Ethical decision-making in the therapeutic space : a psychoanalytic view
- Authors: Silove, Melanie
- Date: 2009
- Subjects: Decision making -- Moral and ethical aspects , Psychotherapy -- Moral and ethical aspects , Psychotherapists -- Professional ethics
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3273 , http://hdl.handle.net/10962/d1020873
- Description: This study examined the ethical decision-making process as it transpired in the everyday context of the therapeutic space. In-depth interviews explored the subjective experiences of six South African psychologists, practicing as psychoanalytic psychotherapists, and their efforts to resolve real-life ethical dilemmas. The theoretical framework used to interpret the data subsumed professional literature in psychology on principle-based ethical decision-making as well as contemporary psychoanalytic debates on the phenomenon of countertransference enactments. A review of ethics codes, survey research and seminal decision-making frameworks suggests that ethical dilemmas have traditionally been resolved by recourse to an objective and impartial “principle ethics” perspective. Empirical evidence shows, however, that logical thinking and the rational application of codes, principles and standards are often insufficient to secure ethical action. The establishment of reflective space and the core theoretical notion of “ethical decision-making enactments” were proposed in order to address the subjective, irrational and unconscious dimension of professional decision-making. This study used a broadly hermeneutic research method which transformed participants‟ descriptions of engagement with real-life dilemmas into a psychoanalytically informed interpretive account of ethical decision-making. Twelve aspirational ethical principles were found to guide participants‟ daily analytic work. Beneficence was the principle most strongly identified with and nonmaleficence was the most neglected ethical principle. Unprocessed countertransference responses were shown to drive earlier prereflective phases of the ethical decision-making process. Mature ethical judgment was predicated upon the retrospective analysis of enactment phenomena. Dissatisfaction was expressed by all participants with regard to the role of professional resources in aiding the resolution of stressful ethical dilemmas. Risk factors for compromised professional decision-making included the paucity and perceived irrelevance of postgraduate ethics training, supervisory failure to confront the ethical and countertransference dimensions of common dilemmas and professional isolation. Rather than eliciting the hope of emotional support and greater insight, professional resources on the contrary mostly appeared to induce anxiety, mistrust and fearfulness. Based on the data and the literature, a pragmatic psychoanalytically informed ethical decision-making model was finally generated. The model, which considers both principle ethics as well as countertransference phenomena, offers a preliminary contribution to professional dialogue on the development and evaluation of empirically based decision-making frameworks. Practical recommendations are made for both the revision of the current South African ethics code and for improving the postqualifying ethics education of psychoanalytic practitioners and supervisors. The limitations of the data are discussed and directions for future research initiatives are proposed.
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- Date Issued: 2009
Breaking the silence : Zanele's journey to recovery
- Authors: Payne, Charmaine
- Date: 2007
- Subjects: Rape victims -- Counseling of -- South Africa Rape victims -- Counseling of -- South Africa -- Case studies Post-traumatic stress disorder -- Patients -- Rehabilitation Post-traumatic stress disorder -- Patients -- Case studies
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3161 , http://hdl.handle.net/10962/d1007651
- Description: This study employed a case-based research design to document the psychological assessment and treatment of Zanele, a 15-year-old black Xhosa speaking female who was raped twice in 2006 by the same perpetrator. The aim of the study was to explore whether, the model for assessment and intervention for posttraumatic stress disorder (PTSD) developed by Ehlers and Clark (2000) was effective and transportable to the South African context. Zanele had a sufficient understanding of English for assessment to proceed without use of an interpreter. She reported a number of PTSD symptoms which were causing her significant distress and had impacted on her social and educational functioning. These included flashbacks of the perpetrator's face when she looked at the faces of black men, nightmares about the traumas she had endured and feeling isolated from others. A number of cognitive techniques were utilised in this study, however the central interventions included working with triggers, imagery rehearsal techniques with a focus on nightmares, and reliving with cognitive restructuring within and outside reliving. Psychoeducation and increasing her social support were also important components of the intervention. Her progress was monitored by means of several self-report measures which were displayed in graphic and tabular form. In addition, a thematically selective narrative of the assessment and first 23 sessions of the intervention was written which documents some of the central processes set in motion by the interventions. These results provide evidence that this model was both effective and transportable to the South African population. In addition, the study demonstrated that it is possible for a white English speaking clinician to work with a black Xhosa speaking individual and make substantial therapeutic gains.
