Various forms of trauma are regularly reported across the spectrum of counseling settings and the potential negative psychological effects on counselors who are repeatedly exposed to traumatic material are well documented. However, many researchers suggest that vicarious traumatization can be prevented and mitigated with personal and professional self-care strategies. The American Counseling Association (ACA) Code of Ethics indicates that counselors have a professional responsibility to engage in self-care activities, as efforts to ensure the psychological health of counselors will have a direct effect on their ability to help clients. The purpose of this mixed-method, descriptive, correlational research was to explore what types of educational preparation and training counselors have received regarding self-care and what types of self-care strategies counselors are using. The efficacy of those training methods and self-care strategies when implemented were also measured, from the perspective of the participants. The Self-Care Training and Implementation Questionnaire (STIQ), a 19-item, structured and semi-structured questionnaire developed for this research, was electronically sent to 3000 randomly selected members of ACA, resulting in 310 responses, 286 of which were deemed appropriate for inclusion. Analysis included descriptive analyses (quantitative data) and content and theme analyses (qualitative data). The results of this study indicated that counselors recognized the value of self-care and participated in activities that promoted a healthy lifestyle and mitigated stress, thus working toward a balance that fostered effective work performance. However, the findings demonstrated that most counselors do not receive formal self-care training and self-care has been an endeavor pursued independently, outside of education and work settings. Implications for counselor education, training, policy and research are discussed.

Psicólogo / El estudio pretende analizar las dificultades que se presentan en la relación madre-hijo producto de experiencias traumáticas acontecidas en la infancia precoz materna. Se intenta reflexionar por medio de un caso clínico que expone el nacimiento prematuro de un hijo, la activación de inscripciones no representadas en la psiquis materna que impactarán de modo traumático el vinculo madre-hijo, desencadenando un patología psicosomática que afectará el cuerpo del infans. Se examinarán los mecanismos psíquicos presentes y ausentes en la transmisión de aquello no representado, considerando las manifestaciones fenomenológicas que informan respecto de sus efectos en la constitución subjetiva del paciente

Magíster en Psicología Clínica de Adultos / En la presente tesis, me planteo reflexionar sobre el malestar en la cultura presente en la modernidad de las sociedades occidentales y en sus subjetividades, tomando como eje uno de sus principales conflictos: la violencia. Indago sobre la traumática historia del siglo XX, y como esta puede influir en las actuales relaciones y subjetividades. Para esto utilizaré como objeto de estudio la novela literaria 2666 del escritor chileno Roberto Bolaño, con el fin de encontrar claves y elementos para una comprensión del problema. Tomo como punto de referencia histórico y conceptual la obra de Freud de 1930: El malestar en la cultura. Ahí el autor sugiere un malestar inherente del ser humano que vive dentro de una civilización debido a su incapacidad para descargar la agresión que comanda la pulsión de muerte. En esa época, el superyó y el Otro del campo social con características autoritarias, eran los encargados de domeñar lo pulsional. Sin embargo, el discurso de ese Otro presente en los desastres políticos del siglo XX: Guerras Mundiales, Totalitarismos, Holocaustos, bombas nucleares, las dictaduras latinoamericanas, etcétera, traerían consecuencias en los sujetos del siglo XXI. A través de un ensayo que toma elementos de la novela de Bolaño, conceptos de la filosofía histórica-política, de la literatura social, de Freud y de la orientación francesa de psicoanálisis, mi intención es de reflexionar y denunciar que la violencia política ha influido en las formas de hacer lazo social, en el desplazamiento del lugar del Otro y en la violencia presente en las subjetividades actuales

Magister Artium (Psychology) - MA(Psych) / Due to the recent findings that the majority of South African’s have been exposed to high levels of trauma, the effects of trauma on mental health and wellbeing have become an important area of research in the South African context. Although many individuals in our country experience high exposure and multiple incidences of trauma, there are a significant number of people who seem to cope well in the face of adverse circumstances and trauma and do not develop stress symptomology as a result of exposure to a traumatic event. These individuals are viewed as resilient as they are able to utilize protective factors at their disposal, aiding them in preventing the development of symptoms associated with Posttraumatic Stress Disorder (PTSD). A large body of literature exists that identifies various protective factors, which may have a positive influence on an individual’s response to a traumatic event, thus making them more resilient. However, there is a gap in the South African research on the relationship between exposure to trauma, protective factors and the development of PTSD. The aim of this study is to explain how protective factors mediate PTSD symptoms. It investigates protective factors that resilient individuals utilize in the face of trauma such as; internal characteristics or traits, various demographic factors (i.e., age, gender), supportive interpersonal relationships, religious affiliation and community and family factors that have been identified as protective factors in the literature. Resilience emerged as significant in that it mitigated the development of posttraumatic symptoms (PTS) amongst the sample of university students. This indicates that despite the high incidences of exposure to trauma, individuals have the ability to be resilient, which therefore serves as a protective factor in the event of trauma. The present study constitutes a secondary analysis of previously collected survey data. The data being analysed is from a quantitative, cross-sectional survey that adopted a non-random, convenience sampling method. Logistic regression was undertaken in order to determine the relationship between age, religious affiliation, type of exposure, resilience and posttraumatic stress exposure. Only resilience emerges as a significant predictor underlying its importance for mediating traumatic outcomes. It highlights the importance od including protective factors in future research and interventions.

