Counselling services as provided by non-professional counsellors have been in place for a number of decades. Counselling traumatised people demands a significant amount of emotional investment from the counsellor. A neglected area as far as non-professional counsellors in South Africa is concerned, is the well-being of the counsellors. Burnout as well as its antithesis, work engagement, are two possible transactional outcomes impacting on the well-being of these counsellors. The measurement of burnout and work engagement requires valid and reliable measuring instruments. The dearth of research studies in the area of burnout and work engagement, together with the unique contribution of non-professional counsellors in organisational settings, has led to the primary focus of this study being the exploration of the experience of this group of counsellors doing trauma counselling in financial institutions in South Africa. A lack of norms for the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), and the Utrecht Work Engagement Scale (UWES) for non-professional counsellors doing trauma counselling makes the identification of burnout and work engagement within this specialist environment difficult. Consequently, investigating the reliability and validity of the MBI-HSS and the UWES would result in the standardisation of these specific measuring instruments, therefore contributing to the identification of burnout and work engagement with non-professional trauma counsellors. Some of the factors that could play a role in the prevalence of burnout and work engagement are secondary traumatic stress, the demands of counselling, lack of resources, personal consequences, social support and sense of coherence. The objectives of this research were to standardise the MBI-HSS and UWES for non-professional counsellors as well as to develop and test a causal model of burnout and work engagement for this specialist group. The research method involved four separate articles, each consisting of a brief literature overview and an empirical study. A cross-sectional design, whereby a sample is drawn from a population at a particular point in time, was used. The data for this study was collected from 168 non-professional counsellors, employed by three of the major banks in South Africa. The MBI-HSS, UWES, Orientation to Life Questionnaire (OLQ) as well as a Self-Report Questionnaire (SRQ) and a biographical questionnaire were administered. Descriptive statistics, analysis of variance, correlations, canonical analysis, and structural equation modelling were used. Structural equation modelling confirmed a three-factor model of burnout (emotional exhaustion, depersonalisation and personal accomplishment). In contrast with research findings confirming the three-factor model of the UWES (vigour, dedication and absorption), a one-factor model for the UWES was confirmed for non-professional counsellors. The internal consistency of the scales for the MBI-HSS and UWES was found to be satisfactory and in line with reported findings in the literature. Structural equation analysis showed that the lack of resources and job demands predicted the core of burnout, namely emotional exhaustion and depersonalisation. The conflicts and pressures that are already associated with the everyday work of non-professional counsellors are likely to be magnified by the counselling role. Non-professional counsellors continually face conflicts created by the fact that they are accountable to large organisations, but professionally, ethically and morally devoted to their clients (the victims of trauma who are being counselled by them). They must balance the competing, and sometimes opposing demands of several parties such as trauma victims, employees, families and communities. To add to these circumstances it is important to remember that counselling is not the main job objective of the non-professional counsellors. Counselling is seen as an "add-on" to their job description and is in most instances not part of their performance measurement/assessment. Work engagement was related to low burnout scores, while personal accomplishment was associated with work engagement. High sense of coherence had a mediating effect on burnout and a positive effect on work engagement. This study seems to emphasise that job demands have a more negative effect on engagement when sense of coherence is low than when sense of coherence is high. Conversely, it is assumed that sense of coherence provides functions such as increased perception of coping capacity or minimised stress appraised, which decreases the effects of stress on an individual. Recommendations for the organisations and future research were made. / Thesis (Ph.D. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2004.

