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81 Abstract The presented diploma thesis solves fears which are experienced by workers in low-threshold institutions for children and youth (NZDM) in their ongoing contact work. The theoretical articles are focused on the description of NZDM - it's principles, target group, methods and protective mechanisms of work. The following articles describes workers in NZDM. Due to the topic of diploma thesis, the fears are defined in the next articles. The research part of the thesis solves meanings and experiencing of fears using the interpretative phenomenological analysis by A. Smith. The analysis outcome is of high importance experiencing frustration, uncertainty and refusal. The fears are experienced in the background of their own personal life experiences, in the clients specific lives, in the relationship with clients, experiencing competency and work requirements. The most commented values are the intrapsychical safety and self-esteem. The analysis also shows the protective strategies for coping with the fears. Workers talked about the benefits of the experienced problems.

Family secrets can be a driving force, whether explicitly or implicitly, for many seeking therapy. Despite this, there is little qualitative research examining how individuals experience and make sense of their family secrets. Through this study the researcher examined the phenomenon of family secrets amongst five individuals from different families. Qualitative research using Interpretative Phenomenological Analysis (IPA) along with a Bowen Family Systems Theory approach was used to explore multigenerational family secrets. Purposive sampling was used to select that participants and data was collected through semi-structured interviews. A genogram was also drafted to identify multigenerational relationships and the history of family secrets. By exploring and mapping the functions of multigenerational family secrets, the researcher examined in detail how participants make sense of their lived experience with holding a family secret. Through semi-structured interviews, the researcher was able to extract the meanings found within keeping a secret and the functions that secrets serve within families. Six superordinate themes were identified: what’s in a secret, living with a secret, finding meaning, anxiety and differentiation, multigenerational transmission process, and functions of family secrets. The data collected and analysis reflecting the experiences shared by the five participants add to the existing literature on the phenomenon of keeping family secrets and details the implications for the emotional system and marriage and family therapy. By mapping the hidden, a new conversation on the taboos of family secrets can lead to new hope for individuals and generations to come.

The effectiveness of antiretroviral therapy (ART) transformed the pediatric HIV epidemic. The disease changed significantly over the course of three decades: while early in the epidemic it was almost always fatal, it has become a chronic condition. This study examined how perinatally-infected youth experience the impact of HIV in their lives. A qualitative study using interpretative phenomenological analysis (IPA) was conducted. Twenty in-depth interviews were carried out among 12 women and 8 men aged 18 to 30 years in Puerto Rico. These were conducted in Spanish, audio-recorded, transcribed and translated into English. While narrating their experiences, participants were interpreting what the situation meant to them and how they make sense of it. Three topics emerged: (1) perception and response to treatment and illness, particularly their lived experiences with ART; (2) disclosure experiences; and (3) family matters. Most participants challenged their therapy, in most cases to force their caregivers to disclose their status. Problems with adherence were attributed to busy schedules or forgetfulness. Participants experienced the disfiguring adverse effects of ART, which they endured for years without being informed that ART was the cause of these. Participants’ experiences with disclosure demonstrated the importance of validating them as individuals capable of managing their health. The paternalistic approach of withholding their diagnosis to spare them suffering resulted in increased anxiety. Participants acknowledged the difficulties of revealing their HIV status to their partners. They referred to family and friends as essential in coping with HIV. However, some encountered discrimination and stigma within their families. Participants who had suffered the loss of their parents found other parental figures such as adoptive parents or other family members. Most participants expressed a desire to have children. Perinatally HIV-infected youth will require health services for the rest of their lives. The adult health care into which they transition should consider their needs and journey. Services should consider including family members. This study underscores the need for improved access to mental health services. It is also essential to transcend medical treatment and develop a broader perspective of health care. Health care services should include reproductive decision-making counselling services.

Anxiety is one of the most studied research topics in sport psychology literature (Guillen & Sanchez, 2009); however, even though the Olympics are considered to be one of the most pressure-filled sporting events (Birrer, Wetzel, Schmidt, & Morgan, 2012), to date there has been no research aimed specifically at investigating Olympic athletes’ competitive state anxiety and its impact on subsequent performance. Furthermore, according to Nesti (2011), in order to support athletes in dealing with their experience of anxiety, researchers must turn towards the phenomenological, real-lived experience of the athlete to uncover what might best support positive anxiety management and interpretation in competition. The purpose of this study, therefore, was to respond to the gap in Olympic athlete anxiety research by examining the phenomenological experience of competitive state anxiety for female beach volleyball players at the 2012 London Olympics. Six in-depth, phenomenological interviews were conducted with these Olympic female beach volleyball players. Results indicated that, while all athletes in this study experienced anxiety at the 2012 Olympics, it was not the reduced intensity of anxiety that positively impacted their performance but rather the athletes’ ability to recognize, manage, and positively interpret their anxiety. In addition, it was shown that self-confidence further buffered the potentially negative impacts of anxiety. It is recommended that future research focus on extending phenomenological anxiety research to other sports and genders, and to specifically examine the impact of trait anxiety, team dynamics, and the experience of flow on athletes’ anxiety interpretation.

