Småföretag har inte samma finansiella och personella resurser som stora företag och kan få svårt att genomföra önskade IT-relaterade förändringar. De företag som väljer att satsa för att uppnå sina visioner måste många gånger hitta andra lösningar för att nå framgång. Avhandlingen bygger på en åtta månader lång fallstudie i ett småföretag och identifierar kompensationer som ett sätt att lösa problemet. En kompensation är en ersättning för en förändring i ett informationssystem. Ett exempel på kompensation är att göra dubbelarbete istället för att integrera två informationssystem. Andra exempel är att införa regler för hur informationen skall användas och tolkas istället för att sätta restriktioner i informationssystemet, eller att ta fram en rapport ad hoc med en rapportgenerator istället för att låta externa experter utveckla rapporten direkt i verksamhetssystemet. Småföretagens korta planeringshorisont med intuitiva och erfarenhetsbaserade beslutsprocesser bildar en gynnsam miljö för att arbeta med kompensationer - det går snabbt att samla hela personalen och säga: ”nu gör vi så här istället”. Men, kompensationen kan också visa sig vara ett tveeggat svärd. I fallstudien visar sig kompensationerna många gånger bidra till negativa bieffekter när de väl används. Exempel på negativa bieffekter är merarbete, stress, ökad osäkerhet och tekniska problem. Fyra risker med att arbeta med kompensationer har identifierats. Resursberoendet: om kompensationen leder till att arbetsbördan ökar, är risken stor att personerna får mindre tid att delta i förändringsarbetet Illusionen: om kompensationen ger sken av att lösningen fungerar i praktiken, är risken stor att ledningens fokus flyttas till andra mer akuta projekt trots att viktiga problem kvarstår. Den tekniska skulden: när tekniska problem inte åtgärdas ordentligt, utan hanteras med kompensationer, ackumuleras problemen till en ”teknisk skuld”. Skulden växer i takt med att nya förändringar genomförs och den tekniska infrastrukturen blir mer och mer komplex. På sikt blir det både svårt och dyrbart att åtgärda problemen. Legitimeringen: om arbetet med kompensationer anses ”fungera i praktiken” kan det bli legitimt att inte lösa problem ordentligt. Det bidrar till att företaget inte utvecklar viktiga kompetenser som till exempel användning av formella metoder, beställarkompetens och förmågan att samarbeta med externa experter. Kompensationer är en viktig del i småföretagets arbete med IT-relaterade förändringar och kan inte undvikas. Tidigare forskning har dock inte tagit hänsyn till hur kompensationer påverkar förändringsarbetets framgång. Dessa studier har identifierat framgångsfaktorer som användarinvolvering, VD:s stöd, samarbetet med externa experter och användningen av formella metoder. Den här studien visar på att kompensationerna kan påverka framgångsfaktorerna negativt via de fyra riskerna, exempelvis genom att tiden för användarinvolvering minskar, VD:s fokus förskjuts samt att relationerna med externa experter aldrig utvecklas. Implikationen är att kompensationerna måste hanteras medvetet därför att de får konsekvenser som kan vara svåra att förutse intuitivt. Dessa konsekvenser kan bidra till att förutsättningarna för framtida förändringar försämras. Det är därför viktigt att överväga vad som lönar sig mest för att uppnå en varaktig framgång: att tillsätta resurser för att göra de nödvändiga förändringarna i informationssystemen, att sänka ambitionsnivån eller att hitta smarta kompensationer. För småföretag som vill förbättra sättet att bedriva förändringsarbete blir konsekvensen att det inte räcker att ta hänsyn till traditionella framgångsfaktorer. De småföretag som verkligen vill få bättre effekter måste också ifrågasätta hur det egna, invanda sättet att arbeta med IT-relaterad förändring påverkar möjligheterna att genomföra både aktuella och framtida förändringarna. / Lic.-avh. Stockholm : Handelshögskolan, 2006

