate between being well and ill, or do I occupy another territory entirely? And if I do, what is it? My study shows that writing the story (or stories) of chronic kidney disease is complex, nuanced and dynamic and that, far from being an extended liminal experience, kidney disease is littoral. This distinction is important in coming to narrative terms with an identity that is not damaged so much as different. Through this I hope to demonstrate to both outsiders and insiders, who often submit to narratives that are forced on them, that more satisfying alternatives can be found. / AFRIKAANSE OPSOMMING: Ondanks die hoë voorkomssyfer van chroniese nierkwale word nierverhale nie genoeg aangemeld nie. Die meerderheid van dit wat oor nierversaking geskryf word, word deur gesondheidsorgdeskundiges vir gesondheidsorgdeskundiges en oor pasiënte geskryf. Terwyl mediese deskundiges en gesondheidsorgpraktisyns een soort kennis het, het hulle pasiënte ’n ander soort kennis op grond van hulle ervaring van hulle eie toestande. Van binne die gestremdheid en pasiënteregte-bewegings het ’n dringende oproep weerklink vir die outentieke stemme van mense met gestremdhede en pasiënte om gehoor te word sonder die tussenkoms van professionele perspektiewe. In reaksie hierop kombineer my verhandeling persoonlike en akademiese beskrywings om my eie ervaring van eindstadium- nierkwale, dialise, oorplanting en die lewe na oorplanting te verken. Ek het outo-etnografie as metodologie gebruik. Outo-etnografie is ’n relatief nuwe, ietwat postmoderne vorm van ondersoek wat in die tweede deel van die twintigste eeu uit die refleksiewe wending in antropologie en narratiewe studies ontwikkel het. Dit is baie bruikbaar wanneer oor die belewenis van siekte en besinning oor siekte-narratiewe geskryf word aangesien die waarnemer en die waargeneemde, die verteller en dit wat vertel word, die ingewyde en die buitestander in outo-etnografiese skryfwerk dieselfde persoon is. Dit laat meer ruimte vir verkenning van die problematiek van voorstelling en vir die opspoor van alternatiewe vir reeds bestaande wyses om sekere stories te vertel. My bemoeienis met postmoderne aspekte van outo-etnografie het dit vir my moontlik gemaak om ervaringe wat ek tot en met hierdie navorsing nooit kon artikuleer nie, te konseptualiseer, aangesien die tradisionele (statiese) vorme van siekte-narratiewe nie tot my ervaring of my begrip van my toestand gespreek het nie. ‘Hoe vertel ek die storie van chroniese siekte nadat ek ’n orgaanoorplanting gehad het?’ is ’n sentrale vraagstuk in my verhandeling. Hieruit spruit ’n aantal newevraagstukke voort: Kan my storie verander? Hoe beskryf ek myself: Die gesonde persoon, die sieke, die verswakte, die gestremde, die aangetaste? Hoe beskryf ek myself wat in ’n niemandsland woon? Fluktueer ek in my narratief tussen gesond wees en siek wees of betrek ek ’n geheel ander gebied? En indien wel, wat is dit? My studie toon dat, om die storie (of stories) van chroniese niersiekte te skryf, kompleks, genuanseerd en dinamies is en dat niersiekte glad nie ’n uitgebreide liminale ervaring is nie, maar eerder littoraal is. Dit is belangrik wanneer daar tot ’n narratiewe verstandhouding gekom moet word met ’n identiteit wat nie soseer beskadig is nie, maar eerder anders. Hierdeur hoop ek om aan beide buitestanders en ingewydes, wat dikwels voor narratiewe wat op hulle afgedwing word, moet buig, te wys dat daar meer bevredigende alternatiewe gekry kan word.

