Thesis (MA)--University of Stellenbosch, 2008. / ENGLISH ABSTRACT: Sometimes it is not entirely clear why certain clients improve. Critical clinical ingredients which may have led to this improvement or recovery are hard to identify and describe and decisions about therapeutic interventions often appear to be intuitive rather than following a strict modus operandi. This is true particularly if refractory or chronic cases start to improve and maintain this improvement. Refractory and chronic cases are the norm amongst clients suffering from complex, chronic trauma, also termed complex PTSD. Complex trauma is a multi-facetted, often multi-layered condition. It includes damage to the individuals’ self and to her ability to interpersonally relate, additionally to the DSM IV TR diagnosis of PTSD. Due to the manifold unique presentations of the syndrome, particular after long-term exposure and confounded by co-morbidities and rigid defenses, it is difficult to diagnose and treat the condition effectively. This study focuses on one such complex trauma case with an initially very poor prognosis, which improved significantly over a treatment period of eighteen months. The therapeutic intervention and progression of the case are closely examined, using the phenomenological method, with the aim of discerning and describing themes and patterns that could assist in understanding the healing process of this client during therapy and to promote further research in this regard. Integration of psychodynamic conceptualization, particularly self-psychology and intersubjectivity, and person-centered, supportive therapeutic methods were found helpful in the treatment of this case. The common factor to these approaches is their emphasis on the relationship between client and therapist. This therapeutic relationship was concluded to be the determining factor in the successful treatment of this client, because it addressed damage to self and to her relational ability. The research took place concurrent to the therapy with the client and this process led to a degree of integration on three levels: integration of the client’s self and interpersonal functioning, integration of the abovementioned approaches to form a creative synthesis in the therapist’s individual approach to trauma clients, and the integration of a phenomenological methodology with a psychodynamically conceptualized case study. It is noted that the theoretical explorations and therapeutic procedures described and explored in this study are but one way to conceptualize and treat complex trauma. / AFRIKAANSE OPSOMMING: Somtyds is dit nie duidelik hoekom sekere kliente se toestand verbeter nie. Dit is soms moeilik om die kritiese bestanddele wat tot hierdie verbetering of herstel gelei het, te identifiseer en te beskryf. Besluite met betrekking op therapeutiese intervensies blyk dikwels eerder intuitief, as die gevolg van ‘n streng modus operandi, te wees. Dit is spesifiek die geval wanneer chroniese en hardnekkige gevalle begin om te verbeter en die verbetering volhou. Hardnekkige en chroniese gevalle is nie ongewoon by kliente wat aan komplekse, chroniese trauma - ook genoem komplekse post-traumatiese stressversteuring - ly nie. Komplekse trauma is ‘n multi-fasettige toestand, wat dikwels ‘n verskeidenheid lae of vlakke van versteuring opwys. Dit sluit skade tot die individu se self in, asook verlies aan vaardigheid om met ander mense suksesvolle interpersoonlike verhoudings op te bou. Hierdie kenmerke is toevoegings tot die diagnose van die sindroom soos uitgevoer in die DSM IV TR. As gevolg van die meervoudige unieke voorstellings van die sindroom - in besonder na langtermyn blootstelling en verwarring deur co-ongesteldhede en rigiede verdedigings - is dit moeilik om die toestand korrek te diagnoseer en efektief te behandel. Hierdie studie fokus op die soort geval wat aanvanklik ‘n baie swak prognose gehad het, maar vervolgens oor ‘n tydperk van 18 maande ‘n beduidende verbetering getoon het. Die terapeutiese intervensie en die progressie van die geval is in hierdie studie noukeurig ondersoek, deur gebruik te maak van fenomenologiese ondersoekmetodes, met die doel om temas en patrone vas te stel en te beskryf wat die begrip van die genesingsproses van die klient gedurende terapie moontlik kan bevorder, en wat verdere navorsing op hierdie gebied kan stimuleer. Integrasie van psigodinamiese konseptualisering (spesifiek self-sielkunde en intersubjektiwiteit) asook persoongesentreerde, ondersteunende beradingsmetodes, is as waardevol bevind in die behandeling van hierdie geval . Die gemeenskaplike faktor tot hierdie benaderings is die klem op die verhouding tussen klient and terapeut. Die gevolgtrekking is gemaak dat hierdie terapeutiese verhouding die bepalende faktor in die sukkesvolle behandeling van hierdie klient was, omdat dit sowel die skade aan die self as die verlies aan die vaardigheid om verhoudings te bou, aangespreek het. Die navorsing en die terapeutiese intervensie met die klient het terselftertyd plaasgevind, en die proses het ten slotte tot ‘n mate van integrasie op drie vlakke gelei: integrasie van die klient se self en herstelling van interpersoonlike funksionering, integrasie van die bogenoemde benaderings wat tot ‘n kreatiewe sintese in die berader se benadering tot trauma behandeling gelei het, en die integrasie van fenomenologiese metodes en psigodinamies konseptualisering in ‘n gevallestudie. Dit is belangrik om in gedagte te hou dat die teoretiese navorsing en praktiese prosedures wat in hierdie studie beskryf en uiteengesit is, net een manier is om komplekse trauma te konseptualiseer en te behandel.