A Psicoterapia Analítica Funcional (FAP) aponta a relação terapêutica como meio de promoção de mudanças clínicas. Os comportamentos do cliente em sessão são classificados como CCR1s (comportamentos problema), CCR2s (comportamentos de melhora) e CCR3 (descrições funcionais a respeito do próprio comportamento). É papel do terapeuta atuar sobre esses CCRs com o intuito de aumentar CCR2 e CCR3, bem como diminuir a emissão de CCR1, o que é planejado por meio das regras: estar atento aos CCRs (regra 1), evocar diretamente CCRs (regra 2), consequenciar CCRs (regra 3), observar os efeitos do seu comportamento sobre o comportamento do cliente (regra 4) e fornecer interpretações analítico-funcionais e implementar estratégias de generalização (regra 5). Compreende-se que a similaridade funcional do contexto terapêutico com outros ambientes do cliente possibilita o acesso do terapeuta à classe de comportamentos alvo de intervenção clínica e que, ainda, é papel do terapeuta evocá-los diretamente, componente da FAP expresso pela regra 2. As pesquisas que investigam o mecanismo de mudança da FAP têm enfatizado o papel da consequenciação (regra 3) sobre a mudança comportamental observada nos clientes, entretanto, há indícios de que tal mudança seja também resultado de um processo evocativo ocorrendo em sessão, responsável por produzir o aumento da emissão de CCR2s e diminuição de CCR1s quando a FAP é conduzida. Sendo assim, o objetivo do presente estudo foi o identificar quais os efeitos da evocação direta pelo terapeuta na FAP (variável independente) sobre os CCRs do cliente em sessão (variáveis dependentes), sendo utilizado delineamento experimental de caso único de reversão, com arranjo A-B1-BC1-B2-BC2 para uma cliente, com controle da inserção da evocação (arranjo A-BC1-B1-BC2-B2) para outro cliente. A fase A foi correspondente à linha de base, com realização de análise de contingências externas, as fases B corresponderam à condução de FAP sem evocação direta e as fases BC, à FAP completa. As sessões foram categorizadas com o Functional Analytic Psychotherapy Rating Scale (FAPRS) pela terapeuta e aferidoras de concordância, foi aplicado semanalmente o Outcome Questionnaire (OQ-45.2) que possibilitou o acompanhamento da evolução global dos clientes. Após três meses do encerramento do estudo, foi realizada uma sessão de follow-up com cada cliente, a qual indicou a manutenção de progressos com os mesmos. Como resultado no FAPRS, registrou-se o abrupto aumento de CCR2s e diminuição de CCR1s quando a evocação direta foi inserida, o aumento de CCR1 e diminuição de CCR2 quando a mesma foi retirada, bem como a replicação dessas duas fases e de seus efeitos sobre os comportamentos dos dois clientes. Nas fases em que a evocação não esteve presente, as porcentagens de CCRs assemelharam-se às observadas na linha de base. Observou-se também a importância da consequenciação com função evocativa, o que sustenta que a evocação e a consequenciação atuam de forma complementar. Tais resultados solidificam a proposta de que a produção de CCR2 nas sessões FAP tenha também por base a existência de processos evocativos atuantes, já que diante da ausência da evocação, registrou-se imediata diminuição de sua ocorrência. Nesse sentido, a evocação direta pode ser destacada como possuindo impacto relevante no mecanismo de mudança dessa psicoterapia / Functional Analytic Psychotherapy (FAP) points to the therapeutic relationship as a way of promoting clinical changes. The client behaviors in session are classified as CRB1s (problem behaviors), CRB2s (improvement behaviors) and CRB3 (functional descriptions regarding any client´s behavior). FAP therapist should act on these CRBs in order to increase CRB2 and CRB3 and to reduce the emission of CRB1, which is planned by using the rules: to be aware of CRBs (rule 1), to evoke CRBs directly (rule 2), to contingently respond to CRBs (rule 3), to observe the effects of therapist´s behavior on client´s behavior (rule 4) and to provide analytic-functional interpretations and implement generalization strategies (rule 5). It is understood that the functional similarity of the therapeutic context to other client environments allows the therapist to access the class of target behaviors of clinical intervention