Objective: The present studies aimed to examine temporal patterns of symptom change over the course of cognitive behavioural therapy (CBT) in individuals with treatment-resistant depression (TRD) and evaluate their relationship to outcomes. They further sought to investigate whether case-conceptualisation competence, client hope and processing were associated with therapeutic change. Method: Participants were 156 individuals with TRD receiving 12-18 sessions of CBT as part of a randomised controlled trial. Depressive severity was assessed at each session. Audio-recordings of therapy sessions proximal to sudden gains and control sessions for 25 sudden gainers and 25 non-sudden gainers were rated for client hope and emotional processing, and therapist competence in case-conceptualisation. Results: The overall shape of change was best described as cubic, with frequent discontinuities in symptom trajectories. Sudden gains were associated with reduced depressive severity and a greater likelihood of remission at 12 months. Sudden gainers demonstrated greater hope than non-sudden gainers and emotional processing increased prior to a gain. Therapists showed greater competence in case-conceptualisation with sudden gainers. Conclusion: The present study describes a non-linear shape of change in TRD and extends the phenomenon of sudden gains to this population. It suggests that the combination of hope for change with supported efforts to process and make meaning of experiences may predispose individuals favourably towards experiencing sudden gains in therapy.

No description available.

The therapeutic alliance is largely recognized as an important component of the therapeutic process. For clients of all ages, the therapeutic alliance has been associated with positive outcomes and increased engagement in therapy (Bachelor, 2013; Bhola, & Kapur, 2013; Liber et al., 2010). However, very few studies have explored the complex process of fostering the therapeutic alliance with adolescent clients, while also maintaining a positive therapeutic relationship with the adolescent’s caregivers. The present study attempted to fill the gap in the literature through qualitatively exploring therapists’ perspectives of the therapeutic alliance with adolescents and their caregivers. In order to discover the essence of therapists’ experiences of the therapeutic alliance with adolescents and their caregivers, a phenomenological research design was employed. Nine therapists were interviewed about their experiences of the therapeutic alliance with adolescents and their caregivers. The interviews were transcribed and analyzed, and various themes and subthemes were revealed. The themes were divided into three sections: (1) conceptualizing the therapeutic alliance, (2) therapeutic alliance with adolescents, and (3) therapeutic alliance with caregivers. Two themes emerged within the ‘conceptualizing the therapeutic alliance’ section: (1) trust, and (2) foundation of therapy. Two themes and various subthemes emerged within the ‘therapeutic alliance with adolescents’ section. The first theme describes the obstacles that therapists face when attempting to build the alliance with adolescent clients, and contained three subthemes: (1) viewed as an authority figure, (2) resistance to therapy, and (3) differences in SES. The second theme describes the strategies that therapists use to develop the therapeutic alliance and contains three subthemes: (1) discuss interests, (2) honor their voice, and (3) describe limits of confidentiality. Two themes were unveiled within the ‘therapeutic alliance with caregivers’ section: (1) obstacles, and (2) strategies. The ‘obstacles’ theme describes barriers that therapists face when constructing the alliance with caregivers of adolescent clients, and contains two subthemes: (1) fear of triangulation, and (2) caregivers’ expectations. The ‘strategies’ theme contains four subthemes: (1) empathy, (2) give caregivers an active role, (3) collaborative approach, and (4) establish clear boundaries. Clinical implications, recommendations for future research, and limitations of the study are discussed.

No description available.

