| 1. |
- Falkenström, Fredrik
(författare)
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The Capacity for Self-Observation in Psychotherapy
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The phenomena of self-awareness and self-observation are thought by many to be uniquely human qualities, and questions about how they develop have engaged philosophers and spiritual thinkers throughout history. More recently these issues have come to interest psychologists, psychotherapists, and researchers of diverse clinical psychology orientations as well. This dissertation explored conceptual issues and empirical measurement methods related to self-awareness and self-observation capacities. The four studies approached this from different angles: Study I used mainly qualitative methods to study post-treatment processes related to continuing clinical improvement after termination of long-term psychotherapeutic treatments. The main finding was that self-analysis seemed to be related to continued improvement after ending of therapy, but contrary to our hypothesis there was no difference between psychotherapy and the more intensive psychoanalysis in this regard. Study II tested the measurement of mindfulness by self report in a sample of experienced Buddhist meditators. The findings confirmed relationships between mindfulness and psychological well-being, but raised doubt about the instruments’ sensitivity to change. Study III compared different methods for measuring theoretically related concepts of self-observation: mindfulness, mentalization, and affect consciousness. This study showed surprisingly little common variance between affect consciousness and mentalization/mindfulness. Finally, the results of Study IV showed that in patients diagnosed with clinical depression, mentalization about depressive symptoms predicted aspects of the initial psychotherapy process better than mentalization about attachment. Taken together, these studies show the complexity of the phenomenon of self-observation and the corresponding complexity of research on it. The relationships between variables related to self-observation, their measurements, and their relationships to the psychotherapy process seem more complex than would be expected from current theories. A model for types of self-observation in the process of change in psychotherapy is tentatively proposed.
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| 2. |
- Gradin Franzén, Anna
(författare)
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Disciplining Freedom : Treatment Dilemmas and Subjectivity at a Detention Home for Young Men
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This ethnographic study explores treatment practices and staff-resident interaction at a detention home for young men, drawing on video recorded conversations and interviews. It investigates ideological dilemmas inherent in the institutional setting and how these produce complex subject positions to uptake, negotiate or refuse. Study I explores a core treatment dilemma: coercion vs. freedom, involving the dual institutional goal of coercing residents into norm abiding behavior and of producing individuals who behave "properly" out of their own free will. It focuses on staff members’ talk about token economy, illuminating rhetorical resources deployed to avoid the troubled subject position of a disciplinarian. Study II investigates disciplinary humor, illuminating how humor is used both to impose and disrupt social order. It shows how staff members and youths skillfully deploy humor in negotiating local hierarchies related to authority, generation, and age. Humor was also found to be a useful way of navigating ideological dilemmas. Study III explores behavior modification practices, focusing on how selfassessment practices can be conceptualized as responsibilization that emphasizes self-regulation. It documents the participants’ engagement in strategic deployment of specific subject position relations, “young boy”-caregiver rather than delinquent-disciplinarian. In brief, the thesis shows that subject positions are essentially co-constructed, and how positions related to age are highly relevant in this institutional setting. Paradoxical aspects of subject positions provide discursive resources that can be deployed to navigate ideological dilemmas such as that of coercion vs. freedom, but also to handle issues of authenticity.
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| 3. |
- Hartzell, Monica, 1953-
(författare)
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The First Meeting at Child and Adolescent Psychiatry
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children and parents who visited child and adolescent psychiatry (CAP) for the first time were interviewed in the presence of their therapists about the first meeting. The interview was intended to make the attendants describe in their own words what the meeting was like for them. The interview was repeated after six months to get complementary information. Research assistants, reflectors, helped the interviewer to prevent from bias and to hold on to the theme. The grounded theory approach was utilised in papers I, II, and III, and qualitative content analysis was used in paper IV. Children appreciated the therapist being in an active as well as in a more passive but alert position, moving between asking adjusted questions and including the parents. The therapists’ skill of listening was also important to them. For the parents, it was important what happened between their child and the therapists. They questioned their own role and presence. Also, they focused on the plan for the meeting and for the coming process. Certain things that happened in the dialogue were useful after the meeting. The results indicate that what was helpful was connected to family therapy matters rather than psychiatric ones. The therapists balanced between a psychiatric and a family therapeutic position, and it was a dilemma for them how to best fulfil their assignment in the organisation as they perceived it. Two competing discourses were found in the first meeting; Structuring, which stood for structure, planning and expertise, while Collaboration represented negotiations of how to work together, empowerment and emotional aspects. The Structuring discourse tended to dominate. Both discourses consisted of valuable elements that needed to be included to ensure that the atmosphere would not be too strict or too flexible. The findings are tentative because of the lack of studies to compare to, and because of the few interviews made.
