Therapists' constructs of healthy functioning as aspirational goal in transformative psychotherapy
- Authors: Steyn, Reinette
- Date: 2000
- Subjects: Psychotherapy , Mental health -- South Africa , Mental health
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3064 , http://hdl.handle.net/10962/d1002573 , Psychotherapy , Mental health -- South Africa , Mental health
- Description: This dissertation reviews the ways in which psychotherapists working in relatively long-term 'transformational' therapies construct the outcome goals of their interventions. It is generally accepted that a therapist's beliefs about what constitutes mental health will influence the client, and will therefore facilitate a certain outcome accordingly. A problem in a long-term, 'non-directive' therapy is that the eventual outcome is not always visible in the interim development of the client or in the business of individual sessions. Without a clearly defined 'plan' or 'goal' there is a real danger of the intervention having opposite results to what would have been desirable, or no noticeably beneficial results, both of which can be an abuse of the client's investment and trust in the process. The absence of clearly constructed goals makes it difficult to assess efficacy of a therapeutic method used to attain an improved state of mental health that will be lasting, i.e. a positive 'transformation'; it also problematises comparisons across orientations. The identification of explicit goals is of special importance in a developing 'third-world' community like South Africa, where western ('European') concepts of mental health are being offered as an alternative to so-called 'indigenous healing' and where different cultural communities may have different expectations, needs or demands of their members 'in health'. Individual-based therapeutic orientations included in the research were psychoanalysis and psychoanalytic therapies, including object-relational therapies with various emphases and self psychology, as well as transformative types of hypnosis, Gestalt therapy, client-centred therapy and transactional analysis. Twenty of the semi-structured interviews with 52 therapists working in one or more of these areas were selected for construct analysis. Through analysis of the constructs of mental health as aspirational goal that emerged in therapists' talking about their experience of the process and the consequences of therapy observed in their patients, it appeared that there are generalisable constructs across various orientations in the transformative therapies. It is hoped that these constructs may serve as a foundation for further research in the problem areas indicated, but also that therapists working in the field may use this research not only as a basis for self-evaluation, but for adding to the constructs from their own experience, to the further enrichment of the whole field of work.
- Full Text:
- Date Issued: 2000
- Authors: Steyn, Reinette
- Date: 2000
- Subjects: Psychotherapy , Mental health -- South Africa , Mental health
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3064 , http://hdl.handle.net/10962/d1002573 , Psychotherapy , Mental health -- South Africa , Mental health
- Description: This dissertation reviews the ways in which psychotherapists working in relatively long-term 'transformational' therapies construct the outcome goals of their interventions. It is generally accepted that a therapist's beliefs about what constitutes mental health will influence the client, and will therefore facilitate a certain outcome accordingly. A problem in a long-term, 'non-directive' therapy is that the eventual outcome is not always visible in the interim development of the client or in the business of individual sessions. Without a clearly defined 'plan' or 'goal' there is a real danger of the intervention having opposite results to what would have been desirable, or no noticeably beneficial results, both of which can be an abuse of the client's investment and trust in the process. The absence of clearly constructed goals makes it difficult to assess efficacy of a therapeutic method used to attain an improved state of mental health that will be lasting, i.e. a positive 'transformation'; it also problematises comparisons across orientations. The identification of explicit goals is of special importance in a developing 'third-world' community like South Africa, where western ('European') concepts of mental health are being offered as an alternative to so-called 'indigenous healing' and where different cultural communities may have different expectations, needs or demands of their members 'in health'. Individual-based therapeutic orientations included in the research were psychoanalysis and psychoanalytic therapies, including object-relational therapies with various emphases and self psychology, as well as transformative types of hypnosis, Gestalt therapy, client-centred therapy and transactional analysis. Twenty of the semi-structured interviews with 52 therapists working in one or more of these areas were selected for construct analysis. Through analysis of the constructs of mental health as aspirational goal that emerged in therapists' talking about their experience of the process and the consequences of therapy observed in their patients, it appeared that there are generalisable constructs across various orientations in the transformative therapies. It is hoped that these constructs may serve as a foundation for further research in the problem areas indicated, but also that therapists working in the field may use this research not only as a basis for self-evaluation, but for adding to the constructs from their own experience, to the further enrichment of the whole field of work.
