Evidence suggests that Antisocial Personality Disorder (ASPD) is highly prevalent amongst young males involved in the criminal justice system; however effective psychological treatment options for people with the disorder is limited. This thesis therefore explores psychosocial factors implicated in the development of the disorder, with the view to identify specific treatment targets for psychotherapeutic interventions. In the first instance, a systematic review and meta-analysis was conducted to examine the efficacy of Mentalization Based Therapy (MBT), a psycho-dynamically informed intervention. MBT was originally developed to treat people with Borderline Personality Disorder (BPD), yet to date no meta-analysis has evaluated the efficacy of MBT alone. Furthermore, emerging evidence suggests that MBT can be effective for people with ASPD, however at present, there are insufficient studies to examine the effectiveness of the approach with this population. Therefore, MBT was examined with the view to assess treatment outcomes for adolescents with emerging BPD and adults diagnosed with BPD. In accordance with the specific inclusion criteria, five primary articles were retained and analysed. In relation to the MBT group, there was a significant improvement in symptoms. Furthermore, effect sizes for other problems (anxiety, depression, suicidal attempts/self-harm) were found to be large to very large. When considering interpersonal functioning, interestingly, analysis revealed no effect favouring either the treatment or control group. Regarding impairment, a large and significant effect size was found in favour of the control group. Overall, adolescents derived greater benefit from the treatment when compared to adults. Limitations relate to the number of available studies in this review. In order to identify treatment targets for psychotherapeutic interventions, an empirical study explored the relationship between mentalizing capability, attachment style and schema as predictors of ASPD in 79 men recruited from a Young Offenders Institution (YOI). The results confirmed that anxious attachment style and specific Early Maladaptive Schema (EMS) domains relating to Disconnection & Rejection (mistrust-abuse); Impaired Autonomy & Performance (dependence), and Impaired Limits (entitlement) are associated with ASPD in young male offenders. Inferential analyses confirmed that intellectual functioning did not influence performance on any measures. Main limitations relate to the cross-sectional nature of the study and sample size. Following this theme, a single case study relating to the assessment and treatment of a young male with ASPD and comorbid diagnoses was undertaken using a firesetting offence focused treatment programme. Formulation, treatment progress and outcomes are discussed; and recommendations for further work are provided. Thereafter, a critical appraisal of the Revised Adult Attachment Scale (RAAS; Collins, 1996), a measure utilised in the empirical study was conducted. Consideration is given to the utility of the RAAS, particularly within forensic populations. The RAAS was found to be a reliable and valid measure for use with undergraduate, general, and clinical populations. Further research relating to the application within forensic populations is needed to test the reliability and validity of the tool with offenders. Finally, the thesis discusses limitations of the methodologies used and highlights how the overall aim of this thesis was achieved.

Current political drivers are set to increase the volume of people receiving a dementia diagnosis. However, there are problems with how diagnoses are being delivered, with people reporting it to be confusing, anxiety provoking, and being generally dissatisfied. Limited guidance exists that could help improve the delivery and steps are required to address this. Research has begun to explore the components of a good delivery of a diagnosis of dementia, however interventions to support clinicians to deliver diagnoses are limited. This project’s overarching aim was to develop a prototype tool that has future potential to be used by clinicians, patients, and companions who are involved in the delivery of diagnoses of dementia. A two-phase sequential design was undertaken. Phase one explored four Memory Assessment Service (MAS) clinicians’, five patients’, and five companions’ perspectives of what makes a good delivery of a diagnosis of dementia via 10 semi-structured interviews. Thematic analysis of this data produced four overarching themes relevant to a good delivery of a diagnosis of dementia: overcoming barriers; navigation of multiple journeys; and completing overt and covert tasks. Two paper based tools were devised from these themes. One tool for service deliverers to support reflective practice and skill development; and the other for service recipients. This contained three elements: an information guide containing an overview of MAS appointments and outcomes, introduction to choices, bringing a relative or friend; a notes sheet which supported consideration of main concerns and choices, provision of space to record answers; and a prompt sheet to use during appointments to prompt question asking, and recording information discussed. Phase two assessed the tool’s acceptability across four focused group discussions with seven service deliverers and six service recipients. Thematic analysis was used to explore the preliminary acceptability of the tools, as perceived by the participants, and guided revisions to improve the design of both tools. Overall feedback was positive and both tools were deemed to be acceptable. The tools were modified to remove the prompt sheet and incorporate the principles into the service deliverer’s guide. Some minor adaptations to improve acceptability of phrasing were also made. This project developed a novel tool for supporting clinical practice in the delivery of dementia diagnoses. It also contributes towards the knowledge of dementia diagnosis and provides an alternative narrative of quality diagnostic delivery, rather than diagnostic volume. The tool uniquely articulates clinicians' experiences of diverse and changing emotional responses to the process of diagnosis delivery and of their management of this to prevent impact on the recipient. It is suggested that by mastering these skills clinicians can facilitate cohesion with, rather than distancing from, the attendee’s emotions. It also highlights barriers to good practice and the management of power within diagnostic appointments, both considered to potentially extend previous guidelines. The next steps are to take the tools into further development work and then to evaluate the tools. This may include completing further focus groups to establish acceptability of the tools and contribute to further development. Formal evaluation of quality and usability could include field testing to assess feasibility.