and that it is also the role of the therapist to directly evoke them, a component of FAP expressed by rule 2. Researches focused on investigate the mechanism of change in FAP have emphasized the role of consequence (rule 3) on behavioral change observed in clients, however, there is evidence that such a change is the result of an evocative process occurring in session, which is responsible for producing increased CRB2s and decreased CRB1s emissions when FAP is conducted. Thus, the goal of this investigation was to identify the effects of direct evocation by the therapist in FAP (independent variable) on client CRBs in session (dependent variables), using an experimental design of a single-case experimental procedure, with design A -B1-BC1-B2-BC2 for one client, with control of the insertion of the independent variable (design A-BC1-B1-BC2-B2) to another client. Phase A corresponded to the baseline, without systematic use of FAP, phases B corresponded to FAP without direct evocation and phases BC, to the use of complete FAP. The sessions were categorized with the instrument Functional Analytical Psychotherapy Rating Scale (FAPRS) by the therapist and independent coders. The Outcome Questionnaire (OQ-45.2) was applied weekly, allowing the therapist to monitor the overall evolution of clients and after three months of the end of the phases, a follow-up session was conducted with each client, which indicated the maintenance of the observed effects. As a result in FAPRS, it occurred the abrupt increase of CRB2s and decrease of CCR1s when direct evocation was inserted, the increase of CRB1 and decrease of CRB2 when it was withdrawn, as well as the replication of these two phases and their effects on the behaviors of the two clients. In the phases in which evocation was not present, the percentages of CRBs were similar to those observed in baseline. It was also observed the importance of the consequences with evocative function, which maintains that the evocation and the consequences provided by the therapist act in a complementary way. These results solidify the proposal that the increase of CRB2 in FAP is also based on the existence of evocative processes, since in the absence of evocation it is observed its immediate decrease. Therefore, direct evocation can be highlighted as having a relevant impact on the mechanism of change of this psychotherapy

Während Leitlinien „Gold-Standards“ für die Psychotherapie bei bulimischen Essstörungen (Bulimia Nervosa und Binge-Eating-Störung) empfehlen, ist über psychotherapeutische Prozessfaktoren bei Essstörungen wenig bekannt. Ziel war es, mit Hilfe des etablierten Generic Model of Psychotherapy zur Systematisierung psychotherapeutischer Prozessfaktoren die aktuelle Literatur zum Einfluss dieser Faktoren auf den Therapieerfolg, operationalisiert als Symptomreduktion oder -remission, auf Basis einer systematischen Datenbanksuche zu sichten. Während der Einfluss des therapeutischen Settings nach bisheriger Forschungslage kaum Schlüsse hinsichtlich des Therapieerfolgs zulässt, konnte dieser durch spezifische Interventionen, frühe Symptomreduktionen und eine gute therapeutische Beziehung vorhergesagt werden. Weitere Forschung zu Prozessfaktoren bei bulimischen Essstörungen erscheint notwendig, um die praktische psychotherapeutische Arbeit zu unterstützen und Behandlungen effektiver gestalten zu können. / While guidelines recommend gold standards for psychotherapy in bulimic eating disorders (bulimia nervosa and binge eating disorder), less is known about psychotherapeutic process aspects. We aimed to summarize the current literature on the impact of process aspects on significant symptom reductions and/or abstinence as treatment outcome using the Generic Model of Psychotherapy. A systematic literature search was conducted. While effects of treatment settings can not yet be estimated, specific interventions, rapid response, and the therapeutic bond repeatedly predicted outcome. Process-outcome research in bulimic eating disorders will be necessary to support clinical practice and to enhance treatment efficacy.

