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The academic study of how people respond to adverse life experiences has been dominated by Western conceptualisations of distress, resilience and growth. The current literature base regarding responses to adversity has been criticised for focusing on one response trajectory (Post Traumatic Stress Disorder; PTSD). This criticism stems from the privileging of Western understandings of the self and for negating to consider sufficiently the role of context (the available social, cultural and political discourses). The significance of this void in the literature is that it has led to the development of models and theories which could be considered culturally insensitive, if applied outside of the context from which they have derived. This research addresses the highlighted gap in the literature by exploring how the context of Sierra Leone influences how people respond to the experience of Civil War and continuing adversity. Nine in-depth interviews were carried out within two ‘mental health’ organisations in Sierra Leone. The participants were nine individuals and one group, consisting of both ‘patients’ and staff members. The qualitative methodology of Narrative Analysis was used to analyse both the stories people told and the stories which may have remained unexpressed. A focus was placed during analysis on the role of context and the dialogic process. The main findings of the research indicated that the cultural resources within Sierra Leone both influenced and constrained the narratives which individuals were able to tell. ‘Stories of Survival’ seemed to be told through two dominant social narratives of ‘Bear it, and Forget’ and ‘Because of Almighty God, we Forgive’. ‘Stories of Resistance’ however, demonstrate what was implied but often left unsaid, this is characterised by two main unexpressed stories; ‘We Cannot Forget’ and ‘Why God?’. Furthermore, findings suggest that it is the relationship between the dominant social narratives and individual meaning-making which influences the trajectory of stories told. The implications of this research request a commitment to valuing the role of social context in conceptualisations of distress, resilience and growth following adversity. Finally, the need to establish ways of offering support to individuals and communities, which fully considers the role of social context, is emphasised. This paper concludes by exploring the relevance of social content for the planning of services, training programmes and continuing clinical practice.

Background: Empirical evidence suggests a relationship between early trauma and psychosis. However, the underlying mechanisms for this relationship remain unclear. Research into metacognitive functioning in psychosis indicates higher levels of metacognitive dysfunctional beliefs within this patient group. The potential effects of early trauma on metacognitive functioning in psychosis has to date been scarcely researched. Reflective functioning (RF) is believed to be affected by early trauma and leading to psychopathology, particularly borderline personality disorder. However, to date no studies have investigated the effects of early trauma on RF within psychosis. Objectives: The primary aim of this study was to establish core links between the effects of early trauma and metacognitive and reflective functioning in psychosis. A secondary aim was to test the clinical applicability of a brief, newly developed attachment-based measure for RF. Furthermore, the study aimed to explore potential overlaps between the concepts of metacognition and reflective functioning. Method: A quantitative methodology was employed, using a combination of semi-structured interviews and self-report questionnaire, and group comparisons were conducted. Twenty-seven patients with psychosis or bipolar disorder were recruited. Participants were grouped into early trauma versus no early trauma; trauma versus no trauma; and in-patient versus out-patient, and exploratory analyses were completed. Results: No significant effects were found for early trauma but for trauma in general, indicating higher level of dysfunctional beliefs in patients with trauma (early plus adult trauma) history. No significant effect between groups were found for RF. Inpatients, however, showed significantly lower levels of RF when compared with outpatients, and outpatients significantly higher levels of cognitive self-focus(thinking about thoughts). Moreover, a modest positive correlation was found between both measures. Discussion: The findings of the present study suggest core links between the effects of trauma on metacognitive functioning in psychosis. This highlights the importance of routine trauma assessment with psychotic patients. The limitations of the metacognitive model within psychosis are discussed. Further research is implicated to investigate any potential effects of early trauma on RF in psychosis. Low level of RF in in-patients highlights the importance to integrate therapeutic techniques to improve RF functioning in this patient group since high RF is associated with resilience and better therapy outcome. The correlation between metacognition and RF measure indicates construct-validity for the RF measure. The differences between both concepts are considered. Furthermore, the limitations of this study and clinical utility are discussed along with suggestions for future research.

