Thesis (MPsych(Clin))--University of South Australia, 1999

Self-injurious behavior (SIB; e.g., wrist-cutting, burning) is a pervasive coping phenomenon that may be indicative of dysfunctional affect regulation and complex developmental trauma. Previous research findings identify the incidence rate of SIB to be approximately 10% to 15% of the general population with 5% to 10% of those engaging in repetitive or recurring SIB. Other sources identify approximately 2 million individuals active in this behavior within the United States; 70% of those individuals are female. However, limited research has used internet technology as a data gathering tool to access individuals who have engaged in SIB and are apprehensive to participate in face-to-face interviews. The purpose of this qualitative study was to examine the fundamental nature of SIB using an interpretive-phenomenological methodology via internet interviews. Data were gathered from a convenience sample of 18 adult female participants with a reported history of SIB recruited through SIB oriented websites. The data were analyzed through a phenomenological interpretive approach using axial and thematic coding. Results indicated that SIB is a method of coping with stress and emotions as well as a way to regulate and control affect from perceived historical trauma. These findings may advance empirical evaluation of SIB by expanding research designs and informing practitioners about how those who have engaged in SIB view therapeutic treatment. The positive social change implications include generating knowledge useful for program developers, educators, psychologists, and other invested professionals who search for sound, innovative ways to address SIB among women based on the words and experiences of survivors; potential long-term outcomes include improved coping strategies, reduced incidences of bodily harm and improved self-concepts.

Previous research has indicated that the majority of individuals who undergo bariatric surgery have histories of psychological disorders. Only a paucity of research has examined the social and emotional effects of bariatric surgery on patients. Using Kelly's personal construct theory as the conceptual framework, this phenomenological study was designed to gain more insight into how this life-altering bariatric surgery transforms patients socially and emotionally. Fifteen participants who had undergone bariatric surgery in the past 10 years were interviewed for the study. The interviews were transcribed and coded. Similar themes found within the interviews were identified as the primary themes of the study. The majority of the participants saw themselves as "the same" in regards to their personality and sense of self, but felt different physically after undergoing surgery. With weight loss, the participants felt more confident and stable than prior to the surgery. The majority of the participants described how they felt more confident in social situations and felt as though they blended in more. This study enhances social change initiatives through allowing medical professionals, mental health professionals, bariatric patients, and the overall community to have a better understanding of the significant psychosocial changes that bariatric patients undergo after surgery. Thus, the findings of this study may aid clinicians and physicians in providing treatments and information to bariatric patients that can assist patients in adjusting and coping effectively to the social and emotional changes and challenges that they will experience post surgery.

<p> Research on temperament and the development of behavioral problems across cultures often focuses on comparisons of vastly different countries, such as North American and Asian countries. The present study compares toddler samples from two Western countries, which are considered primarily individualistic in value orientation: the U.S. and Germany (N=100). Results suggest differences in mother&rsquo;s descriptions of child temperament in the two samples. In addition, results obtained via caregiver interviews and observations of parent child interactions indicated a stronger emphasis on childrearing values reflecting <i> independence</i> for U.S. mothers, with German mothers favoring comparably more <i>interdependence</i> in their offspring. Finally, associations of temperament and behavioral problems were found to be distinct across countries and culture was identified as a moderator in respect to Positive Anticipation, predicting externalizing behavior in the U.S. sample at higher levels. Results were interpreted in light of the concept of the developmental niche and cross-cultural value models, relevant to the two cultures compared in this study. This study offers a significant contribution to our understanding of culturally different avenues in the development of early behavioral problems, and likely subsequent mental health problems over the life span. This is a particularly timely issue given increasing globalization and intercultural exchange.</p>

