Thesis (Ph.D.)(Practical Theology))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.

I denna undersökning utforskas betydelsen av intersubjektiv kontakt och delad förståelse som en väg att samskapa en förståelseorienterad vägledning i den terapeutiska processen och det dagliga familjelivet. Undersökningens syfte är att utforska båda parters upplevelse av delad förståelse och dess betydelse i systemisk familjeterapi. Frågeställningarna fokuseras på vad som kännetecknar tillstånd av närvaro respektive frånvaro av intersubjektiv kontakt och förståelse. Samt vilken betydelse och vilka konsekvenser denna närvaro/ frånvaro har för terapeut och familj. Undersökningen baseras på fyra kliniska fallbeskrivningar återgivna ur båda parters perspektiv. Genom oberoende intervjuer utforskas båda parters terapierfarenheter efter avslutad terapi. Resultat av studien visar att intersubjektiv närvaro och förståelse i terapin är en nödvändig och avgörande faktor för att utvidga och öka den intersubjektiva kompetensen i systemet. Resultaten visar även på hur denna närvaro i den gemensamma terapeutiska processen blir en sorts modellerande kraft som bär vidare i familjernas vardag. Detta ökar förmågan att ta den andres perspektiv och svara på varandras inre livsvärld. En förståelseorienterad vägledning utvecklas. Resultaten visar god överensstämmelse med teori och forskning inom området. Resultaten har även kliniska implikationer och visar på vikten av att i såväl utbildning som handledning av psykoterapeuter uppmärksamma förståelsens centrala betydelse i det professionella mötet och i klinisk praktik. / This study explores the impact of mutual and shared understanding as a way to create an understanding-oriented guidance in family-therapy and in daily family life. The intention is to investigate the reciprocal experience of shared understanding and it ́s significance in family therapi. The questions focus on what charactarizes the states of prescence or abscence of intersubjective contact and understanding as well as what impact these states will have on the therapist and the family. The survey is based on four clinical case-histories reproduced from the therapists and the families ́ perspectives. Independent interviews explore both parties ́ experiences of the therapy after it was completed.Results of the study show that intersubjective presence and understanding during therapy is an essential and vital factor to extend and increase the intersubjective competence in the system. The results also show how the mutual therapeutic process presence is a kind of modeling force that carries on in families' everyday lives. This process developes the ability to take the other ́s perspective and respond to each other ́s inner world. An understanding-oriented guidance evolves. The results show good accordance with theory and research in the actual science field. They also have clinical implications and emphasizes the importance in both training and supervision of psychotherapists to payattention to the central importance of understanding in the professional meeting and in clinical practice.

Summaries in Afrikaans and English / Text in Afrikaans / Tourettesindroom is 'n lewenslange versteuring wat gekenmerk word deur motoriese en vokale trekkings saam met moontlik ook komorbiede simptome soos aandagtekort-hiperaktiwiteitsversteuring, obsessief-kompulsiewe versteuring, aggressie en depressie. Die sindroom kom in hoe mate in Suid-Afrika voor en die pastor kan dus heel moontlik daarmee te doen kry. Die beste behandeling vir die sindroom is medikasie saam met gedrags- en gesinsterapie toegedien deur 'n multidissiplinere span. Die pastor het 'n rol om te vervul in hierdie span probleme het aangesien persone met Tourettesindroom dikwels in hulle verhoudings met God, hulleself en ander mense. Vir effektiewe pastorale berading aan sodanige persone, moet die pastor deeglike kennis he van die sindroom en die simptome daarvan, asook van sy of haar invalshoek as pastor. 'n Moontlike kernmoment van die sindroom wat deur die pastor aangespreek kan word, is die verlies aan beheer wat deur dje lyer ervaar word. Die sindroom kan as 'n verskoning gedrag en gebruik word vir negatiewe en onverantwoordelike die pastor sal die lyer dus moontlik eties moet konfronteer op 'n medemenslike wyse. / Tourette Syndrome is a lifelong disorder. Symptoms are motoric and vocalic tics with possible comorbid symptoms such as attention deficit disorder with hyperactivity, obsessive-compulsive disorder, and depression. It is frequent among South Africans and the pastor will probably be confronted with persons struggling with the syndrome. The best therapy for Tourette Syndrome is medication in conjunction with behaviour and family therapy administered by a multi-disciplinary team. Persons with Tourette Syndrome have problems maintaining relationships with God, themselves and others. The pastor therefore has a definite role to play in the team. Knowledge of the syndrome and its symptoms, and of pastoral care are essential for succesful pastoral counseling. A possible central theme of the syndrome is the loss of control experienced by the person with the syndrome. The syndrome can become an excuse for negative and irresponsible behaviour and ethical confrontation may be necessary. / Philosophy, Practical and Systematic Theology / M. Th. (Praktiese Teologie)