Counselling services as provided by non-professional counsellors have been in place for a number of decades. Counselling traumatised people demands a significant amount of emotional investment from the counsellor. A neglected area as far as non-professional counsellors in South Africa is concerned, is the well-being of the counsellors. Burnout as well as its antithesis, work engagement, are two possible transactional outcomes impacting on the well-being of these counsellors. The measurement of burnout and work engagement requires valid and reliable measuring instruments. The dearth of research studies in the area of burnout and work engagement, together with the unique contribution of non-professional counsellors in organisational settings, has led to the primary focus of this study being the exploration of the experience of this group of counsellors doing trauma counselling in financial institutions in South Africa. A lack of norms for the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), and the Utrecht Work Engagement Scale (UWES) for non-professional counsellors doing trauma counselling makes the identification of burnout and work engagement within this specialist environment difficult. Consequently, investigating the reliability and validity of the MBI-HSS and the UWES would result in the standardisation of these specific measuring instruments, therefore contributing to the identification of burnout and work engagement with non-professional trauma counsellors. Some of the factors that could play a role in the prevalence of burnout and work engagement are secondary traumatic stress, the demands of counselling, lack of resources, personal consequences, social support and sense of coherence. The objectives of this research were to standardise the MBI-HSS and UWES for non-professional counsellors as well as to develop and test a causal model of burnout and work engagement for this specialist group. The research method involved four separate articles, each consisting of a brief literature overview and an empirical study. A cross-sectional design, whereby a sample is drawn from a population at a particular point in time, was used. The data for this study was collected from 168 non-professional counsellors, employed by three of the major banks in South Africa. The MBI-HSS, UWES, Orientation to Life Questionnaire (OLQ) as well as a Self-Report Questionnaire (SRQ) and a biographical questionnaire were administered. Descriptive statistics, analysis of variance, correlations, canonical analysis, and structural equation modelling were used. Structural equation modelling confirmed a three-factor model of burnout (emotional exhaustion, depersonalisation and personal accomplishment). In contrast with research findings confirming the three-factor model of the UWES (vigour, dedication and absorption), a one-factor model for the UWES was confirmed for non-professional counsellors. The internal consistency of the scales for the MBI-HSS and UWES was found to be satisfactory and in line with reported findings in the literature. Structural equation analysis showed that the lack of resources and job demands predicted the core of burnout, namely emotional exhaustion and depersonalisation. The conflicts and pressures that are already associated with the everyday work of non-professional counsellors are likely to be magnified by the counselling role. Non-professional counsellors continually face conflicts created by the fact that they are accountable to large organisations, but professionally, ethically and morally devoted to their clients (the victims of trauma who are being counselled by them). They must balance the competing, and sometimes opposing demands of several parties such as trauma victims, employees, families and communities. To add to these circumstances it is important to remember that counselling is not the main job objective of the non-professional counsellors. Counselling is seen as an "add-on" to their job description and is in most instances not part of their performance measurement/assessment. Work engagement was related to low burnout scores, while personal accomplishment was associated with work engagement. High sense of coherence had a mediating effect on burnout and a positive effect on work engagement. This study seems to emphasise that job demands have a more negative effect on engagement when sense of coherence is low than when sense of coherence is high. Conversely, it is assumed that sense of coherence provides functions such as increased perception of coping capacity or minimised stress appraised, which decreases the effects of stress on an individual. Recommendations for the organisations and future research were made. / Thesis (Ph.D. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2004.

Thesis (Ph.D. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2010.

Thesis (Ph.D. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2010.

<p>The feeling of anxiety, a conscious experience, is associated with uneasiness, painfulness, or disturbing suspense. The current paper presents the phenomenology of anxiety disorders based on diagnostic criteria and reviews neuroimaging studies on anxiety including dissociation studies. Activity in the anterior cingulate cortex, medial prefrontal cortex, insula, temporal poles and amygdala suggest neural correlates of anxiety. The relevance of the neural correlates, how the feeling of anxiety differs from fear and worry, and the construct validity of anxiety are addressed. Anxiety and pain correlate with activity in the anterior cingulate cortex, which warrants further studies on the painfulness–anxiety relationship.</p>