Ausgehend davon, dass die in einer standardisierten Eiweißmischpräparation enthaltenen Immunglobuline, Anti-Proteasen und Transportproteine eine verminderte zelluläre und Leukozyten-Aktivierung sowie eine verminderte Gewebsschädigung nach Trauma induzieren sollten, war Ziel der Studie zu klären, ob ihr Einsatz in der Traumaversorgung den Verbrauch von Gerinnungssubstanzen (FFP) und Erythrozytenkonzentraten verringern und die Verweildauer der Patienten auf der Intensivstation verkürzen kann. In der vorliegenden Studie wurden insgesamt 71 Traumapatienten prospektiv eingeschlossen; davon erhielten 31 Patienten in den ersten 3Tagen die Eiweißmischpräparation Biseko®. Dies senkte den Verbrauch von Fresh Frozen Plasma und Erythrozytenkonzentraten signifikant. Im Bezug auf eine Kosten-Nutzen-Analyse, welche vor allem durch die Dauer des Intensivaufenthalts bestimmt wird, erbrachte die standardisierte Eiweißmischpräparation jedoch keine Vorteile. Die immunologischen Veränderungen durch die enthaltenen Proteine und Proteasen scheinen nicht so ausgeprägt wie erhofft und spiegelten sich in ihrer Auswirkung auf sekundäre, hier betrachtete Outcomeparameter nicht wider. / Starting from the theory that the immunoglobulines, antiproteases and transport proteins contained in a standardized serum protein solution should induce reduced cellular and leukocyte activation in addition to reduced tissue damage, it was the aim of this study to clarify whether its use in trauma care could cause a reduction of fresh frozen plasma and red cell concentrates used, as well as shorten the time spent in intensive care. In this study, 71 trauma patients were included prospectively. 31 of those received the serum protein solution Biseko in the first three days. This reduced the use of fresh frozen plasma and red cell concentrates significantly. There were no advantages however in a cost-benefit analysis predominantly influenced by the time spent in intensive care. The immunological changes caused by proteins and proteases contained are not as distinct as hoped for, and could not be detected in their effect on secondary outcome parameters examined in this study.

Une coagulopathie aigüe traumatique est constatée chez environ un tiers des patients traumatisés sévères. Ce trouble précoce, endogène et spécifique nécessite l’association d’importantes lésions tissulaires et d’une hémorragie. La phase initiale est caractérisée par l’expression d’un phénotype hémorragique responsable d’une mortalité précoce, la phase tardive par l’expression d’un profil pro-thrombotique responsable d’une mortalité retardée. La physiopathologie de ce phénomène est encore mal comprise. Celle-ci pourrait impliquer une dysrégulation de la voie de la protéine C, une CIVD fibrinolytique, une diminution des stocks en fibrinogène, une altération de la fonction plaquettaire et une agression endothéliale. Plusieurs auteurs ont relevé l’absence de modèle animal pertinent pour vérifier ces hypothèses. Les objectifs de ce travail de thèse ont été la mise au point d’un modèle animal de coagulopathie aigüe traumatique et l’étude de sa physiopathologie. Une première étude a été réalisée, permettant la mise au point d’un modèle murin de coagulopathie traumatique. Celle-ci a mis en évidence un trouble de la coagulation précoce, endogène et spécifique associé à l’expression d’un phénotype hémorragique et répondant à tous les critères clinico-biologiques d’une coagulopathie aigue traumatique. Une deuxième étude basée sur ce modèle a été réalisée afin de mettre en évidence les mécanismes généraux intervenant dans la physiopathologie de la coagulopathie aigüe traumatique. Le rôle protecteur du fibrinogène a été confirmé dans cette étude. Le profil clinicobiologique observé associait une génération de thrombine normale, une discrète thrombopénie et un phénotype hémorragique. Celui-ci infirmait l’hypothèse d’une CIVD mais était compatible avec celle d’une fibrinolyse médiée par une production accrue de protéine C activée. / An acute traumatic coagulopathy is observed in about one-third of severely traumatized patients. This early, endogenous and specific disorder occurs when tissue damages are combined with hemorrhage. The early phase of this condition is characterized by the expression of a bleeding phenotype and a lengthening in prothrombin time.The late phase is characterized by a pro-thrombotic profile leading to multiple organ failure. The physiopathology of this phenomenon is still poorly understood. This could involve a dysregulation of the protein C pathway, fibrinolytic DIC, a decrease in fibrinogen, impairment in platelet function and endothelial damages. Various authors have emphasized the lack of relevant animal model to study this phenomenon.The objective of this work was to develop an animal model of acute traumatic coagulopathy to study its pathophysiology. A first study was performed and led to the development of a murine model of traumatic coagulopathy. This study revealed a hemostasis disorder that meets all the criteria of acute traumatic coagulopathy. Then, a second study based on this model was performed to observe general hemostasis disorders occurring in the context of traumaassociated hemorrhage. This study confirmed the protective role of fibrinogen against ATC. The clinicalbiological profile observed in the case of ATC combining normal thrombin generation, subtle thrombocytopenia and hemorrhagic phenotype observed in the case of ATC invalidated the hypothesis of DIC but was compatible with fibrinolysis mediated by an increase in activated protein C.

