Les programmes de traitement visant à réduire le risque de récidive des individus ayant commis une agression sexuelle envers un enfant (ASE) figurent parmi les interventions les plus efficaces pour remédier à cet enjeu. À ce jour, peu d’études se sont intéressées à l’impact de facteurs liés à la réceptivité du détenu sur l’achèvement d’un traitement, telles que la motivation au changement et l’alliance thérapeutique (AT), ou comment se forment ces deux processus. L’objectif de cette étude était d’investiguer l’impact de l’historique criminel, des distorsions cognitives et du climat social sur la motivation et l’AT, puis de valider le rôle prédicteur de ces derniers sur l’achèvement à un programme. Pour ce faire, 223 hommes ayant participé à un programme de traitement au Québec à la suite d’une ASE ont été sélectionnés à partir d’une base de données. Les résultats découlant d’une analyse de régression logistique démontrent que ni la motivation ni l’AT n’ont prédit l’achèvement de programme adéquatement. Cependant, des analyses de régressions multiples indiquent que les participants affichant moins de distorsions cognitives et percevant leur climat social plus positivement étaient à un stade plus avancé de la motivation et avaient une meilleure alliance avec leur thérapeute. Les participants plus motivés ont également rapporté entretenir une meilleure AT avec leur thérapeute un mois après le début du traitement. Cette étude fournit de nouvelles connaissances sur deux facteurs importants de la réceptivité et souligne l’importance d’un environnement sécurisant pour le détenu afin de permettre une meilleure motivation et AT. / Offending behavior treatments aiming to reduce the risk of reoffending in individuals who committed child sexual abuse (CSA) are among the most effective interventions to tackle this public safety issue. To this date, little attention has been drawn to inmate responsivity factors that can foster positive treatment outcomes such as motivation to change and therapeutic alliance (TA), and what may shape these factors. The objective of this study was to investigate the role of criminal history, cognitive distortions, and social climate on motivation to change and TA, and to validate whether these latter predict treatment outcomes. To do so, 223 incarcerated men who committed CSA and took part in a treatment program in Quebec, Canada, were identified from a database created from 2003 to 2008. Logistic regression analysis indicated that neither motivation nor TA predicted treatment outcome accurately. However, multiple linear regressions revealed that participants with fewer cognitive distortions who perceived social climate more positively were more motivated to change and had a better alliance with their therapist. Participants with higher motivation also maintained better TA one month after treatment. This study provides new knowledge on two responsivity factors and highlights the importance of promoting a safe environment for the inmates to enhance motivation and form a strong TA.

En del av den sociala barnavården i Sverige består av hem för vård eller boende (HVB), som är en typ av institutionsvård utanför det egna hemmet. Aktuell studie syftar till att undersöka hur personal på HVB-hem beskriver institutionens behandlingsmässiga utgångspunkter och hur de uppfattar behandlingsarbetet med ungdomarna. Denna studie utgår från en kvalitativ metod och för att besvara syfte och frågeställningar har semistrukturerade intervjuer använts. Det har genomförts fem intervjuer med personal från två HVB-hem. För att analysera studiens resultat används en tematisk analysmetod. De teoretiska utgångspunkterna omfattas av teorier om samarbete, terapeutisk allians och HVB-hemmens behandlingsmässiga utgångspunkter miljöterapi och KBT (kognitiv beteendeterapi). Det som framkommer i studien är att behandlingsarbetet med ungdomar på HVB är komplext, att det finns ett behandlingsinriktat fokus samt att relationsskapande och samarbete är viktiga aspekter i arbetet. Det beskrivs också finnas svårigheter i arbetet som relateras till relationsskapande och deltagande i behandling. Vidare presenteras det att omfattningen av den psykiska ohälsan hos ungdomarna är utbredd och att HVB-hemmen inte har något specifikt arbetssätt för att behandla ungdomar med psykisk ohälsa utan att detta främst sker hos barn- och ungdomspsykiatrin (BUP). Det framkommer kritik mot bristande resurser hos BUP vilket påverkar behandlingsarbetet negativt. Det framkommer också svårigheter att arbeta med ungdomar i kriminalitet och att sekretessbestämmelserna mellan polis och socialtjänst försvårar samarbetet / A part of the social child welfare in Sweden consists of residential care homes, which is a type of institutional care. The aim of this study is to investigate how staff at residential care homes describe the institution's treatment implementations and how they perceive the work related to treatment with adolescents. This study is based on a qualitative method and semistructured interviews. Five interviews have been conducted with staff from two different residential care homes. A thematic analysis method is used to analyze the results of the study. The theoretical frameworks include theories of collaboration, therapeutic alliance, and treatment implementations of the residential care homes, such as milieu therapy and CBT (cognitive behavioral therapy). The study reveals that the work with treatment of adolescents in residential care homes is complex, that the facilities have a treatment-oriented focus, and that relationships and collaboration are important aspects of the work. Difficulties related to relationships and participation in treatment are also emphasized. Furthermore, the study presents that difficulties regarding mental health among adolescents are prevalent. The residential care homes do not have a specific approach for treating adolescents with mental health issues, the treatment regarding mental health mainly takes place within the child and adolescent psychiatry which receives criticism due to insufficient resources. It also appears that there are difficulties in working with young people involved in crime and that the confidentiality regulations between the police and social services can make cooperation difficult

