No description available.

No description available.

No description available.

Introduktion: I ambulansen sker ett dyadiskt teamarbete, där två personer, varav minst en sjuksköterska, arbetar tillsammans. Ett effektivt och välfungerande teamarbete har visat sig främja personalens hälsa och trygghet samt öka patientsäkerheten, medan hinder i teamarbetet kan skapa ineffektivitet och öka risken för misstag. Syfte: Specialistsjuksköterskors upplevelser av dyadiskt teamarbete i prehospital miljö. Metod: Studien har en kvalitativ design med induktiv ansats. Åtta specialistsjuksköterskor, arbetande på akutambulans i Sverige, intervjuades via semistrukturerade intervjuer. Kvalitativ manifest innehållsanalys valdes som analysmetod. Resultat: Analysen resulterade i fyra kategorier; vikten av öppenhet och trygghet, känslor av ensamhet och otrygghet, kommunikationens betydelse samt kompetens och erfarenhet påverkar samarbetet. Resultatet visade att specialistsjuksköterskorna upplevde att tillit inom teamet var avgörande för teamarbetet, där tryggheten i samspelet med kollegan bidrog till både lust och säkerhet i arbetet. Vid bristande tillit i teamarbetet kunde känslor av ensamhet och otrygghet uppstå vilket kunde ge osäkerhet i arbetet. Kommunikationen i teamet var viktigt för att kunna sköta sitt jobb och vid tydlig kommunikation minskade risken för missförstånd. Specialistsjuksköterskorna beskrev att erfarenhet och kompetens var en stark orsak till trygghet i teamarbetet. Slutsats: En slutsats utifrån studiens resultat är att det är viktigt att det dyadiska teamet i ambulansen är tillitsfullt och har en öppen karaktär. Att man vågar lita på varandra i teamet och att man har en gemensam bild av det arbete som skall genomföras. Att arbetet i ambulansen både blir roligare och säkrare om man har en bra kommunikation och försöker skapa en atmosfär som är tillåtande och utvecklande. Ett teamarbete med bristande tillit leder till osäkerhet, tvivel och ökar risken för missförstånd. Det behövs ytterligare studier för att utveckla metoder för att stärka den psykosociala arbetsmiljön men även för att undersöka teamarbetets påverkan på patientsäkerheten.

Chronic illness and invisible disability are impactful contexts during emerging adulthood and the launching stage of the family life cycle (Beatty, 2011; Capelle, Visser, and Vosman, 2016; Young et al., 2010). The parent-child relationship is important to both developmental and health outcomes in families coping with chronic illness during emerging adulthood (Crandell, Sandelowski, Leeman, Haville, and Knafle, 2018; Fenton, Ferries, Ko, Javalkar, and Hooper, 2015; Waldboth, Patch, Mahrer-Imhaf, and Metcalfe, 2016). While informed clinical competency in counseling families experiencing disablement is a diversity-affirmative ethical imperative among psychotherapists (Mona et al., 2017), little is known in family therapy about how parents and emerging adult children experience launching with chronic illness. This qualitative study explored the parent-child dyadic experience of living with a chronic illness called Postural Orthostatic Tachycardia Syndrome (POTS) during emerging adulthood. Seven dyads of parents and their emerging adult children with POTS were interviewed. Data analysis of in-depth interviews using Moustakas's (1994) transcendental phenomenology uncovered eight thematic clusters of meaning in the shared lived experience of POTS at the launching stage of the family life cycle. Clinical implications for family therapists were explored using Rolland's family system-illness (FSI) model of medical family therapy. Study limitations and future directions for further research were discussed. / Master of Science / More and more young adults are living with chronic illness. Postural Orthostatic Tachycardia Syndrome (POTS) is a little-known chronic illness that tends to begin during adolescence. Like many health problems that disproportionately affect women, POTS is often overlooked by doctors. POTS symptoms, such as dizziness and cognitive difficulty, impact a person's ability to engage in preferred activities and identities. Family therapists can play an impactful role in supporting parents and children with POTS through developmental tasks related to launching an emerging adult in the context of this complex and widely misunderstood chronic illness. This thesis presented the first qualitative study of parent-child dyadic experiences living with POTS. Clinical implications for medical family therapy were highlighted. To construct an interview framework, Rolland's Family Systems-Illness (FSI) clinical model for helping families cope with illness and disability was used in conjunction with Arnett's description of emerging adulthood as a developmental stage in life. Seven parent-child dyads were interviewed for 1-2 hours in fourteen separate interviews generating transcripts about 140,000 words long in total. Analysis of these interviews identified shared themes composing the essence of the parent-child experience living with POTS during emerging adulthood. Results were described through tables and narratives. Clinical implications for family therapists working with parents and children with POTS during emerging adulthood were proposed. Limitations and ideas for future studies were discussed.