Animation films are daily being screened on television, and offer an available medium with themes easily associated with. The researcher became interested in the possibility of utilising animation films in the play therapy process. A deficiency in relevant literature on the use of animation as medium in the play therapeutic process was identified. The aim of this study was to explore how therapists can use animation as a medium in play therapy and to fully describe it. In order to achieve this goal, qualitative research was employed and a focus group discussion with therapists was carried out. The data collected was analysed and the use of animation in the play therapeutic process was described in-depth. The goal of the study was therefore achieved in that the research provided specific information about where and how animation can effectively be used in the different stages of the play therapeutic process. / Animasiefilms word daagliks op televisie vertoon en is 'n beskikbare medium met temas waarmee die mens maklik assosieer. Die moontlikheid dat hierdie animasiefilms in die spelterapeutiese proses benut kan word, het die navorser ge"interesseer. 'n Leemte in die literatuur oor hoe animasie as 'n medium in die spelterapeutiese proses benut kan word, is as navorsingsprobleem geformuleer. Die doelstelling van hierdie studie was gevolglik om te verken hoe terapeute animasie as medium in spelterapie kan benut ten einde 'n volledige beskrywing hiervan te bied. Om hierdie doelstelling te bereik is 'n kwalitatiewe navorsingstudie uitgevoer en 'n fokusgroeponderhoud met terapeute voltooi. Die ingesamelde data is geanaliseer en die benutting van animasie as medium in die spelterapeutiese proses is in diepte beskryf. Daar is dus in die doel van die studie geslaag deurdat die navorsing spesifieke inligting gebied het oor hoe animasie tydens die verskillende momente van die spelterapeutiese proses effektief benut kan word. / Social Work / M. Diac. (Play Therapy)

Regenerative medicine is an emerging technology and with hundreds of cell therapies currently in clinical trials there is a need to expand the limited knowledge related to their storage, shipment and preservation. The most widely used medium for human cell cryopreservation is 10%wt dimethyl sulfoxide (DMSO) in serum. However given its potential toxicity, DMSO usage is a key issue in cryopreservation. Methods specify the need to reduce cell exposure time to DMSO above 0°C as much as possible but the maximum amount of time cells can be exposed to DMSO to prevent a detrimental effect needs to be clarified. There are also regulatory issues and concerns with the xenotoxicity, ethics and supply of the other core component in the standard cryomedia formulation: Foetal Bovine Serum (FBS). Developing a viable alternative to FBS is crucial. In cryobiology literature thawing appears poorly understood. A stable process is as vital as freezing to prevent injury to cells. Protocols are currently too vague for cell therapy regulation and need improvement. The time dependent DMSO cytotoxicity was evaluated by overexposing cells to DMSO during and/or after cryopreservation. A broad investigation found that after 1 hour overexposure post thaw viability of human mesenchymal stem cells (hMSCs) was reduced from 96.3±0.6% to 74.1±4.0% and the co-expression of five key hMSC markers was changed from 97.9±1.3% to 68.3±2.6%. This significant change could cause indicate a change in product efficacy and affect patient health, to prevent this, DMSO exposure must be kept to below 1 hour. A range of alternative vehicle solutions were screened and human platelet lysate (hPL) investigated as an alternative. In depth experimentation with hPL as a cryopreservation vehicle solution and culture supplement (in place of FBS) found it to be a worthy, statistically similar alternative. With no xenological or ethical concerns, lower costs than other serum-free alternatives hPL could allow for a move away from xenological components. A heat transfer model was developed and determined that 720J is required to thaw a vial. Using the heat transfer model and additional factors such as pre-thaw stabilisation and on thaw dilution, a two-stage experiment found that the current standard process (warming in a 37°C waterbath) within the current paradigm of a 1.8mL cryovial is optimal but further work is required to define the process for scaled-up product.

This thesis investigated how clients and therapists discuss the means by which clients can work towards their therapeutic goals. Cooper et al. (2016) termed such discussions meta-therapeutic communication or meta-therapeutic dialogue and Cooper and McLeod (2011) recommend carrying them out since outcomes are robustly related to whether the client accepts the therapeutic strategy as appropriate for their needs (e.g. Horvath et al., 2011). This thesis undertook the first discovery-oriented, Conversation Analysis (CA) study of how clients and therpaists actually carry out meta-therapeutic discussions. It represents a sustained attempt to bridge the practice-research gap and highlights the conceptual and practical challenges in doing so. 42 audio-recorded pluralistic therapy sessions were sampled across seven therapist-client pairs. Before carrying out the CA study proper, it was necessary to conceptually link broad descriptions of meta-therapeutic dialogue to participants’ concrete actions in therapy sessions. This involved a review of related concepts (Chapter Two), as well as a detailed conceptualization of how therapists’ stocks of interactional knowledge (SIKs) (Peräkylä & Vehviläinen, 2003) regarding meta-therapeutic dialogue might demonstrably link with their concrete actions as described by CA findings (Chapters Three through Five). Therapists’ questions to clients about what might be helpful were selected as a likely site for meta-therapeutic dialogue and were subjected to an in-depth CA investigation of the practical issues participants themselves treated as important in their interactions around these questions (Chapters Six through Eight). Findings show how some apparent opportunities for meta-therapeutic dialogue are less facilitative of clients’ independent input, and can sometimes be interactionally coercive. There is evidence that facilitating dialogical opportunities for talking about what might be helpful may require the therapist to move back-and-forth between opposing positions, such as treating the client as potentially unknowing but still also holding open a space for their contribution. These findings extend existing SIKs regarding meta-therapeutic dialogue by specifying some concrete considerations therapists orient to during such endeavours. Some practical similarities between meta-therapeutic dialogue and problem-solving/solution-focused approaches are also highlighted.