<p> Self-esteem, viewed for decades as psychology&rsquo;s Holy Grail, has proved to be an elusive and surprisingly barren destination. One of the oldest concepts in psychology, self-esteem likely ranks among the top three covariates occurring in personality and social psychology research. Propelled by the self-esteem movement of the 1970s, it was popularly believed that self-esteem played a significant causal role in determining a wide range of both positive and negative social behaviors. However, the results of a 2003 large-scale literature review showed that it is actually not a major predictor of almost anything, with the exception of positive feelings (happiness) and possibly greater initiative. With over a decade passing since that publication, the current investigation sought to review, synthesize and critically analyze the more recent literature. Results confirmed a similar dearth of meaningful relationships connected to self-esteem, the only exceptions being some modest correlates to happiness, narcissism, and self-perceived attractiveness and intelligence. However, the literature continues to be plagued with myriad conceptual and methodological problems. This study utilizes specific critical thinking principles to advance understanding in this area, to address why the self-esteem obsession still persists, and to propose a new theoretical model, one that accounts for the construct&rsquo;s heterogeneous and multidimensional nature. Self-esteem is defined as the appraisal of one&rsquo;s own personal value, including both emotional components (self-worth) and cognitive components (self-efficacy). The multiple forms of self-esteem are a function of how accurately or closely it matches an individual&rsquo;s measureable reality, composed of the objective outcome of one&rsquo;s behavior (actual achievements, measurable capabilities) as well as one&rsquo;s interpersonal interactions (i.e., the level of congruence between how one thinks he or she is perceived and how he or she is actually perceived). Self-esteem also varies in terms of its level of stability, or the degree to which it is influenced by evaluative events or the need to match external standards across time and situation. The permutations of these sorting variables yield eight types of self-esteem: Optimal High, Fragile High, Accurate Low, Fragile Low, Non-compensatory Narcissism, Compensatory Narcissism, Pessimal, and Disorganized. Specific recommendations for clinicians and researchers are provided.</p>

<p> This qualitative study examines the situation when an individual is in psychotherapy and twelve-step recovery for compulsive overeating at the same time. Although both are common approaches, controversy exists concerning the relationship between compulsive overeating and addiction, the optimal treatment approaches for compulsive overeating, and the widespread use of twelve-step recovery by consumers and clinicians. This work describes issues related to the integration of psychotherapy and twelve-step programs in the treatment of compulsive overeating and establishes recommendations for psychotherapists who are treating compulsive overeaters who are making or may make use of twelve-step programs. This study utilizes interpretative phenomenological analysis, informed by conceptualizations from Jungian psychology, to analyze the interviews of eight participants in order to generate phenomenological description of the nature and elements of change when these two approaches are concurrent, and the ways in which the two approaches interact, making use of the participants&rsquo; understandings of their own experiences to inform clinical practice.</p><p> Keywords: psychotherapy, twelve step, compulsive overeating, addiction, phenomenology, Jungian, Overeaters Anonymous.</p>

<p> This study explores what happened that led a woman with long-term recovery from a severe substance use disorder back into active addiction. Recovery over the long term requires ongoing personal development and involves awareness and interaction between both conscious and unconscious aspects of the psyche. Long-term recovery was likened to C. G. Jung&rsquo;s concept of individuation and it can be imagined that relapse occurs when a woman&rsquo;s commitment to abstinence cannot withstand the alchemical pressures involved in moving through a difficult period. A method of Interpretive Phenomenological Analysis was employed as a means to explore the themes and patterns which emerged in narratives obtained through interviews and writings of six women who relapsed after more than 10 years abstinence and had been previously active in 12-step based recovery. Patterns expressed in the narratives suggested that an initially insufficient understanding or limited personal investment in the recovery process, as well as, undertreated co-occurring disorders were factors that facilitated a return to active addiction. These dynamics seemed to reduce resiliency and allowed the women to justify a pharmaceutical solution when intense life stressors manifested and the participant became isolated. Relapse is a reality that may benefit from re-conceptualization and for some can be an indispensable continuation of the recovery process. The experience of failure seemed necessary and though the experience was painful and perilous, each of the women reported that their recovery was ultimately strengthened from it. Key words: substance use disorders, relapse, women, long-term recovery, and individuation</p>

