<p> One commonly accepted protective factor, social support, is hypothesized to be both helpful and harmful following exposure to traumatic events (Bonanno, 2008; Ellis, Nixon, &amp; Williamson, 2009; Lyons, 1991). Although at least 10 theoretical models have been proposed to explain the relationship between social support and post-traumatic responses, existing theories do not adequately capture the multidimensional experience of social support, which is comprised of several constructs and structures (e.g., received and perceived support; support functions and content). Moreover, existing social support theories have not been studied in research related to therapy with traumatized clients. The present study, therefore, examined how clients who experienced trauma expressed social support in psychotherapy. A qualitative content analysis was conducted using a directed coding system developed for this study that was based on the constructs and structures commonly discussed in psychology literature on post-traumatic experiences, namely: (a) received support, (b) perceived support, (c) extended support, (d) social support functions, and (e) social support contents. </p><p> The current study observed that clients who have experienced trauma are likely to mention social support in sessions but that salient factors related to the benefits and harms associated with social support were discussed less. Although many expressions of social support fell into "not otherwise specified" categories because the quality or type of support experienced was not clearly stated, inductive analysis identified the following salient factors: support needs, relationship elements, planned future support activities, past perceived support, and past support that did not occur. The study also provided support for some existing models of social support and trauma (i.e., network orientation, stress-buffering, erosion, social-cognitive processing, and COR models). </p><p> Clinical implications related to social support discussions in individual therapy include the need to examine and potentially change therapists' views of social support. Psychotherapists are encouraged to explore the support relationships identified by clients, as well as the quality and types of support experienced and perceived, in order to understand the role and impact of social support and address the benefits and risks associated with support. Clinicians should also recommend that clients engage in adjunctive mutual aid and affiliative support groups.</p>

It is a critical time in health care characterized by new models of service delivery, complexity of care, diverse practice environments, and evolving regulatory and legislative requirements. This is accompanied by recognition that the experiences and supports provided by workplaces are critical for initially developing the knowledge required for work and also for lifelong learning. In occupational therapy, there is relatively little understanding of how beginning occupational therapists learn to practice and how they resituate knowledge learned in the context of school, to the context of work. The objective of this research was to understand how beginning occupational therapy practitioners learn in the practice context, how clients mediate practitioners' learning, and the factors which shape practitioners' participation and learning through work. This qualitative study used an ethnographic approach to understand the situated practices, interactions and actions of occupational therapists in an acute care hospital context. Data collection consisted of semi-structured interviews, observations of practice, participant journal entries, researcher journal entries and meetings with the occupational therapy manager, over a period of twelve months. The study participants comprised five occupational therapists with less than two years of clinical experience. Activity theory provided an integrative, conceptual framework to understand how knowledge is co-constructed and distributed across a particular hospital system. The findings of this research help us understand how workplace affordances and constraints, and individuals' agency shape beginning occupational therapists' participation and learning through work. There are complex relations and interactions among the components of the activity system engaged in the object of patient care. A conceptual framework, the Workplace Learning Model for Occupational Therapy, was developed to understand how learning occurs in practice and the pedagogic means to support occupational therapists' engagement in work. The findings of this study contribute to the evidence in workplace learning and participation.

Rehabilitation outcomes are an important measurement of trauma system effectiveness. However, currently there is no clinically applicable trauma rehabilitation score or framework available to evaluate health and rehabilitation needs after trauma. The World report on Disability (2011) recommended the application of the World Health Organisation International Classification of Function, Disability and Health (ICF) as a framework for all aspects of rehabilitation. A standardised language, based on coded categories would aid in international efforts to evaluate health and disability globally. The ICF framework has not been applied in trauma rehabilitation or trauma systems to date. The objectives were to investigate rehabilitation needs of trauma patients and evaluate to what extent the ICF can be used as a framework to capture and assess health and rehabilitation outcome of patients following traumatic injuries. Two cohort studies with 103 and 308 patients respectively demonstrated the utility of the Rehabilitation Complexity Scale (RCS) in an acute trauma setting. The RCS outperformed other acute measures and rehabilitation complexity correlated with length of stay and discharge destination. A systematic review of 34 articles confirmed that outcome measures frequently used in trauma outcome studies represent only six percent of health concepts contained in the ICF. A quantitative international on-line questionnaire with expert clinicians working in trauma (n=217), identified 121 ICF categories pertinent to rehabilitation and health outcome of trauma patients. Qualitative patient interviews (n=32) identified nearly double the amount of ICF categories (n=234) compared to clinicians. Combined analysis of qualitative and quantitative data presents 109 ICF categories important for rehabilitation and health outcome assessment of trauma patients, using the ICF as a framework. This thesis describes the need for improved outcome evaluation of trauma patients. It demonstrates the acceptability of the ICF language and framework amongst clinicians and suggests the application of the ICF as a framework for trauma service delivery and outcome assessment.

Thesis (Ph. D.)--University of Sydney, 2003. / Title from title screen (viewed Oct. 26, 2009) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Discipline of Surgery, Faculty of Health Sciences. Degree awarded 2003; thesis submitted 2002. Includes bibliography. Also available in print form.

This study addressed two questions: (a) how do the various discourses that are at work in everyday practice of occupational therapists inhibit or enhance a collaborative therapist-client therapeutic relationship and (b) what are the ways of strategizing a more client-centred collaborative approach in the midst of the tensions and disjunctures of everyday clinical practice? These questions were addressed by analyzing narratives from the everyday practice of occupational therapy. These narratives were constructed from my own practice in order to provide an insider’s view from the clinician’s perspective, a view that is missing from the extensive literature on client-centred practice in occupational therapy. Guided by an emancipatory interest, the study focused primarily on the tensions between dominant health care discourses that position the therapist as expert and a collaborative, egalitarian therapeutic relationship, which I called “participatory consciousness” after Heshusius (1994). The methodology of critical reflexivity had two parts. The first was the assemblage and interpretations of a collage for the purpose of critically examining my values, beliefs and theoretical predispositions; and the second was the critical reading and rereading of the practice narratives using as analytical tools the concepts of discourse and of occupational therapy clinical reasoning. Discourse refers to ways of thinking, feeling and acting that constitute social and cultural reality. Clinical reasoning refers to how clinicians think in the midst of practice and was the key to identifying how the clinician consciously and/or consciously negotiated or resisted the discourses shaping the clinician-client relationship. The study demonstrated what was entailed in the move to participatory consciousness and offered recommendations to the profession for supporting therapists to move toward a deeper sense of collaboration within client-centred practice.

Licentiatavhandling (sammanfattning) Linköping : Linköpings universitet, 2010. / Härtill 2 uppsatser.

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