The therapeutic relationship within psychotherapy is well recognised as a pertinent component of successful treatments. In particular, the alliance component of the therapeutic relationship has demonstrated a moderate and robust correlation to positive outcomes. The alliance is considered the change mechanism within the more relationally focused therapies (e.g., psychodynamic). In contrast, therapies that focus on specific techniques related to underlying theory regarding the development and amelioration of mental health difficulties, prioritise the protocols as the change mechanism. Mental health services can be seen to have moved towards offering more time-limited, protocol driven therapies (e.g., CBT) to widen access to therapy and to meet financial incentives. EMDR is a relatively new psychotherapy which has amassed evidence of efficacy since its development by Francine Shapiro in the 1980s and is now recommended within the NICE guidelines. EMDR is predominantly a protocol driven therapy based on its underlying theory which suggests that mental health difficulties are a result of dysfunctionally stored memories. Currently, little is known about the role of therapeutic relationship within EMDR and whether additional focus on relational aspects within the therapy could enhance outcomes. A single-case design with two therapist-client dyads was used to explore the therapeutic alliance within two EMDR therapy cases in a primary care setting. The study had three aims; to investigate the relationship between the therapeutic alliance and outcome; to investigate the fluctuations of the alliance throughout EMDR; and to explore how the alliance is experienced by the client and therapist during EMDR treatment. The principal findings, presented via visual analysis, display a strong alliance and positive outcomes in the two EMDR cases, suggesting the presence of the alliancewithin a predominantly protocolised therapy. This is further supported by the qualitative data, in which the alliance was a highly valued aspect by therapist and clients in both cases. Whilst this study is limited by generalisability given the small sample size and correlational design, it draws researchers’ and clinicians’ attention to the paucity of information guiding the practice of EMDR in terms of the relational imperative.

This thesis explores crimes related to online dating. After an introduction to online dating crimes (chapter 1), a systematic literature review (chapter 2) looks at current studies considering online dating romance scams. Studies indicate several factors that make victims more vulnerable to these scams, such as their romantic beliefs. Techniques used by scammers are also discussed. Chapter 2 collates what is known so far and highlights gaps in the literature: namely the lack of research. Later chapters focus on crimes occurring on face to face dates with an online partner. Chapter 3 provides the first empirical look at these crimes, and explores potential ways of predicting when these crimes will occur. Results indicate that sexual, pressuring, arrogant, or self-deprecating message content is more likely to indicate risk. Chapter 4 uses interpretative phenomenological analysis to obtain rich qualitative information on the experience of sexual assault on dates. It reveals that this experience triggers a range of negative emotions in the victim, and indicates that better education on consent may be an important prevention technique. Finally, chapter 5 presents a critique of the Romantic Beliefs Scale (Sprecher & Metts, 1989), which has been used to measure romantic beliefs of online dating crime victims. The review suggests the scale is adequate for use in predicting who may fall victim to online dating crimes. These studies are then summarised in chapter 6 to provide implications for prevention of online dating crimes and suggests areas of further research.