<p> Volunteerism has been relied upon by many organizations. Unfortunately, for communities that rely on volunteers to run a fire department, the rate of volunteering has declined significantly. Previous researchers have suggested that psychological burnout leads to a decrease in desirable behaviors, however, there has been no data examining burnout in volunteer firefighters. Researchers have suggested there are relationships between personality traits and volunteering behavior, as well as personal values and volunteering behavior. </p><p> The current study was designed to identify relationships between response rates to fire calls and personality traits, as well personal values. Also, the present study examined the efficacy of an Acceptance and Commitment Therapy (ACT) focused values intervention to increase the response rates of volunteer firefighters to fire calls as well as decrease burnout. Volunteers from multiple fire departments across Long Island, NY were recruited for participation (n = 40). Subjects completed a demographics questionnaire, the Portrait Values Questionnaire, the Big Five Inventory, and the Maslach Burnout Inventory-General Survey. Subjects participated in an activity aimed at clarifying their personal value of being a volunteer firefighter. The data were analyzed to determine the efficacy of the values intervention. </p><p> It was hypothesized that volunteers who participated in the values intervention would have an increase in response rate, as well as a decrease in burnout as measured by the Maslach Burnout Inventory. The researcher also investigated whether or not personality traits have a mediational effect on burnout and response rate. </p><p> Results demonstrated that following ACT-focused values intervention response rate to fire calls significantly increased and scores on the Cynicism and Exhaustion subscales of the Maslach Burnout Inventory significantly decreased. Also, results showed significant relationships between the personality traits of Extraversion, Agreeableness and Conscientiousness and response rates, however, failed to show a relationship between personal values and response rates. </p><p> Future research could examine the efficacy of a more comprehensive ACT intervention on response rates and burnout in various first responders. Future researchers might consider the development of a protocol to decrease burnout among first responders. Also, future research should examine the predictive ability of personality traits on first responder behavior.</p>

<p>Reflection of feeling (ROF), a component of empathy, has been widely theorized as a technique that can benefit clients and enhance the therapeutic relationship, but scant research has been conducted on it. The current study aimed to fill a gap in the literature by being the first to examine how often novice therapists utilized reflections of feeling in actual psychotherapy sessions with clients who experienced trauma. </p><p> A deductive and inductive qualitative content analysis was employed to investigate the use of ROF by four therapist-client pairs in 12 psychotherapy sessions at a university&rsquo;s community counseling clinics. For each therapist-client pair, three recorded sessions representing the beginning, middle, and end of treatment were selected, transcribed and analyzed. </p><p> Results indicated that the ROF technique was used infrequently (11.6%). When ROF was used, simple reflections were more prevalent than complex reflections, and were the most frequently coded reflection type (18 out of 31 ROF codes) in both trauma and non-trauma discussions. Inductive analyses revealed that the most common codes observed throughout psychotherapy sessions included acknowledgements (e.g., &ldquo;mm hmm;&rdquo; &ldquo;yeah&rdquo;; 50.56%) and follow-up questions (25.1%). </p><p> Future research regarding ROF in a naturalistic setting appears needed to study whether clients find this technique useful or not, how it impacts the therapeutic relationship, what training conditions enhance its use, and whether it differentially affects different populations (e.g., trauma and nontrauma survivors). Researchers who aim to study ROF could replicate and enhance the coding scheme developed in the present study. </p>

<p> Despite the momentum towards using EBTs in clinical practice, there are still significant barriers to implementing EBTs for children who have experienced maltreatment. Research has examined predictors of EBT utilization, such as clinician factors and attitudes toward EBTs, and the results are inconsistent. There is also no qualitative research on clinicians&rsquo; training in and utilization of EBTs and barriers to training in and utilization of EBTs. The present study used a mixed-methods approach to examine clinicians&rsquo; knowledge, training, and utilization of evidence-based treatments (EBTs) for child maltreatment in a national sample of 157 clinicians who provide psychotherapy to children and adolescents who have experienced maltreatment. Quantitative methods found that clinician factors (i.e., graduate training in EBTs, educational background, and theoretical orientation) did not predict EBT utilization. In addition, clinicians&rsquo; attitudes toward EBTs did not moderate the relationship between training in and utilization of EBTs. However, the number of EBTs clinicians received training in significantly predicted EBT utilization, even when statistically controlling for variability in attitudes toward EBTs. Qualitative methods examined clinicians&rsquo; barriers to training in and utilization of EBTs, as well as the solutions to the implementation of EBTs. The qualitative results suggest that a comprehensive response from agencies is needed to provide more opportunities for training in EBTs, as well as ongoing supervision and consultation. Specific solutions to the implementation of EBTs were also discussed. </p>