M.A. / Despite the fact that the helping professions in the SAPS make use of a multi-professional team approach to provide a service with regards to trauma intervention, statistics confirm that there is still a high occurrence of stress-related problems amongst police officials'. The aim of this study is to explore and describe the police officials' experience of trauma and the trauma intervention programmes in the SAPS, in order to create guidelines and to make certain recommendations with regard to client-focussed programmes for police officials' attached to the high-risk units in the Eastern Cape. The aims of this study were best realised by the exploratory and descriptive goals of fundamental research as expounded by de Vos et al. (1998). The exploratory and descriptive goal ofthe problem is best achieved by combining the qualitative and quantitative approaches to research, as proposed by Cresswell (1994). For the purposes of this study, the researcher has first made use of a qualitative approach to research. The population with regards to this phase of the study consisted of the police officials' attached to the high risk units in Port Elizabeth. The researcher made use of the purposive sampling method in order to select the participants of the focus group. A semi-structured interview schedule, consisting of four pre-designed questions, was employed in order to obtain maximum information on the subject. The four questions are as follows: experience of trauma, impact on and reaction to trauma, coping with trauma and the experience of trauma intervention programmes. The themes arising from the findings are divided into eleven categories including the classification of their respective sub-categories. The categories are as follows: 1) the concept trauma, 2) traumatic incidents, 3) trauma reinforcers, 4) post traumatic events, 5) post traumatic stress disorder, 6) social support, 7) avoidance/denial, 8) problem-focussed coping, 9) consumer orientation, 1 0) consumer satisfaction and 11) a core marketing strategy. A quantitative approach was used during the second phase of the study, whereby the themes that resulted from the findings of the focus group interview, were distributed amongst the police officials' representing the high risk units in the Eastern Cape. The latter was done in order to explore the extent of the items arising from the focus group in the population. For the purposes of the second phase of the study, the researcher employed the simple random sampling method, whereby 10% of the population was selected. The researcher made use of the group administered method whereby respondents were involved in a group and were thereby provided with an opportunity to complete the questionnaire. The social workers responsible for the high risk units in the various areas in the Eastern Cape were trained as field workers in order to facilitate the completion of the questionnaire by means of the group administered method. The following conclusions were drawn from the findings. Firstly, it is concluded that the police officials' attached to the high risk units in the Eastern Cape are exposed to a variety of traumatic incidents. The latter vary with regards to occurrence and intensity. The nature, frequency and intensity of the incident have an influence on the extent to which police officials' experience these incidents as traumatic, and this also influences the cumulative impact thereof on the individual. The internal and external stress factors which police officials' are exposed to on a daily basis in the carrying out of their duties, also plays an important role in the extent to which police officials' are capable of coping with trauma. In some cases it is experienced so intensely that it leads to a traumatic reaction by some police officials'. Secondly, it is concluded that police officials' generally react differently, depending on their exposure to trauma. These reactions are generally similar to the symptoms of post-traumatic stress and post traumatic stress disorder. Thirdly, the conclusion is reached that police officials' reveal different coping styles. These vary with specific reference to social support, avoidance/denial and problem focussed coping mechanisms. Lastly, it is concluded that the trauma intervention programmes are not consumer orientated as a thorough needs assessment is not done and police officials' individual needs, expectations, perceptions and preferences are not taken into consideration most of the time. Police officials' are also greatly dissatisfied with the programmes because the elements of the marketing strategy, with specific reference to product, place, cost and promotion as expounded by Terblanche (1993), do not live up to their expectations and perceptions of the programme. Finally, the findings were compared with each other, whereafter certain conclusions were reached and a number of recommendations were made.