- Full Text:
- Date Issued: 2000
Psychiatric problems in the primary health care context: a study in the Border-Kei area
- Authors: Cook, Jacqueline
- Date: 1996
- Subjects: Primary health care -- South Africa , Mental health services -- South Africa , Black people -- Mental health -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2954 , http://hdl.handle.net/10962/d1002463 , Primary health care -- South Africa , Mental health services -- South Africa , Black people -- Mental health -- South Africa
- Description: A clinic survey was undertaken to investigate the nature of psychiatric problems experienced by the primary health care (PHC) patient population in the Bisho-King William's Town area of the Eastern Cape Region. The study took as its point of departure research findings which attest to the high rate of psychiatric distress amongst this population group in different parts of the world and ohservations regarding the form of presentation in terms of physical complaints. Hypotheses posited relationships between psychiatric problems experienced by patients attending PHC clinics in the study area and four types of variables, namely; somatic complaints, socio-demographic characteristics, patterns of health service utilisation and patient satisfaction with health services. Using a quasi-experimental descriptive approach, a two-stage screening procedure sorted the patient sample into three groups on the basis of the degree of psychiatric symptomatology experienced. The triangulation of the results of between-groups analyses with case materials recorded during psychiatric interviewing provided for an ethnographic account of the cultural experience of distress in the study area. The screening process used standard instruments, the Self-Reporting Questionnaire (SRQ) in the first stage and the Present State Examination (PSE) in the second stage. A pilot study was conducted prior to the fieldwork for the main study. Using the SRQ, thirteen psychiatric paticnts and 31 general PHC patients were sampled for the pilot study and 148 PHC patients were sampled for the main study. Using the PSE, 11 and 57 PSE interviews were conducted in the pilot and main studies respectively. Between-groups analyses used chi-square and F-statistics to investigate possible associations with identified patient correlates (P<0.5). These were socio-demographic, utilisation and satisfaction variables, measured by a separate face-valid self-response instrument compiled for the purposes of this study. Psychiatric symptomatology was found to be statistically significantly related to age, marital status and educational level. Further, patients experiencing more psychiatric symptomatology reported significantly more illnesses requiring treatment, longer consultation periods and a greater number of sick bed days. No statistically significant relationships were found between psychiatric symptomatology and number of children, number of failures at school, amount of treatment utilised, number of consultations, or patient satisfaction with services. Descriptive analyses of symptom and syndrome profiles found certain somatic complaints to be particularly prevalent amongst the patient sample. These include headaches and various tension pains, decreased energy levels and digestive problems. Qualitative analysis of interview data found that many somatic and psychiatric problems experienced constitute culturally defined and meaningful experiences, especially 'umbilini' (or nerves), 'ufufunyana' (a possession state), and accusations of witchcraft. Interpretation of complaints from the local traditional healing perspective, revealed a more complex mode of communication between patients and the health delivery system than may be accounted for in terms of a simple biomedical model. The interpretive analysis in the study showed that some forms of presentation incorporating somatic symptoms, such as 'nerves' may he viewed as help seeking behaviour of the socially unempowered. Implications of the results are discussed in relation to the need for improved identification and management of psychiatric distress at PHC level facilitated by a better developed referral network and closer interaction between biomedical and anthropological perspectives.
- Full Text:
- Date Issued: 1996
- Authors: Cook, Jacqueline
- Date: 1996
- Subjects: Primary health care -- South Africa , Mental health services -- South Africa , Black people -- Mental health -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2954 , http://hdl.handle.net/10962/d1002463 , Primary health care -- South Africa , Mental health services -- South Africa , Black people -- Mental health -- South Africa
- Description: A clinic survey was undertaken to investigate the nature of psychiatric problems experienced by the primary health care (PHC) patient population in the Bisho-King William's Town area of the Eastern Cape Region. The study took as its point of departure research findings which attest to the high rate of psychiatric distress amongst this population group in different parts of the world and ohservations regarding the form of presentation in terms of physical complaints. Hypotheses posited relationships between psychiatric problems experienced by patients attending PHC clinics in the study area and four types of variables, namely; somatic complaints, socio-demographic characteristics, patterns of health service utilisation and patient satisfaction with health services. Using a quasi-experimental descriptive approach, a two-stage screening procedure sorted the patient sample into three groups on the basis of the degree of psychiatric symptomatology experienced. The triangulation of the results of between-groups analyses with case materials recorded during psychiatric interviewing provided for an ethnographic account of the cultural experience of distress in the study area. The screening process used standard instruments, the Self-Reporting Questionnaire (SRQ) in the first stage and the Present State Examination (PSE) in the second stage. A pilot study was conducted prior to the fieldwork for the main study. Using the SRQ, thirteen psychiatric paticnts and 31 general PHC patients were sampled for the pilot study and 148 PHC patients were sampled for the main study. Using the PSE, 11 and 57 PSE interviews were conducted in the pilot and main studies respectively. Between-groups analyses used chi-square and F-statistics to investigate possible associations with identified patient correlates (P<0.5). These were socio-demographic, utilisation and satisfaction variables, measured by a separate face-valid self-response instrument compiled for the purposes of this study. Psychiatric symptomatology was found to be statistically significantly related to age, marital status and educational level. Further, patients experiencing more psychiatric symptomatology reported significantly more illnesses requiring treatment, longer consultation periods and a greater number of sick bed days. No statistically significant relationships were found between psychiatric symptomatology and number of children, number of failures at school, amount of treatment utilised, number of consultations, or patient satisfaction with services. Descriptive analyses of symptom and syndrome profiles found certain somatic complaints to be particularly prevalent amongst the patient sample. These include headaches and various tension pains, decreased energy levels and digestive problems. Qualitative analysis of interview data found that many somatic and psychiatric problems experienced constitute culturally defined and meaningful experiences, especially 'umbilini' (or nerves), 'ufufunyana' (a possession state), and accusations of witchcraft. Interpretation of complaints from the local traditional healing perspective, revealed a more complex mode of communication between patients and the health delivery system than may be accounted for in terms of a simple biomedical model. The interpretive analysis in the study showed that some forms of presentation incorporating somatic symptoms, such as 'nerves' may he viewed as help seeking behaviour of the socially unempowered. Implications of the results are discussed in relation to the need for improved identification and management of psychiatric distress at PHC level facilitated by a better developed referral network and closer interaction between biomedical and anthropological perspectives.
- Full Text:
- Date Issued: 1996
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