This thesis investigated the experience of taking part in a psychosocial assessment following an episode of self-harm from the service user perspective. Psychosocial assessments are a key aspect of self-harm management in secondary care, designed to identify needs and risk and determine further care. This study utilised interpretative phenomenological analysis to privilege the voices of service users and produce in-depth, contextualised understandings of the experience of assessment and its impact on future help-seeking and engagement with services. Data collection consisted of semi-structured interviews with thirteen participants soon after their hospital attendance; follow-up semi-structured interviews were also completed with seven participants three months later, to explore patient-derived outcomes from assessment and hospital attendance. The lived experiences of participants were characterised by two main features: experiences of life as a struggle and of the self as “less than”. As a result of these struggles and experiences of powerlessness and devaluation, participants mostly saw self-harm and suicide as a natural progression in their narratives. Expressions of suicidal intent reflected a struggle between a desperate desire for change and hopelessness in the face of current circumstances. The key message gained from participants’ accounts of assessment was that the interaction with staff had the power to reinforce or challenge hopelessness and negative self-evaluations. In addition, the way an assessment was conducted had influence beyond the hospital: as an experience which created or reinforced expectations for future instances of help-seeking; as a deterrent or an encouragement to seek help; and as the first step along the path to change. Unfortunately, participants’ experiences of aftercare were dominated by a sense of stagnation due to the failure of services to follow through with promises of aftercare, which affected their attitudes towards future help-seeking and towards themselves. This thesis is the first study to utilise an in-depth idiographic methodology to explore and contextualise the service user experience of psychosocial assessment following self-harm within the wider circumstances of their lives. It demonstrates how patient-staff interactions within the hospital and after discharge can affect future help-seeking through reinforcing or challenging the hopelessness and self-negativity of patients.

Bowen Family Systems Theory’s (BFST) concept of differentiation of self has the ability to contribute to the self-development of the therapist, and is considered the technique of this theory (Kerr & Bowen, 1988). Emotional intelligence is an essential skill for Marriage and Family Therapists (MFTs), as it provides the ability to accurately perceive, express, and evaluate emotions in one’s self and others to facilitate thought, and the regulation of emotions in order to enhance emotional and intellectual growth (Salovey & Mayer, 1997). This study explored the lived experiences of Marriage and Family Therapy students who studied BFST and related those experiences to concepts of differentiation of self and emotional intelligence. This qualitative study utilized Interpretative Phenomenological Analysis (IPA) to gather, process, and analyze the essence of students’ experiences. This process included semi-structured open-ended interviewing of six doctoral students, transcribing, and analyzing the data in accordance with IPA. This study led to the outcome of the coined term differentiated intelligent emotion. The findings of the study produced nine themes: (1) BFST impact on clinical work, (2) BFST impact on personal development, (3) Differentiation of self, (4) Emotional intelligence, (5) Anxiety, (6) Nuclear family emotional process, (7) Multigenerational transmission process, (8) Triangulation, and (9) Individuality and Togetherness. The findings suggest the study of BFST resulted in awareness and an increase in the differentiation of self supported by an increase in emotional intelligence. This led to improvements in personal development, professional development in therapeutic relationships, anxiety, nuclear family functioning, multigenerational transmission process, detriangulation, and sense of individuality. This study contributes to the existing training and development literature concerning MFT’s in terms of their differentiation of self and emotional intelligence. The research presents implications for future research, clinical practice and training.