Der Zweck der vorliegenden Studie besteht darin, die These zu überprüfen, ob das analytische Paar eine selbstständige Einheit ist. Die Beobachtung, definiert als Etwas, das einen Unterschied im Umfeld des Anderen macht, ist eine Handlung, die vom Analysten, dem Patienten und dem analytischen Paar durchgeführt wird. Die zentrale Frage beschäftigt sich mit der Art und Weise, in der sich die analytische Sitzung aus einer triadischen Perspektive entfaltet: Kann das analytische Paar in seinem eigenen Umfeld einen Unterschied machen und sich zum Zweck der Anpassung verwandeln? Es wird eine mathematisch modellierte Herangehensweise benutzt, die davon ausgeht: “sind diese funktionell äquivalent oder unterschiedlich?”. Das neue Modell bietet eine binär geschriebene ‘Form’, von “symmetrischer Differenz” bestimmt, während jegliche selbstständige Identität zweidimensional ist, der Sprecher und der Zuhörer. Es wird gezeigt, dass Beobachtung mit Rekursion verbunden ist. “Beobachtung”, so wie diese vom Paar ausgeübt wird, gestaltet permanent neue Unterschiede in dem Umfeld, als Folge der Äußerungen, die Abläufe von Äußerungen widerspiegeln. Rekursion und Komplexifikation beantworten wie das Paar neue Unterschiede macht und diese “Beobachtungen” umwandelt und sich auf das was vor sich geht, anpasst. Das Paar entfaltet sich demnach: “weniger Ordnung → Schwankungen → mehr Ordnung” und bestätigt die theoretisierte Form des Prozesses: “Rekursion → Komplexifikation → Vorgänge auf der nächsten Ebene”. Paar zeichnet Unterschiede in seinem Umfeld auf, indem es sich selbst widerspiegelt. Es wird gezeigt, dass Vorgänge auf der nächsten Ebene aus einer Abfolge von selbstgespiegelten Vorgängen hervorgehen. Eine derartige Herangehensweise bedeutet, (empirisch) zu zeigen, ob diese Perspektive beobachtbare Elemente bietet und wie diese für die Art und Weise, in der der analytische Vorgang betrachtet wird, von Bedeutung sind. / The aim of the present study is to test the idea that the analytic couple is an autonomous entity. Observing, defined as making distinctions in one’s environment, is seen as an action performed by the analyst, the patient and by the analytic couple. The main question addresses how the analytic session unfolds in a triadic view: Is the analytic couple able to make distinctions in its own environment and transform for adapting? A mathematical inspired modelling approach is employed, that starts from: “are they functionally equivalent or different?”. The new model provides a binary written ‘form’, governed by “symmetric difference”, while any autonomous entity is bidimensional, involving the speaker and the listener. It is shown that observing involves recursion. So, “observing” as performed by the couple is ongoingly devising new distinctions in the environment, as sequences of utterances mirroring sequence of utterances. Recursion and complexification answer to how the couple makes new distinctions and transform them, adapting to what is. The couple unfolds under “less order → fluctuations → more order” and confirms the form of process: “recursion → complexification → next-level-events”. It is shown that next-level-events emerge from self-reflecting sequences of actions. What such view means equates showing (empirically) if such view provides observables, and how such observables are meaningful regarding the analytic process.

No description available.