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| 4. |
- Johnson Frankenberg, Sofia
(författare)
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Caregiving Dilemmas : Ideology and Social Interactionin Tanzanian Family Life
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis explores caregiving ideology and social interaction in Tanzanian families with a focus on guidance and control of young children. The study is set within a context of social change in terms of urbanization as well as the implementation of the Convention on the Rights of the Child. The aim of the study was to explore how the conditions for children’s participation are shaped within local deology and situated practice. A qualitative study was undertaken inspired by the traditions of language socialization, sociocultural theory and discursive psychology. Data was collected in one urban and one rural district in the coastal region in Tanzania. The thesis contains four articles. Article one and two are based on data from focus group discussions with parents and grandparents exploring caregiving responsibilities. The first study explores caregivers’ discourses regarding the responsibility of guidance and control of children related to social change. The analysis constructed two interpretative repertoires: guidance and control as a community matter and guidance and control as a family matter. These repertoires are related to an ideological caregiving dilemma regarding parental authority and individual rights. The second study investigates caregivers’ discourses regarding early childhood discipline strategies. The analysis suggested a model illustrating various levels of power asymmetries related to corporal punishment, conceptualized in terms of to beat with care, to treat like an egg, as if beating a snake and the non-care of non-beating. Article three and four are based on video recorded data and present analyses of moment-to-moment, multimodal sequences of interaction. The third study explores how siblings in Tanzania actively engage in their own socialization concerning caregiving responsibilities through the negotiation of guidance and control between younger siblings, older siblings and adults. The forth article presents findings from analyses of naturally occurring literacy events. The analysis shows how participation is negotiated in terms of symmetries and asymmetries between younger and older siblings. Norms and values belonging to the social order of the formal school are enacted parallel to the social order of participatory learning with roots in everyday interaction in the home. The four studies illustrate conditions of participation in terms of symmetries and asymmetries in early childhood relationships. The findings are also discussed in terms of a caregiving dilemma regarding individual rights versus parental authority. This dilemma is identified both in lived and theoretical ideology as presented in caregivers’ discourses and the ideology of children’s rights.
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| 5. |
- Lech, Börje
(författare)
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Consciousness about own and others’ affects
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is essential for individuals’ well-being and relationships that they have the ability to consciously experience, express and respond to their own and others’ affects. The validity of a new conception of affect consciousness (AC), incorporating consciousness of both own and others’ affects, was investigated in this thesis. The clinical usefulness of the new conception was explored and an interview (affect consciousness interview – self/other; ACI-S/O) intended to capture this new definition was validated. In study I the interrater reliability and the concurrent validity of the ACI-S/O were assessed and found to be acceptable. There were significant differences in all variables of ACI-S/O between the four groups that participated in the study. Joy and interest had the highest ratings in all groups and guilt and shame had the lowest. By means of a factor analysis, two factors, labeled “general affect consciousness” and “consciousness about shame and guilt,” were obtained. General affect consciousness was related to different aspects of relational and emotional problems and possibly protection against them. In study II the clinical implications of AC were further explored in relation to eating disorders (ED). The level of AC in the ED group was compared with a comparable non-clinical group. The relation between AC and aspects of ED pathology were explored, as well as whether AC should be seen as a state or trait in patients diagnosed with ED. ACI-S/O was not significantly related to ED pathology or general psychological distress. There were no significant differences in AC between the different sub-diagnoses of ED but there were between the ED group and the non-clinical group. Significant pre-post correlations for both factors of ACI-S/O were found, indicating that AC could be seen as a stable dimension that might be important for ED pathology but is unrelated to ED symptoms. In study III the relationship between AC and self-reported attachment style (ASQ) was explored in a non-clinical group and three patient groups. There were significant correlations between all scores on ACI- S/O and the ASQ, with the exception of consciousness about guilt. Multiple regression analyses showed that AC, and especially others’ affects, contributed significantly to the ASQ subscales. AC and in particular own joy and others’ guilt and anger seem to be of importance for attachment style. In study IV the importance of AC for the treatment process was explored. Patients’ AC before therapy was significantly correlated with patients’ positive feelings towards their therapists but not with their alliance ratings. Patients’ warm and positive feelings were related to pre-therapy AC, whereas negative feelings were related to low alliance ratings in the previous sessions.