Self-enhancement is a process by which individuals misperceive themselves by viewing themselves in a positively biased manner. Past research indicates that self-enhancement can have both positive and negative effects on romantic relationships. The purpose of this dissertation was to explore the role of self-enhancement in unmarried dating couples (N = 124 couples; 248 individuals) with respect to conflict, dyadic adjustment, causal and responsibility attributions, and possible moderators between self-enhancement and dyadic adjustment. The results are organized in four sections. First, I found a curvilinear relationship between participant self-enhancement and conflict. At very low and very high levels of self-enhancement there were increased levels of conflict. Second, participant self-enhancement was positively associated with positively associated with increased participant dyadic adjustment, but there was no relationship between participant self-enhancement and partner dyadic adjustment. Third, there was no relationship between participant self-enhancement and causal and responsibility attributions. Fourth, forgiveness and commitment did not moderate the relationship between self-enhancement and dyadic adjustment; however, there were main effects for both forgiveness and commitment - both forgiveness and commitment were positively associated with dyadic adjustment. I conclude by discussing limitations, areas of future research, and implications for counseling.

While previous studies have demonstrated significant associations between partners' emotion regulation and overall well-being, few studies provide knowledge on emotion regulation in clinical couples, especially across couple therapy sessions. With 168 heterosexual couples who attended at least the initial eight sessions of couple therapy, the current study was designed to examine the intra- and inter-personal effects of emotion regulation difficulties (i.e., lack of awareness, nonacceptance, limited strategies, and impulsivity) on the development of relationship quality over the course of couple therapy. The results of the current study provide a few important findings. First, gender differences exist in emotion regulation and relationship quality. Second, across couple therapy sessions, relationship quality improves and partners change at a similar rate. Third, emotion regulation difficulties have intra- and inter-personal effects on the starting scores and rates of change of relationship quality in the process of couple therapy. For clinical implications of findings, I specifically discussed that clinicians working with couples may find it beneficial to utilize couple therapy modalities with a specific emphasis on the emotion regulation process, such as Greenberg's version of emotionally focused couple therapy. The need for future studies with more diverse samples was also discussed.

People spend substantial parts of their life in a close dyadic relationship. The results range from the fulfillment of emotional, intellectual, social and physical needs, to physical and emotional abuse. The study clarifies the association between sex-role identity type, with its two traits (masculinity and femininity), and relationship satisfaction, at the dyadic level. The latter implies a focus on the identical (or different) levels of presence of the two constructs among partners in couples. Extraneous factors and personal (non-dyadic) effects are covered in addition. The two main variables are evaluated with the Bem Sex Role Inventory (BSRI) and Spanier's Dyadic Adjustment Scale (DAS). In each case, a second instrument was administered for validation. The survey-type study followed a correlational, cross-sectional design. The main purposes have been to test new theoretical frameworks against empirical data, and knowledge production. A three-pronged approach included: an extensive literature review to identify methodological and knowledge gaps; a theory-driven design and methodology to ensure a sound study; and empirical data collection to verify the theoretical position through hypothesis testing. Likely sources of bias were countered by involving balanced numbers of male and female, and homosexual and heterosexual respondents, from non-student populations, over a wide age range, and living in close relationships spanning at least two years. The correlational design and relatively small sub-samples dictated the application of descriptive frequencies, and chi-square, variance (ANOVA) and regression analyses, as statistical techniques. The findings emerged as more similar than different for homosexual and heterosexual participants. This implies that homosexuals are not a deviant group, but equally able to achieve happiness. Congruent (identical) sex-role identity traits between partners were not strong(est) in predicting satisfaction. However, femininity and androgyny, as highest adaptive type, and identical sex-role identity types between partners did. As a result, the initial sex-role identity congruence theory has been modified into the adaptive femininity trait theory. Married heterosexual women face a predicament. While for them an undifferentiated sex-role identity type correlates with their husbands' happiness, and their own unhappiness, the inverse applies to their femininity and androgyny. The practical implications of this and other conclusions are also detailed. / Psychology / D. Litt et Phil (Psychology)