This study explores the possible use of digital media as an effective psychotherapeutic aid in art psychotherapy, specifically in addressing the effects of trauma experienced by adolescents. A literature review provides evidence on what exactly can be understood under the concepts 'art psychotherapy' and 'digital media'. The literature study further investigates trauma, its treatment and how art psychotherapy can be used as a psychotherapeutic tool with adolescents who have been exposed to trauma. An empirical study including six participants, chosen through a specific sampling process, and whose background information regulates the appropriate methods of intervention demonstrates the practicality of digital media in art psychotherapy. Data gathered from pre-assessment activities, art psychotherapy sessions and post-assessment activities are analysed, interpreted, and reduced through a systematic process. The empirical findings are then presented in a detailed, concise manner From the empirical investigation, it is determined that digital media can be used as a successful tool in art psychotherapy, specifically with adolescents who have experienced trauma. The researcher gained experience in the implementation of digital media in art psychotherapy and was able to provide valuable information about this practice, specifically for professionals interested in the field of art psychotherapy. The researcher was also able to identify limitations and further areas for research in this field. / Psychology of Education / M. A. (Guidance and Counselling)--University of South Africa --2013

This study explores the possible use of digital media as an effective psychotherapeutic aid in art psychotherapy, specifically in addressing the effects of trauma experienced by adolescents. A literature review provides evidence on what exactly can be understood under the concepts 'art psychotherapy' and 'digital media'. The literature study further investigates trauma, its treatment and how art psychotherapy can be used as a psychotherapeutic tool with adolescents who have been exposed to trauma. An empirical study including six participants, chosen through a specific sampling process, and whose background information regulates the appropriate methods of intervention demonstrates the practicality of digital media in art psychotherapy. Data gathered from pre-assessment activities, art psychotherapy sessions and post-assessment activities are analysed, interpreted, and reduced through a systematic process. The empirical findings are then presented in a detailed, concise manner From the empirical investigation, it is determined that digital media can be used as a successful tool in art psychotherapy, specifically with adolescents who have experienced trauma. The researcher gained experience in the implementation of digital media in art psychotherapy and was able to provide valuable information about this practice, specifically for professionals interested in the field of art psychotherapy. The researcher was also able to identify limitations and further areas for research in this field. / Psychology of Education / M. A. (Guidance and Counselling)

No description available.

patterns, severe personality patterns, depressive constructs, other clinical syndromes, severe clinical syndromes and dissociation following EMDR treatment. Thirty-two people, ranging from 23 to 65 years old, underwent the full EMDR protocol treatment for up to three traumas. The findings regarding clinical personality patterns revealed that EMDR is most effective in reducing the symptoms of dependent personality pattern because 76% of participants with clinically significant dependent personality pattern before EMDR treatment no longer had a clinically significant score (>75) on the MCMI-III at the end of EMDR treatment; compared to 75% with masochistic personality pattern, 77% with negativistic personality pattern, 69% with avoidant personality pattern, 40% with depressive personality pattern and 29% with schizoid personality pattern. These gains were maintained on the MCMI-III at follow-up by 76% with dependent personality pattern, 64% with masochistic personality pattern, 46% with negativistic personality pattern, 38% with avoidant personality pattern, 30% with depressive personality pattern and 29% with schizoid personality pattern. The analysis of the severe personality patterns at the end of EMDR treatment revealed that the scores on the MCMI-III reduced from within one standard deviation above the mean (60-74) to below the mean (<60) for 84% of participants with borderline personality pattern, compared to 68% with paranoid personality pattern and 52% with schizotypal personality pattern. These gains were maintained on the MCMI-III at follow-up by 84% with borderline personality pattern, 68% with paranoid personality pattern and 48% with schizotypal personality pattern. The analysis of the depressive constructs revealed that EMDR is most effective in reducing symptoms of major depression as 86% of participants with clinically significant major depression before EMDR treatment no longer had a clinically significant score (>75) on the MCMI-III at the end of EMDR treatment; compared to 73% with dysthymia and 40% with depressive personality pattern. These gains were maintained on the MCMI-III at followup by 86% with major depression, 58% with dysthymia, and 33% with depressive personality pattern. The findings regarding the other clinical syndromes revealed that 91% of participants with clinically significant post traumatic stress before EMDR treatment, no longer had a clinically significant score (>75) on the MCMI-III at the end of EMDR treatment, compared to 75% of participants with anxiety. These gains were maintained on the MCMI-III at followup by 91% of participants with post traumatic stress and 69% of participants with anxiety. The analysis of the severe clinical syndromes at the end of EMDR treatment revealed that the scores on the MCMI-III reduced from within one standard deviation above the mean (60-74) to below the mean (<60) for 78% of participants with delusional disorder, compared to 67% with thought disorder, 32% with bipolar (manic), 28% with alcohol dependence and 28% with drug dependence. These gains were maintained on the MCMI-III at follow-up by 67% of participants with delusional disorder, compared to 63% with thought disorder, 53% with bipolar (manic), 48% with alcohol dependence and 57% with drug dependence. The analysis of the effects of EMDR on dissociation revealed that there was a significant decrease in symptoms of dissociation on the DES at the end of EMDR treatment and these gains were maintained at the follow-up measurement at the end of the study. Whilst the findings of the present study cannot be generalised due to the small sample size, the findings do suggest that EMDR is successful in the treatment of a number of clinical conditions in addition to post traumatic stress; with further research being strongly indicated in order to further explicate the efficacy of EMDR across different psychiatric conditions. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

