The personal characteristics of the therapist are strongly associated with therapeutic alliance and treatment outcome. Since treatment techniques are often shown to be equally effective, differential outcomes may be attributed to the therapist's early experiences and personality features. The purpose of this study was to determine the influence of childhood relational trauma in predicting specific components of mentalizing skills (i.e., affect consciousness, psychological mindedness, mindfulness, cognitive empathy and theory of mind) among therapists. Participants were 121 clinical psychology doctoral and master's in mental health counseling students (20 males, 101 females) aged 22 to 53 years old (M = 27.26, SD = 5.25). Measures included the Child Abuse and Trauma Scale (CATS), Kentucky Inventory of Mindfulness Skills (KIMS), Toronto Alexithymia Scale (TAS), Psychological Mindedness Scale (PMS), Reading the Mind in the Eyes Test-revised (RMET), Interpersonal Reactivity Index (IRI-PT/IRI-EC), Relationship Structures Questionnaire (RSQ) and a questionnaire assessing demographic information, graduate training and interests, personal therapy, objective childhood familial trauma and adult and peer support. Linear regression and hierarchical multiple linear regression analyses (HMLR) were conducted to assess the relationship between childhood relational trauma (CATS) and the various components of mentalization. HMLR was also used to determine whether relational style (anxious/avoidance) as measured through the RSQ moderated between childhood relational trauma and the mentalizing components. Finally, emotional empathy (IRI-EC) was examined as a potential mediator between childhood relational trauma and the mentalizing components using Andrew Hayes' SPSS macro. Post hoc analysis explored associations between the mentalization variables and demographic questionnaire items related to objective childhood familial trauma and support. Results revealed that childhood relational trauma significantly predicted lower levels of affect consciousness, psychological mindedness and mindfulness among therapists. Relational style was not found to be a significant moderator and emotional empathy was not found to be a significant mediator. Growing up with a parent who had a disability or physical illness was significantly associated with higher levels of emotional empathy in therapists. The implications of these results for the training and supervision of graduate level therapists are discussed.

Introduction: A systematic review was undertaken to identify any psychological predictors of treatment dropout for individuals diagnosed with an eating disorder, to help inform psychological therapy and reduce attrition. An empirical study was conducted to understand developmental psychological mechanisms at play in the aetiology and maintenance of eating disordered symptomology by assessing reflective functioning and attachment from a trans-diagnostic perspective. Methods: Twenty-one papers were identified through a systematic search of databases using predefined extraction criteria, identifying psychological predictors of treatment dropout in eating disorders. Fourteen female adolescents with a diagnosis of an eating disorder were recruited to the empirical study from CAMHS inpatient and outpatient departments in NHS Scotland, as well as eighteen same age controls from local secondary schools. Participants completed questionnaires regarding eating behaviour, difficulties in emotion regulation, reflective functioning and were interviewed using the Adult Attachment Projective. Results: The systematic review revealed varied psychological predictors of dropout falling onto a continuum ranging from maturity fears to interpersonal difficulties. Results did not significantly differ for inpatient or outpatient treatment or diagnosis. The empirical study found adolescents with an eating disorder to have significantly more difficulties with their emotion regulation and reflective functioning as well as a more insecure attachment style when compared to controls, none of which were weight dependent. Conclusion: Further research is required to operationalise a definition of dropout. Although eating disorders can be seen as a defence mechanism to control and avoid emotional distress, this actually exacerbates them and causes disengagement from treatment. Clinical interventions need to focus on therapeutic rapport from the outset of treatment in order to reduce interpersonal difficulties leading to attrition. The results of the empirical study support the use of early intervention and person centred therapies for adolescents with an eating disorder, even when acutely starved. Specifically therapies that target reflective functioning and take insecure attachment styles into account may improve psychological efficacy and engagement.