Thesis (PhD (Psychology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: There is a paucity of research documenting women’s undisclosed drinking. This study explored the discursive accounts of women’s alcohol dependence, treatment history and barriers in accessing alcohol dependence treatment. The goals of this dissertation were to explore women’s alcohol dependence history; explore women’s treatment history (or lack thereof); identify barriers and nature of barriers that limit women’s access to alcohol dependence treatment; identify the reasons for women not accessing treatment, and to interpret women’s experiences of treatment per se. A Human Scientific Approach was adopted to examine and interpret how women’s drinking is socially constructed. A social constructionist approach was utilised to access and construct meaning from the discourses emanating from the women’s narratives of their experience with alcohol and their attempts at rehabilitation. Ten women were interviewed using the life story (narrative) interview method. The findings illustrate two major discourses namely, secret drinking and inaccessibility of appropriate treatment facilities for women alcohol dependents. This means that participants feel forced to conceal their drinking and to drink secretively because of the stigma associated with women drinking heavily. The stigma they experience translates into barriers (mostly internal barriers) to seeking institutionalised treatment. This makes it easier for them to seek alternative treatment such as an anonymous fellowship, like Alcoholics Anonymous. Other discourses signify the importance of problem identification and treatment readiness. This means that if the alcohol dependent woman realises what the real problem is causing her to use alcohol as an escape or as a coping strategy, she will be more willing to address the underlying problem. Recommendations are made focusing on micro and macro-level intervention strategies such as access to treatment, public health campaigns and policies to improve the quality of life of women recovering from alcohol dependence. / AFRIKAANSE OPSOMMING: Daar is min inligting beskikbaar oor die dokumentering van vroue wat in-die-geheim alkohol gebruik. Hierdie studie het die diskursiewe weergawe van vroue se alkoholgebruik, behandelingsgeskiedenis en hindernisse tot die behandeling van alkohol-misbruik verken. Die doelstellings van hierdie verhandeling is om die volgende te verken: Vroue se afhanklikheidsgeskiedenis; vroue se rehabiliteringsgeskiedenis (of die gebrek daaraan); die identifisering van hindernisse en die aard van die probleme wat vroue se toegang tot die behandeling van alkohol-misbruik beperk; die identifisering van redes waarom vroue rehabilitering weier; en die interpretasie van vroue se belewings van behandeling per se. ‘n Humanisties-wetenskaplike benadering is gebruik om die sosiale konstruksie van vroue se drinkgewoontes te ondersoek en te interpreteer. Die verstaan van en die skep van betekenis van die diskoerse van die vroue, en die temas wat na vore gekom het vanuit hul vertellings/narratiewe van hul alkohol-ervarings en hul pogings tot rehabilitering, is binne die raamwerk van die sosiaal-konstruksionistiese uitgangspunt aangepak. Onderhoude is met tien vroue gevoer en die narratiewe metode is gebruik. Die bevindings toon twee hoofdiskoerse naamlik, drinkery in-die-geheim en die ontoeganklikheid van gepaste behandelingsfasiliteite vir vroue met afhanklikheidsprobleme. Dit beteken dat vroue ondervind dat hulle gedwing word om in-die-geheim te drink, as gevolg van die stigmatisering van vroue en oormatige alkohol-gebruik. Hierdie stigmatisering kan herlei word tot hindernisse (meestal interne hindernisse) te make met ge-institutionaliseerde behandeling. Om die rede is dit makliker vir vroue om alternatiewe behandeling soos anonieme gemeenskappe, byvoorbeeld Alkoholiste Anoniem te oorweeg. Ander diskoerse beklemtoon die identifisering van probleme en die instemming tot rehabilitering. Dit beteken dat wanneer die alkoholis die werklike probleem vir alkohol-gebruik verstaan as ‘n ontsnapping of as ‘n hanteringsstrategie, sy meer gewillig sal wees om die onderliggende probleem aan te spreek. Aanbevelings is gemaak met die fokus op mikro- en makrointervensiestrategieë, soos die toegang tot rehabilitering, openbare gesondheidsveldtogte en beleide ten einde die leef-kwaliteit van vroue in die herstelproses van alkoholafhanklikheid te verbeter.

Thesis (PhD)--Universiteit van Stellenbosch, 2000. / ENGLISH ABSTRACT: Most researchers agree that for a child the death of a parent constitutes a psychological risk. Some of these children might experience the first onset of psychiatric disorder (depression, anxiety or substance use disorder) prior to age 20, with a peak age of occurrence at 18. Within the South African context children are more and more confronted with parental death due to the upsurge of violence, the increase in HIV, aids and tuberculoses, as well as many fatal traffic accidents. The need for psychological support of these children within the school system was brought to the attention of the researcher by concerned surviving parents. Society tends to expect an early (often premature) return of survivors to the activities of everyday life. The adult or child thus often