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- Date Issued: 2007
A phenomenological hermeneutic investigation into the psychoanalytic psychotherapist's experience of using the psychoanalytic couch
- Authors: Milton, Christopher
- Date: 2004
- Subjects: Freud, Sigmund, 1856-1939 -- Criticism and interpretation Psychoanalysis Psychotherapy Psychotherapy -- Methods
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3162 , http://hdl.handle.net/10962/d1007655
- Description: The aim of this study was to describe and critically explore the psychoanalytic, psychotherapist's lived experience of the technique of using the couch. Through examination of the literature a question was formulated that would disclose the analyst's experience of the technique of using the couch. Four experienced psychoanalytic practitioners who could be operationally defined as 'analysts' were interviewed. Using a phenomenological method the protocols were comprehensively analyzed to produce descriptions of the general structure of the experience. These were then texturally enhanced using interleaved direct citations from the interviews. The structural and textural 'findings ' so produced were then hermeneutically dialogued with contemporary psychoanalytic notions of critical discourse and intersubjectivity. The phenomenological ' findings ' of the study disclosed the meaning of the couch as context-based, paradoxical and ambiguous. The couch was found to be a symbol of the analyst as analyst and the process as authentic analysis. Furthermore, at its best, the couch was found to mediate a mode of being that is containing and intimate and in which psychological life may be evoked, tracked and interpreted. The most significant contributor to this mode of being was found to be privacy, which, in particular, helps the analyst maintain an analytic attitude. The couch was also found to be significantly implicated in the generation of an intersubjective analytic third and to support reverie. These 'findings' were hermeneutically dialogued with literature on the couch as well as contemporary psychoanalytic theoretical notions. The dialogue fell into three foci. The first focus entailed deconstructing the meaning of the couch as context-based and ambiguous and not essential. The second pursued critiques of the role that the couch plays in domination, of its function as a symbol/evocative object and of the way in which it shapes being-together, bodily attunement, privacy, the intersubjective analytic third and reverie. Finally the 'findings' were critically examined in terms of both Lacan's notion 'analytic discourse ' and its role in revealing/concealing the analysand as subject. The study concludes with an examination of its own limitations and suggestions for further research.
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- Date Issued: 2004
Processes that influence the experiences of children living with mothers that have HIV: two case studies
- Authors: Castelletto, Simona
- Date: 2004
- Subjects: AIDS (Disease) in women , AIDS (Disease) -- Social aspects -- South Africa , HIV infections -- Social aspects -- South Africa , Mothers and daughters -- Social aspects , Mothers and sons -- Social aspects , AIDS (Disease) in children -- Social aspects -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3166 , http://hdl.handle.net/10962/d1007728 , AIDS (Disease) in women , AIDS (Disease) -- Social aspects -- South Africa , HIV infections -- Social aspects -- South Africa , Mothers and daughters -- Social aspects , Mothers and sons -- Social aspects , AIDS (Disease) in children -- Social aspects -- South Africa
- Description: Maternal HIV-infection is considered to be a threat to the psychosocial development of AIDS-affected children. In South Africa, AIDS-affected children may be particularly vulnerable due to the unprecedented effects of the HIV/AIDS epidemic on the breakdown of family and community resources in already disadvantaged communities. The aim of this study was to explore the contextualised experiences of two children living with mothers who have HIV by conducting two case studies. Mother-child dyads were recruited from local HIV/AIDS centres and informed consent was obtained. The mothers were in the minor symptomatic phase of HIV-infection and the children were uninfected and aged between 10 and 12 years. Through semi-structured interviewing, the mothers provided background and contextual information about the children. Play techniques were used in the child interviews to encourage the introduction and exploration of issues salient to the children. Play facilitated engagement around sensitive and potentially anxiety-provoking material. A key issue for the children was their concerns about the anticipated deaths of their mothers. The children held misconceptions about the transmission of HIV/ AIDS. They feared HIV/AIDS and expected that others would have negative perceptions of them. Family processes such as secrecy and avoidance around HIV/AIDS-related issues were understood to perpetuate the children's fears and false beliefs in a broader community context that stigmatised HIV/AIDS. It was argued that the mothers' shame over HIV-infection and their need to protect their relationship with their children compromised their ability to communicate openly with their children and to offer them meaningful emotional support. Limited parental involvement was identified as the key contextual process that engendered vulnerability in the children, as they were isolated within and beyond the family. Recommendations to address the processes that engendered vulnerability in the children are discussed.
