The Systemic Clinical Outcome and Routine Evaluation version 15 (SCORE-15) is an assessment used to assess for clinical change in family functioning. The SCORE-15 has been demonstrated in the past to be a reliable and valid measure for assessing for clinical change and is largely used throughout the UK. However, the SCORE-15 lacks the ability to determine whether an individual's change in family functioning is clinically significant. This study aims to establish a reliable change index and clinical cutoff score based on a US sample so that researchers and clinicians can determine clinically significant change. A sample of 63 clinical participants and 244 community participants completed the SCORE-15, including 165 community participants who completed the SCORE-15 a second time. Results established a cutoff of 51.92 and a reliable change index of 17.51 for the SCORE-15. This indicates that therapy clients who improve their SCORE-15 score by at least 17.5 points and who cross the threshold of 52 during the course of therapy are considered to have experienced clinical significant improvement.

No description available.

The current models that we use in systemic family therapy came out of office/clinic-based practice. To date, there is no model specifically orientated to systemic family therapy in the home. As a systemic family therapist, I argue that non-traditional approaches may need to be considered; and that systemic family therapy models should come closer to reflecting discourses that have shades of global influences. My interest in the area emerged from a position of ignorance – making assumptions that the tools used in the clinic could easily be colonised into a family’s home – but I found that the models often used in the clinic do not necessarily transfer easily into the home. an adaptation of a systematic review was conducted that undermined the notion that therapists are ‘knowing’ with particular skill and competency to work in the home. I ask the question: How do I improve upon my systemic family therapy practice to work in families’ homes? African oral traditional ideas (AOTI) are broadly explored to consider the notion of self and bodily feelings as a source of knowledge. Through the use of AOTI I created an approach known as Seselelame, foregrounding a new practice stemming from ideas that are not home grown within the systemic family therapy perspectives, to support my practice within the home. the inquiry offers the following contribution of new knowledge to family systemic therapy: conceptualization of a method (Seselelame) that incorporates the idea of self in the context of awareness of feelings in the body; a method that incorporates African oral traditional ideas and thus expanded the traditional Western view of family/systemic therapy; contextualization of the significance of home as a source of knowledge; the Seselelame model was used as an analytical tool alongside a systemic constructionist analytical model to compare and contrast the data produced. The findings conclude that the inquiry has implications for the practice and teaching of systemic family therapy, which will eventually be published once the thesis is completed.

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Thesis (Ph.D.)(Practical Theology))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.