How people survive and thrive through adversity is a question which has prompted much research. There is little agreement on the definition of resilience beyond the basic idea of "bouncing back", resulting in many studies which offer contradictory and confusing information. This study sought to organise the literature into broad conceptual categories, and attempted to explain some of the differences in definitions and research methods at the level of paradigm. A need to reconceptualise resilience was identified and undertaken in view of input from ecosystemic, cybernetic and postmodem paradigms. Attention was given especially to the role oflanguage, meaning and description, and the role of the observer/researcher in such a reconceptualisation. Guidelines were offered for approaching research in future. Finally, the context of the researcher was examined in an attempt at self-reflexivity as part of the process of research as proposed in the reconceptualisation. / Psychology / M.A. (Clinical Psychology)

A dissertação analisa a utilização de rituais terapêuticos na Terapia familiar sistêmica, promovendo a resiliência em situações de sofrimento e crise.A primeira parte aborda os ritos dentro de uma perspectiva antropológica e psicossocial, enfocando a finalidade dos rituais na humanidade, como processo de reconhecimento e inserção do ser humano no grupo social. Aborda, também, os ritos familiares, suas funções e de que maneira os mitos construídos na família influenciam o surgimento do sofrimento.Ainda neste capítulo, é apresentada a terapia familiar sistêmica, a fim de compreender a utilização dos ritos terapêuticos, como técnica utilizada na terapia, principalmente para possibilitar a mudança no sistema terapêutico. A terapia familiar contribui com os estudos sobre o ciclo vital familiar, ajudando a conhecer e identificar as etapas do desenvolvimento, a fim de restaurar vínculos, rupturas e paralisações, que ocasionam surgimento de sintomas na família.A segunda parte analisa a resiliência familiar, tentando compreender como algumas pessoas, apesar de sofrerem enormes adversidades e traumas, adquirem força para vencer a crise, saindo mais fortalecidas.A fim de compreender em que contexto os ritos terapêuticos são aplicados, esta parte, ainda, nos apresenta quem é o terapeuta familiar sistêmico, suas crenças, convicções, seu universo pessoal e profissional.A terceira parte apresenta a pesquisa, realizada com terapeutas de família, onde foram investigadas as suas práticas, com rituais na terapia, assim como objetivo, avaliação e análise dos resultados terapêuticos.Foi analisado em quais etapas do ciclo vital, precisa-se de maior intervenção terapêutica através dos rituais, auxiliando a família a ultrapassar a fase cristalizada, proporcionando vivenciar um rito de passagem. Finaliza com análise dos rituais estudados, sob a perspectiva antropológica, compreendendo os três momentos de um rito: margem, separação e agregação.Os rituais são essenciais no desenvolvimento do ser humano, através deles, a sociedade reafirma seus valores, crenças e sua identidade, oferecendo oportunidade para expressão do individual e coletivo. / The dissertation analyses the use of therapeutic rites in systemic family therapy, promoting resilience in situations of suffering and crises. The first part approaches these rites from an anthropologic and psychosocial perspective, focusing in the finality of the rites in mankind as a process of recognition and insertion of the human being in the social cycle. Likewise, it approaches family rites; its functions and how the myths built in the family environment influence the appearance of suffering. Moreover, it is presented the systemic family therapy, in order to understand the use of therapeutic rites as a technique used in therapy, mainly to make a change possible in the therapeutic system. Family therapy contributes with the studies of the family vital cycle, helping to be aware of and to identify the development stages, in order to restore bonds, ruptures and stops, which cause the appearance of symptoms in the family. The second part analyses family resilience, trying to understand how some people, besides suffering enormous adversities and traumas, find power to beat the crises, ending stronger than they were before. In order to comprehend in which context the therapeutic rites are applied, this part also presents to us who is the systemic family therapist, his/her beliefs, his/her convictions, his/her personal and professional universe. The third part presents the research performed with family therapists, where their procedures with rites in therapy were investigated as well as the objective, evaluation and analysis of the therapeutic results. It was analyzed in which stages of the vital cycle more therapeutic intervention is needed with the help of the rites, assisting the family to pass the crystallized stage, providing the experience of a rite of passage. It ends with the analyses of the rites studied from an anthropologic perspective, including the three stages of a rite: margin, dissociation and aggregation. The rites are essential in the development of the human being. By these, society reaffirms its values, beliefs and identity, offering an opportunity to the individual and the collective to express them.