Background: High levels of dissociation have been found in recent studies involving psychiatric inpatients. Proponents of the ‘dissociative psychoses’ have found that trauma-focused intervention strategies can improve outcomes of patients with major mental illness. Despite this, levels of dissociation have not been measured in forensic inpatients in Scotland. This study investigates levels of dissociative symptoms (DES-II) within a sample of male patients in secure forensic psychiatry settings in Scotland. It explores levels of psychosis (PANSS) and self-reported childhood trauma (CTQ), current PTSD symptoms (IES-R), levels of depression (BDI-II) and broad attachment style (RQ). Four groups were arbitrarily defined based on presence or absence of psychosis and childhood trauma. It was hypothesised that levels of dissociation would be predicted by presence of childhood trauma. Methods: A quantitative cross-sectional design was used in which 56 mentally disordered offenders were interviewed across three different secure hospitals in Scotland: The State Hospital – a maximum security psychiatric hospital, and two medium secure facilities. Attempts are made to clarify the relationship of dissociation with different types of childhood trauma and psychosis symptom clusters. By splitting the data into groups the study seeks to discern whether the groups differ significantly on dissociation scores in relation to the childhood experiences they reported and presence of psychosis they are experiencing. Results: Childhood traumatic experiences were frequent where median CTQ total score = 47.0 (IQR: 42-70.5). Physical neglect was reported by 58.9% of the sample closely followed by emotional neglect (55.4%). 46.4% of the sample reported physical abuse of significant levels, 44.6% reported being emotionally abused and almost a third reported being sexually abused (28.6%). DES-II (dissociation) scores were significantly associated with delusions and hallucinatory behaviour from PANSS. Emotional abuse and sexual abuse were significantly associated with dissociation scores. Mann Whitney tests revealed that dissociation was significantly higher in the groups which reported childhood trauma. Kruskal-Wallis results indicated no significant differences between groups within the data and dissociation scores. Conclusion: Patients with clinically significant levels of dissociative symptoms were identified. This indicates that dissociation is a key characteristic, warranting further consideration in this sample. Levels and severity of reported childhood trauma were higher than expected. The findings add weight and support to the importance of dissociation and trauma in formulations of male, mentally disordered offenders. Clinical implications of these findings are considered and further directions are discussed.

This PhD thesis examines the ‘working through’ of traumatic memories of the Holocaust and representations of Romani cultural identity in autobiographical writing by Romanies in Germany and Austria. In writing their memories in German, these Romani writers ended the ‘muteness’ previously surrounding their own experiences of persecution in the Third Reich and demanded an end to the official silence regarding the Romani Holocaust in their home countries. The thesis aims to explore how the writing of these narratives works to create a space for Romani memories within German language written tradition and to assert a more positive Romani identity and space for this identity in their homelands. Further, it aims to demonstrate that, in the struggle to create this safe space, their texts also reveal insecurity and landscapes that are not free from threat. The thesis also addresses the broad question of whether or not the shift from oral to written tradition in order to represent experiences of the Holocaust will result in a continuation of Romani writing in Germany and Austria. The thesis begins by examining the first Romani accounts of Holocaust memories published in Germany (1985) and Austria (1988) and ends with more recent narratives published in 2006 (Germany) and 2007 (Austria). In chapters one and two on writing by Philomena Franz and Ceija Stojka, I focus on their pioneering texts as assertions of space for Romani identity within their homelands; I analyse how these authors work through their traumatic memories by narrating their experiences and by identifying the landscapes of Germany and Austria as Heimat. In chapter 3, I continue to explore themes of Heimat and identity in Alfred Lessing and Karl Stojka ’s accounts which, while working through their own traumatic memories of the Third Reich, struggle with the loss of Romani cultural identity in their homelands. In chapter four, I address the generational memory of the Holocaust in Otto Rosenberg’s account of his experiences in the concentration camps and his daughter Marianne Rosenberg’s recent autobiography. In chapter 5, I will examine the presence of the ‘threat of Auschwitz’ in Stefan Horvath’s writing, in which he remembers the attack on a Romani settlement in 1995 which killed his son and three other Romanies in Oberwart, Austria. In all of these chapters, attention will also be given to the editorial construction of these texts as well as their reception. Throughout the thesis, I take a comparative approach, referring to similarities and differences between the works of these authors.

M.A. thesis, Faculty of Humanities, University of the Witwatersrand, 1999

A una muestra constituida por 20 niños varones entre 12 y 13 años de edad cronológica, alfabetos, con educación básica, sin confirmar, recientemente ingresados a un albergue de Lima Metropolitana -después de una larga permanencia en situación de calle-, se le administró el Test de Rorschach, con la metodología del Sistema Comprensivo Exner. La evaluación estuvo dirigida a destacar las características intrapsíquicas de estos niños cuyas vivencias traumáticas dentro del hogar, los impulsaron a la calle. Las variables seleccionadas del sistema comprensivo proporcionaron información relevante sobre las capacidades asociadas a la construcción de la resiliencia en este sector de la población infantil, en situación de riesgo, orientada a potenciar conductas y actitudes resilientes hacia un desarrollo saludable. Los factores estudiados son: las potencialidades y recursos, el estilo vivencial predominante, la auto-percepción, la confianza y la seguridad. La percepción y la vivencia de las demandas estimulantes y presiones externas, las habilidades sociales y el modo de afrontamiento a las situaciones adversas o conflictivas. Asimismo se ha efectuado un intento de articulación o correspondencia entre los resultados obtenidos a través del sistema comprensivo y las áreas de detección, intervención y promoción de la resiliencia, actualizado por Néstor Suárez Ojeda y las Fuentes de la Resiliencia de Edith Grotberg: YO SOY, YO ESTOY, YO PUEDO, YO TENGO. / A sample of 20 male children between 12 and 13 years old, with irregular basic education, recently checked in an orphans house in Lima, -after a long time in street situation- was evaluated by the Rorschach Test with the Comprehensive System method. The assessment was directed to detect the intrapsychic characteristics, whose traumatic life experience inside their homes, leaded them to the streets. The variables selected through comprehensive system brought relevant information about the capacities associated to the construccion of the resilience in this sector of child population in risk situation, oriented to encourage behaviours and resilient attitudes towards a healthy development. The factors studied were: skills and resources, the predominant life experience style, autoperception, confidence and security; perception and experience of stimulus demands and external pressures, social skills and type of coping to adverse and conflicted situations. An attempt of articulation has been made between the obtained results through the Comprehensive System and the detection areas, intervention and Resilience promotion, according to two world known work systems, The Pillars of Resilience, actualized by Néstor Suárez Ojeda and the Sources of Resilience by Edith Grotberg: I HAVE, I AM, I CAN.

