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The James Lind Alliance approach is a widely used method for research priority setting, yet comprehensive reviews of its implementation are lacking. This thesis therefore focused on reviewing and analyzing the barriers and facilitators to its implementation and on carrying out the early stages of our own priority setting partnership to prioritize research in myelodysplastic syndromes (MDS). A scoping review of the barriers and facilitators encountered when undertaking a James Lind Alliance priority setting partnership was conducted. Our analysis identified that most barriers could be categorized into three main areas: representation, data collection and processing and result useability. We also identified a number of methods that were used successfully to overcome some of the barriers and offered our suggestions for further study. Along with the Aplastic Anemia and Myelodysplasia Association of Canada, we conducted the initial stages of the Canadian MDS Priority Setting Partnership. We were able to collect 206 relevant research questions from people living with MDS, their caregivers and front line health professionals which can be put forward for further prioritization.

In the counseling profession, clinical supervision is utilized to facilitate the personal and professional development of counselors in training (Bernard and Goodyear, 2014). Within this supervisory relationship, supervisors must adhere to the 2015 ACA Code of Ethics, which describes the need for infusing cultural competence into both counseling and supervision practices. This emphasis is warranted; as the population of the United States is growing more diverse and cultural sensitivity in counseling will be needed in order to best serve clients. Both qualitative and quantitative research in various allied fields and settings suggest that supervisor cultural competence positively impacts the supervision working alliance (i.e., Ladany, Brittan-Powell and Pannu, 1997; Ancis and Marshall, 2010; Wong, Wong and Ishiyama, 2013). However, research conducted from the perspective of supervisors working in community settings is limited. This study sampled 78 community supervisors to address the dearth in the counselor education literature concerning the relationships between supervisor cultural competence and the working alliance. Results indicated an overall positively correlated relationship between supervisor multicultural competence and the working alliance. Additionally, the results suggested that supervisor cultural knowledge and supervisor cultural skills are the greatest predictors of a strong working alliance, while supervisor multicultural relationship and supervisor multicultural awareness accounted for some additional variance. The results support the trend away from a competency-based model of cultural sensitivity and attention in counseling and toward a model of cultural humility. / Ph. D.

Vertical alliances are an increasingly common form of organization for participants in the beef industry. The implications of combining feeding and packing margins into one alliance are investigated. Moving average based selective hedging strategies are used to hedge the major inputs and outputs for cattle owners and packers to improve the level of mean revenue to the alliance. The success of the hedging program is evaluated from mean-variance and cash-flow perspectives. / Master of Science

Studiens syfte var att undersöka leg. psykoterapeuters uppfattningar om och erfarenheter av att identifiera och reparera rupturer i den terapeutiska relationen (alliansen) i kognitiv beteendeterapi (KBT). Datainsamlingen bestod av narrativa intervjuer. Den kvalitativa metoden fenomenologisk hermeneutik (Lindseth & Norberg, 2004), där intresset riktas mot den levda erfarenheten, användes vid analys och tolkning av texten. Resultatet visade att de terapeutiska färdigheterna medveten närvaro och metakommunikation används för att identifiera, förebygga och reparera rupturer i alliansen. Slutsatsen är att psykoterapeuternas berättelser bär på den dolda innebörden att alla slags terapeutiska interventioner i KBT samtidigt utgör relationella handlingar, och att ett språk för detsamma är önskvärt. Meningsfullhet och yrkesstolthet kan dessutom tillägnas, om uppmärksamheten vänds från misslyckanden till mod att ta ansvar för det terapeutiska förloppet och relationen. / The aim of the study was to investigate psychotherapists perceptions about and experiences of identifying ruptures in the therapeutic alliance in cognitive behavioural therapy (CBT). The data collection consisted of narrative interviews. The qualitative method, a phenomenological hermeneutical method for researching lived experience (Lindseth & Norberg, 2004), was used in the analysis and interpretation of the texts. The result showed that the therapeutic skills awareness and metacommunication was used to identify, prevent and resolve ruptures in the alliance. The conclusion is that psychotherapists stories carries a hidden meaning of any therapeutic interventions in CBT at the same time constitutes relational actions, and a language for the same is desirable. Meaningfulness and professional pride can also be adopted, by shifting attention from failures, into courage to take responsibility for the therapeutic process and the relationship.

Based on the assumption that security institutions are designed rationally, I study the variations in design schemes and their possible effects on institutional performance. Military alliances vary with respect to their membership size, level of security obligations undertaken by the allies, incorporation of non security clauses such as economic agreements, level of institutionalization, specified duration of existence, as well as the conditions under and reasons for which they are formed. This dissertation studies the effects of above mentioned design features on the probability of security alliances expanding their scope by addressing non-security agreements such as free trade agreements and conflict management clauses. I find support for the argument that states include economic agreements within a military alliance as a means to bolster the credibility of an otherwise weak security alliance. Results indicate that allies facing high levels of external threat and low levels of intra alliance cohesion are more likely to include conflict management provisions in the alliance. Finally, I conduct a systematic study of the possible effects of variation in structural design on the durability of an alliance. I find that design features that increase the costs of breaking the alliance increase the duration of an alliance.

Background: attachment theory provides an account of human behaviour across the lifespan, has a strong theoretical foundation and is clinical applicable. It is particularly relevant to older adults, who are often exposed to a greater number of losses. Despite a growing awareness of increasing life expectancy worldwide, services for older adults in the NHS remains under-resourced. However, increased exposure to death and loss in the work might result in clinical psychologists being more reluctant to choose this specialism and may raise issues about their own early attachment experiences. Therefore, it is important to understand how clinical psychologists approach the complexities of their work in light of their own early attachment experiences. Qualitative research of the lived experiences of clinical psychologists is sparse and to date there are no studies addressing this specific issue. Aims: this is an exploratory study which addresses a gap in the literature. The aims are to capture the early attachment experiences of clinical psychologists specialising in working with older adults. It is hoped that the outcome of the study will shed some light on the characteristics of this under-researched group and how they manage the challenges of the work. Methodology: a semi-structured interview schedule was developed to explore how clinical psychologists make sense of their work with older adults in light of their early attachment experiences. Interviews were carried out with five clinical psychologists working in specialist older adult services. The transcripts of the interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: the analysis of the five interviews yielded five main themes – “Making sense of early attachment relationships”, “Developing identity in childhood and adolescence”, “Understanding of decision to work with older adults”, “Work with older adults as both challenging and rewarding” and “The person within the professional”. Each of the main themes and their subthemes were supported by excerpts from narratives of participants experiences. Implications: this study highlighted several research and clinical implications. First, the role of non-parental childhood attachments in the development of internal working models is currently an under-researched area which may provide important insights into resilience factors in the face of childhood adversity. Second, clinical implications suggest that access to older adult work early on in the career of clinical psychologists may increase desirability of working in specialist services. Third, the study supports attachment theory as a useful approach to understanding the work with older adults and as a valuable area for the professional development of clinical psychologists. Finally, systemic working with older adults remains an important part of the work which would benefit from further research in this area.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.