The #MeToo movement was established as a grassroots initiative in Brooklyn by Tarana Burke, as a way to bring awareness to the commonality of sexual violence towards African American women. Despite the awareness brought by the movement, it was virtually not inclusive of men who have experienced sexual violence. This study intends to provide educators an understanding of this phenomenon, as well as provide practitioners, scholars, and organizations supporting gay male rape survivors a qualitative perspective beneficial to enhance support systems in order to foster post-traumatic growth. This study answered questions of how participants described their experience of having been raped; how learning revealed itself during the participants’ journey towards post-traumatic growth; and what factors participants described that helped and/or hindered their ability to manage the experience, learn, and develop towards post-traumatic growth. Six individual in-depth cases are presented; each participating in a two-hour interview. Using Lifelines and Nohl’s (2015) five phase analysis of the unfolding of deep learning over time, this study demonstrated that Transformative Learning revealed itself throughout each of these cases. As described by O’Sullivan et al. (2002), Transformative learning is “[an] experiencing [of] a deep, structural shift in the basic premises of thought, feeling, and actions. It is a shift of consciousness that dramatically and permanently alters our way of being in the world. Such a shift involves our understanding of ourselves and our self-locations; our relationships with other humans and with the natural world; our understanding of relations of power in interlocking structures of class, race, and gender; our body-awareness; our visions of alternative approaches to living; and our sense of the possibilities for social justice and peace and personal joy.” The study provides insight into the various systems and social relationships that help and/or hinder the interviewees’ learning experience, as well as how they managed their lives along the way. Moreover, this study demonstrates that Transformative Learning can take over 20-years, as well as that the process requires recalibration after encountering obstacles as learners journeyed towards post-traumatic growth.