Thesis (MComm (Industrial Psychology))--Stellenbosch University, 2009. / ENGLISH ABSTRACT: Organisations in open market economic systems aspire to optimally utilize the scarce resources at their disposal so as to maximize profits. To achieve this goal, the human resources function is tasked with the responsibility to acquire and maintain a competent and motivated workforce in a manner that would add value to the bottom-line. Selection thereby becomes a critical human resources management intervention in any organisation in as far as it regulates human capital movement into and through the organisation. To be able to make informed selection decisions, industrial-organisational psychologists and human resources practitioners need valid and reliable information on predictor constructs to allow them to make accurate predictions of the criterion construct. This provides the essential justification for the primary objective of this study which was to undertake a factor analytic investigation of the first-order factor structure of the Fifteen Factor Questionnaire Plus (15FQ+) on a sample of Black South African managers. The data used in this study was drawn from the database of Psymetric (Pty) Ltd with the permission of Psytech SA. The sample comprised 241 Black managers assessed by Psymetric (Pty) Ltd between 2002 and 2006. Item- and dimensionality analyses were performed on the 15FQ+ subscales to assess the success with which they represented the underlying personality constructs. The outcome of both the item and dimensionality analyses showed that although the items in each of the subscales seemed to be representing the underlying personality construct, they were not without problems. A spectrum of goodness-of-fit statistics was used to assess the measurement model fit. The model‟s overall fit was found to be good. The model parameter estimates, however, gave some reason for concern. The results of the confirmatory factor analyses suggest that the claim made by the 15FQ+ authors that the items included in each subscale reflect specific personality dimensions is tenable. The magnitude of the estimated model parameters, however, suggests that the items generally do not reflect the latent personality dimensions they were designated to reflect with a great degree of success. The items are reasonably noisy measures of the latent variables they represent. Based on these findings, this instrument should be used with caution, particularly on groups different from the UK samples on which it was originally developed and standardised. This study expands our understanding of this measure. Its findings should guide future research on a larger, more representative sample from the same target population to give credence to, or to refute these findings. / AFRIKAANSE OPSOMMING: Organisasies in „n vrye-mark ekonomiese stelsel streef daarna om die skaars hulpbronne tot hul beskikking optimal aan te wend ten einde wins te maksimeer. Om hierdie doel te bereik word die menslike hulpbronfunksie getaak met die verantwoordelikheid om ‟n bevoegde en gemotiveerde werksmag te verkry en in stand te hou op ‟n wyse wat waarde tot die onderneming voeg. Keuring word daardeur ‟n kritieke menslike hulpbronintervensie in enige organisasie in so verre dit die beweging van menskapitaal in en deur die organisasie reguleer. Ten einde ingeligte keuringsbesluite te kan neem, benodig bedryfsielkundiges en menslike hulpbronpraktisyns betroubare en geldige inligting oor voorspellerkonstrukte om hul in staat te stel om akkurate voorspellings van die kriteriumkonstruk te maak. Dit bied wesenlik die regverdiging vir die primêre oogmerk van hierdie studie, naamlik om „n faktoranalitiese ondersoek van die eerste-orde faktorstruktuur van die Fifteen Factor Questionnaire Plus (15FQ+) op „n steekproef swart Suid Afrikaanse bestuurders te onderneem. Die data wat in die studie gebruik is, is verkry uit die databasis van Psymetric (Pty) Ltd met die toestemming van Psytech SA. Die steekproef het bestaan uit 241 swart bestuurders wat tussen 2002 en 2006 deur Psymetric (Pty) Ltd getoets is. Item- en dimensionaliteitontledings is op die 15FQ+ subskale uitgevoer ten einde die sukses vas te stel waarmee hul die onderliggende persoonlikheidskonstrukte verteenwoordig. Die resultate van beide die item- en die dimensionaliteitontledings het aangedui dat ofskoon die items van elke subskaal die onderliggende persoonlikheidskonstruk skyn te verteenwoordig, was hulle nogtans nie sonder probleme nie. ‟n Spektrum passingsmaatstawwe is gebruik om die pasgehalte van die metingsmodel te beoordeel. Die model se algehele passing was goed. Die skattings van die model parameters het egter wel rede tot kommer gegee. Die resultate van die bevestigende faktorontleding dui daarop dat die aanspraak van die ontwikkelaars van die 15FQ+ dat die items wat in elke subskaal ingesluit is spesifieke persoonlikheidsdimensies reflekteer, wel houbaar is. Die grootte-orde van die geskatte modelparameters dui egter daarop dat die items oor die algemeen nie die persoonlikheidsdimensies wat hul ontwerp is om te reflekteer met groot sukses reflekteer nie. Die items is redelik raserige metings van die latente veranderlikes wat hul verteenwoordig. Gebaseer op hierdie bevindinge behoort hierdie instrument met omsigtigheid gebruik te word, veral op groepe wat verskil van die VK steekproewe waarop die instrument ontwikkel en gestandaardiseer is. Die study dra by tot ons begrip van die instrument. Die bevindinge van die studie behoort toekomstige navorsingop 'n groter, meer verteenwoordigende steekproef uit dieselfde teikenpopulasie te rig ten einde die onderhawige bevindinge te steun of te weerlê.