The purposes of this study are: a) to understand the treatments compliance behavior of the patient with chronic disease at the behavioral level, particularly, the relationship between treatments compliance behavior and normative beliefs; b) develop a behavioral model of patient's treatments compliance behavior that could be used for predicting, combating, treating, tracking and controlling the treatments compliance behavior of the patients with chronic disease. Seventy-two patients from senior daycare centers in the Dallas area, who suffer or had suffered from at least, one chronic disease, participated in the study. Data gathering was conducted using paper-based questionnaire. The most significant finding of this study is the relationship between normative beliefs and the treatments compliance behavior of the patient with chronic disease. Normative beliefs were found to have significant impact on the treatments compliance intent and behavior of the patients with chronic disease. Another important finding showed that side-effects of prescribed treatments have little or no influence on the treatments compliance behavior of the patient with chronic disease. A relationship between the effectiveness of medicine, particularly, predictive medicine, and treatments compliance behavior was established. The design of the study was intended to provide coverages for a set of constructs that may be the interacting units in the environment of any chronic disease treatments decision. It depicts relational, information communications links between the constructs. The Imhonde model of treatments compliance behavior was designed to include cultural norms and other beliefs that are significant for real-time human ailments decisions behaviors. It is recommended that further studies may include the use of a larger population of participants from diverse cultures and localities in multiple states and countries, with the object of finding the differences that culture and local environments may have on the normative leaning for treatments compliance behavioral decisions in chronic disease cases.

No description available.

Text in Afrikaans / I wanted to investigate the way people experienced confessional pastoral therapy by conducting a qualitative research study. The role of the pastor were examined as well as the effect of discourses of power and ethics in pastoral counseling. I interviewed clients who were counseled by pastors of the AFM Church (Apostolic Faith Mission). The research supposes that knowledge and power discourses have a major influence in pastoral counseling which is often not accounted for. I wanted to see how clients experienced the effects of these discourses of power and ethics. I furthermore wanted to see how these power discourses could result in clients feeling subordinate to the pastor and his knowledge and the effect that these feelings might have on them. The purpose of this study was not to generalize the experiences of the participants, but rather to set a contextual background of the experiences of power in confessional pastoral counseling. / Practical Theology / M. Th. (Pastorale Terapie)

