The main purpose of this thesis is to explore experiences of two different psychological interventions based on art psychotherapy in women with a psychological or physical illness. The two interventions are art psychotherapy and art therapy. The difference between these two interventions is that the art therapist works with the transference in art psychotherapy but not in art therapy. The thesis consists of two studies of art psychotherapy: An art psychotherapy intervention is evaluated in Study 1 (papers III and V) which examines a group of patients diagnosed with depression and Study 2 (paper II) which examines experiences in a group of six patients diagnosed with vulva vestibulitis. An art therapy intervention is evaluated in the third study (papers I and IV); where experiences in patients diagnosed with breast cancer are examined. In Study 1, forty-three (n=43) depressed women were randomly assigned to either an intervention group or a control group (verbal psychotherapy). The aim was to examine the outcome of time limited psychodynamic art therapy compared to time-limited psychodynamic verbal therapy for patients with depressive symptoms. Interviews were performed before, immediately after, and three months after the termination of psychotherapy, and self-rating scales which focus on stress reactions, depression and symptoms as well as an observer rating scale on depression were used. The interviews and the art sessions were video-recorded, and the verbal psychotherapy was tape-recorded. The results showed that the art and verbal psychotherapies were comparable. The conclusion was that short-term psychodynamic art psychotherapy could be a valuable treatment for depressed women. In an in-depth content analysis, the method of scribbling was further investigated and exemplified with the therapies of two participants. In this study, the patients’ pictures and verbal expressions of progress, along with considerations of how to interpret the pictures were in focus. When leaving therapy the two patients took advantage of the paper, made complete forms, symbolised in words what they have expressed in pictures; in pace with psychotherapy the themes alter towards separation, individuation, and attempt to relate in a new way. The conclusion was that limelimited psychodynamic art therapy suggests giving a safer place for the self as the cohesion is firmer with better boundaries. Study 2 is a pilot study, which involved six young patients newly diagnosed with vulva vestibulitis. The aim of the study was to investigate pain at vestibulum, mental health, and self-image after fifteen sessions of art psychotherapy. Five of the patients were judged to have less pain three months after termination of therapy. The conclusion was that art psychotherapy with its openness seemed to affect young women in their experiences of vulva vestibulitis in a positive direction. Study 3 examined the potential benefit of art therapy for women with primary breast cancer. The sample comprised forty-one (n=41) patients who were randomly assigned either to an art therapy group or to a control group. The art therapy was going on during five weeks radiation treatment, one session per week. The aim was to investigate the outcome of art therapy, to quantify and compare the participant coping s, self-image, and the symptoms with the participant in the control group. Interviews were performed before, immediately after, and six month after inclusion. A set of self-rating scales was used: Coping Resources Inventory, the Structural Analysis of Social Behavior, and Symptom Check List – 90. The result showed that the patients in the art therapy group rated their coping s and especially their social s, higher than the control group, and that the average patients in the art therapy group improved in depressive symptoms and symptoms of anxiety, and that the general psychiatric symptoms improved as well. A linear regression analysis showed a tendency that the coping s increased in the art therapy group and decreased in the control group or even stagnated in the social domain. A second report on self-image, symptoms, treatment, and social variables showed that art therapy was related to lower ratings of depression, anxiety, and general symptoms after treatment; chemotherapeutic treatment predicted lower depressive symptoms and general symptoms in contrast to axilliary surgery and hormonal treatment. The results showed that art therapy could be valuable complementary therapy in routine oncology practise. The conclusion is that art therapy can have a positive long-term effect on the crisis following the primary breast cancer and its consequences. Conclusion: The results show that time-limited psychodynamic art psychotherapy is valuable for depressed women; that it is a valuable complement for women with vulva vestibulitis; and that art therapy is a valuable complement in the care and cure of women with primary breast cancer.

Vaginismus is a sexual pain disorder, where spasm of musculature of the outer third of the vagina interferes with intercourse. Vaginismus exists in two forms: total vaginismus, where intercourse is impossible, and the more seldom described partial vaginismus, in which intercourse is possible but painful. The aim of the thesis was to develop a useful definition of partial vaginismus for both clinical and scientific purposes; to describe the prevalence of partial vaginismus among women with superficial coital pain; to report on symptoms and clinical findings in women with partial vaginismus; and to present treatment results for women with vaginismus. In a clinical sample of 224 women with superficial coital pain, we found a great overlap of the clinical diagnoses of partial vaginismus (PaV) and vulvar vestibulitis (VVS) (nowadays called provoked vestibulodynia); 102 women had both PaV and VVS. All women with VVS had vaginismus. Partial vaginismus was more common in all our samples than total vaginismus. sEMG of pelvic floor muscles was found to be of no value in distinguishing women with partial vaginismus with or without vulvar vestibulitis (PaV+/-VVS) (n=47) from each other or from an asymptomatic group (n=27). Women with PaV+/-VVS (n=53) reported not only burning pain but also itch during a standardized penetration situation (sEMG of pelvic floor muscles), while asymptomatic women (n=27) did not. In most cases, the appearance of burning pain preceded the appearance of itch. In a retrospective interview study, 24 women with PaV+/-VVS reported pain after intercourse more often than pain during penetration at the onset of the problem. When the women ceased having intercourse, both symptoms were equally common. Intensity of pain during penetration increased dramatically from very low at onset of the problem to very high when the women ceased having intercourse, while intensity of pain after intercourse was already high at onset of the problem and increased to very high when the women ceased having intercourse. Pain after intercourse in women with PaV+/-VVS was described as burning and/or smarting and lasted in mean for two hours, while pain during penetration was described with words like sharp/incisive/bursting and lasted for one minute. At long-term follow-up (more than three years) of a group of women treated with cognitive behaviour therapy for vaginismus (n=59, response rate 44/59 on a questionnaire), a majority were able to have and enjoy intercourse. The proportion of women with positive treatment outcome was, however, associated to the definition of treatment outcome. An ability to have intercourse at end of therapy was maintained at follow-up. Every tenth women with vaginismus healed spontaneously after thorough assessment. Conclusion: Partial vaginismus was more common in our studies than total vaginismus, and all women with vulvar vestibulitis had partial vaginismus. Women with PaV+/-VVS reported not only burning pain during standardized penetration but also itch. When the problem started in women with PaV+/-VVS, pain after intercourse was more common than pain during penetration. Pain after intercourse was described as longlasting and burning and/or smarting, while pain during penetration was described as short and sharp/incisive/bursting. Long-term follow-up results of a series of women treated with CBT for vaginismus show good treatment outcome.