Thesis (MComm (Industrial Psychology))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The choice of career path could create a stressful situation for many individuals. Researchers seem to agree that if a person is able to find fit between what they would like to do and what a job (work environment) involves then a person is likely to perform their chosen occupation well. Interest assessment is a method that assists in making personal and organisational career related decisions. The Campbell Interest and Skill Survey (CISS, Campbell, Hyne & Nilsen, 1992) is a well-known interest assessment instrument that can be used for such decisions. Even though interest assessment can assist, these instruments have been criticised for being gender biased and typically forcing people into stereotypical gendered type occupations. Bias is indicated as nuisance factors that threaten the validity of cross-group (cultural) comparisons (Van de Vijver & Leung, 1997). These nuisance factors could be due to construct bias, method bias and/or item bias. Therefore, due to the importance of the decisions made, it would seem essential that the information provided by test results apply equally across different reference groups – this would imply equivalent measurement. Equivalence is achieved at three levels: Configural, metric and scalar (Vandenberg & Lance, 2000; Vandenberg, 2002). Full measurement invariance (achieved when scalar invariance is found) implies the ability to compare observed scores directly. By making use of confirmatory factor analytic techniques suggested by Vandenberg and Lance (2000), increasing constraints of equivalence were proposed for the CISS measurement model. While adequate model fit was found for the CISS Basic scales, the sample size did not afford independent gender sample confirmatory factor analyses (CFAs) and consequent measurement invariance tests to be conducted on the Basic scales. The CISS Orientation scales were then subjected to CFA on the combined gender sample and then were subjected to independent CFAs on the separate gender samples. Unfortunately poor model fit was found at this global level of measurement in the CISS. This prevented the researcher from completing the necessary measurement invariance tests on the Orientation scales for the CISS. The implications of the results are discussed, limitations are indicated and areas for further research are highlighted. / AFRIKAANSE OPSOMMING: Die maak van ‘n loopbaankeuse kan spanning veroorsaak in baie mense. Dit wil voorkom of navorsers saamstem dat indien ‘n person se werklike beroep ooreenstem met dit wat hy/sy graag sou wou doen – dan sal die persoon waarskynlik goed presteer in die gekose beroep. Die benutting van belangstellingsvraelyste kan individue help om effektiewe persoonlike en beroepsgerigte keuses te maak. Die “Campbell Interest and Skill Survey” (CISS, Campbell, Hyne & Nilsen, 1992) is ‘n bekende belangstellingsvraelys wat gebruik kan word om ondersteuning te bied om bogenoemde keuses te maak. Alhoewel belangstellingsvraelyste oor die algemeen waardevolle hulpbronne is in die maak van beroepskeuses, is hierdie vraelyste al gekritiseer dat hulle sydig kan wees op grond van geslag en as sulks mense kan lei om geslagsgetipeerde beroepskeuses te maak. “Sydigheid” in toetse kan beskryf word as “lastige” faktore wat die geldigheid van kruiskulturele vergelykings bedreig (Van de Vijver & Leung, 1997). Hierdie faktore kan veroorsaak word deur konstruksydigheid, metodesydigheid en/of itemsydigheid. Dit is dus noodsaaklik dat die informasie wat verskaf word deur die toetsresultate dieselfde betekenis moet hê oor al die verskillende verwysingsgroepe en dit noodsaak ekwivalente meting. Ekwivalensie kan bereik word op drie vlakke: konfiguraal, metries en skalêr (Vandenberg & Lance, 2000; Vandenberg, 2002). Volle invariansie van meting (wat bereik word wanneer skalêre invariansie bevind word) impliseer dat waargenome metings direk met mekaar vergelyk kan word. Deur gebruik te maak van bevestigende faktoranalitiese tegnieke voorgestel deur Vandenberg en Lance (2000), is toenemende ekwivalensiebeperkinge voorgestel vir die “CISS” metingsmodel. Alhoewel ’n bevredigende passing gevind is vir die “CISS Basic scales” model, het die grootte van die steekproef nie toegelaat dat die “CISS Basic scales” model onafhanklik op die twee geslagsgroepe gepas word nie en ook nie toegelaat dat die metingsinvariansie van die model oor die twee geslagsgroepe ondersoek word nie. Die “CISS Orientation scales” is toe blootgestel aan bevestigende faktorontleding op die gekombineerde geslagsteekproef en asook op die onderskeie geslagsgroepe. Op hierdie globale vlak kon daar egter nie bevredigende modelpassing gevind word nie. Die gebrekkige modelpassing het gevolglik die navorser verhoed om enige verdere metingsvariansie toetse op die “Orientation scales” te doen. Die implikasies van die resultate word bespreek, beperkinge word aangedui en verdere moonlike navorsingsgebiede word uitgelig.