Cette thèse s’intéresse à la gouvernance de changements en contextes pluralistes. Nous souhaitons mieux comprendre l’exercice de gouvernance déployé pour développer et implanter un changement par le biais d’une politique publique visant la transformation d’organisations pluralistes. Pour ce faire, nous étudions l’émergence et l’implantation de la politique encadrant la création de groupes de médecine de famille (GMF) à l’aide d’études de cas correspondant à cinq GMF. Les cas sont informés par plus de cents entrevues réalisées en deux vagues ainsi que par une analyse documentaire et des questionnaires portant sur l’organisation du GMF. Trois articles constituent le cœur de la thèse. Dans le premier article, nous proposons une analyse de l’émergence et de l’implantation de la politique GMF à l’aide d’une perspective processuelle et contextuelle développée à partir du champ du changement organisationnel, tel qu’étudié en théorie des organisations. Les résultats démontrent que la gestion du changement en contexte pluraliste est liée à de multiples processus prescrits et construits. Nous avons qualifié ce phénomène de régulation de l’action social (regulation of collective action). La conceptualisation développée et les résultats de l’analyse permettent de mieux comprendre les interactions entre les processus, le contexte et la nature du changement. Le deuxième article propose une conceptualisation de la gouvernance permettant l’étude de la gouvernance en contextes pluralistes. La conceptualisation de la gouvernance proposée tire profit de plusieurs courants des sciences politiques et de l’administration publique. Elle considère la gouvernance comme un ensemble de processus auxquels participent plusieurs acteurs détenant des capacités variables de gouvernance. Ces processus émergent des actions des acteurs et des instruments qu’ils mobilisent. Ils permettent la réalisation des fonctions de la gouvernance (la prospective, la prise de décisions ainsi que la régulation) assurant la coordination de l’action collective. Le troisième article propose, comme le premier, une analyse de l’émergence et de l’implantation de la politique mais cette fois à l’aide de la conceptualisation de la gouvernance développée dans l’article précédent. Nos résultats permettent des apprentissages particuliers concernant les différentes fonctions de la gouvernance et les processus permettant leur réalisation. Ils révèlent l’influence du pluralisme sur les différentes fonctions de gouvernance. Dans un tel contexte, la fonction de régulation s’exerce de façon indirecte et est étroitement liée aux fonctions de prospective et de prise de décisions. Ces fonctions rendent possibles les apprentissages et le développement de consensus nécessaires à l’action collective. L’analyse des actions et des instruments a permis de mieux comprendre les multiples formes qu’ils prennent, en lien avec les contextes dans lesquels ils sont mobilisés. Les instruments indirects permettent les interactions (p. ex. commission d’étude, comité ou réunion) et la formalisation d’ententes entre acteurs (p. ex. des contrats ou des protocoles de soins). Ils se sont révélés fondamentaux pour coordonner les différents acteurs participant à la gouvernance, et ce tant aux niveaux organisationnel qu’inter organisationnel. Les résultats démontrent que les deux conceptualisations contribuent à l’étude de la gouvernance du changement. Nous avons développé deux perspectives inspirées par les sciences politiques, l’administration publique et la théorie des organisations et les analyses qu’elles ont permises ont révélé leur complémentarité. Les résultats permettent de mieux comprendre les processus impliqués dans un tel changement ainsi que leur lien avec les efforts déployés aux différents niveaux par les acteurs mobilisant leurs capacités de gouvernance pour influencer et construire la politique GMF. / This thesis is concerned with the governance of change in pluralistic contexts. We wanted to gain a better understanding of the governance processes utilised to develop and implement a public policy aimed at transforming pluralistic organisations. To this end, we conducted a multiple-case study of the emergence and implementation of a policy supporting the creation of family medicine groups (FMG) as it unfolded in five FMGs. The case studies were informed by over 100 interviews conducted in two periods in time as well as from an analysis of documents and questionnaires relating to the organisation of the FMGs. This thesis is essentially composed of three articles. In the first article, we propose an analysis of the emergence and implementation of the FMG policy based on a combined processual-contextual perspective, which has its roots in the field of organisational change, as studied in organisational theory. The results demonstrated that the management of change in a pluralistic context is associated with multiple prescribed and constructed processes. We termed this phenomenon a regulation of collective action. The conceptual framework we developed enabled an analysis which in turn fostered a more enlightened understanding of the interactions that take place between