Aims: The aims of this thesis were focused on the social climate of inpatient forensic mental health settings. Firstly, the study reviewed the literature of qualitative studies of staff and patient experiences of social climate. Secondly, the utility of a case study methodology to examine innovations to practice in forensic mental health settings are discussed. Thirdly, a longitudinal case study aimed to examine the impact of a Mentalization based treatment (MBT) training and case consultation intervention on the functioning of a low secure ward. Method: A systematic review and qualitative synthesis of social climate in forensic mental health settings was completed using the ‘best-fit’ framework approach. Secondly, a critical analysis of case study methodology was presented based on key decision points. A longitudinal ward case study with staff (n=37) and patient (n=7) participants examined the impact of staff MBT training and MBT based case consultation sessions. MBT based case consultation sessions ran on the ward over an eight month period. Data was collected through a range of methods including questionnaires, semi-structured interviews, ward observations and routinely reported data. The case study data was tested through a pattern matching approach with reference to rival explanations. Results: The systematic review identified 20 papers that met the inclusion criteria. The framework synthesis identified 22 themes related to social climate, which were organised in a conceptual model. Ten themes were seen to represent the experience of social climate. Consideration of the applicability of the case study method to forensic settings found the method to be feasible and acceptable to staff though a limitation is that outcomes are tentative and open to rival explanations. Positive impacts of the training and case consultation intervention included an increase in enthusiasm for working with patients with a personality disorder diagnosis and evidence of some increased team cohesion. The main rival explanation identified was the impact of changes to the composition of the staff and patient group. Conclusions: The systematic review findings highlight that current quantitative measures of social climate may not fully represent the construct. The conceptual model developed allows for generation of potential interventions to improve social climate. In the case study, staff reported positive perspectives of both MBT training and the case consultation sessions. The intervention did not appear to impact on patient motivation, though patients reported positive changes in staff behaviour. The case study method was seen as applicable to forensic mental health settings and provided interpretable data useful for analytical generalisations, and clinically in considering innovations to practice.

No description available.

v anglickém jazyce In the present work, I am primarily concerned with the approach of mentalization by Fonagy (Fonagy, 2006; Fonagy & Target, 2001; Fonagy & Target, 2002; Fonagy, Gergely, Jurist & Target, 2008; etc.), which is strongly associated with the attachment theory, psychoanalysis and also developmental psychology. Centrality to the development of mentalization are early relationships. I will present some authors, which dealt with this subject matter, psychoanalysts, development psychology and attachment theory, focusing on the attachment theory of John Bowlby. The aim of this work is to introduce the important coherences, in the literature empirically investigated factors that influence the development of reflective capacity - in particular the environmental factors (parents, foster parents, peers) and the development background of the child.

Made available in DSpace on 2015-03-05T19:36:36Z (GMT). No. of bitstreams: 0 Previous issue date: 31 / Nenhuma / O foco desse estudo foi a psicoterapia de crianças que sofreram maus-tratos, especificamente no que se refere à possibilidade de desenvolvimento da função reflexiva e da capacidade de mentalização durante o processo de intervenção. A função reflexiva e a capacidade de mentalização são conceitos que vêm sendo elaborados com base na vertente psicanalítica da teoria do apego, nas contribuições de alguns teóricos das relações objetais, especialmente Bion e Winnicott e na Psicologia Cognitiva. Baseado na abordagem qualitativa de pesquisa, esse estudo foi pautado pelo método clínico. O procedimento adotado foi o Estudo de Casos Múltiplos, que permite a investigação sistemática e tão exaustiva quanto possível de casos individuais. Os participantes foram duas meninas de classe média baixa de 10 e 12 anos de idade e seus pais ou cuidadores. Eles foram atendidos na clínica-escola de uma universidade da Região Sul do Brasil, e apresentavam história de vivência de alguma forma de maus-tratos. Os procedimentos para coleta

Made available in DSpace on 2015-03-05T19:37:25Z (GMT). No. of bitstreams: 0 Previous issue date: 28 / Nenhuma / Essa Dissertação de Mestrado em Psicologia Clínica focalizou a possibilidade de desenvolvimento da função reflexiva e da capacidade de mentalização na psicoterapia de crianças que residiam em instituição de abrigo e que apresentavam sintomas ou indicadores de depressão. Com base nas contribuições da vertente psicanalítica da teoria do apego, mais especificamente nos conceitos de função reflexiva e capacidade de mentalização, foi realizado um estudo pautado pela abordagem qualitativo-exploratória, adotando-se o procedimento de Estudos de Casos Múltiplos. Duas crianças com idades de 7 e 9 anos foram acompanhadas em psicoterapia durante o período de 6 meses. Antes e depois do processo psicoterapêutico as crianças foram avaliadas com os instrumentos Children‟s Depression Inventory (CDI) para o levantamento dos indicadores de depressão e o Manchester Child Attachment Story Task – MCAST para a identificação das representações internas dos relacionamentos de apego das crianças e da capacidade de mentalização d / This study on Clinic Psychology focused the possibility of development of the reflective function and the mentalization capacity in the psychotherapy of children living in sheltering institutions and that presented depression symptoms or indicators. Based on the contributions of the attachment theory, specifically the concepts of the reflective function and capacity of mentalization, a study guided by the qualitative-exploratory approach was made adopting the procedure of Multiple Case Studies. Two children aged 7 and 9 years were followed in psychotherapy for 6 months. The children were evaluated before and after the psychotherapeutic process with Children’s Depression Inventory (CDI) for the analysis of depression indicators and the Manchester Child Attachment Story Task – MCAST for the identification of the children’s internal representations of attachment and their mentalization capacity. In accordance with the qualitative analysis and with the aid of the instruments, it was possible to establish that psy