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- Date Issued: 2004
An exploration of high self control scores among South African university students
- Authors: Riordan, Janet Susan
- Date: 1991
- Subjects: College students -- South AFrica -- Psychology , Self-control , Self-control -- Research
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: vital:2902 , http://hdl.handle.net/10962/d1002066
- Description: The Rosenbaum Self Control Schedule is a self-report instrument developed to assess individual tendencies to apply self-control methods to the solution of behavioral problems. Tested on Hebrews and English-speaking Americans, it was found to transfer easily from one situation to the other. When administered in a battery of self-report questionnaires to South African university students it was found that while means of the total sample were similar to those reported overseas, the means of black and white students within the sample were significantly different from each other, with black students having higher self-control scores than the white students in the study and higher than those reported in previous studies. The study was repeated in this research project using a larger group of black students. The finding of significantly higher self-control scores was replicated. This finding was not due to response set, either acquiescence or social desirability, although black subjects were found to be more subject to social desirability response set. Distributions of the samples showed a group of low scoring white subjects for which there was no equal in the black sample. The findings suggest that black university students in South Africa have high levels of learned resoursefulness. This may be due to a selection process reflecting the relative difficulty with which black students reach university level - difficulties relating to student unrest, educational and financial limitations and economic and social drawbacks so that only those students with moderate to exceptional levels of problem solving stategy skills do succeed. Such individuals should be good candidates for cognitive therapies. Item and factor analyses showed the SCS to be psychometrically adequate for the white group but were much less conclusive for the black sample. In this group, a lower Cronbach's alpha was obtained and the factor analysis was less clear.
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- Date Issued: 1991
An investigation of the interrelationship between group commitment, religiosity, marital adjustment and attitude to divorce in the Jewish ethnic group
- Authors: Miller, Bernice
- Date: 1991
- Subjects: Jews -- Psychology , Judaism , Jews -- Attitudes , Ethnicity , Marriage (Jewish law) , Divorce (Jewish law)
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3019 , http://hdl.handle.net/10962/d1002528 , Jews -- Psychology , Judaism , Jews -- Attitudes , Ethnicity , Marriage (Jewish law) , Divorce (Jewish law)
- Description: The purpose of this research was to investigate the interrelationships between marital adjustment, group commitment, religiosity and attitude to divorce in the Jewish group. It amounted to a within group empirical study of the Jewish community of Cape Town. Research, to date, has focused on marital stability where researchers have found that Jews have lower divorce rates than the general population. The present study attempted to assess the psycho-social outcomes of group commitment in the form of marital adjustment, thus bridging the gap between marital quality and marital stability in the Jewish group. On a wider level, the purpose of this research was to assess whether a social structural framework, utilizing the concept of social integration, is a perspective that can be used in explaining variations in marital adjustment. The following were the findings of the research : Religiosity was correlated to group commitment but not to marital adjustment; group commitment was correlated to marital adjustment; a negative attitude to divorce was not correlated to marital adjustment, group commitment or religiosity.