L’objectif général de cette thèse est d’examiner le lien entre l’attachement amoureux des conjoints, la satisfaction conjugale, le mandat thérapeutique et le résultat de la thérapie conjugale telle que conduite en milieu naturel. Afin d’atteindre cet objectif, des couples se présentant en thérapie conjugale ont d’abord complété une batterie de questionnaires comprenant l’Échelle d’ajustement dyadique (Spanier, 1976) et le Questionnaire sur les expériences d’attachement amoureux (Brennan, Clark, & Shaver, 1998). Les thérapeutes ont par la suite indiqué le mandat thérapeutique poursuivi avec chaque couple (réconciliation ou résolution de l’ambivalence), suivant la classification de Poitras-Wright et St-Père (2004). À la fin de la consultation, le jugement du thérapeute a été utilisé pour classer chacun des cas comme ayant abandonné ou complété le traitement. Les couples ayant complété la thérapie ont rempli l’Échelle d’ajustement dyadique au post-traitement. Dans le premier des articles composant cette thèse, le lien entre l’attachement amoureux et la satisfaction conjugale a été examiné auprès d’un échantillon de 172 couples en détresse débutant une thérapie conjugale, de même qu’auprès de 56 couples non en détresse débutant également une thérapie conjugale, pour fins de comparaison. Les résultats ont démontré que l’évitement de la proximité semble être une caractéristique distinctive des couples en détresse et que cette dimension de l’attachement est fortement liée à l’insatisfaction conjugale de ce même groupe. Dans le deuxième article, le mandat thérapeutique, l’attachement amoureux et la satisfaction conjugale ont été examinés en tant que prédicteurs de l’abandon de la thérapie conjugale, auprès de 141 couples. Les résultats ont notamment démontré qu’un mandat de résolution de l’ambivalence augmente les probabilités d’abandon de la thérapie conjugale. De plus, les prédicteurs du résultat de la thérapie ont également été examinés dans ce second article. Les résultats obtenus au moyen d’analyses acteur-partenaire ont démontré que la satisfaction conjugale pré-traitement apparaît comme le meilleur prédicteur de la satisfaction conjugale post-traitement, et ce, malgré l’inclusion de l’attachement amoureux parmi les variables investiguées. Considérés dans leur ensemble, les résultats de cette thèse suggèrent que l’insécurité d’attachement serait fortement associée à l’insatisfaction des couples en détresse, mais ne nuirait pas pour autant à l’obtention d’un résultat positif en thérapie conjugale. En somme, cette thèse contribue à l’avancement des connaissances en se penchant sur l’utilité de la théorie de l’attachement en thérapie conjugale et en soulignant la nécessité de tenir compte des mandats thérapeutiques dans les futures études en thérapie conjugale. Les implications cliniques des résultats et des recommandations pour la recherche clinique sont présentées dans la conclusion de l’ouvrage. / The aim of this thesis was to elucidate the link between adult romantic attachment, relationship satisfaction, therapeutic mandates and couple therapy outcome. Couples seeking therapy in a natural setting completed the Dyadic Adjustment Scale (Spanier, 1976) and the Experiences in Close Relationships Questionnaire (Brennan, Clark, & Shaver, 1998) at intake. Therapists classified the therapeutic mandate pursued in each case (i.e., alleviation of couple distress or ambivalence resolution) according to the Classification of Therapeutic Mandates Questionnaire (Poitras-Wright & St-Père, 2004). When treatment ceased, couples were classified as dropouts or completers according to therapists’ judgment, and completers were further assessed using the Dyadic Adjustment Scale. In the first of two articles, the association between adult romantic attachment and pre-treatment marital satisfaction was investigated in a sample of 172 distressed couples seeking therapy, as well as in a comparison sample of 56 nondistressed couples seeking therapy. Results showed that attachment avoidance was a distinctive characteristic of distressed couples and that it was a strong predictor of marital dissatisfaction among distressed couples seeking therapy. Based on a series of 141 couple therapy cases, the second article examined therapeutic mandates, romantic attachment orientations, and pre-treatment marital satisfaction as predictors of premature disengagement from couple therapy. The most striking result was that an ambivalence resolution mandate was strongly associated with increased chances of treatment discontinuation. Predictors of couple therapy outcome were also examined: actor-partner analyses revealed that the strongest predictor of post-treatment marital satisfaction was pre-treatment marital satisfaction, despite the inclusion of romantic attachment among the predictor variables. Overall, these results indicate that attachment insecurity is strongly related to distressed couples’ marital dissatisfaction, but that it might not impede the attainment of a positive outcome in couple therapy. In sum, this thesis contributed to the field of couple therapy by investigating the pertinence of attachment theory in couple treatment, and highlighting the need for further study of therapeutic mandates in couple therapy. Clinical implications for couple therapy are discussed, and recommendations for clinical research offered.