This paper gives the summary of the six-year operations of multi-family therapy programme in eating disorders at The Eating Disorders Centre at The Psychiatric Clinic, Prague. The research done has been the first experience with multi-family treatment of psychiatric patients in the Czech Republic. This therapy concept is often used abroad as a form of work with patients suffering from the diagnosis of eating disorders. It is a "first choice" method due to NICE Guideline(2004). The inspiration for the Prague team was the London Maudsley model. The main aims of the research were: 1/ to introduce this therapeutic approach into a complex treatment of patients suffering from eating disorders, optimize the functioning structure and programme and stabilize the therapeutic team and 2/ to evaluate the effectiveness of multi-family treatment and suggest the suitable metodology. Since 2004 twenty families which form the observed group have been involved in the project. The combination of qualitative and quantitative methodology was chosen during the primary stage of the research. The methods used were: questionnaires of Beck Depression Inventory (BDI),Schwartz scale of therapy assessment (SOS-10), the life quality questionnaire (SQUALA) and Rosenberg self-concept questionnaire (RSE). We evaluated ten...

Esse é um estudo sobre consultas terapêuticas familiares destinadas a crianças abrigadas e seus pais. Como objetivos desta tese. têm-se: refletir sobre a situação de abngamento e o rompimento da convivência familiar; e favorecer o desenvolvimento de recursos que contribuam para o desenvolvimento emocional de todos os membros da família, preservando-se, ainda, os vínculos familiares na medida do possível. A hipótese do trabalho terapêutico, nesse estudo, refere-se à família que. quando ela mesma é acolhida, pode desenvolver recursos próprios para cuidar de si mesma e dos filhos. Os atendimentos foram realizados no próprio abrigo, uma organização não-governamental, localizado na região do Grande ABC. no Estado de São Paulo. Foi realizada uma análise clínica-quahtativa dos dados obtidos com enfoque psicanalítico. Para a análise foram realizados estudos de caso com a compreensão da situação problema, a qual foi auxiliada por observação documental. No trabalho são apresentados quatro (4) estudos de casos de quatro (4) famílias. A análise do conteiido do procedimento de consultas terapêuticas, na forma individual e familiar, teve por base a livre inspeção de material, que revelou como o fenômeno da ruptura dos laços familiares pode ser melhor compreendido pelos atores familiares envolvidos. Mostramos que a partir de um vértice psicanalítico, seguindo uma abordagem compreensiva, próxima, humana, acolhedora e continente, sendo transmitida caso a caso, é possível promover verdadeiras mudanças. Observamos que tanto as crianças como os pais já apresentavam conflitos antes do abrigamento. o qual pode amenizar a situação de risco, mas pode trazer também muito sofrimento para a criança e a sua família. Identificamos muitas situações de conflito e dor, entretanto observamos que em alguns casos houve possibilidades para a remtegração da criança ao grupo familiar, e que mesmo no caso de pais mais perturbados em suas condições emocionais, com o trabalho das consultas, pôde haver uma evolução. Algumas estratégias utilizadas de modo espontâneo mostraram ser muito úteis no trabalho de consultas psicoterapêuticas, revelando ser o acolhimento fundamental para a elaboração do ódio e da angústia presentes em situações como as descritas nesse estudo. / This is a study of family therapeutic consultations for sheltered children and then parents. The objectives of this thesis are to: reflect on the situation of housing and disruption of family lives, and to encourage the development of the resources that contribute to the emotional development of all members of the family, although sail preserving the family bonds as possible. The idea of therapeutic work, in this study refers to the family that, when harbored, can develop its own resources to take care of itself and its children. The consultations took place in their own shelters, a uon-governniental organization, located in the Great ABC, in the state of Sao Paulo. A clinical-quantitative analysis based on a psychoanalytical approach of the obtained data was made. For the analysis case studies were conducted for the comprehension of the problem, which was helped by documentary observation. Four (4) case studies of four (4) families are presented within this work. The analysis of the content of the therapeutic procedure of consultation, as individual and family, was based on the free inspection of material, which showed how the phenomenon of breaking of family ties can be better understood by the involved family actors. We have shown that from a psychoanalytic point of view, following a comprehensive, close, human, warm and continent approach, which is transmitted case by case, it is possible to promote real changes. We noticed that both children and parents have had conflicts before the shelter, which can alleviate the situation of risk, but can also bring great suffering for the child and its family. We have also identified many situations of conflict and pain, however we have observed that in some cases there were opportunities for the reintegration of the child to the family group, and, even in cases when parents were more disaubed in their emotional conditions, with the work developed diuing the consultations, an evolution was attested. Some strategies used spontaneously proved to be very useful in the study of psychotherapeutic consultations, revealing themselves to be the main key for the development of hatred and anguish in situations such as those described in this study.