Emergency medical services (EMS) personnel experience direct traumatic exposure that can leave a lasting negative impact. However, little is known about the vicarious exposure that EMS personnel experience at challenging calls when family and loved ones are present at the scene. Additionally, there is minimal research that has looked at the experiences among paramedics and EMTs who arrive to mental disturbance calls or completed suicides. In order to add to the substantial body of literature on EMS personnel and traumatic exposure, this study explored their experiences of multifaceted traumatization; the lived experiences of paramedics and EMTs who have responded to completed suicides where loved ones of the deceased were present, and as a result, experienced both a negative psychological impact and posttraumatic growth. The study explored the risk factors and protective factors that paramedics and EMTs experience in their work. Additionally, this inquiry sought to explore the ways in which participants find meaning in providing emergency medical services and how they sustain their work. <br>This qualitative, phenomenological study was conducted through semi-structured individual interviews with 12 paramedics or EMTs who have been employed or volunteered for at least one year. Explication of data was completed using van Manen's (1990) four existential themes: spatiality, corporeality, temporality, and relationality. The results of this study identified themes that address van Manen's (1990) lived existentials, protective factors against posttraumatic symptoms through direct and vicarious traumatization, risk factors that contribute to these symptoms, and meaning making in their work. The implications of the study for the field of emergency medical services and suggestions for future research are provided. / School of Education; / Counselor Education and Supervision (ExCES) / PhD; / Dissertation;

Psicólogo / La presente memoria de investigación abordará las consecuencias de la violencia organizada que el Estado chileno infringió a su propia población de habitantes durante la dictadura militar de Augusto Pinochet. El estudio se enfocará en el testimonio de nietos de víctimas de la represión política que hayan nacido a fines de la dictadura y que hayan crecido en democracia y de terapeutas del programa PRAIS que han trabajado con esta población de pacientes para explorar los efectos del trauma ocasionado por el Estado en la generación que vivió el suceso, en la generación de hijos y, finalmente, en la generación de los nietos. Para esta exploración se realizarán entrevistas semiestructuradas para los dos grupos de estudio ya mencionados, los nietos de víctimas conformado por 5 jóvenes y los terapeutas del programa PRAIS conformado por 6 psicólogos. Para su análisis se recurrirá a la técnica metodológica cualitativa del Análisis de Contenido. En cambio, para su comprensión teórica se utilizarán diversos conceptos obtenidos del enfoque psicoanalítico. Los principales resultados sugieren la formación de una cripta tanto en la víctima de la represión de Estado como en sus hijos, transformando a los nietos entrevistados y a los nietos pacientes en portadores de un fantasma de primera generación. Por otra parte, se cuestiona el concepto de “generación familiar” cuando hay un evento traumático atravesando la historia de dicho grupo y también se cuestiona el concepto de “víctima”, que ya no sólo recae sobre la persona torturada o desaparecida sino que también sobre sus familiares testigos de la desaparición u otro acto violento contra la persona. También se critica el poco reconocimiento que hay del Estado actual, democrático, sobre los hechos acontecidos en la dictadura en un intento de hacer silenciar lo vivido en dicho período, redactando leyes de Amnistía y homenajeando a los líderes de las fuerzas de represión de la época

Experiential avoidance (EA) is a process in which a person attempts to avoid, dismiss, or change experiences such as emotions, behaviors, and thoughts. EA is associated with a number of psychological disorders and is generally harmful to psychological well-being. Various studies have explored the role of EA as a mediator, while others have studied EA as a moderator. The current study aimed to further understand and broaden the knowledge of the role of EA in regard to trauma, substance abuse, aggression, and impulsivity by examining relationships between these variables with EA as a mediator and as a moderator. Experientially avoidant behaviors (i.e., substance abuse, aggression, and impulsivity) were related to higher levels of EA. EA was found to partially mediate the relationship between the number of traumatic experiences and posttraumatic stress disorder (PTSD) symptoms, as well as the relationship between substance abuse and PTSD. EA was also found to moderate the relationship between PTSD symptoms and aggression. Findings from the present study as well as its limitations and future directions for research are discussed.