Die Entwicklung der neuen Systemtherapien führte in den letzten Jahren zu einer bedeutenden Verbesserung des Langzeitüberlebens bei Patienten mit metastasiertem Melanom. Die verschiedenen Therapieoptionen mit ihren entsprechenden jeweiligen Toxizitäten sowie die Unterschiede im Therapieansprechen auf die differenten Therapieformen machen es erforderlich, anhand von prädiktiven Faktoren und Biomarkern Therapieentscheidungen zu treffen, um individuell die beste Therapie für den Patienten auszuwählen. Die Tumorwachstumskinetik wird dabei immer wieder als relevanter Faktor genannt. Ihr genauer Einfluss sowie die genaue Definition einer schnellen Tumorkinetik ist jedoch bis heute nicht klar definiert. Diese Arbeit soll dazu beitragen, die prognostische Wertigkeit der Metastasenwachstumsrate (MGR) als prädiktiven Marker vor dem Start einer Systemtherapie zu untersuchen. Konkret soll die Hypothese geprüft werden, ob eine schnelle MGR vor Therapiebeginn einen negativen Einfluss auf das Therapieansprechen sowie das klinische Outcome hat. Vor diesem Hintergrund wurde retrospektiv ein Patientenkollektiv von insgesamt 115 Patienten, aufgeteilt in drei Kohorten (Monotherapie mit PD-1-Antikörpern: n = 33, Kombinationstherapie mit PD-1- und CTLA-4-Antikörpern: n = 34, zielgerichtete Therapie mit BRAF- +/- MEK-Inhibitoren: n = 48), untersucht. Die Erhebung der Dresdner Daten war dabei Teil eines Verbundprojekts mit 12 teilnehmenden Kliniken, sodass zusätzlich zur Dresdner Auswertung für die Monotherapie aus PD-1-Antikörpern auch eine multizentrische Gesamtanalyse der Daten stattfinden konnte. Für die Datenerhebung wurden alle Patienten in Betracht gezogen, die seit Zulassung der einzelnen Therapieformen aufgrund eines kutanen, uvealen, mucosalen oder okkulten Melanoms im Stadium IIIB oder höher am Universitätsklinikum Dresden mit einer entsprechenden Systemtherapie behandelt wurden und eine messbare Metastasierung (CT/MRT/PET-CT) im Baseline-Staging sowie einem Pre-Baseline-Staging aufwiesen. Bei fehlenden Follow-Up-Daten sowie einer adjuvanten Therapiesituation wurden die Patienten aus der Datenerhebung ausgeschlossen. Die MGR wurde für den Zeitraum zwischen Pre-Baseline-Staging und dem Baseline-Staging bestimmt. Mittels Kaplan-Meier-Überlebenskurven sowie univariater und multivariater Cox-Regression wurde der prognostische Einfluss der MGR analysiert. Die Untersuchung des Einflusses der MGR auf das Therapieansprechen erfolgte mithilfe des Fisher-Tests und des Mann-Whitney-U-Tests. In der Dresdner Studie war eine hohe MGR (>3,9 mm/Monat) mit einem signifikant schlechteren progressionsfreien Überleben (PFS) für Patienten unter einer zielgerichteten Therapie verbunden. Zusätzlich zeigten diese Patienten ein signifikant schlechteres Ansprechen auf die Therapie mit BRAF- und MEK-Inhibitoren, im Vergleich zu Patienten, die eine MGR < 3,9 mm/Monat aufwiesen. Für das Gesamtüberleben (OS) zeigte sich trotz geringer Fallzahl sowohl in der Kohorte der zielgerichteten Therapie als auch in der Kohorte der kombinierten Immuntherapie mit Ipilimumab und Nivolumab ein Trend zu einem kürzeren OS, wenn eine hohe MGR vorlag. Dieser Trend konnte für die kombinierte Immuntherapie zusätzlich auch für das PFS festgestellt werden. Für die PD-1-Antikörper-Monotherapie konnte anhand der Dresdner Daten kein signifikanter Unterschied für das OS und PFS zwischen Patienten mit niedriger und hoher MGR festgestellt werden. In der Gesamtbetrachtung stellt die MGR einen prognostischen Marker für Patienten unter einer zielgerichteten Therapie mit BRAF- und MEK-Inhibitoren sowie in Zusammenschau mit den Ergebnissen der Gesamtstudie auch für Patienten unter einer PD-1-Antikörper-Monotherapie dar. Zusätzlich ergaben sich innerhalb dieser Arbeit Hinweise darauf, dass dies auch für die Immunkombinationstherapie mit Ipilimumab und Nivolumab zutrifft. Um die prognostische Wertigkeit der MGR für die unterschiedlichen Systemtherapien gleichermaßen beurteilen zu können, sind weitere Untersuchungen an größeren Patientenkollektiven notwendig. / The development of new system therapies has resulted in an important improvement in the long term survival of patients with a metastatic melanoma. Different therapy options with their respective individual toxicity, as well as differences in the reactions to different forms of therapy, require therapeutic decisions on the basis of predictive factors and bio markers in order to choose individually the best therapy for the patient. Tumor growth kinetics is often considered to be a relevant factor. Its specific influence as well as the exact definition of fast tumor kinetics has, however, not yet been clearly defined. This paper is supposed to support the examination of the prognostic value of the metastatic growth rate (MGR) as a predictive marker before a system therapy is introduced. The hypothesis that a fast MGR before a therapy begins has a negative influence on the therapy response and the clinical outcome has to be examined. On the basis of this hypothesis a patient collective of 115 patients in total, divided into three cohorts (mono therapy with PD-1-antibodies: n=33, combination therapy of PD-1- and CTLA-4-antibodies: n=34, target-orientated therapy with BRAF- t/- MEK inhibitors: n=48) was examined retrospectively. The collection of the Dresden data was part of a cooperative project of 12 participating clinics resulting in a multi-centric overall analysis of the data in addition to the Dresden evaluation of the mono therapy of PD1-antibodies. For the collection of the data those patients were considered who had been treated at Dresden university hospital since the approval of their individual form of therapy with a respective system therapy because of a cutaneous, uveal, mucosal or occult melanoma stage IIIB or higher and who showed a measurable metastasis (CT/MRT/PET-CT) in baseline staging as well as in pre-baseline staging. Patients without any follow-up data and an adjuvant therapy were excluded from the collection of data. The MGR was fixed for the timespan between pre-baseline staging and baseline staging. The prognostic influence of the MGR was analysed by means of the Kaplan-Meier-survival curve as well as univariate and multivariate cox regression. The study of the influence of MGR on the therapy response was based on the Fisher-Tests and the Mann-Whitney-U-Tests. The Dresden study showed the correlation between a high MGR (>3,9 mm/month) and a significantly worse progression free survival (PFS) for patients having a target-orientated therapy. Additionally, those patients showed a significantly weaker reaction to the therapy with BRAF - and MEK-inhibitors in comparison to patients who had an MGR < 3,9mm/month. Considering the overall survival (OS) of those with a fast MGR a trend to a shorter OS could be established, in spite of low case numbers in the cohort of the target-orientated therapy as well as in the cohort of the combined immune therapy with Ipilimumab and Nivolumab. This trend could be found for the combined immune therapy as well as for the PFS. Referring to the anti-PD1- mono therapy no significant difference could be found for the OS and the PFS between patients with faster and slower MGR. In the overall view the MGR proves to be a prognostic marker for patients having a target-orientated therapy with BRAF- and MEK-inhibitors and, also looking at the results of the overall study, for patients having a PD-1- antibody mono therapy. Additionally, this study revealed a significant indication that this also applies to the immune combination therapy of Ipilimumab and Nivolumab. Further studies with larger collectives of patients are necessary to be able to likewise judge the different prognostic valency of the MGR for the different system therapies.

