Thesis (doctoral)--La Salle University, 2002. / ProQuest dissertations and theses ; AAT 3064084. Includes bibliographical references (leaves 63-72).

D.Cur. / It was established during research that I have done for my master’s degree that therapists experience secondary traumatisation in a specific private psychiatric clinic when they listen to the trauma filled stories of their clients. This often led to the therapist’s personal and professional disintegration. The main purpose of this research was to describe, operationalise and evaluate a model for the advanced psychiatric nurse practitioner to facilitate the mental health of therapists who experience secondary traumatisation in a specific private psychiatric clinic in South Africa. I used a qualitative, descriptive, contextual and theory-generating research design to achieve the above purpose. The development of the model consisted of four steps. Step one consisted of concept analysis that included the identification, classification and defining of the central, essential and relational concepts in the model. During concept analysis, facilitation of wholeness was identified as the most relevant concept for the model instead of mental health. It was evident that personal disintegration became the specified concept and focussed aspect in terms of secondary traumatisation in this research project. Step two consisted of a description of how the identified and defined central concepts interrelate with each other as part of the model. During step three, the model to facilitate wholeness in therapists with personal disintegration due to secondary traumatisation in a specific private psychiatric clinic was described. The structure of the model was described in terms of its purpose, assumptions and context. Definitions of the central concepts, as well as the relationship statements between the central and essential concepts, were described. The structure of the model was also described in terms of a visual representation that included the dynamic and interactive narrative process of deconstruction, choosing of alternatives and celebration.

Please read the abstract in the section, 00front, of this document / Thesis (D Phil (Psychotherapy))--University of Pretoria, 2007. / Psychology / unrestricted

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Client outcomes in psychology training clinics have been shown to be generally worse than other outpatient settings. Although this finding has been repeatedly demonstrated, no consensus of cause has emerged in the literature. One possible explanation of such findings may relate to psychotherapist effects, a historically neglected variable that has received increased attention in more recent literature. Among psychotherapist effects researched, competency has emerged as a compelling factor worthy of more research. Given that most growth in competence occurs during graduate training, investigating the relationship between competency and client outcome offers great potential benefit for informing optimal training, nature of client symptom improvement, and a more accurate depiction of differences in psychotherapist effects across training and non-training settings. The purpose of this study was to explore the trajectory of competence development during doctoral training in health services psychology and to investigate the association of trainee competency to the psychotherapy outcomes evidenced by their clients. Practicum evaluations of 36 trainees and outcome data (using the Outcome Questionnaire-45.2) from 244 adult clients were included in analyses. Results of the study suggest there is a positive relationship between cumulative semesters of training and competency scores (rs[118]= .34, p < .001). Notably, there was no significant difference in psychotherapy outcome between low and high trainee competence. The results of the current study, relevant literature and limitations are discussed. Suggestions for future research are proposed.

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Purpose: Assessment and management of suicidal risk often relies on the client’s willingness to disclose suicidal thoughts or behaviors. Understanding why clients make the decision to conceal these symptoms is key to improving techniques of assessment. This study directly queried suicide concealers to learn how psychotherapists can better elicit honest disclosure of suicidal material. Method: A sample of 107 suicide concealers provided both short essay responses and multiple choice responses explaining why they concealed suicidal thoughts from their therapist. In addition, a sub-sample of 64 suicide concealers provided short essay responses describing what they thought their therapist could do differently to help them disclose, and answered multiple-choice questions explaining how they felt about concealment, and whether concealment impacted their therapy. Content analysis was used to identify motives and themes in short essay responses. Results: Nearly three-fourths of suicide concealers cited fear of practical consequences as the reason they did not disclose. Chief among these fears was involuntary hospitalization, which respondents viewed as the likely outcome of telling a therapist about their suicidal thoughts. Less concrete motives for concealment, such as shame or embarrassment, were significant but secondary concerns. Nearly half of suicide-concealing clients said they would be more honest only if the threat of hospitalization was somehow reduced or controlled. Many asked for some form of assurance or explanations about the chances of being hospitalized as a result of their disclosure. Concealers most commonly felt conflicted about their decision to conceal, with significant numbers feeling frustrated or guilty as well as safe or in control. While a quarter of concealers believed concealment hurt their progress in therapy, the majority reported no effect. Limitations: While responses suggest a range of symptom severity, the sample includes an unknown proportion of mild versus severe suicide risk, reducing generalizability to the general or clinical population. Male and minority clients are under-represented in the sample. Conclusions: The concerns expressed by the suicide concealers in this sample suggest that improving techniques of suicide risk assessment may require renewed attention to providing transparent, complete, and easy-to-understand psychoeducation about the triggers for hospitalization and other possible outcomes of disclosure. Clients ultimately control their level of disclosure, and the results of this study suggest they desire sufficient knowledge to make an informed decision.

This study examined client-reported changes in the therapeutic relationship across 29 sessions, spanning ten cases of short-term, Process-Experiential psychotherapy. Cases and sessions were empirically identified, based on clients' end-of-session ratings on the Working Alliance Inventory (WAI). This empirical selection strategy was intentionally broad and atheoretical, to encompass a variety of change scenarios. Therapist and client behaviors and interactions during selected sessions were explored using the Structural Analysis of Social Behavior (SASB) and the Hill Counselor and Client Verbal Response Modes (VRM) Systems. Both frequency and sequential analysis of category codes were conducted, followed by a session-by-session review of the ten cases. Observed therapist and client behaviors clearly reflected the Process-Experiential therapy model as well as therapist efforts to establish and maintain empathic attunement. No significant differences were found in the frequencies of SASB or VRM codes between strongest and weakest alliance sessions or between rupture and post-rupture sessions. This raises questions about the ability of these measures to differentiate between subtle in-session processes. The case reviews underscored the clients' independent and often-overlooked contributions to the formation and repair of the therapeutic relationship.