Early stressors like trauma can lead to developmental changes that have life-long negative health consequences (Merikangas et al., 2010; Anda et al., 2006). Approximately 1 in 4 youth experience substantial trauma during their developmental years (Merikangas et al., 2010; Duke, Pettingell, McMorris, and Borowsky, 2010). Such findings suggest the need for early intervention and treatment for adolescents exposed to traumatic events and adversity. Ideally, adolescents could be treated within primary care settings where parents overwhelmingly seek services for their children. Primary care settings are sought out at a 94% to 97% rate of services as compared to only a 4% to 33% rate of parents seeking out mental health services (Guevara et al., 2001). Unfortunately, no adolescent trauma-informed interventions have yet been adapted for use in primary care (Glowa, Olson, and Johnson, 2016). This study aimed to fill this critical gap between adolescent mental health issues associated with trauma and adverse childhood experiences and the lack of treatment in integrated primary care settings. The need for trauma-informed treatment for adolescents who have experienced trauma and adverse experiences is especially salient as evidence-based treatment for adolescents in this setting is limited. A modified Delphi approach was employed to address this gap in the research. Two rounds of questionnaires and focus groups were utilized with a panel of experts and youth stakeholders to gain consensus on treatment recommendations. Ultimately, expert panelists and youth stakeholders identified 59 recommendations for adolescent trauma treatment to be delivered in integrated primary care settings. / Doctor of Philosophy / Childhood trauma can have negative health, social, and educational outcomes that extend into adulthood and over one’s lifespan (Black, Woodworth, Tremblay, & Carpenter, 2012; Merikangas et al., 2010). Approximately 1 in 4 youth today experience trauma (Duke et al., 2010). Trauma can include a variety of things such as physical, sexual, or emotional abuse; being the victim of a crime; witnessing violence in the home; living through a natural disaster or experiencing an accident (Anda et al., 2006; APA, 2017). The frequency of trauma in adolescence suggests the need for early intervention and treatment. Ideally, adolescents could be treated within primary care settings where parents and adolescents frequently seek care services. Unfortunately, no adolescent trauma interventions have been created for this setting (Glowa, Olson, & Johnson, 2016). This study was designed to improve the treatment of adolescent trauma in primary care settings. For this research study a modified Delphi technique was used. Two rounds of questionnaires and focus groups were utilized with participants that consisted of a panel of experts from the field and youth aged 14-18 years old. Ultimately, the study participants made 59 recommendations for adolescent trauma treatment to be delivered in primary care settings.

An alarming portion of youth experience traumatic events during childhood, and there is a robust body of literature documenting the adverse consequences of trauma exposure on the developing child. Fortunately, numerous empirically-supported phase-based interventions have been developed for youth that target the deleterious effects of trauma. While several of these interventions have demonstrated symptom reduction from the baseline to completion of treatment, much less is known regarding the trajectory of posttraumatic stress symptoms (PTSS) during the course of treatment. Information in this regard may have important implications for service delivery and help to illuminate the mechanisms of change responsible for treatment outcomes. Furthermore, gender-related differences in the prevalence and expression of PTSS following trauma exposure have been observed, but the reasons for these differences is unclear and there is a paucity of research concerning whether boys and girls may progress differently through trauma-focused treatment. As a result, the aims of this study were to (1) examine the progression of PTSS during the various components of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); (2) assess whether symptoms progress differently for males and females; (3) examine whether (a) sexual abuse history or (b) age moderates any gender-related symptom differences identified; and (4) explore the trauma narratives of boys and girls. This study utilized an embedded sequential mixed methods design. For the quantitative strand, aggregate scores on the UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) were mapped for the entire sample and then according to gender at baseline, during various components of TF-CBT, and at termination among a sample (N = 138) of polyvictimized youth ages 7-18 who completed TF-CBT at a university-based child trauma treatment clinic. Mixed Analysis of Variance (ANOVA) analyses were conducted for each of the outcome measures (UCLA-PTSD RI overall, arousal, avoidance, and intrusion scores) to examine whether there were symptom differences between males and females from baseline to completion of TF-CBT, and 2 X 2 full factorial ANOVAs were conducted to determine whether sexual violence history or age moderated the relationship between gender and symptom severity during any phase of TF-CBT. For the qualitative strand, trauma narratives (N = 16) completed during TF-CBT were analyzed through the use of thematic analysis. Findings revealed that males and females reported differences in PTSS symptoms from baseline to termination of treatment, and during various phases of treatment. Additionally, thematic analysis of the trauma narratives augmented findings from the quantitative strand and revealed variations in the narratives of males and females. Although further investigation is warranted, study findings help to further understand the complex interplay between gender and the progression of PTSS during treatment. Implications for practice, policy and social work education are discussed.

This study explores the use of visual art therapy with traumatised adolescents. A literature review sheds light on the concepts of “visual art therapy” and “psychological trauma”, by exploring the therapeutic nature of visual art as a technique aimed at addressing the effects of trauma in the lives of adolescents. An empirical study including seven voluntary and purposefully selected participants demonstrates the efficacy of using visual art therapy with adolescents affected by trauma. Data gathered through observation, questionnaires, and interviews is qualitatively interpreted and analysed. The research findings are presented accordingly. Based on the empirical investigation, it is established that visual art can be used as a valuable therapeutic technique in the lives of adolescents affected by trauma. / Psychology of Education / M. Ed. (Guidance and Counselling)