Submitted by Nara Lays Domingues Viana Oliveira (naradv) on 2015-08-27T18:37:09Z No. of bitstreams: 1 CamillaBaldiceraBiazus.pdf: 1346212 bytes, checksum: c6361b1bc953164bf06ebe780a53bdf1 (MD5) / Made available in DSpace on 2015-08-27T18:37:09Z (GMT). No. of bitstreams: 1 CamillaBaldiceraBiazus.pdf: 1346212 bytes, checksum: c6361b1bc953164bf06ebe780a53bdf1 (MD5) Previous issue date: 2011-06-17 / Nenhuma / Essa Dissertação de Mestrado em Psicologia Clínica teve como foco a possibilidade de desenvolvimento da capacidade de mentalização na psicoterapia de uma adolescente que apresentava sintomas depressivos e havia buscado atendimento no Serviço de Psicologia de uma Universidade do Sul do Brasil. Com base nas contribuições da vertente psicanalítica da teoria do apego, mais especificamente nos conceitos de função reflexiva e capacidade de mentalização, foi realizado um estudo pautado pela abordagem qualitativo-exploratória, adotando-se o procedimento de estudo de caso. A participante desse estudo foi uma adolescente de 18 anos, que foi atendida em psicoterapia pelo período de seis meses, duas vezes por semana. Antes e depois do processo psicoterápico, a adolescente foi avaliada com o Children’s Depression Inventory (CDI) para o levantamento dos indicadores de depressão e com uma Entrevista Estruturada, sobre a qual foi aplicado o Checklist para Avaliação Clínica da Mentalização. Além desses instrumentos, foi utilizado também o dispositivo da escrita em psicoterapia a fim de explorar seus benefícios tanto para o desenvolvimento da capacidade de mentalização quanto para a redução dos sintomas depressivos na adolescência. Os resultados obtidos apontaram que a adolescente apresentava uma capacidade de mentalização comprometida no início do tratamento, mas que pôde ser desenvolvida ao longo deste, contribuindo significativamente para a diminuição dos seus sintomas depressivos. O uso da escrita nesta abordagem psicoterápica facilitou o desenvolvimento da capacidade de mentalização da paciente, ajudando-a a alcançar uma compreensão mais profunda da própria experiência afetiva, atribuindo novos significados aos afetos que se traduziram em formas novas e mais flexíveis de lidar com a sua problemática. / This study in Clinic Psychology focused the possibility of development of mentalization in the psychotherapy of an adolescent who had depressive symptoms and had sought treatment at a Department of Psychology University of Southern Brazil. Based on the contributions of the attachment theory, specifically the concepts of the reflective function and capacity of mentalization, a study guided by the qualitative-exploratory approach was made adopting the procedure of Case Study. The participants of this study was a adolescent of 18 years which was treated in psychotherapy for six months, twice a week. The adolescent were evaluated before and after the psychotherapeutic process, with Children's Depression Inventory (CDI) for the analysis of depression indicators and a Structured Interview, which was applied on the Checklist for Evaluation of Clinical Mentalization. Besides these instruments, was also used the device of writing in psychotherapy in order to exploit its benefits both for the development of mentalization as for reducing depressive symptoms in adolescence. The results showed that the teenager had committed a mentalization at the beginning of treatment, but that could be developed over this, contributing significantly to the reduction of their depressive symptoms. The use of writing in this psychotherapeutic approach facilitated the development of mentalization of the patient, helping them to achieve a deeper understanding of their own affective experience, giving new meaning to the affects that were translated into new and more flexible to cope with its problematic.