Enligt forskning har kvinnor en högre rädsla för brott än män. En förklaring är att kvinnors rädsla för sexuella brott ökar rädslan för alla typer av brott. Andra faktorer som har visat sig påverka rädsla för brott är fysisk och psykisk ohälsa. Dessa faktorer och teorin om att kvinnors rädsla för brott påverkas av rädsla för sexuella brott kan innebära att smärtsjukdomar som vulvodyni och vaginism som innebär svår smärta vid penetration och / eller beröring av slidan gör att kvinnor som lider av det kan uppleva en högre rädsla av brottslighet än andra kvinnor. Studiens syfte var att undersöka om vulvodyni har en inverkan på kvinnors rädsla för brott. Deltagarna bestod av 243 kvinnor (medelålder= 24,58, SD= 5,15) med (n=129) och utan (n=114) vulvodyni. Resultaten av studien indikerar att vulvodyni påverkar rädsla för brott och gör kvinnor som lider av den mer rädda för brott än de utan vulvodyni. Kvinnor med vulvodyni har också en högre rädsla för sexualbrott som våldtäkt och sexuella trakasserier. Vulvodyni visar på en unik association till rädsla för brott vid kontroll över andra variabler som tidigare forskning visat samband med rädsla för brott. Rädsla för sexualbrott visar också associationer med rädsla för andra brott hos kvinnor med och utan vulvodyni. Mer forskning om ämnet behövs för att se hur kvinnor med vulvodyni resonerar om sin rädsla för brott. / According to research, women have a higher fear of crime than men. one explanation is that women's fear of sexual offenses increases the fear of all types of crime. Other factors that have been shown to affect fear of crime are physical and mental health. The factors and the theory that women's fear of crime is affected by fear of sexual offenses could mean that pain diseases such as vulvodynia and vaginism that involve severe pain when penetrating and/or touching the vagina make women who suffer from it to have a higher fear of crime than other women. The purpose of the study was to investigate if vulvodynia has an impact on women's fear of crime. The study sample consisted of 243 women (mean age=24,58, SD= 5,15) with (n= 129) and without (n=114) vulvodynia. The results of the study indicate that vulvodynia affects fear of crime and makes women who suffer from it more afraid of crime than those without. Women with vulvodynia also have a higher fear of sexual offenses such as rape and sexual harassment. Vulvodynia also demonstrates having a unique compound to fear of crime proud control for other variables. Fear of sexual crime also shows associates of fear to other types of crimes for women with and without vulvodynia. More research on the subject is needed to see how women with vulvodynia reason about their fear of crime.

Vestibulodyni är ett medicinsk tillstånd som orsakar en brännande och svidande känsla runt slidöppningen och har setts drabba uppemot 15% av den kvinnliga befolkningen. För många kvinnor är smärtproblematiken så pass omfattande att det påverkar flera aspekter av livet och kan medföra psykosociala konsekvenser för de drabbade. Syftet med denna studie är att undersöka hur kvinnor med vestibulodyni beskriver sin livskvalitet samt hur de upplever bemötandet inom vården. Åtta kvalitativa djupintervjuer med vestibulodynidrabbade kvinnor ligger till grund för resultatet, som har analyserats utifrån genusteori, stigmateori och teorier om coping. Den empiriska datan har analyserats utifrån en tematisk narrativ analys, som har genererat ett flertal teman som utgör studiens resultat. Resultaten indikerar att vestibulodynidrabbade personer upplever smärta som en begränsning, en brist på adekvat vård, tycker att behandlingsprocessen är frustrerande samt erfar en stor psykisk påfrestning och självstigmatisering. / Vestibulodynia is a medical condition that causes a burning and stinging sensation around the vaginal opening and has been seen to affect up to 15% of the female population. For many women, the pain problem is so extensive that it affects several aspects of life and can have psychosocial consequences for those affected. The purpose of this study is to investigate how the women with vestibulodynia describes their quality of life and their experiences with the healthcare system. Eight qualitative in-depth interviews with women affected by vestibulodynia form the basis of the results, which have been analyzed through gender theory, stigma theory and theories of coping. The empirical data have been analyzed using a thematic narrative analysis, generating a number of themes that constitute the results of the study. The results indicate that people with vestibulodynia experience pain as a form of limitation and a lack of adequate health care. They also find the treatment process frustrating and experience a great deal of mental strain and self-stigma.