Family Therapy training programmes have recently come to appreciate the importance of addressing the personal growth of the trainee-therapist, in addition to the traditional focus on skill development. Suggestions in the available literature on how this "person-of-the-therapist" issue could best be addressed, represent almost exclusively the ideas of authorities (authors, clinicians and trainers) in the field of systemic therapy. Constructivist thought endorsed by the UNISA training programme, encourages and values different viewpoints. According to this view, students and faculty co-construct the training process. The aim of this study is therefore to present the voice of the trainee. Several training contexts, the essential qualities of the different supervisory relationships and difficulties encountered, are explored from the trainee's perspective. It is hoped that this "inside story" about the author's experiences on her journey toward becoming a psychotherapist, will engender sensitivity for and a deeper understanding of the complexity involved in training the person of the therapist. / Psychology / M.A. (Clinical Psychology)

Project (D. Min.)--Perkins School of Theology, Southern Methodist University, 2005. / Abstract and vita. Includes bibliographical references (leaves 159-160).

Project (D. Min.)--Perkins School of Theology, Southern Methodist University, 2005. / Abstract and vita. Includes bibliographical references (leaves 159-160).

Family Therapy training programmes have recently come to appreciate the importance of addressing the personal growth of the trainee-therapist, in addition to the traditional focus on skill development. Suggestions in the available literature on how this "person-of-the-therapist" issue could best be addressed, represent almost exclusively the ideas of authorities (authors, clinicians and trainers) in the field of systemic therapy. Constructivist thought endorsed by the UNISA training programme, encourages and values different viewpoints. According to this view, students and faculty co-construct the training process. The aim of this study is therefore to present the voice of the trainee. Several training contexts, the essential qualities of the different supervisory relationships and difficulties encountered, are explored from the trainee's perspective. It is hoped that this "inside story" about the author's experiences on her journey toward becoming a psychotherapist, will engender sensitivity for and a deeper understanding of the complexity involved in training the person of the therapist. / Psychology / M.A. (Clinical Psychology)