The phenomena of self-awareness and self-observation are thought by many to be uniquely human qualities, and questions about how they develop have engaged philosophers and spiritual thinkers throughout history. More recently these issues have come to interest psychologists, psychotherapists, and researchers of diverse clinical psychology orientations as well. This dissertation explored conceptual issues and empirical measurement methods related to self-awareness and self-observation capacities. The four studies approached this from different angles: Study I used mainly qualitative methods to study post-treatment processes related to continuing clinical improvement after termination of long-term psychotherapeutic treatments. The main finding was that self-analysis seemed to be related to continued improvement after ending of therapy, but contrary to our hypothesis there was no difference between psychotherapy and the more intensive psychoanalysis in this regard. Study II tested the measurement of mindfulness by self report in a sample of experienced Buddhist meditators. The findings confirmed relationships between mindfulness and psychological well-being, but raised doubt about the instruments’ sensitivity to change. Study III compared different methods for measuring theoretically related concepts of self-observation: mindfulness, mentalization, and affect consciousness. This study showed surprisingly little common variance between affect consciousness and mentalization/mindfulness. Finally, the results of Study IV showed that in patients diagnosed with clinical depression, mentalization about depressive symptoms predicted aspects of the initial psychotherapy process better than mentalization about attachment. Taken together, these studies show the complexity of the phenomenon of self-observation and the corresponding complexity of research on it. The relationships between variables related to self-observation, their measurements, and their relationships to the psychotherapy process seem more complex than would be expected from current theories. A model for types of self-observation in the process of change in psychotherapy is tentatively proposed. / Förmågan till självmedvetande och självobservation brukar sägas vara unik för människan, och frågor om hur den uppstår och utvecklas har engagerat filosofer och andliga tänkare genom historien. Under de senaste årtiondena har detta även kommit att intressera psykologer, psykoterapeuter och forskare inom olika kliniska psykologiinriktningar. I denna avhandling utforskades konceptuella frågor och empiriska mätmetoder relaterade till självobservationsförmåga. De fyra studierna tog sig an detta från olika utgångspunkter: I Studie I användes främst kvalitativ metod för att undersöka processer relaterade till fortsatt klinisk förbättring efter avslutning av längre psykoterapeutisk behandling. Beskrivningar av självanalys var relaterade till fortsatt förbättring efter avslutad terapi, men i kontrast till vår hypotes syntes ingen skillnad mellan psykoterapi och den mer intensiva psykoanalysen ur denna aspekt. I Studie II prövades mätning av medveten närvaro (mindfulness) genom självrapport på ett urval erfarna Buddhistiska meditatörer. Resultaten bekräftade samband mellan medveten närvaro och psykologiskt välmående, men visade på osäkerhet kring instrumentens känslighet för förändring. I Studie III jämfördes olika metoder för mätning av teoretiskt relaterade självobservationsbegrepp: medveten närvaro, mentalisering och affektmedvetenhet. Resultaten visade på förvånansvärt liten gemensam varians mellan affektmedvetenhet och mentalisering/medveten närvaro. Slutligen visade resultaten i Studie IV att hos patienter diagnostiserade med klinisk depression predicerade mentalisering om depressiva symptom aspekter av den initiala psykoterapiprocessen bättre än det vanliga måttet på mentalisering utifrån anknytningsintervju. Sammantaget visar dessa studier på komplexiteten i fenomenet självobservationsförmåga och dess utforskande. Relationerna mellan variabler relaterade till självobservation, mätning av dem och samband med psykoterapiprocessen tycks mer komplexa än förväntat utifrån nuvarande teorier. En tentativ modell för samband mellan typer av självobservation i den psykoterapeutiska förändringsprocessen presenteras.

Människor med allvarligare missbruksproblem lider ofta av samsjuklighet. Syftet med studien var att undersöka kvantitativ förekomst av PTSD bland klienter med diagnosen missbruk/beroende på ett behandlingshem i Sverige samt skillnader i förekomst av PTSD mellan män och kvinnor. Även ett kvalitativt syfte fanns avseende missbrukande människors livsvärld och deras syn på sambandet mellan trauma och missbruk samt behandling. Urvalet bestod av 41 individer med diagnosen missbruk/beroende som testats med mätinstrumentet PCL-C vilket mäter problem och besvär som människor kan få som en reaktion på stressande upplevelser. Två av individerna från urvalet valdes för djupintervjuer. Studiens kvantitativa resultat visade att urvalsgruppen i förhållande till en normalpopulation, har betydande större del individer med indikationer på PTSD (65% mot 5,6%). Mer än dubbelt så många kvinnor som män indikerade förekomst av PTSD vilket överensstämmer med normalpopulationen. 90% av kvinnorna hade värden över det kritiska värdet på PCL-C. Studiens kvalitativa resultat visade på ett möjligt samband mellan tidigare svåra upplevelser i livet och situationen idag. Båda de intervjuade individerna hade erfarenhet av svåra händelser i barndomen, tonåren och i vuxenlivet. Båda såg de svåra händelsernas påverkan på psykisk- och fysisk hälsa och relationer samt en koppling mellan svåra händelser och missbruk. Båda hade också tankar om att fokus på/behandling av svåra händelser kan påverka missbruket. Slutsatser av studien kan sammanfattas i att många människor med missbruksproblem också har en traumabakgrund, att kvinnor har det i större utsträckning än män och att detta bör beaktas vid mötet med, och i behandlingen av missbrukare.