A partir da Reforma Psiquiátrica, observamos uma valorização da participação da família no tratamento, buscando por alternativas de atenção a esses familiares nos serviços. Acrescentando ao debate os desafios da aproximação da clínica ao Sistema Único de Saúde, o conceito de clínica ampliada surge, associando a noção de subjetividade à de cidadania e enfatizando a importância de lidar com a singularidade de cada situação concreta como parte de contextos e relações sociais. Em consonância com essas preocupações, existe, em um Hospital-Dia de Psiquiatria, um Programa de Assistência Familiar. Dentre diversas atividades oferecidas nesse programa, as Reuniões Familiares são o contexto específico de estudo desta pesquisa. Essas reuniões são conduzidas a partir de contribuições da terapia familiar de uma orientação construcionista social, que tem como foco os processos de construção e transformação de sentido. A presente pesquisa teve como objetivo analisar a aproximação de uma prática com famílias (as reuniões familiares) à noção de clínica ampliada no cuidado em saúde mental. Especificamente, visou: a) compreender o processo de produção de sentidos nessa prática, analisando a construção de recursos conversacionais na interação, bem como seus efeitos para as transformações de sentidos de problema e de si ao longo do processo; e b) descrever como esses recursos contribuem para a ampliação da prática clínica com famílias. Para isso, 33 reuniões familiares (os atendimentos de três famílias) foram acompanhadas na instituição. Essas sessões foram gravadas em áudio e transcritas integralmente, constituindo-se, assim, o corpus de pesquisa. Uma compreensão construcionista social sobre a prática de pesquisa orienta metodologicamente este trabalho. Todas as sessões foram submetidas a uma análise temático-sequencial do processo de produção de sentidos. A partir disso, descrevemos a negociação e transformação de sentidos em torno de um problema considerado, pelo paciente e pela família, como central em suas vidas. Para cada caso, o principal recurso conversacional construído no processo terapêutico foi analisado e descrito. São eles: a) convidar o social para dentro do individual; b) tecer o diálogo familiar; e c) conhecer a si em outras vozes. A análise de cada caso considerou: como algo foi construído como um problema a ser trabalhado; como o uso do recurso se deu; e que efeitos esse uso produziu no decorrer do caso. Oferecemos como tese uma leitura construcionista social para a clínica ampliada, chamando atenção para como a ampliação da clínica se produz a partir dos efeitos de determinados modos de se relacionar no contexto das práticas. É no momento interativo que profissionais e pacientes, ao conversarem sobre suas questões de saúde, conjuntamente criam entendimentos sobre quem são, o quê são seus problemas e o que podem fazer com relação a eles. Discutimos como o uso dos recursos se constrói nas interações e contribui para a prática da clínica ampliada. Descrevemos essas práticas como politicamente implicadas. Em última instância, a pesquisa descreve recursos práticos para profissionais interessados em trabalhar em um enquadre crítico e transformador no cuidado em saúde mental / Since the Brazilian Psychiatric Reform, we have witnessed an increased value of family participation in treatment. Alternatives of attention to family members in the context of services have been sought. When the challenges of bringing clinical practices into the Unified Health System are added to the debate, the concept of the expanded clinic arises, and this concept associates the notions of subjectivity and citizenship. Emphasis is placed on the importance of dealing with each concrete situation as part of contexts and social relations. A Program of Family Care in a Psychiatric Day Hospital exists in line with these concerns. This program offers several activities for families. Family Reunions are amongst these activities, and they are the specific context of this research. The contributions of a social constructionist orientation for family therapy guide family reunions with a focus on processes of meaning making. This research aimed to analyze the approximation of a practice with families (family reunions) to the notion of the expanded clinic in mental health care. The research specifically aims to: a) understand the process of meaning making in this practice, while analyzing the construction of conversational resources in the interaction, as well as their effects to the transformations of the meanings of problem and self throughout the process; and b) describe how these resources contribute to the expansion of clinical practices with families. Thirty-three family reunions (three family cases) were followed in the institution. These sessions were audio recorded, and fully transcribed, in order to constitute the research corpus. A social constructionist understanding about research practices is the methodological guide for this investigation. All sessions were submitted to a thematic-sequential analysis of the process of meaning making. We have described the negotiation and transformation of meanings about a problem that was considered, by the patient and by their family, as central to their lives. For each case, the main conversational resource constructed during the process was analyzed and described. These conversational resources are: a) inviting the social into the individual; b) weaving family dialogue; and c) knowing yourself in other voices. The analysis of each case considered: how something was constructed as a problem to be worked out; how the use of the resources was carried through; and the effects the use of this resource created throughout the case. We offer, as our thesis, a social constructionist reading of the expanded clinic, where we call attention to how the expansion of clinical practice is crafted from the effects that particular ways of interacting create in the context of practices. It is in the interactive moment that professionals and patients jointly generate understandings about who they are, what their problems are, and what they can do in relation to them, while they talk about their health issues. We discuss how the use of these resources is constructed in interactions, and how this use can contribute to the practice of the expanded clinic. We also describe clinical practices as politically committed. The research ultimately describes practical resources for those professionals interested in working within a critical and transformative frame in mental health care

