| 1. |
- Åkerman, Anna-Karin E., 1969-
(författare)
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Relationally focused specialized foster care : Relational experiences and changes in mental health and adaptive functioning
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Foster care is a relatively common arrangement when parents are unable to meet the needs of their children. Specialized foster care is sometimes applied in cases when problems are more serious and complex. More knowledge is needed about the effects of such specialized foster care.Aims: To explore trajectories of change associated with specialized foster care in a treatment model with a relational and mentalization-based orientation, and to develop the understanding of foster children’s and their foster parents’ experiences of their relationship living in a treatment foster family.Methods: Children and young people between the ages of 5 and 20 years who received treatment within a specialized foster care model, Treatment By Foster care (TBF), participated in this study. Longitudinal data collected in a naturalistic setting were analyzed quantitatively. In Studies 1 and 2, the number of participants at baseline varied for different instruments between 76 – 105. The Achenbach System of Empirically Based Assessment (ASEBA) was used to measure how psychiatric symptoms change from the perspectives of the foster children, the foster parents, and teachers. The Adaptive Behavior Assessment System – second edition (ABAS-II) was used to measure adaptive functioning from the foster parents’ perspective. Self-ratings by the children and young people of their emotional and social problems were measured with the Beck Youth Inventories of Emotional and Social Impairment (BYI). Data about experiences of the relationship between child and foster parent were collected through repeated individual short interviews/speeches with both children and their foster parents according to Five Minute Speech Sample (FMSS) (n = 14). Interviews/speeches were analyzed using Thematic Analysis (TA).Results: The ratings of foster parents and foster children differed. The analyses showed a significant reduction in psychiatric symptoms, emotional and social problems according to the self-ratings by the children and young people. According to foster parents and teachers, psychiatric symptoms did not decrease. The baseline ratings of adaptive functioning by foster parents showed that adaptive functioning was considerably below peers from the Swedish non-clinical norm group. Adaptive functioning did improve but not enough to approach or catch up with peers.Analysis of the interviews/speeches generated three main themes containing seven subthemes. Main themes were: No 'real' family, A co-created relationship, and Time. Participants related to a norm for what a 'real' family is and seemed to presuppose that the biological family is the 'real' family. A co-created relationship related to No 'real' family as an answer or a solution. The challenges in the foster family constellation could be overcome by a mutual ambition to build a relationship and by liking each other. Time appeared as a common theme and both as an opportunity and a threat to the relationship. Despite the fact that no interview question concerned the duration of the relationship, the participants described their relationship based on how long they had known each other.Conclusions: According to the foster children’s and young people’s self-ratings, their mental health improved, and their social problems decreased. It is likely that the TBF-model contributed to this improved psychological well-being, although causal relationships could not be established without any comparison group. However, the model did not seem to contribute to the foster parents experiencing improvement in the foster children’s psychological well-being or adaptive functioning.Based on the results of this thesis, it may be effective to place children and young people in specialized foster care with a relational and mentalization-oriented focus, but the results are not clear-cut. Practice and policies should take greater account of the time aspect in foster care, and work with the aim of increasing clarity and security, and thereby enabling a more stable upbringing for some of society’s most vulnerable children. Also, this may make foster parents want to continue their mission.More studies are needed to gain knowledge about how specialized foster care should be applied. Future studies also need to focus on creating knowledge about which aspects of the treatment are decisive.