finds him-/herself isolated in grief. In family context on the other hand, the single parent has to deal with the personal loss of a spouse, the children's loss of a parent and often also the grandparents' loss of a child. Furthermore, roles within the family have to be reallocated so as to accommodate the lost person's functions. The surviving parent is therefore often not adequately available for the child who, having had his/her personal world and belief system shattered, does not always understand the consequences of death, primarily due to cognitive immaturity. They may react with anxiety, irrational beliefs and suppression, thus blocking a healthier course of grief. The aim of this study was to design and implement a psycho-educational grief resolution program and to investigate the effect thereof on the mood states, coping skills and self-concepts of 17 urban adolescents who had experienced parental death. Using the General Systems Theory as metatheory and the Intervention Designand- Development research methodology (Thomas & Rothman, 1994), a model of adolescent grief resolution was devised which served as basis for the design of the program. The participants were requested to reappraise personal resolution of grief tasks and were introduced to cognitive restructuring (for example the relinquishment of suppression and the disputing of irrational beliefs). With a clearer understanding and the skills to control emotions and behaviour, they were encouraged to attribute (now with hindsight) meaning to the experience of having lost a loved one, and to incorporate the event into a personal narrative. Statistical analyses of test-retest results indicated, amongst others, that adolescents tend to prematurely avow acceptance of the loss; that the experimental group demonstrated less fatigue-inertia after attending the program than the control group; and that a high risk group, comprised of members of both the experimental and control groups, showed more depression during the re-test situation. The last finding indicates that a high risk group should rather receive psychotherapy than participate in a psychoeducational program which is not primarily of a psychotherapeutic nature. On the other hand taking part in the program caused those adolescents to become aware of their need for psychotherapy. / AFRIKAANSE OPSOMMING: Die meeste navorsers is dit eens dat die dood van 'n ouer vir die kind sielkundige risiko's inhou. Sommige van dié kinders mag voor die ouderdom van 20 jaar (met die grootste aantal teen 18 jaar) psigiatriese probleme soos depressie, angs of middelmisbruik vertoon. Suid-Afrikaanse kinders word tans toenemend aan ouersterfte blootgestel weens die toename in geweld, die Hl-virus, vigs, tuberkulose en verkeersongelukke. Agtergeblewe ouers het die behoefte aan sielkundige ondersteuning van dié kinders binne skoolverband onder die aandag van die navorser gebring. Dit blyk dat die gemeenskap 'n vroeë (dikwels voortydige) terugkeer van die treurende na die gewone daaglikse aktiwiteite verlang. Die treurende beleef hom-/haarself dus dikwels as alleen in smart. In gesinsverband word daar verder hoë eise aan die enkelouer gestel, soos om die verlies van 'n huweliksmaat te verwerk, om kinders wat 'n ouer verloor het, en moontlik ook grootouers wat 'n kind verloor het, te ondersteun. Verder moet die rolle binne die gesin herverdeel word om ook die oorledene se funksies te vervul. Die beskikbaarheid van die agtergeblewe ouer is dus ingekort, en die kind wie se leefwêreld en oortuigings aan flarde is, het weens veral kognitiewe onrypheid, selde begrip vir die nagevolge van sterwensverlies. Hulle mag reageer met angs, irrasionele denke en onttrekking wat die rouproses kan inhibeer. Die doel van die studie was die ontwerp en toepassing van 'n verliesverwerkingsprogram Cn psigo-ontwikkelingsprogram) en die bepaling van die programeffek op die gemoedstoestand, streshanteringsvaardighede en selfkonsep van 17 stedelike adolessente met ouerverlies. Met die Algemene Sisteemteorie as metateorie en die Intervensie-Ontwerp-en-Ontwikkelingsnavorsingsparadigma (Thomas & Rothman, 1994) kon 'n adolessente verliesverwerkingsmodel saamgestel word wat gedien het as basis vir die ontwerp van die program. Die deelnemers kon die eie verwerking van routake herbeoordeel en kognitiewe herstrukturering waar nodig toepas (onder meer deur die opheffing van onderdrukte gedagtes en die betwisting van irrasionele aannames). Met beter begrip vir die eie situasie en beheer oor emosie en gedrag kon ook betekenisgewing (terugskouend oor die verliesgebeure) volg en kon die ervaring geïnkorporeer word in 'n persoonlike lewensverhaal. Statistiese ontleding van die toets-hertoetsresultate het onder meer daarop gedui dat adolessente neig om voortydig aanvaarding van die verlies aan te dui; dat die eksperimentele groep, vergeleke met die kontrolegroep, minder vermoeid-lusteloos was na programdeelname; en dat hoë risikodeelnemers uit beide die eksperimentele en kontrolegroepe met die na-toetsing meer depressief voorgekom het. Laasgenoemde bevinding dui daarop dat die hoë risikogroep eerder op psigoterapie aangewese was. Diegene uit die hoë risikogroep wat wel aan die program deelgeneem het, het nogtans bewus geword van die behoefte aan sodanige terapie en dit daadwerklik opgevolg.