Syftet med studien var att undersöka om och hur bildterapi kan kombineras med familjeterapi samt vad, i så fall, bildterapi kan tillföra. Intervjuer genomfördes med sju psykoterapeuter som kombinerar dessa två terapiformer i arbete med par och familjer. Vid sidan om intervjustudien genomfördes en litteraturstudie för att inventera, för studien, relevant litteratur och forskningsläge. Resultatet av studien visar att bildterapi och familjeterapi kombineras och att bildterapi kan vara ett bra komplement till familjeterapi. Det finns likheter mellan vissa familjeterapeutiska och bildterapeutiska interventioner som gör terapiformerna kompatibla. Övningar som innebär externalisering, gestaltning och omstrukturering är exempel på detta. Bildterapin kan fungera utjämnande mellan vuxna och barn, på så sätt att barn, oftare än vuxna, är vana vid att uttrycka sig i bild och att det verbala övertag de vuxna ofta besitter, vägs upp av barnens rikare tillgång till bildspråk. Bildterapi kan generellt sett hjälpa barn att få sin röst hörd i terapirummet. Bildterapin är till hjälp för synliggörandet av relationella mönster i familjen eller i parrelationen. Såväl psykoterapeut som klienter blir hjälpta av detta. Synliggörandet sker både i bildskapandet och i samtalet om bilden. / The aim of this study was to examine whether and how art therapy is combined with family therapy, as well as what art therapy in such cases can bring. Seven psychotherapists combining these two therapies in their work with couples and families, was interviewed. In addition to the interview study, a literature review was carried out for inventory of relevant literature and research. Results of the study shows that art therapy and family therapy are combined, and that art therapy can be a good complement to family therapy. There are similarities between some family therapy and art therapy interventions that make the therapy forms compatible. Interventions that involve externalization, sculpting and restructuring are examples of this. Art therapy can work balancing between adults and children, as children, more often than adults are accustomed to express themselves in artmaking, and that the verbal advantage of the adults can be balanced by children´s richer access to imagery. Art therapy can generally help children to get their voice heard in the therapy room. Art therapy is helpful for visualization of relational patterns in the family or couple relation. Both psychotherapist and clients are helped by this. The visualization occurs both in image making and in the talk about the picture.

Syftet med studien var att beskriva arbetsalliansens funktion i familjebehandlares arbete ur behandlarens perspektiv för att bidra till kunskapsdiskussionen om arbetsalliansens betydelse inom socialt arbete. Studiens frågeställningar var vilken betydelse arbetsallians har för familjebehandlares uppdrag samt vilka faktorer som har betydelse för hur arbetsallians skapas, vidmakthålls och avslutas på ett bra sätt i arbetet med familjer. Med en fenomenologisk ansats genomfördes kvalitativa, halvstrukturerade intervjuer med sex familjebehandlare verksamma inom socialtjänsten. Respondenterna delgav nyanserade beskrivningar av arbetsalliansens betydelse för familjebehandling. Studiens resultat analyserades utifrån socialkonstruktionism, systemteori och anknytningsteori. Studiens centrala resultat var att familjebehandlarna upplevde arbetsalliansen som mycket betydelsefull i sitt arbete. Studiens resultat ligger i linje med psykoterapiforskningen som också betonar arbetsalliansens betydelse för att uppnå ett positivt behandlingsresultat. / The aim of this study was to describe the function of a working alliance in the social work of family therapists in order to make contribute to the knowledge discourse of the importance of working alliance in social work. The questions were what of importance the work alliance is in the task of family therapists and what the important factors are in how to create, sustain and end a working alliance in a good way within the social work with families. Interviews were pursued with six family therapists. The respondents described the function of the working alliance from their perspective. The result was analysed with social construction theory, system theory, attachment theory and a multidimensional perspective. The central result of the study was that the therapists experienced that the working alliance was of great importance in their work which is in agreement with psychotherapy research which emphasise the importance of a working alliance in order to reach a good result of the therapy.