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| 2. |
- 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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| 3. |
- Frankl, My, 1968-
(författare)
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Psychotherapy for Substance Use Disorders – the importance of affects
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Substance use disorder (SUD) is a serious disorder with severe consequences for the individual, the family and for society. Comorbidity is common in the SUD population and the diversity of the disorder calls for a multiplicity of treatment options.The overall aim of this thesis was to explore the role of affects in psychotherapy for SUD. Further aims were to investigate affect-focused therapeutic orientations, demonstrate the importance of common factors and evaluate a measure of affect phobia.In Study I a naturalistic design was employed to examine how the discrepancy between patients' expectations and experience of psychotherapy related to alliance in 41 patients: 24 in individual therapy and 17 in group. An additional analysis concerned whether different dimensions of role expectations predicted retention in psychotherapy. Study II was the first psychometric evaluation of the Affect phobia test – a test developed to screen the ability to experience, express and regulate emotions. Data were collected from two samples: A clinical sample of 82 patients with depression and/or anxiety participating in a randomized controlled trial of Internet-based affect-focused treatment, and a university student sample of 197 students. Data analysed included internal consistency, test-retest reliability, factor analysis and calculation of an empirical cut-off. Study III focused on the feasibility of individual 10 week Affect Phobia Therapy (APT) for patients diagnosed with mild to moderate alcohol use disorder (AUD) and problematic affective avoidance in a nonconcurrent multiple baseline design. Study IV comprised an evaluation of the feasibility and preliminary effectiveness of APT adapted to a structured group format for patients (n=22) with comorbid substance use disorder and ADHD with core features of affective avoidance/emotion dysregulation in an open design.In Study I an overall discrepancy between role expectations and experiences was significantly related to a lower level of therapeutic alliance in group therapy. This relationship was not found in individual therapy. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention, even when controlling for waiting time for therapy. In Study II the internal consistency for the total score on the Affect phobia test was satisfactory but it was not for the affective domains, Anger/Assertion, Sadness/Grief, and Attachment/Closeness. Test retest reliability was satisfactory. The exploratory factor analysis resulted in a six-factor solution and only moderately matched the test´s original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. In Study III patients reported no adverse events due to the treatment and finished the whole study period. The patients had different trajectories of alcohol consumption and craving and the hypothesis that heavy episodic drinking would subside during the time in therapy did not hold true. In Study IV patients reported significant pre-to post changes in increased self-compassion and decreased affect phobia but no change in psychological distress or emotion dysregulation. Craving fluctuated throughout the study period and patients’ drinking pattern changed in the direction of more social drinking.Main conclusions are the following: The Affect Phobia Test is a useful screening instrument for detecting emotional difficulties related to psychological malfunction. APT in both group and individual format are feasible treatments for the SUD population and has the potential to broaden the treatment options for some patients with SUD. Investigating expectations and fears prior to therapy may be means to prevent attrition.
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| 4. |
- 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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| 5. |
- 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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| 6. |
- Holmqvist Larsson, Mattias, 1977-
(författare)
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Rupture and Repair in the Working Alliance : Relation to Psychotherapy Outcome and Within-Session Interaction
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ruptures and repairs are processes related to shifts in the collaborative relationship Cthe working allianceJ between patient and therapist in psychotherapy. Ta study ruptures and repairs is one way ta disentangle mechanisms that might underlie the association between the working alliance and psychotherapy outcome. The overarching aim af this thesis was ta analyze the clinical relevance af the rupture and repair concepts at different process levels. The same three alliance patterns were investigated in the three empirical studies: the rupture pattern, the repair pattern, and the no-rupture/stable pattern. The analyses af the alliance patterns moved fromwhole treatments ta session segments. In Study I ruptures were found ta be associated with worse outcomes than treatments without ruptures. Repairs were, in longer therapies, shown ta be related ta better outcomes than norupture treatments. In Study Il it was found that the three alliance patterns could be discerned within sessions. Ruptures and repairs within sessions were found ta be associated with patient-ratings af the working alliance. In Study 111 the alliance patterns were found ta be related ta different interaction patterns within sessions. In these analyses, importont patient contributions ta repairs af ruptures were found.
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| 7. |
- 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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| 8. |
- 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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| 9. |
- Uckelstam, Carl-Johan, 1983-
(författare)
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Looking into the Future : How to Use Advanced Statistical Methods for Predicting Psychotherapy Outcomes in Routine Care
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychotherapy research has shifted from mainly focusing on the average effects of different treatments to concentrating more on questions related to the individual patient. When research attention shifts, it can give rise to the implementation of new statistical methods that, in turn, can illuminate new challenges that must be addressed.The aim of the thesis was to study how traditional methods for predicting certain psychotherapy outcomes have been conducted in the past, and how more advanced statistical methods might be used to enhance knowledge of how to predict these outcomes today.Three studies were performed: Paper I focused on how Multi Level Modeling (MLM) can be used to study certain aspects of the relationship between working alliance and treatment outcome. In Paper II, Latent Profile Analysis (LPA) and item-level analysis were used to give nuance to the relationship between psychological distress at baseline and change rate during treatment. Finally, in Paper III, Machine Learning (ML) was used to detect dropout patients in the early phase of treatment by exploring complex patterns of symptom distress during the early phase of treatment.The thesis showed how different goals of scientific exploration can be studied in the context of routine care with the use of these statistical frameworks and discussed some of the challenges and opportunities worth noting when entering this line of research.
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| 10. |
- 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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