The aim of the diploma thesis "Maternal Identification in Anorexia Nervosa" is to map the developmental context of the onset of anorexia nervosa in female patients related with the formation of relationships with immediate caregivers and the detailed focus on the daughter's relationship with the mother. The theoretical part offers a cross-section of psychoanalytic theories that specifically deal with such process. These are mainly the object relations theory, the attachment theory as well as the recent theory of mentalization. The initial premise of the whole work is the femininity itself, the age of the patients when the period of adolescence and female gender are amongst the main risk factors for the development of anorexia nervosa and contribute to the disproportion between male and female patients. The concept of identification between daughter and mother within the separation-individuation process is described both in early childhood and during adolescence. The empirical part focuses on a particular examination of the patient's relationships with primary caregivers, the immediate environment from childhood to adulthood and the factors involved in the development of the disease. Through a semi-structured in-depth interview, the study monitors key moments of psychosocial development in four...

The purpose of this study was to deepen the understanding of how the social workers' self-images are affected by how they perceive public attitudes and news media's portrayal of their profession as well as understanding how they are coping with it. Interpretative phenomenological analysis (IPA), which focuses on how individuals experience a certain phenomenon, has been used as a method. One of IPA's theoretical underpinnings is symbolic interactionism and therefore experiences which have effect on a person's self-image is significant. The results show that social workers perceive public attitudes as mainly negative and that the media often portrays social workers in a negative way, which aligns with previous studies. Furthermore, there seems to be a dissonance between the social workers' view of their professional role and how they feel that others perceive them, which led to the use of cognitive dissonance as a theory to support the results in the analysis. The social workers use different strategies to lessen the discomfort that emerges from the dissonance. For instance they tend to avoid telling others what they work with. A successful reduction of the dissonance can help the social workers to maintain a positive self-image.

Bakgrund: Pandemin orsakad av Covid-19 har tvingat intensivvården till stora omställningar. Som del av restriktioner för att reducera risk för smittspridning måste skyddsutrustning användas vid patientkontakt med smittad patient. Användandet av skyddsutrustning har introducerat tankar på hur den vårdande relationen mellan patient och intensivvårdssjuksköterska påverkats.  Syfte: Syftet med studien var att belysa intensivvårdssjuksköterskans upplevelse av hur arbetet i skyddsutrustning under pågående pandemi påverkat den vårdande relationen med patienten. Metod: Semistrukturerade intervjuer genomfördes med sex intensivvårdssjuksköterskor. Intervjuerna låg vidare till grund för analys enligt tolkande fenomenologisk analys (IPA).  Resultat: Fyra överordnade teman framträdde ur analysen. I temat fokus på kommunikation framkom olika sätt skyddsutrustningen påverkat kommunikationen. Upplevelsen av avskärmning framkom i temat fokus på distans där närhet uttrycktes som avgörande för en vårdande relation. I temat fokus på lidande beskrevs hur skyddsutrustningen inverkat på lindrande beröring men också att den kan orsaka lidande. Känslor av otillräcklighet i den vårdande relation och maktlöshet inför att inte förmå förändra eller påverka framkom i temat fokus på känslor.  Slutsats: Skyddsutrustningen påverkar den vårdande relationen. Skyddsutrustningen reducerar möjligheten till etablering av vårdande relation vilket riskerar minska patientens möjlighet till delaktighet. Behov föreligger av ytterligare forskning om påverkan med fokus på prevention. Ett organisatoriskt medvetande om skyddsutrustningen inverkan på den vårdande relationen kan ligga till grund för interventioner ämnade att reducera dess negativa påverkan. / Background: The pandemic caused by COVID-19 has forced the intensive care to make several adjustments. As part of restrictions to prevent spread of infection personal protective equipment (PPE) has to be used when in contact with infected patients. The use of PPE has introduced questions of its impact on the caring relationship between the patient and intensive care nurse.  Aim: The aim with this study was to illustrate the intensive care nurses experience of how working in PPE during the pandemic has affected the caring relationship with the patient.  Method: Semi- structured interviews was conducted with six intensive care nurses. The interviews served as data for an interpretative phenomenological analysis (IPA).  Results: Four superior themes emerged from the analysis. In the theme focus on communication emerged different way of which the PPE has affected communication. The experience of being shielded emerged in the theme focus on distance where closeness was expressed as essential. In the theme focus on suffering was the PPE´s impact on touch described and also its potential cause of suffering. Emotions of inadequacy in regards to the caring relationship and powerlessness in regards of not being able to change or affect emerged in the theme focus on emotions.  Conclusion: The caring relationship has been affected by the use of PPE. PPE reduces the possibility of establishing a caring relationship which endangers the patient’s active participation. There is need for further research about affect with focus on prevention. An organizational awareness regarding PPE´s effect on the caring relationship could lay the foundation for interventions supposed to reduce its negative impact.