L’objectif général de cette thèse est d’examiner le lien entre l’attachement amoureux des conjoints, la satisfaction conjugale, le mandat thérapeutique et le résultat de la thérapie conjugale telle que conduite en milieu naturel. Afin d’atteindre cet objectif, des couples se présentant en thérapie conjugale ont d’abord complété une batterie de questionnaires comprenant l’Échelle d’ajustement dyadique (Spanier, 1976) et le Questionnaire sur les expériences d’attachement amoureux (Brennan, Clark, & Shaver, 1998). Les thérapeutes ont par la suite indiqué le mandat thérapeutique poursuivi avec chaque couple (réconciliation ou résolution de l’ambivalence), suivant la classification de Poitras-Wright et St-Père (2004). À la fin de la consultation, le jugement du thérapeute a été utilisé pour classer chacun des cas comme ayant abandonné ou complété le traitement. Les couples ayant complété la thérapie ont rempli l’Échelle d’ajustement dyadique au post-traitement. Dans le premier des articles composant cette thèse, le lien entre l’attachement amoureux et la satisfaction conjugale a été examiné auprès d’un échantillon de 172 couples en détresse débutant une thérapie conjugale, de même qu’auprès de 56 couples non en détresse débutant également une thérapie conjugale, pour fins de comparaison. Les résultats ont démontré que l’évitement de la proximité semble être une caractéristique distinctive des couples en détresse et que cette dimension de l’attachement est fortement liée à l’insatisfaction conjugale de ce même groupe. Dans le deuxième article, le mandat thérapeutique, l’attachement amoureux et la satisfaction conjugale ont été examinés en tant que prédicteurs de l’abandon de la thérapie conjugale, auprès de 141 couples. Les résultats ont notamment démontré qu’un mandat de résolution de l’ambivalence augmente les probabilités d’abandon de la thérapie conjugale. De plus, les prédicteurs du résultat de la thérapie ont également été examinés dans ce second article. Les résultats obtenus au moyen d’analyses acteur-partenaire ont démontré que la satisfaction conjugale pré-traitement apparaît comme le meilleur prédicteur de la satisfaction conjugale post-traitement, et ce, malgré l’inclusion de l’attachement amoureux parmi les variables investiguées. Considérés dans leur ensemble, les résultats de cette thèse suggèrent que l’insécurité d’attachement serait fortement associée à l’insatisfaction des couples en détresse, mais ne nuirait pas pour autant à l’obtention d’un résultat positif en thérapie conjugale. En somme, cette thèse contribue à l’avancement des connaissances en se penchant sur l’utilité de la théorie de l’attachement en thérapie conjugale et en soulignant la nécessité de tenir compte des mandats thérapeutiques dans les futures études en thérapie conjugale. Les implications cliniques des résultats et des recommandations pour la recherche clinique sont présentées dans la conclusion de l’ouvrage. / The aim of this thesis was to elucidate the link between adult romantic attachment, relationship satisfaction, therapeutic mandates and couple therapy outcome. Couples seeking therapy in a natural setting completed the Dyadic Adjustment Scale (Spanier, 1976) and the Experiences in Close Relationships Questionnaire (Brennan, Clark, & Shaver, 1998) at intake. Therapists classified the therapeutic mandate pursued in each case (i.e., alleviation of couple distress or ambivalence resolution) according to the Classification of Therapeutic Mandates Questionnaire (Poitras-Wright & St-Père, 2004). When treatment ceased, couples were classified as dropouts or completers according to therapists’ judgment, and completers were further assessed using the Dyadic Adjustment Scale. In the first of two articles, the association between adult romantic attachment and pre-treatment marital satisfaction was investigated in a sample of 172 distressed couples seeking therapy, as well as in a comparison sample of 56 nondistressed couples seeking therapy. Results showed that attachment avoidance was a distinctive characteristic of distressed couples and that it was a strong predictor of marital dissatisfaction among distressed couples seeking therapy. Based on a series of 141 couple therapy cases, the second article examined therapeutic mandates, romantic attachment orientations, and pre-treatment marital satisfaction as predictors of premature disengagement from couple therapy. The most striking result was that an ambivalence resolution mandate was strongly associated with increased chances of treatment discontinuation. Predictors of couple therapy outcome were also examined: actor-partner analyses revealed that the strongest predictor of post-treatment marital satisfaction was pre-treatment marital satisfaction, despite the inclusion of romantic attachment among the predictor variables. Overall, these results indicate that attachment insecurity is strongly related to distressed couples’ marital dissatisfaction, but that it might not impede the attainment of a positive outcome in couple therapy. In sum, this thesis contributed to the field of couple therapy by investigating the pertinence of attachment theory in couple treatment, and highlighting the need for further study of therapeutic mandates in couple therapy. Clinical implications for couple therapy are discussed, and recommendations for clinical research offered.