The interview is considered to be a critical technique in the therapeutic process. The effective (and by implication, the ineffective) use thereof determines to a great extent the outcome of the therapeutic process. Training in therapeutic interviewing forms an integral part of the training of counsellors and therapists. This study was prompted by BEd (Specialisation in Guidance and Counselling) students' need for a structured and systematic approach to training in therapeutic interviewing skills. A literature study of the phenomenon therapeutic interviewing revealed firstly that the skills needed for effective therapeutic interviewing can be identified and operationally defined and secondly that these skills can be systematically trained. Having a repertoire of interviewing skills is however not a guarantee that therapy or counselling will have a positive outcome. The therapist must be able to create a therapeutic relationship with the client and in this regard the therapist's personality and attitudes, including empathy, warmth, respect, genuineness and unconditional positive regard for the client, are of major importance in helping to create an atmosphere wherein the client can feel free to discuss his problems and innermost feelings and thoughts. In the design of a model to train therapeutic interviewing, consideration must be given to both content and procedure. Not only were interviewing skills addressed in this model, but also skills to communicate empathy, warmth, respect, genuineness and unconditional positive regard. For the purposes of this study, the therapeutic interview was divided into six stages. Skills used in each stage were identified, defined and discussed. A pilot study was conducted to evaluate the effectiveness of the training model. Subjects were trained in accordance with the proposed training procedure. In order to evaluate the subjects' progress and thus also the effectiveness of the training procedure, each subject's pre- and post-training interviews were compared. An evaluation scale was designed for this purpose. The results of the pilot study indicated an improvement in the subjects' interviewing skills. It is hoped that this study will pave the way for innovation in the training of counsellors and therapists in therapeutic interviewing. / Die onderhoud word as 'n kritieke tegniek in die terapeutiese proses beskou. Die effektiewe (en by implikasie, die oneffektiewe) gebruik daarvan bepaal tot 'n groot mate die uitkoms van die terapeutiese proses. Opleiding in terapeutiese onderhoudvoering vorm 'n integrale deel van die opleiding van terapeute en voorligters. BEd (Spesialisering in Skoolvoorligting)studente het 'n bepaalde behoefte aan 'n gestruktureerde en sistematiese benadering tot die opleiding van terapeutiese onderhoudvoeringsvaardighede uitgespreek. 'n Literatuurstudie oor die fenomeen terapeutiese ondemoud het eerstens aan die lig gebring dat vaardighede onderliggend aan die terapeutiese onderhoud geidentifiseer en operasioneel gedefinieer kan word en tweedens dat hierdie vaardighede sistematies aangeleer kan word. 'n Repertoire van onderhoudvoeringsvaardighede is egter nie 'n waarborg dat terapie 'n positiewe uitkoms sal he nie. Die terapeut moet 'n terapeutiese verhouding met die klient kan stig en in hierdie opsig is die terapeut se persoonlikheid en sy houding van empatie, warmte, respek, egtheid en onvoorwaardelike agting van kritieke belang in die skep van 'n atmosfeer, waarbinne die klient vry kan voel om sy probleme, diepste gevoelens en gedagtes te kan bespreek. In die ontwerp van 'n model vir opleiding in terapeutiese onderhoudvoeringsvaardighede moet aandag aan beide inhoud en opleidingsprosedure geskenk word. In hierdie model word nie net die vaardighede vir terapeutiese onderhoudvoering aangespreek nie, maar ook vaardighede om empatie, warmte, respek, egtheid en onvoorwaardelike positiewe agting aan die klient te kommunikeer. Vir die doeleindes van hierdie studie is die terapeutiese onderhoud in ses fases verdeel. Vaardighede wat in elke fase gebruik word, is gerdentifiseer, gedefinieer en bespreek. 'n Loodsondersoek is ondemeem om die effektiwiteit van die opleidingsmodel te evalueer. Proefpersone is aan die hand van die voorgestelde opleidingsprosedure opgelei. Ten einde die proefpersone se vordering en so ook die effektiwitieit van die model te evalueer, is elke proefpersoon se voor- en naopleiding onderhoude vergelyk. 'n Evalueringsskaal is vir hierdie doel ontwerp. Die resultate van die loodsondersoek het getoon dat die proefpersone se onderhoudvoeringsvaardighede verbeter het. Die hoop word uitgespreek dat hierdie studie die weg sal baan vir vernuwing in die opleiding van voorligters en terapeute in terapeutiese onderhoudvoering. / Psychology of Education / D. Ed. (Psychology of Education)