Eating disorders remain extremely difficult to treat and investigation has revealed that manual-based eating disorder treatment outcomes have failed to improve over the second half of the last century. Various studies have observed that clinicians use evidence-based treatments for eating disorders inconsistently and often exclude fundamental theoretical techniques. Some argue that this departure from evidence-based practice may in some cases be the efforts of clinicians to develop methods more sensitive to real world situations. It stands to reason that some of the techniques currently being used by clinicians are promising treatment approaches. The purpose of this study was to explore the therapeutic process of a select group of clinicians at one eating disorder treatment center. Semi-structured interviews were conducted with 16 clinicians. A hermeneutic analysis of the interview transcripts revealed a common treatment approach with nine areas of focus: (a) stabilizing behaviors, (b) relationship building, (c) providing education, (d) increasing motivation, (e) challenging cognitions, (f) understanding emotions, (g) finding purpose and meaning, (h) improving body image, and (i) preventing relapse. Insights acquired from the clinicians in this study could contribute to the development of more effective treatments for clients with eating disorders.

Animation films are daily being screened on television, and offer an available medium with themes easily associated with. The researcher became interested in the possibility of utilising animation films in the play therapy process. A deficiency in relevant literature on the use of animation as medium in the play therapeutic process was identified. The aim of this study was to explore how therapists can use animation as a medium in play therapy and to fully describe it. In order to achieve this goal, qualitative research was employed and a focus group discussion with therapists was carried out. The data collected was analysed and the use of animation in the play therapeutic process was described in-depth. The goal of the study was therefore achieved in that the research provided specific information about where and how animation can effectively be used in the different stages of the play therapeutic process. / Animasiefilms word daagliks op televisie vertoon en is 'n beskikbare medium met temas waarmee die mens maklik assosieer. Die moontlikheid dat hierdie animasiefilms in die spelterapeutiese proses benut kan word, het die navorser ge"interesseer. 'n Leemte in die literatuur oor hoe animasie as 'n medium in die spelterapeutiese proses benut kan word, is as navorsingsprobleem geformuleer. Die doelstelling van hierdie studie was gevolglik om te verken hoe terapeute animasie as medium in spelterapie kan benut ten einde 'n volledige beskrywing hiervan te bied. Om hierdie doelstelling te bereik is 'n kwalitatiewe navorsingstudie uitgevoer en 'n fokusgroeponderhoud met terapeute voltooi. Die ingesamelde data is geanaliseer en die benutting van animasie as medium in die spelterapeutiese proses is in diepte beskryf. Daar is dus in die doel van die studie geslaag deurdat die navorsing spesifieke inligting gebied het oor hoe animasie tydens die verskillende momente van die spelterapeutiese proses effektief benut kan word. / Social Work / M. Diac. (Play Therapy)

Client reports of perceived helpfulness in therapy may provide valuable information to clinicians and researchers about what makes therapy therapeutic for individuals. This may help us to understand more about common factors in effective psychotherapies, to explain the processes through which these factors might operate and to understand how the therapeutic relationship contributes to change for different clients. However, the meth-methodological complexity involved in the design of experimental studies has so far prevented research from being able to fully utilise what clients can tell us about their experience of change. This thesis aimed to address some of these challenges in client centered psychotherapy process research.