Introdução: O conceito de contratransferência evoluiu de “um obstáculo ao tratamento” à ferramenta útil à compreensão do paciente dentro de uma relação bi-pessoal. Atualmente, buscam-se evidências da sua especificidade, correlacionando padrões específicos de contratransferência com características do paciente e terapeuta, classes diagnósticas e desfechos do tratamento. Acredita-se que, devido à intensidade das reações emocionais despertadas nos terapeutas que atendem vítimas de trauma, o estudo da contratransferência nesta população auxilie no autoconhecimento dos terapeutas, amplie a compreensão sobre o fenômeno e contribua para um melhor atendimento dos pacientes. O desenvolvimento de pesquisas nesta área esbarra no reduzido número de escalas validadas para acessar a contratransferência. No Brasil, estão disponíveis a escala para Avaliação da Contratransferência e as versões traduzidas do Inventory of Countertransference Behavior e Mental States Rating System, mas nenhuma validada.A Escala para a Avaliação da Contratransferência (EACT) foi criada em nosso meio, com elevada validade de face, construída em torno de três dimensões conceituais de sentimentos. Entretanto, suas propriedades psicométricas ainda não foram avaliadas. Objetivos: Investigara validade de construto da EACT, respondida por terapeutas de vítimas de trauma psíquico (Artigo 1). Secundariamente, analisar a correlação entre a contratransferência inicial com vítimas de trauma psíquico e os dados demográficos e clínicos de terapeutas e pacientes e o tipo de trauma, e investigar a associação entre a contratransferência inicial e a adesão dos pacientes ao tratamento e o seu desfecho, operacionalizado como alta ou abandono (Artigo 2). Método: Delineamento transversal (Artigo 1) e análises secundárias com dados longitudinais (Artigo 2). A amostra foi composta por 50 psiquiatras no segundo ano de formação durante estágio no Núcleo de Estudos e Tratamento de Trauma Psíquico do Hospital de Clínicas de Porto Alegre, Brasil. Esses terapeutas atenderam 131 pacientes recrutados consecutivamente durante 4 anos, que incluiu a primeira ou segunda consulta de vítimas de abuso sexual, seqüestro, assalto, agressão física, tentativa de homicídio, tortura e trauma indireto, independentemente do tempo decorrido entre a consulta atual e o evento traumático. Foram excluídos atendimentos de pacientes que chegaram à primeira consulta com ideação suicida grave, sintomas psicóticos e/ou com indicação de internação psiquiátrica. Os pacientes foram selecionados após triagem, que avaliou as variáveis clínicas e o diagnóstico segundo os critérios do DSM-IV-TR. Na primeira consulta, foram coletados os dados demográficos e clínicos e avaliada a contratransferência identificada pelo terapeuta através da EACT. Os pacientes foram acompanhados ao longo do tratamento psiquiátrico para determinar o número de consultas, faltas e o desfecho: alta ou abandono. A EACT é uma escala auto-aplicável, composta por 23 itens pontuados para 3 momentos da sessão (início, durante e final) em escala tipo Likert (0=ausência a 3=muito), e distribuídos em 3 domínios: aproximação (10 itens), afastamento (10 itens) e indiferença (3 itens). A validade de constructo da EACT no atendimento desta população foi avaliada através da análise fatorial exploratória (EFA) e consistência interna (α de Cronbach). O tamanho amostral foi calculado a partir de pelo menos 5 aplicações da EACT para cada item da escala (mínimo N = 115). E a análise fatorial confirmatória foi usada para determinar os parâmetros de adequação (goodness-of-fit) da versão da EACT no atendimento de vítimas de trauma obtida na EFA em comparação com a versão original. Resultados: A EFA mostrou 3 fatores com homogeneidade consistente, sendo distinta da versão original da EACT a correlação entre os itens e o terceiro fator: afastamento (9 itens com 24% da variância; α = 0,88), aproximação (7 itens com 15% da variância; α=0,82) e tristeza (6 itens com 9% da variância; α = 0,72). O item alegria, com carga fatorial baixa, foi retirado da análise por ser considerado irrelevante neste contexto. A análise fatorial confirmatória evidenciou melhores critérios de goodness-of-fit em todos os parâmetros testados para a presente versão da EACT do que a original. Secundariamente, as características demográficas e clínicas dos terapeutas e dos pacientes dos grupos alta e abandono foram similares. Os terapeutas com idade ≤ 27 anos pontuaram maior afastamento que os mais velhos (0,14 ± 1 vs. -0,21 ± 0,9; P=0,019). Os pacientes casados induziram nos terapeutas mais sentimentos de afastamento (0,20 ±1 vs. -0,19 ± 0,9; P = 0,016) e tristeza (0,18 ±1 vs. -0,17 ± 1; P = 0,049) que os que vivem sozinhos. Nas variáveis clínicas, as vítimas de trauma indireto e de múltiplos traumas despertaram mais tristeza (0,38 ± 1 e 0,76 ± 0,4, respectivamente), comparadas às vítimas de violência sexual (0,03 ± 0,9) e urbana (-0,3 ± 1) (P = 0,039). A mediana de consultas realizadas foi 5 [4; 8], faltas 1 [0; 1] e a taxa de abandono foi de 34,4%. Na análise multivariada, identificou-se que os pacientes com relato de história de trauma na infância abandonaram menos o tratamento (OR = 0,39; P = 0,039; CI 95% 0,16- 0,95). Não foi detectada associação entre sentimentos contratransferenciais iniciais com os desfechos do tratamento. Conclusões: A EACT apresentou propriedades psicométricas consistentes, demonstrando ser um instrumento confiável para acessara contratransferência inicial de terapeutas de vítimas de trauma psíquico. Os sentimentos contratransferenciais no atendimento inicial destes pacientes associaram-se a parâmetros demográficos e clínicos, mas não se associaram ao abandono do tratamento. Estudos futuros devem avaliar a modificação dos sentimentos contratransferenciais ao longo do tratamento e o seu impacto sobre os desfechos do tratamento. / Introduction: The concept of countertransference (CT) evolved from an “obstacle to treatment” to "an useful tool to understand patients within a bi-personal relationship". Currently, evidences of its specificity are searched for, correlating specific CT patterns to patients and therapists’ features, diagnostic classes, and treatment outcomes. Due to the intensity of emotional reactions aroused in therapists caring for trauma victims, it is believed that the study of CT in this population will help self-knowledge of therapists and contribute for a better patient care. The development of studies in this field is hindered by the reduced number of validated scales to assess CT. In Brazil, the Assessment of Countertransference Scale and the translated versions of the Inventory of Countertransference Behavior and Mental States Rating System are available, however, none of them has been validated. The Assessment of Countertransference Scale (ACS) has been created in our department with high face validity, built around three conceptual dimensions of feelings. However, its psychometric properties have not been assessed yet. Objectives: To investigate the construct validity of the ACS answered by therapists of psychological trauma victims (Article 1). Then, to assess the correlation between initial CT with victims of psychological trauma and the clinical and demographic data of therapists and patients and the type of trauma, and to investigate the association between initial countertransference and patients’ adherence to treatment and its outcome, defined as discharge or drop-out (Article 2). Methods: A Cross-sectional study (Article 1) and secondary analysis with longitudinal data (Article 2) were carried out. The sample was formed by 50 psychiatrists in the second year of training in their internship in the Center for