Text in English / This research explores the meaning of the first and second-order therapeutic stances with reference to the therapist's professional and personal development. The dominant positivist paradigm was reflected in the therapist's initial position of expert observer, outside of the observed. The observed phenomena were a group of children suffering from thalassemia major, a terminal genetic disease, and their mothers. The initial idea of short-term intervention and focus on the observed evolved into six-year journey where the observer and the observed became an interconnected unit of observation, understanding and change. A first-order stance led to therapeutic stuckness, where the therapist's confrontation with her therapeutic failure and the limitations of the dominant paradigm provoked a deconstruction of the expert position and promoted a self-reflexive therapeutic stance. The author's self-searching process took her back to her personal self, her family of origin and the ''wounded healer". The researcher moved from an initial disconnection between her professional and personal selves to an awareness of the interface between the two and, ultimately, to a unification of her professional and personal selves. Such development involved an individuation process moving from a narcissistic belief in her objective stance towards a therapeutic stance where she sees herself less as a powerful agent of change and moves to an increasingly higher order of integration of the professional and personal selves (Skovholt & Ronnestad, 1992). The process with the children and mothers shifted from a focus on compliance and medical issues to more personal and emotional stories. The therapist's participation and collaborative stance created a context for change, where greatly improved medical compliance was just one of the many transformations experienced by all the participants. The researcher speculates that development of a second-order stance requires second-order change, which comes "at the end of long, often frustrating mental and emotional labor" (Watzlawick et al., 1974, p. 23), promoting integration between the professional and personal selves of the therapist. The researcher therefore contends that this process has important implications for psychotherapy training, supervision and continuing education. / Psychology / D. Litt. et Phil. (Psychology)

Au sein de la périnatalité organisée en réseau(x), entre les objectifs préventifs et thérapeutiques attendus pour les bébés et leurs parents et les vécus concrets, des écarts sont à constater. Nous avons dans cette recherche souhaité proposer quelques pistes de réflexion concernant ces constats : notre démarche en psychopathologie et psychologie clinique s’associe à un positionnement ethnopsychologique, psychanalytique et systémique, pour aborder la complexité de cette problématique.Notre hypothèse est que la compréhension du travail psychique des réseau(x) de soins, ici situés autour de la Naissance, passerait par :1) la prise en compte de l’existence d’un « réseau dans la tête » de chaque protagoniste de l’enfantement, professionnel et parent, en tant que formation psychique spécifique des groupalités intra, inter et trans-subjective de la réticularité2) le fait d’envisager les résistances et ressources propres aux exigences de ce travail psychique en réseau, qui entravent et/ou étayent les qualités dynamiques des processus perceptifs, relationnels et communicationnels3) le principe selon lequel ces processus perceptifs fragilisent et/ou soutiennent les qualités potentiellement préventives et thérapeutiques de cette organisation de soins spécifiques à la mise et à la venue au monde des enfants.4) l’idée que cette organisation des soins se modélise en réticularité pour permettre une adaptabilité des processus psychiques défensifs, groupaux et singuliers plus ou moins conscientisés, face aux émergences et réminiscences mobilisées par le phénomène de la Naissance.Le recueil des perceptions attenantes au réseau périnatal et à la place de chacun au sein de cette organisation, a été effectué selon la méthode ethnobiographique auprès des protagonistes de l’enfantement (familles et professionnels) en Languedoc-Roussillon, de 2005 à 2009, au sein de services d’obstétrique, de pédiatrie et de pédopsychiatrie périnatale. A partir de l’analyse de ces données et de trois vignettes cliniques, sont questionnés ici les élaborations et les processus psychiques participant et procédant des liens institués autour de la Naissance. L’analyse, étayée de certains apports des théoriciens du chaos, aboutit à établir peu à peu un modèle de compréhension du travail psychique propre aux réseaux de soins, dont notamment la périnatalité. Ce modèle propose de procéder par :- l’analyse psychologique simultanée des situations cliniques en cinq focales ; niveau singulier conscient, niveau singulier inconscient, niveau groupal conscient, niveau groupal inconscient et selon les différentes strates du réseau (réseau-dispositif ; réseau local-informel ; réseau de proximité formalisé ; réseau-famille ; réseau-professionnel ; réseau dans la tête).- le repérage et l’instrumentalisation des protagonistes-clés de cette méthodologie ; le référent, le répondant et le préoccupé.Face aux mobilisations convoquées par l’enfantement, chacun et tous, familles et professionnels, mettent en place des processus et des élaborations psychiques propres au domaine de la périnatalité réticulaire, à travers des dynamiques psychiques complexes, où le sujet apparaît de, dans, entre et à travers le(s) groupe(s), afin de permettre une adaptabilité défensive adéquate face aux éprouvés participant et procédant de la mise et de la venue au monde des enfants. Entre exigences et possibilités de chacun et de tous, il s’agit d’un tissage dynamique, entre accordages et désaccordages intra, inter et trans-subjectifs : groupalités psychiques réticulaires, réseau(x) dans la tête, dont les qualités en termes de flexibilité et/ou de rigidification, vont permettre, ou peu, ou pas, les potentialités créatrices de la Naissance, dans des contextes préventifs et thérapeutiques / In the context of perinatal nexus, there are differences between the preventive and therapeutic purposes set for the baby and her/his parents on one hand and actual experiences on the other hand. In this research, we wish to develop some reflections about these differences, by mainly resorting to clinical psychology and psychopathology approaches, with ethno-psychological, psychoanalytic and systemic views to grasp the complexity of this theme. Our hypothesis is that a better understanding of the mental shaping of network around the birth could proceed from : - acknowledging this mental shaping in network for each and all partners, professional and parent, as specific mind shaping of network in intra, inter and trans-subjective groups. - taking into account the resistances and resources fitted to mental shaping of network, that hinder and/or support the dynamic qualities of perceptive processes that partake and originate in this care organisation and which weaken and/or prop up its preventive and therapeutic potentialities.Using an ethno-biographical method, a data collection of the birth protagonists’ (the families and medical-nursing staff) perceptions of perinatal nexus and the part played by each one of them in it, made in obstetric, paediatric and child psychiatric units, in Languedoc-Roussillon, from 2005 to 2009. From the data analysis and from three clinical examples, were particularly examined psychological elaborations and processes that originate and partake in the established birth nexus. This analysis, made complete with some contributions of chaos theoreticians, leads to a pattern of understanding of the mind shaping in this specific perinatal network. This model suggests to proceed from : - simultaneous psychological analysis of clinical situation in five levels ; conscious individual level, unconscious individual level, conscious group level, unconscious group level and various network levels (system-network, locally and informally network, formal closeness network, family-network, professional-network, mental shaping in network). - the key-protagonists’ identification and instrumentalization of this method; “the” referent, “the” guarantor and “the” involved.Facing thoughts about child birth, everyone (the families and medical-nursing staff) sets up psychological elaborations and processes that originate and partake in specific perinatal nexus, through psychological and complexe dynamics, which emerges the subject “from”, “in”, “between” and “through” human group(s), in order to permit adequate defensive adaptability when facing feelings partaking and originating in coming and bringing into the world. In between the demands and possibilities of each protagonist, a dynamic weaving of thoughts is ranging from being tune to being out of tune : there lies a mind shaping of network whose flexibility and/or rigidity can or cannot much entice, creative potentialities on human birth, in preventive and therapeutic context