processes, the context and the nature of change. The second article proposes a conceptualisation of governance that enables it to be studied in pluralistic contexts. This framework draws from several branches of political science and public administration. It considers governance as the set of processes involving the participation of many actors, who possess varying degrees of governance capacities. These governance processes are manifested in actors’ actions and the instruments they mobilise. Furthermore, the governance processes consist of three types of functions—avenue-prospecting, decision-making and regulation—which together serve to coordinate collective action. Like the first article, the third proposes an analysis of the emergence and implementation of a policy; however this article incorporates the framework of governance developed in the preceding article. Our analyses yielded some novel findings about the various functions of governance and the processes that lead to their realisation. Specifically, they revealed how the pluralistic context influences and shapes governance functions. In such contexts, the regulation function was found to be carried out in an indirect manner and to be closely tied to the functions of avenue-prospectings and decision making. These functions fostered the knowledge gathering and the consensus building needed to mobilise collective action and were manifested in the use of governance instruments. An analysis of actors’ actions and the instruments they used gave us insight into the many forms that such actions and instruments can take as well as the contexts in which they may be mobilised. Indirect instruments allowed for interactions (e.g. task force, committee or meeting) and the formalisation of agreements between actors (e.g. contracts, care protocols). These instruments proved to be fundamental to the coordination of the various actors participating in governance, both within organisations and between them. Our results demonstrate that the two frameworks contribute significantly to the study of change governance. We developed two conceptualisations inspired from political science, public administration and organisational theory, and the analyses they enabled revealed how the two frameworks complement each other. These results have given us a more clarified understanding of the processes involved in such a systemic change as well as the relationship between these processes and the efforts deployed at various levels of governance by actors exercising their capacity to influence or shape a far-reaching public policy.

Cette thèse s’intéresse à la gouvernance de changements en contextes pluralistes. Nous souhaitons mieux comprendre l’exercice de gouvernance déployé pour développer et implanter un changement par le biais d’une politique publique visant la transformation d’organisations pluralistes. Pour ce faire, nous étudions l’émergence et l’implantation de la politique encadrant la création de groupes de médecine de famille (GMF) à l’aide d’études de cas correspondant à cinq GMF. Les cas sont informés par plus de cents entrevues réalisées en deux vagues ainsi que par une analyse documentaire et des questionnaires portant sur l’organisation du GMF. Trois articles constituent le cœur de la thèse. Dans le premier article, nous proposons une analyse de l’émergence et de l’implantation de la politique GMF à l’aide d’une perspective processuelle et contextuelle développée à partir du champ du changement organisationnel, tel qu’étudié en théorie des organisations. Les résultats démontrent que la gestion du changement en contexte pluraliste est liée à de multiples processus prescrits et construits. Nous avons qualifié ce phénomène de régulation de l’action social (regulation of collective action). La conceptualisation développée et les résultats de l’analyse permettent de mieux comprendre les interactions entre les processus, le contexte et la nature du changement. Le deuxième article propose une conceptualisation de la gouvernance permettant l’étude de la gouvernance en contextes pluralistes. La conceptualisation de la gouvernance proposée tire profit de plusieurs courants des sciences politiques et de l’administration publique. Elle considère la gouvernance comme un ensemble de processus auxquels participent plusieurs acteurs détenant des capacités variables de gouvernance. Ces processus émergent des actions des acteurs et des instruments qu’ils mobilisent. Ils permettent la réalisation des fonctions de la gouvernance (la prospective, la prise de décisions ainsi que la régulation) assurant la coordination de l’action collective. Le troisième article propose, comme le premier, une analyse de l’émergence et de l’implantation de la politique mais cette fois à l’aide de la conceptualisation de la gouvernance développée dans l’article précédent. Nos résultats permettent des apprentissages particuliers concernant les différentes fonctions de la gouvernance et les processus permettant leur réalisation. Ils révèlent l’influence du pluralisme sur les différentes fonctions de gouvernance. Dans un tel contexte, la fonction de régulation s’exerce de façon indirecte et est étroitement