Study and Treatment of Traumatic Stress in Hospital de Clínicas de Porto Alegre, Brazil. These therapists cared for 131 patients consecutively recruited for 4 years, including the first and second appointment with victims of sexual abuse, kidnapping, robbery, physical assault, homicide attempt, torture and indirect trauma, regardless of the time elapsed between the current appointment and the trauma event. We have excluded patients that arrived in the first appointment with severe suicidal ideation, psychotic symptoms and/or referral for psychiatric hospitalization. Patients have been selected after screening, which assessed the clinical variables and the diagnoses according to DSM-IV-TR criteria. In the first appointment, demographic and clinical data were collected and CT, identified by therapists through the ACS, was assessed. Patients were followed-up during psychiatric treatment to determine the number of appointments, absences, and the outcome: discharge or drop-out. ACS is a self-applied scale composed by 23 items scored for 3 moments of the session (start, midpoint and end) in a Likert-type scale (0=absence to 3=very), and distributed into 3 dimensions: closeness (10 items), distance (10 items) and indifference (3 items). The construct validity of ACS in the care for this population was assessed through the Exploratory Factor Analysis (EFA) and the internal consistency (α de Cronbach). The sample size was calculated for at least 5 applications of ACS for each item of the scale (minimum N = 115). The Confirmatory Factor Analysis (CFA) was used to determine the goodness of fit parameters of the ACS version in the care for trauma victims obtained in the EFA compared to the original version. Results: EFA showed 3 factors with consistent homogeneity, but the correlation between the items and the third factor were different from the original version, in the following: rejection (9 items with 24% of variance; α = 0.88), closeness (7 items with 15% of variance; α = 0.82) and sadness (6 items with 9% of variance; α = 0.72). The item “happiness”, with low factorial load, was withdrawn from the analysis because it was considered to be irrelevant in this context. CFA showed better goodness of fit criteria in all tested parameters for the present version of ACS compared to the original version. Secondly, the demographic and clinical characteristics of therapists and patients of the discharge and drop-out groups were similar. Therapists with ages ≤ 27 years scored more rejection than older therapists (0.14 ± 1 vs. -0.21 ± 0.9; P = 0.019). Married patients induced in therapists more feelings of rejection (0.20 ± 1 vs. -0.19 ± 0.9; P = 0.016) and sadness (0.18 ± 1 vs. -0.17 ± 1; P = 0.049) than those patients living alone. In the clinical variables, the victims of indirect trauma and of several traumas aroused more feelings of sadness (0.38 ± 1 and 0.76 ± 0.4, respectively) compared to sexual violence (0.03 ± 0.9) and urban violence victims (-0.3 ± 1) (P = 0.039). Median of appointments performed was 5 [4; 8], absences 1 [0; 1] and the drop-out rate was 34.4%. In the multivariate analysis, we have identified that patients with reported history of childhood trauma were less likelihood of dropping out treatment (OR=0.39; P = 0.039; CI 95% 0.16-0.95). Association between the initial CT feelings and the treatment outcomes has not been detected. Conclusions: ACS presented sound psychometric properties, and it has been demonstrated to be a reliable instrument to access initial CT of therapists in victims of psychological trauma. Countertransference feelings in the initial care of patients were associated with clinical and demographic parameters, but it were not associated with treatment drop-out. Further studies should assess the changes in CT feelings over treatment and their impact on treatment outcomes.