No description available.

Il presente lavoro di tesi si colloca all’interno della tradizione di ricerca nota come Empirically Supported Therapy Relationships, un modello d’indagine centrato sulla natura e sulla funzione della relazione al di là della contrapposizione tra ricerca sugli esiti e ricerca sul processo. I tre studi in cui si articola il lavoro assumono come focus d'indagine porzioni progressive del trattamento: la prima seduta, le prime due sedute, l’intero percorso. Nel primo studio sono messi a confronto differenti esiti terapeutici per verificare se le ricadute sul piano clinico del metodo interpretativo siano riconducibili ad un criterio di presenza/assenza o da ricercare nell’intreccio con altri fattori caratterizzanti il percorso di cura. Il secondo studio si propone di affrontare casi di interruzione prematura del trattamento, differenziati in funzione del raggiungimento o meno della stipulazione di un contratto terapeutico: l’obiettivo è quello di evidenziare le caratteristiche connesse alla diversa fase di abbandono del contesto di cura. Infine il terzo studio, nella forma del single-case study, è incentrato sui momenti di frattura dell’alleanza terapeutica lungo un intero processo terapeutico di quaranta sedute. / The present dissertation refers to the theoretical background known in the literature as Empirically Supported Therapy Relationships, a research tradition focused on the relationship and its nature, beyond the outcome and process research opposition. The three studies included in this work focused on different portions of treatment: respectively the initial intake session, the first two sessions, and the overall treatment. In the first study different outcomes were compared in order to examine if the effects of interpretations were connected to specific factors of psychotherapeutic process. The second study aimed to assess clinical cases of premature termination, differentiated on the basis of the contract attainment: the purpose was to depict specificities due to the different phase of dropping out. Finally, the third study was a single-case research examining alliance ruptures within an entire clinical process of forty sessions.