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| 6. |
- Wilhelmsson Göstas, Mona, 1950-
(författare)
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Psychotherapy patients in mental health care: : attachment styles, interpersonal problems and therapy experiences
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mona Wilhelmsson Göstas, School of Health and Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden, mona.vilhelmsson gostas@orebroll.se Attachment styles are relevant to psychotherapy since they highlight the way a person handles interpersonal and emotional stress. This thesis aimed to examine how psychotherapy patients in the public mental health care system report attachment styles related to interpersonal problems and diagnosis before and after psychotherapy and to examine problems and changes and psychotherapy contract and process from patients’ experiences of cognitive behavioural oriented therapy (CBT) and psychodynamic oriented psychotherapy (PDT).The studies are based on data from patients admitted to psychotherapy within the public psychiatric services in Örebro County Council. Studies I and IV were quantitative and used self-reports to examine attachment styles and interpersonal problems before and after psychotherapy. Studies II and III were qualitative interview studies examining patients experiences of problems, changes and psychotherapy process. The patients were diagnosed with mood disorders, anxiety disorders, adjustment disorders and personality disorders and reported insecure avoidant and anxious attachment styles that correlated positively with interpersonal problems when they started therapy. Psychotherapy with CBT or PDT enabled them to turn attachment styles into more secure ones and decrease interpersonal problems Patients aged between 26 and 39, patients who attended 11-25 sessions and patients diagnosed with a personality disorder reported greater changes in secure related attachment than others. Patients described their problems as emotions that could not be regulated, as cognitive disabilities and as problematic behaviours that implied a self-centredness. During the course of psychotherapy, the patients gained abilities to handle their problems. The perceived self-centeredness changed which increased their participation in their life-context.Similarities across the therapy orientations showed that the creation of a new context was essential to pay full attention to the patient’s problems, and that the working method and cooperation with the psychotherapist made up a whole. To make the therapy effective, it is important to build up confidence in cooperation and secure base functions like offering predictability and shaping interventions according to the needs of the patient and their ability to use them.
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| 7. |
- Viklund, Erika
(författare)
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Therapy talk and talk about therapy : Client-identified important events in psychotherapy
- 2013
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Capturing and studying the moments in psychotherapy that clients find most important can help us understand more about how psychotherapy works, what the curative ingredients are, and by what processes they are mediated. Qualitative research in this area has, so far, mainly focused on describing, and categorizing clients’ experiences of important factors and events. The methods employed to analyse the data have been rather limited in variation and are usually based on a realist epistemology, according to which data are basically treated as reflections of the clients’ actual experiences. This entails a risk of overlooking and obscuring other aspects of therapy and the therapy process that are equally important to explore, for example the microprocesses of interaction within important events, or how clients’ accounts of their experiences are shaped and limited by the context in which they are produced. The overall aim of this licentiate thesis was to explore client-identified important events in psychotherapy with a focus on studying therapy talk and talk about therapy from a social constructionist point of view, which would allow a closer exploration of the understudied areas mentioned above.In Study I, Conversation Analysis was used to explore the interaction taking place between seven client-therapist dyads in 16 client-identified important events collected from their third sessions. The analysis identified that 12 of the events contained clients’ expressions of disagreement. Three different ways that the therapists handled the disagreement were discerned: The first, and most common, way was to orient to the client’s cues of disagreement by inviting the client to elaborate on his or her point of view and to establish a shared understanding acceptable to both participants. The second way was to orient to the client’s disagreement cues but define the therapist’s own point view as more relevant than the client’s, and the third way was a single case in which the therapist did not in any way orient to the client’s disagreement cues.In Study II, two qualitative methods based on different epistemologies were used to analyse the same set of eight clients’ accounts of 18 important events. The aim was to first identify what types of events clients describe as important, and then explore how their accounts of these events were contextually shaped and organized, and the consequences of this. The first analysis, a content analysis, yielded descriptions of five different types of events, which were similar to the ones found in previous research on important events. The second analysis, a discourse analysis, demonstrated how clients’ accounts were not only influenced by the participants’ ability to accurately remember and report their experience, but also by what was sayable within the context of the research interview. In conclusion, the two studies demonstrate how qualitative methods based on a socialconstructive perspective can contribute to our understanding of clientidentified important events by highlighting and describing participants’ use of language in interaction, and its forms and functions within therapy sessions and in research interviews. The findings point out the need to broaden the range of qualitative methods used in psychotherapy research in general and indicate the potential value of methods like CA and DA to psychotherapy process research and research on important events in particular.
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