xi, 108 p. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Micro-level survey data are widely used in applied economic research. This dissertation, which consists of three empirical papers, demonstrates challenges in empirical research using micro-level survey data, as well as some methods to accommodate these problems. Chapter II examines the effect of China's recent public health insurance reform on health utilization and health status. Chinese policy makers have been eager to identify how this reform, characterized by a substantial increase in out-of-pocket costs, has affected health care demand and health status. However, due to self-selection of individuals into the publicly insured group, the impact of the reform remains an unresolved issue. I employ a Heckman selection model in the context of difference-in-difference regression to accommodate the selection problem, and provide the first solid empirical evidence that the recent public health insurance reforms in China adversely affected both health care access and health status for publicly insured individuals. Chapter III examines the construct validity of a stated preference (SP) survey concerning climate change policy. Due to the fact that the SP survey method remains a controversial tool for benefit-cost analysis, every part of the survey deserves thorough examination to ensure the quality of the data. Using a random utility approach, I establish that there is a great deal of logical consistency between people's professed attitudes toward different payment vehicles and their subsequent choices among policies which vary in the incidence of their costs. Chapter IV employs the same survey data used in Chapter III, but demonstrates the potential for order effects stemming from prior attitude-elicitation questions. In addition, it considers the potential impact of these order effects on Willingness to Pay (WTP) estimates for climate change mitigation. I find the orderings of prior elicitation questions may change people's opinions toward various attributes of the different policies, and thereby increase or decrease their WTP by a substantial amount. Thus, this chapter emphasizes the significance of order effects in prior elicitation questions, and supports a call for diligence in using randomly ordered prior elicitation questions in stated preference surveys, to minimize inadvertent effects from any single arbitrary ordering. / Adviser: Trudy Ann Cameron

Made available in DSpace on 2011-05-04T12:36:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / Estudos sobre a importância de rede e apoio social nos desfechos em saúde têm sido desenvolvidos nos últimos 30 anos. Rede social é definida como o grupo de pessoas com as quais o indivíduo mantém contato ou alguma forma de vínculo social. Apoio social refere-se à funcionalidade da rede social (apoio emocional, apoio material entre outros). O presente estudo dá continuidade à avaliação das propriedades psicométricas da escala de apoio social utilizada em um estudo de coorte de trabalhadores de uma universidade pública no Rio de Janeiro - Estudo Pró-Saúde por meio da avaliação de sua validade de constructo através da análise fatorial confirmatória. Essa investigação baseia-se nos dados de 4030 participantes obtidos na primeira fase desse estudo (1999), onde um questionário multidimensional foi utilizado. Nesse foi incluída a escala de apoio social elaborada para o Medical Outcomes Study (MOS), que foi adaptada para o português, no âmbito do estudo. Foi realizada a análise fatorial confirmatória com o intuito de avaliar os modelos com três, quatro e cinco fatores quanto ao ajuste, validade convergente e validade discriminante. (...) / Studies about the importance of social support on health outcomes have been developed since 30 years. Social network is defined as a group of people which a person has contact with or any kind of social connections. Social support is related to the functionality of the social network. The present study continues the psychometric testing of the social support scale, used in a cohort of public university servents of Rio de Janeiro - Pró-Saúde Study – through evaluation of the construct validity using the confirmatory factor analysis. This investigation was based on information about 4030 participants in the first stage of the study (1999), which a multidimensional instrument was used. In this study, it was included the social support scale of the Medical Outcomes Study (MOS), which was adapted to Portuguese, in the study‟s environment. The confirmatory factor analysis was used to test the three, four and five factors models adjustment, the convergent and discriminant validity. The estimation method used was the WLSMV (robust weighted least squares) recommended to models with multivariate non-normal distributed indicators which is the case of the categorical indicators of the MOS social support scale. The fit indices used were the CFI (comparative fit index), the TLI (Tucker Lewis index), the RMSEA (root mean square error of approximation), the χ² statistic, and the WRMR ((weighted root mean square residual). The statistic program used was the Mplus. The four factor model was the one which presents the best goodness-of-fit measures (CFI=0,897; TLI=0,987). However, the residuals were high (RMSEA=0,131; WRMR=3,727), indicating a poor adjust. The convergent validity was good, presenting values above 0,50 of extracted variance and values above 0,70 of composed reliability in all dimensions. Only the material dimension presented good discriminant validity. In conclusion, nevertheless the four factor model presented some vantages compared with the other models, it is necessary implement changes to improve the adjust of the model. This modifications are related to itens exclusion, and not only about the dimentions addiction, which is suggested through insufficient results of the discriminant validity of that model - highly correlations in the “information” and “emotional‟ dimensions. A scale with a smaller numbers of itens should improve the measurements of social support and bring news conclusions in the investigations about the importance of social support in the social determinants and wellness.