liée aux fonctions de prospective et de prise de décisions. Ces fonctions rendent possibles les apprentissages et le développement de consensus nécessaires à l’action collective. L’analyse des actions et des instruments a permis de mieux comprendre les multiples formes qu’ils prennent, en lien avec les contextes dans lesquels ils sont mobilisés. Les instruments indirects permettent les interactions (p. ex. commission d’étude, comité ou réunion) et la formalisation d’ententes entre acteurs (p. ex. des contrats ou des protocoles de soins). Ils se sont révélés fondamentaux pour coordonner les différents acteurs participant à la gouvernance, et ce tant aux niveaux organisationnel qu’inter organisationnel. Les résultats démontrent que les deux conceptualisations contribuent à l’étude de la gouvernance du changement. Nous avons développé deux perspectives inspirées par les sciences politiques, l’administration publique et la théorie des organisations et les analyses qu’elles ont permises ont révélé leur complémentarité. Les résultats permettent de mieux comprendre les processus impliqués dans un tel changement ainsi que leur lien avec les efforts déployés aux différents niveaux par les acteurs mobilisant leurs capacités de gouvernance pour influencer et construire la politique GMF. / This thesis is concerned with the governance of change in pluralistic contexts. We wanted to gain a better understanding of the governance processes utilised to develop and implement a public policy aimed at transforming pluralistic organisations. To this end, we conducted a multiple-case study of the emergence and implementation of a policy supporting the creation of family medicine groups (FMG) as it unfolded in five FMGs. The case studies were informed by over 100 interviews conducted in two periods in time as well as from an analysis of documents and questionnaires relating to the organisation of the FMGs. This thesis is essentially composed of three articles. In the first article, we propose an analysis of the emergence and implementation of the FMG policy based on a combined processual-contextual perspective, which has its roots in the field of organisational change, as studied in organisational theory. The results demonstrated that the management of change in a pluralistic context is associated with multiple prescribed and constructed processes. We termed this phenomenon a regulation of collective action. The conceptual framework we developed enabled an analysis which in turn fostered a more enlightened understanding of the interactions that take place between processes, the context and the nature of change. The second article proposes a conceptualisation of governance that enables it to be studied in pluralistic contexts. This framework draws from several branches of political science and public administration. It considers governance as the set of processes involving the participation of many actors, who possess varying degrees of governance capacities. These governance processes are manifested in actors’ actions and the instruments they mobilise. Furthermore, the governance processes consist of three types of functions—avenue-prospecting, decision-making and regulation—which together serve to coordinate collective action. Like the first article, the third proposes an analysis of the emergence and implementation of a policy; however this article incorporates the framework of governance developed in the preceding article. Our analyses yielded some novel findings about the various functions of governance and the processes that lead to their realisation. Specifically, they revealed how the pluralistic context influences and shapes governance functions. In such contexts, the regulation function was found to be carried out in an indirect manner and to be closely tied to the functions of avenue-prospectings and decision making. These functions fostered the knowledge gathering and the consensus building needed to mobilise collective action and were manifested in the use of governance instruments. An analysis of actors’ actions and the instruments they used gave us insight into the many forms that such actions and instruments can take as well as the contexts in which they may be mobilised. Indirect instruments allowed for interactions (e.g. task force, committee or meeting) and the formalisation of agreements between actors (e.g. contracts, care protocols). These instruments proved to be fundamental to the coordination of the various actors participating in governance, both within organisations and between them. Our results demonstrate that the two frameworks contribute significantly to the study of change governance. We developed two conceptualisations inspired from political science, public administration and organisational theory, and the analyses they enabled revealed how the two frameworks complement each other. These results have given us a more clarified understanding of the processes involved in such a systemic change as well as the relationship between these processes and the efforts deployed at various levels of governance by actors exercising their capacity to influence or shape a far-reaching public policy.