ABSTRACT South Africa has a high incidence of violence and death due to unnatural causes. Gunshot and/or multiple stab wounds to the trunk are consequently injuries commonly seen in South African hospitals. Penetrating injuries often necessitate explorative surgical intervention to identify and treat injuries to the internal organs. Patients are managed in the intensive care unit and frequently return to theatre for abdominal lavage prior to eventual wound closure. Critical illness with prolonged mechanical ventilation and immobilization results in some degree of muscle dysfunction. Survivors of critical illness suffer from poor functional capabilities and decreased quality of life. No formal rehabilitation programmes exist in South Africa for these patients following discharge. Purpose: To determine if patients that survived penetrating trunk trauma recover adequately spontaneously following critical illness over the first six months following discharge from the hospital. Methods: A prospective, observational study was conducted. Patients with penetrating trunk trauma were recruited from four intensive care units in Johannesburg. Patients who received mechanical ventilation < 5 days were placed in Group 1 and those who received mechanical ventilation 5 days were placed in Group 2. Lung function tests, dynamometry, quality of life, six-minute walk distance and oxygen uptake tests were performed over six months following discharge from the hospital. The obtained results for dynamometry, exercise capacity and quality of life were compared between groups and to that measured for a healthy (age and sex-matched) control group. Results and Discussion: No pulmonary function abnormalities were detected for subjects in Groups 1 or 2. Distance walked during 6MWD test was significantly reduced for subjects in Group 2 compared to the control group [one-month (p = 0.00), three-months (p = 0.00)]. Morbidity correlated significantly with distance walked by subjects in Group 2 during 6MWD test [three-months (p = 0.03), six-months (p = 0.02)]. No statistically significant differences were found between subjects during the VO2peak test although subjects in Group 1 performed better clinically than those in Group 2. At one-month there was a significant reduction in upper and lower limb strength for subjects in Group 2 compared to those in Group 1 and the controls (p = 0.00 – 0.04). Similar results were detected at the three- and six-month assessments. ICU and hospital length of stay did demonstrate a significant relationship with muscle strength at one and three months following discharge for subjects in Group 2. Severity of illness and morbidity in ICU did not have a significant relation to muscle strength for subjects in Groups 1 or 2 at any of the assessments. Subjects in Group 1 had a significant reduction in right deltoid and triceps strength compared to the controls at one-month (p = 0.00 respectively) only. No significant differences in upper and lower limb muscle strength were detected between the control group and subjects in Group 1 three and six months after discharge. Subjects in both groups had similar limitations in physical and mental aspects of quality of life one-month after discharge. Subjects in Group 1 reported a quality of life comparable to the control group by three-months. Subjects in Group 2 had significant limitations in the physical components of quality of life at three- and six-months compared to those in Group 1 and the controls [p = 0.00 – 0.02]. Conclusion: Subjects in Group 1 recovered adequately on their own within three months after discharge from hospital with regard to muscle strength, exercise capacity and all aspects of quality of life. Subjects in Group 2 presented with significant limitations in exercise capacity, muscle strength and the physical aspects of quality of life even at six months after discharge. Impaired function was related to the duration of critical illness and immobility. A physiotherapist-led rehabilitation programme may be indicated for survivors of penetrating trunk trauma that received prolonged mechanical ventilation to address cardiovascular endurance and peripheral muscle strength retraining between one and three months after discharge to address the physical disabilities observed in these subjects.

MA,Clinical Psychology, Faculty of Humanities, University of the Witwatersrand, 2002

M.Sc. (Med.), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, 2009

ABSTRACT This study is a combination of the qualitative and quantitative approach using an exploratory/descriptive design conducted at the Ekurhuleni Metropolitan Municipality, Northern Region. The study explored how Line Managers at Ekurhuleni Metropolitan Municipality perceive the impact of stress and trauma on work performance among employees. The study was conducted with 29 line managers sampled through a random sampling procedure, who had been working for Ekurhuleni Metropolitan Municipality for at least three years. A questionnaire was used to collect the required data. The study found that line managers at Ekurhuleni Metropolitan Municipality were of the view that stress and trauma can affect work performance among employees. It was also found that line managers are uninvolved in their sub-ordinates’ personal matters that are likely to cause mental health problems like stress and trauma.