Thesis (DPhil (Psychology))--University of Stelenbosch, 2010. / ENGLISH ABSTRACT: A probe into resilience research has revealed that psychologists have taken on the role of “keepers of the crypt”, where our attained knowledge has been “entombed” by virtue of our reluctance to allow it to bear practical fruition. Consequently, the impetus of the research is a response to the aforementioned gap and is explicated in four phases: Phase 1: A detailed literature review consisting of the review and integration of appropriate preceding resilience research, thereby serving as a possible reference guide for future studies; Phase 2: Provision of a succinct, comprehensive framework for programme development within the field of psychology; Phase 3: Family hardiness was selected as the resilience quality to be attended to via the development of a universal, multidimensional resilience-enhancement programme; Phase 4: An assessment of whether the resilience-enhancement programme is successful in developing the selected resilience quality in families. Following the salutogenic approach, the main theoretical foundation of the investigation resides in the Resiliency Model of Stress, Adjustment and Adaptation (McCubbin & Thompson, 1991). The significant contribution of the research is its provision of a framework for programme development within the field of psychology. Self-report questionnaires and open-ended questions were completed by mothers as representatives of their families. Therefore, the research amalgamated both qualitative and quantitative measures in its quasi-experimental, pretest-posttest natural control-group research design. A total of fifty families living in the Western Cape, South Africa participated in the research. The statistical trends observed in the study hinted at the enhancement potential of family hardiness. It became evident that gender, level of education, income and occupation, emotional intelligence and the time frame of interventions affected the enhancement potential of family hardiness. Age may also play a role, but the conflicting research results render conclusions about the correlation between age and hardiness questionable. Comparative studies would clarify this aspect. Future studies attempting to develop these findings further, need to consider the influence of factors such as gender, level of education, income and occupation, emotional intelligence and the time frame of interventions. Family hardiness is but one of the identified resilience qualities. An exploration of the enhancement potential of other identified resilience qualities will provide a plethora of interventions for service providers to choose from, enabling them to meet families and communities at their point of need. / AFRIKAANSE OPSOMMING: Nadere ondersoek van veerkragtigheidsnavorsing het aangedui dat sielkundiges die rol van “bewaarders” aangeneem het, waar ons versamelde kennis verberg word as gevolg van ons onwilligheid om dit prakties toe te pas. Gevolglik is hierdie navorsing gedoen in respons op bogenoemde gaping in die navorsing, en word dit in vier fases gelewer: Fase 1: ’n literatuuroorsig wat die voorafgaande veerkragtigheidsnavorsing integreer en hersien ten einde as verwysingsgids te dien vir toekomstige studies; Fase 2: Die voorsiening van ‘n omvattende raamwerk vir programontwikkeling binne die veld van die sielkunde; Fase 3: Gesinsgehardheid is gekies as die veerkragtigheidsfaktor om deur middel van ’n universele, multidimensionele program verryk te word; Fase 4: ‘n Bepaling om te ontdek of die veerkragtigheidsverrykingsprogram suksesvol is om die geselekteerde veerkragtigheidsfaktor in families te verryk. Die studie is gedoen vanuit die salutogeniese benadering. McCubbin en Thompson (1991) se “Resiliency Model of Family Stress, Adjustment and Adaptation” is as teoretiese basis benut. Die navorsing se betekenisvolle bydrae lê in die voorsiening van ‘n raamwerk vir programontwikkeling binne die veld van sielkunde. Selfbeskrywingsvraelyste en oop vrae is deur moeders as verteenwoordigers van hulle gesinne voltooi. Die navorsing het dus van beide kwalitatiewe en kwantitatiewe metings gebruik gemaak in die kwasi-eksperimentele voortoets-natoets, natuurlike kontrolegroep navorsingsontwerp. ’n Totaal van vyftig families wat in die Wes-Kaap van Suid Afrika woonagtig is, het aan die navorsing deelgeneem. Die statistiese neigings wat in die navorsing waargeneem is, sinspeel op die verrykingspotensiaal van gesinsgehardheid. Dit het aan die lig gekom dat geslag, opvoedkundige vlak, inkomste en beroep, emosionele intelligensie en die tydsduur van intervensies die verrykingspotensiaal van gesinsgehardheid beïnvloed. Ouderdom kan ook ‘n invloed hê, maar die teenstrydige navorsingsresultate in dié verband maak gevolgtrekkings oor die korrelasie tussen ouderdom en gesinsgehardheid twyfelagtig. Vergelykende studies sal die bogenoemde kan uitklaar. Toekomstige studies wat poog om die bevindinge van hierdie navorsing verder te ontwikkel, moet die invloed van faktore soos geslag, opvoedkundige vlak, inkomste en beroep, emosionele intelligensie en die tydsduur van intervensies in ag neem. Gesinsgehardheid is maar een geïdentifiseerde veerkragtigheidsfaktor. Verdere ondersoeke na die verrykingspotensiaal van ander veerkragtigheidsfaktore sal ‘n oorvloed van intervensies aan diensleweraars beskikbaar stel, ten einde in die behoeftes van families en gemeenskappe te voorsien.