Unresolved painful emotional experiences such as bereavement, trauma and disturbances in core relationships, are common presenting problems for clients of psychodrama or psychotherapy more generally. Emotional pain is experienced as a shattering of the sense of self and disconnection from others and, when unresolved, produces avoidant responses which inhibit the healing process. There is agreement across therapeutic modalities that exposure to emotional experience can increase the efficacy of therapeutic interventions. Moreno proposes that the activation of spontaneity is the primary curative factor in psychodrama and that healing occurs when the protagonist (client) engages with his or her wider social system and develops greater flexibility in response to that system. An extensive case-report literature describes the application of the psychodrama method in healing unresolved painful emotional experiences, but there is limited empirical research to verify the efficacy of the method or to identify the processes that are linked to therapeutic change. The purpose of this current research was to construct a model of protagonist change processes that could extend psychodrama theory, inform practitioners’ therapeutic decisions and contribute to understanding the common factors in therapeutic change. Four studies investigated protagonist processes linked to in-session resolution of painful emotional experiences. Significant therapeutic events were analysed using recordings and transcripts of psychodrama enactments, protagonist and director recall interviews and a range of process and outcome measures. A preliminary study (3 cases) identified four themes that were associated with helpful therapeutic events: enactment, the working alliance with the director and with group members, emotional release or relief and social atom repair. The second study (7 cases) used Comprehensive Process Analysis (CPA) to construct a model of protagonists’ processes linked to in-session resolution. This model was then validated across four more cases in Study 3. Five meta-processes were identified: (i) a readiness to engage in the psychodrama process; (ii) re-experiencing and insight; (iii) activating resourcefulness; (iv) social atom repair with emotional release and (v) integration. Social atom repair with emotional release involved deeply experiencing a wished-for interpersonal experience accompanied by a free flowing release of previously restricted emotion and was most clearly linked to protagonists’ reports of reaching resolution and to post session improvements in interpersonal relationships and sense of self. Acceptance of self in the moment increased protagonists’ capacity to generate new responses within each meta-process and, in resolved cases, there was evidence of spontaneity developing over time. The fourth study tested Greenberg’s allowing and accepting painful emotional experience model as an alternative explanation of protagonist change. The findings of this study suggested that while the process of allowing emotional pain was present in resolved cases, Greenberg’s model was not sufficient to explain the processes that lead to in-session resolution. The protagonist’s readiness to engage and activation of resourcefulness appear to facilitate the transition from problem identification to emotional release. Furthermore, experiencing a reparative relationship was found to be central to the healing process. This research verifies that there can be in-session resolution of painful emotional experience during psychodrama and protagonists’ reports suggest that in-session resolution can heal the damage to the sense of self and the interpersonal disconnection that are associated with unresolved emotional pain. A model of protagonist change processes has been constructed that challenges the view of psychodrama as a primarily cathartic therapy, by locating the therapeutic experience of emotional release within the development of new role relationships. The five meta-processes which are described within the model suggest broad change principles which can assist practitioners to make sense of events as they unfold and guide their clinical decision making in the moment. Each meta-process was linked to specific post-session changes, so that the model can inform the development of therapeutic plans for individual clients and can aid communication for practitioners when a psychodrama intervention is used for a specific therapeutic purpose within a comprehensive program of therapy.

Syftet med denna studie var att undersöka hur terapeuters personlighetskonfiguration aktualiseras i relation till patienten tidigt i terapin samt samband mellan olika mönster av samstämmighet eller komplementaritet mellan patientens och terapeutens personlighetskonfiguration och dess betydelse för utfall.  I 33 par bestående av patient och terapeut klassificerades terapeuterna som antingen i huvudsak anaklitiska eller introjektiva utifrån Prototype Matching of Anaclitic-Introjective Configuration (PMAI) av två oberoende bedömare vilka uppvisade god interbedömarreliabilitet (kappa =0,63). Resultatet visar en signifikant större förbättring för den samstämmiga gruppen. Studien pekar på betydelsen av att terapeuten tidigt anpassar sin stil att relatera till patientens personlighetsbaserade orientering på relaterande eller autonomi/självavgränsning.

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