The aim of this study was an attempted elucidation of the possible pathogenic role of life events in the onset and development of depression. Although several authors seem to agree that the impact of life events should be seen in relation to the person experiencing them, no comprehensive studies have been published so far where life events have been analysed in relation to the vulnerability of the individual who becomes depressed. The present study was inspired by Freud’s concept of ”Ergänzungsreihe”, and was based on the general assumption that biological as well as psychological and social factors contribute greatly to modifying an individual’s vulnerability to external events. To test this hypothesis the occurrence of life events was studied by means of a semistructured interview in a consecutive series of 206 depressed patients of both sexes treated as in- or outpatients, and the results have been analysed in relation to a series of variables which could be assumed to be of importance in modifying the vulnerability of the patients. The main hypothesis was that the more vulnerable the individual was in relation to each of the investigated factors, the fewer events would be necessary to produce a depressive breakdown and the more negative would be the experience of such events. Biological, psychological and clinical variables were taken into account in different parts of the present study. The results support the view that the impact of life events should be seen idiosyncratically and in relation to the specific vulnerability of each individual. Furthermore the study illustrates a fruitful approach for further studies aimed at a closer understanding of the role of external events in the development of a depressive illness. / digitalisering@umu

The purpose of this study was to investigate whether level of acculturation among Hispanic adolescent males (n = 174) influenced treatment outcome in a substance abuse program, specifically on the Brief Situational Confidence Questionnaire (BSCQ) which measures relapse confidence. It was hypothesized that lower levels of acculturation were likely to be predictive of positive change, whereas higher levels of acculturation were likely to be predictive of no change or negative change. It was found that adolescents changed over time in BSCQ scores regardless of which acculturation variable was measured. Contrary to expectations, for those adolescents placed in family treatment, place of birth was not significantly associated with treatment response. However, both, U.S. and non-U.S. born adolescents demonstrated a change over time when receiving family treatment, suggesting that the family substance abuse treatment utilized in this intervention effected change over time.

The main purpose of this study is to examine the uses of forensic clinics in the administration of criminal justice as devices for the identification, diagnosis of treatment of psychiatric disorder in convicted offenders. A subsidiary aim of the study is to assess the feasibility of the establishment of such a facility in British Columbia. The thesis is introduced by an account of those changes in the criminal law which have resulted in its ceasing to be a simple instrument of deterrence and in increasing attention being paid to the principles of extenuation and rehabilitation. An attempt is then made to survey and evaluate recently published data on the prevalence and distribution of mental disorders in criminal populations, and the conclusion is drawn that approximately one fifth of all persons convicted of an indictable offence in typical North American jurisdictions are suffering from psychiatric problems serious enough to play an important part in their prospects of rehabilitation, even if those problems have had little direct causal significance in the commission of the original crimes. This is followed by a survey of the statutory auspices, administrative structures, clinical programs and financial bases of eight established forensic clinics, seven in the United States and one in Canada. This survey, together with material drawn from the published literature of criminology and public administration, serves as the basis of an attempt to formulate the requirements of an "ideal" forensic clinic. The model synthesized in this fashion is then applied to the local Provincial situation and a series of recommendations are made concerning the procedures to be followed and the principles to be observed in establishing a forensic clinic in British Columbia. The principal desiderata of effectiveness for a forensic clinic identified in the thesis are that: (1) in regard to both staffing arrangements and the character of its program, the clinic should be inter-disclipinary rather than purely psychiatric; (2) it should be expected to give purpose and precision to existing correctional facilities in the penal system, and not to compensate for the fact that none actually exist; (3) it should have no fixed commitment to dealing exclusively with one particular class of offenders (such as sexual offenders), but should hold itself ready to deal with any offenders whose problems and whose treatment it can competently advise on; (4) its workloads should never be such as to reduce its activities to routine levels or raise the dangers of perfunctoriness; (5) it must be sensitive to the working problems and needs of the courts of criminal justice but independent of direct control by the judiciary. / Arts, Faculty of / Social Work, School of / Graduate