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- Date Issued: 1991
Bulimia Nervosa: a case study in cognitive psychotherapy
- Authors: Kanfer, Josephine
- Date: 1990
- Subjects: Uncatalogued
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10962/192988 , vital:45287
- Description: This project uses the case-study method to illustrate the application of integrating varied accepted modes of psychotherapeutic interventions. It concentrates on the first 22 out-patient sessions of therapy with a diagnosed bulimic, spanning a 6 month period. A brief summary of the subsequent 10 follow-up sessions is also given. The case presented is of a 22 year old female student diagnosed as bulimic (of 7 year duration), dysthymic and with a dependent personality disorder. She has symptoms of anxiety. She has a history of anorexia nervosa. Fairburn's (1985) cognitive-behavioural programme for bulimia was used initially. Its structured framework with the emphasis on the eating behaviour was an essential aspect in contributing to the success of the initial phase of the therapy. This patient had had previously experienced 8 sessions of non-directive depth psychotherapy which had confused and compounded her problems. The structure had provided her with a sense of control. In implementing the second stage of Fairburn's programme, where the focus is cognitive, the patient could no longer work in this this structured manner. The attempts to implement the standard cognitive techniques provided the catalyst for activating deeper underlying emotions and cognitions. Furthermore, this gave impetus to work actively with the interpersonal aspect of the therapeutic relationship. Young's (1989) model for identifying Early Maladaptive Schemas could be applied. The focus then moved from the behaviours and dealt with these schemas as activated in the therapeutic relationship. The patient was able to make links to her family and her past. The therapy proved successful, as not only were the behavioural symptoms alleviated, but also the patient's interpersonal problems which underlay her personality disorder were accessed. The patient had become more self-assertive, her mood had improved considerably, she was less concerned with body image and more accepting of herself. She had become more reality based and her interpersonal relational abi1ity had improved. , Thesis (MA) -- Faculty of Humanities, Psychology, 1990
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- Date Issued: 1990
The empty-nest stage of life : a comparative study of women and men facing transition
- Authors: Kaplan, Ernest
- Date: 1989
- Subjects: Empty nesters , Parent and child , Sex role -- Psychological aspect , Men -- Sexual behavior , Women -- Sexual behavior
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: vital:2899 , http://hdl.handle.net/10962/d1002063
- Description: This thesis encompasses a study of the empty-nest stage of life. For the purposes of this study, the above-mentioned stage was defined as that period in the family when the youngest child matriculates. Thirty-five empty-nest couples were interviewed during 1984, in the city of Port Elizabeth, South Africa. The mean age of the subjects was 49.5, and the standard deviation was 4.9. The couples were asked about their attitudes towards the empty-nest, using a structured questionnaire, the Family Attitude Survey (FAS). This survey consisted of nine-point attitude statements, which focused on theoretical issues pertinent to this stage, viz. children are on-time or off-time with regard to major life events, impact of children leaving home on the parents, degree of parental involvement with children, parent-child relationships, ageing, sexuality, menopause, work-career, and attitudes towards the past, future and death. The general purpose of the present study was to determine the extent to which the empty-nest stage of life constitutes a negative crisis period, or a positive period of stability and growth for the empty-nest parents. Overall, it was concluded that the empirical evidence depicting the empty- nest stage of life as a positive period of stability and growth rather than a negative crisis period, is persuasive for some of the empty-nest parents in the present study, in view of the empirical findings regarding certain of the above-mentioned theoretical issues examined in the present thesis. Notwithstanding this, it was deemed essential to qualify the above conclusion, given the fact that the same and other respondents experienced difficulty with the following issues, viz. children being off-time with regard to major life events, the departure of children from the home, overinvolvement with children, problematic relationships with them, perceptions of themselves as failures as parents, inability to accept their own ageing, problems with changing sexuality, diminishing enjoyment in their occupations, and lack of prospects for future career advancement, negative preoccupation with the past and future, anxiety about death, and an impoverished marital relationship. It was also demonstrated empirically that wives experience particular psychological problems at this time, viz., firstly, they are more adversely affected by their children's departure from the home than their husbands, secondly, they undergo a rehearsal for widowhood more frequently than them, and thirdly, a minority of them are unable to come to terms with the menopause. Finally, the finding that the majority of wives experienced relief with the onset of the menopause when viewed from the perspectives of general emotional impact, children, and the spousal relationship, conflicts with existing theories in this area. However, it is supported by and large by the majority of empirical studies.