There have been many changes in the focus and direction of social casework since Mary Richmond published Social Diagnosis in 1917. Casework in her day emphasized the socio-economic aspects of the family's adaptation to society. With the advent of psychoanalytical concepts, the focus shifted from the family's social reality to the individual's subjective response to it, as one way of understanding the client's maladjustment to his life circumstances. In agencies and clinics, office interviews with individuals replaced home visits to the family. Consequently, the caseworker's knowledge of the day-to-day social functioning of the client and his family was often incomplete. Caseworkers and psychiatrists in Child Guidance Clinics learned that the child could not be helped with his emotional difficulties unless the parents were included in the treatment process, since the child's maladjustment so frequently stems from unhealthy relationships with his parents. While the focus was upon the child and his family, the emotional aspect of each parent's adaptation was emphasized. The interplay between family members' personalities and the problems for which they were seeking help was still too complex for full understanding. The search for helpful concepts is still in process. Current casework emphasis on the client's social functioning is attempting to integrate psychological and social concepts in casework theory. Role theory, combined with psychological concepts, holds the promise of providing a method by which the caseworker can diagnose and treat the problematic aspects of the individual's and family's adaptation. In order to understand the individual, it is necessary to know how he interacts with family members, they with him, and his group with society at large. This study is an exploratory assessment, from casework recording alone, of the extent to which psychosocial diagnosis and treatment has been adapted to casework practice for families with disturbed children in the Children's Clinic of the B.C. Mental Health Centre. Twenty cases of disturbed children were selected: between the ages of five and ten years living with their own parents; capable of attending public schools; and not suffering from physical handicaps. Most of the children had siblings. They were active cases in which treatment had proceeded a substantial distance. Two rating scales were: (a) the child's emotional and social adjustment and (b) parental and family relationships and strengths. These pointed up the areas of information obtained by the caseworker for the psychosocial diagnosis of the child's family, and also made it possible to compare the child's adaptation with that of his family's. The evidence is that the social functioning of the family as a unit is not apparent from the recording, that most emphasis is upon the mother-child relationship, and that the child's relationships with other family members are not sufficiently explored. The Casework contributions to the diagnostic study of the child's problems are largely in the area of the parents' (particularly the mother's) emotional adjustment, and the child's particular development. The original intention was to measure the child's and parents' social functioning between two points in the treatment process, but the recorded data was insufficient for this purpose. Only descriptive comparisons are possible, also a descriptive evaluation of the outcome of treatment in relation to the casework focus. The recording which described the greatest improvements in family relationships, and in the parents' and child's social functioning, was oriented, in the treatment phase, to the client in his family, even though this focus was not evident in the diagnostic study. Those cases which showed the least movement emphasized the emotional adjustment of individual members of the family. The main reference point in the former cases was the client's interaction with people and situations in his current life circumstances; in the latter cases, the worker's efforts were directed towards helping the client with his emotional conflicts, which stemmed from his early life experiences. This is an exploratory study of areas highly significant for family casework in the Children's Clinic. Although the conclusions require repeated research to verify their validity, they nevertheless suggest that a casework focus on the client in his family holds more promise of helping than a focus which emphasizes the client's emotional adjustment alone. Such an orientation contributes to the definition of the casework function, and distinguishes the caseworker's role from that of the psychiatrist. It has contributions to make also, in the task of integrating theory and practice in family casework. / Arts, Faculty of / Social Work, School of / Graduate

The individual effects that echoic, mand, and sign language training procedures have on the acquisition of verbal behavior have been widely demonstrated, but more efficient strategies are still needed. This study combined all three treatment strategies into one treatment intervention in order to investigate the joint effects they may have on verbal behavior. Six participants took part in the study. Intervention totaled 1 hour/day for 5 days/week until mastery criterion for motor echoic behavior was achieved. Although motor echoic behavior were solely targeted for acquisition, significant increases in spontaneous motor mands were noted in all treatment participants. Additionally, 4 treatment participants also demonstrated significant gains in vocal echoics and spontaneous vocal mands. No significant increases were noted for the control participant. Results suggest that the aforementioned procedure may provide more efficient results as a first-step to teaching a functional repertoire of verbal behavior to developmentally delayed children.

The purpose of the present study was to examine the origins of anxiety sensitivity (AS) by assessing youths' learning experiences in relation to their AS symptoms and anxiety symptoms. Participants were 33 youths between 7 to 13 years old (M = 9.39 years, SD = 2.01). Youths were assessed using a structured interview and self-report measures. Chi-square analyses revealed no statistically significant differences in the proportions of boys vs. girls, Hispanic vs. non-Hispanic, and married vs. non-married. Pearson correlation analyses revealed that youths' AS learning experiences were significantly related to youths' AS and to youths' anxiety symptoms scores. Partial correlations between youths' learning experiences associated with AS symptoms in relation to AS scores controlling for anxiety symptoms effects were statistically significant. Findings were consistent with theory and suggest that learning mechanisms may be involved in AS acquisition and maintenance. The findings' implications are discussed regarding possible learning experiences' role in the development of AS.