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- Date Issued: 1989
The interrelationship of physical fitness, somatotype, body cathexis and personality in a group of white schoolboys
- Authors: Fieldsend, Jeremy Rowell
- Date: 1980
- Subjects: Somatotypes -- Psychological aspects , Physical fitness for children -- Psychological aspects
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:5139 , http://hdl.handle.net/10962/d1006343 , Somatotypes -- Psychological aspects , Physical fitness for children -- Psychological aspects
- Description: The evaluation of physical fitness is dependent upon the body and its capacity to generate requisite degrees of strength, speed, mobility and endurance, for effective physical performance. The physical properties of the body, and in particular the degree of muscularity and adiposity, are affected substantially by varying levels of physical fitness. This degree of muscularity and adiposity is closely related to the shape or physique of the body, which in turn, can influence the attitudes an individual adopts toward his body and himself (body cathexis). The purpose of this study was to investigate the reciprocal relationship between physical fitness, somatotype (physique) and body cathexis (satisfaction). A secondary objective was to examine the relationship between these variables and personality. The subjects who participated in this study were white schoolboys completing Standard Eight. Seventy seven subjects, all of whom were either 14 or 15 years of age, were studied. A total of 22 observations were made on each subject, which included a battery of physical fitness tests, anthropometric and somatotypological observations, and two questionnaires. Fleishman's Basic Fitness Test battery, which was slightly modified, was utilized to evaluate the subjects' level of physical fitness. Standardized anthropometric techniques and equipment were used to measure heights, mass, diameters, girths, and skinfolds. These basic anthropometric observations were then utilized to determine the subjects' Heath-Carter somatotype rating, absolute and relative body fat, and lean body mass. Body cathexis was measured by the Secord-Jourard Body Cathexis Scale and personality was assessed by the Howarth personality Questionnaire. The results indicated that physical fitness performance on the events which required the body mass to be displaced were highly and negatively related to the degree of excess adipose tissue. Significant differences in endomorphy (p < 0,005) were apparent in high and low fit groups, but no somatotypological differences were indicated for those events which did not involve the displacement of the body mass. The one exception to this was a static strength event, in which significant somatotypological differences between high and low fit groups were indicated for mesomorphy (p < 0,005) and ectomorphy (p < 0,01). Body cathexis was not closely related to physical fitness, somatotype, or personality. A number of weak relationships were apparent: there was a negative correlation between body cathexis and the personality trait of inferiority; high levels of adipose tissue negatively influenced the level of body cathexis; and good performance on the strength events was positively associated with body cathexis. In the physical fitness events requiring strength and the body mass to be displaced, the body cathexis levels of high fit subjects exceeded that of low fit subjects at a statistically significant level (p < 0,005). No significant differences in body cathexis were indicated for those events which did not require the displacement of the body mass. Personality was not related to physical fitness, somatotype or body cathexis. The only relationship that was discerned was the low correlation between inferiority and body cathexis . The findings of this investigation suggest that, in this context, dynamic physical fitness performance, is closely related to physique; and in particular a high endomorphic content is a limiting factor. Body cathexis is not closely related to physical fitness, somatotype or personality. It is likely, however, that feelings of inferiority and excess adipose tissue are associated with a low body cathexis, while strength is related to a high body cathexis. Personality is not related to physical fitness, physique or body.
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- Date Issued: 1980