5,922 results for Auckland University of Technology

  • A qualitative descriptive study of youth with Crohn's disease

    Lynch, Teresa

    Thesis
    Auckland University of Technology

    This qualitative descriptive study explores the experience of four youth between the ages of 16-21 years who were diagnosed with Crohn’s disease within 18 months of commencement of this study. Patients with Crohn’s disease have been reported as coping well with the diagnosis and subsequent treatment of their condition, although other researchers have argued that these people needed a lot of support and assistance to live with the daily symptoms, severity of their disease and efforts to cope. Single, semi-structured audio-taped interviews were carried out to discover the participant’s feelings, perceptions and thoughts. Thematic analysis of the verbatim-transcribed interviews was conducted. This study has identified three main themes that describe young peoples’ experiences coping with a chronic lifelong condition that significantly impacts aspects of their lives. These themes are: 1) Stress as integral to living with Crohn’s disease, 2) The paradoxical relationship between fear and hope and 3) What helps and what hinders. Each theme is discussed in relation to school, study, work, social situations, family, peers, and the future. Clearly articulating what it is like for youth to live with Crohn’s disease will contribute to the ‘promoting wellness’ literature and inform the collaborative endeavours of patients, their support networks and health professionals in relation to the delivery of health care. Working closely with other health care professionals, skilled and well-informed nurses are in an ideal position to coordinate the seamless provision of services to people with chronic illness.

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  • Living with peripheral vascular disease: A one-person case study

    Richardson, Jim

    Thesis
    Auckland University of Technology

    This single-person case study, informed by phenomenology, describes the meaning for Tom (the participant) of living with peripheral vascular disease (PVD). Data collection included one face-to-face semistructured conversation and a further brief telephone conversation to seek Tom’s confirmation of the study findings. The data was analysed using Colaizzi’s (1978) phenomenological seven-step descriptive analysis framework. The findings are presented in the form of five narrative themes that best represent Tom’s experience of living with PVD. They include Living in a Mindset, A Male Thing, Facing Reality, A Weird Existence and A Heightened Awareness. They reveal how living with peripheral vascular disease has been incorporated into Tom’s way of life. The themes demonstrate how Tom managed his ulcers, how he accommodated his limitations, his state of vulnerability and how he continued to lead a “weird” yet rewarding life, despite the hardship he endured. The unexplained weirdness of Tom’s story has been presented in a way that aims to facilitate understanding of the phenomenon. Some of the significance of this study therefore lies in the tactful action of the phenomenologically informed approach, which enables the reader to understand the puzzle and weirdness of why Tom delayed treatment and acted as he did. The study facilitates the potential to heighten the awareness and challenge assumptions of nurses and other health professionals as they attempt to interpret a chronic illness experience from the patient’s perspective. A key suggestion made from the study findings is that health professionals should include in their practice routine assessments for patient fears and self-imposed delays to treatment in order to facilitate the provision of timely and suitable interventions. Further research allowing patients’ voices to be heard is necessary to substantiate the extent of this problem and how it can most appropriately be resolved.

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  • Surrender to the drama: The enacted process in the psychotherapeutic relationship: A systematic literature review with clinicial illustrations

    Chetwynd-Talbot, Jo

    Thesis
    Auckland University of Technology

    This dissertation is a systematic literature review, with clinical illustrations. The interpersonal phenomenon of enactment in the psychotherapeutic relationship is explored with the aim of producing phenomenological, or rich description to inform clinical practice. This is a relatively contemporary topic in the psychoanalytic literature. Not every aspect of the therapeutic relationship can be symbolized in language from the outset. A communication occurs which becomes manifest in action and this has a strong feature of surprise, feeling unusual to the therapist, as if she is unwittingly taking part in a drama. This emerges from within the transference-countertransference matrix. The therapist can be engaged in fulfilling a wish, repeating an old pattern, generating a new, nurturing response to the patient, or in enacting their own conflicts, sometimes leading to negative therapeutic outcomes. Being ‘recruited in’ to feel a difficult or overwhelming feeling engendered in the relationship, (often hitherto dissociated affect), the therapist is in a position to regulate and/or moderate for the patient, and thereafter to articulate a more conscious understanding. Classical and relational therapists note the ubiquitous nature of enactments, and also hold different views as to the therapist’s subjective involvement, ranging from the solipsistic to the mutual. In reviewing the literature, it emerges that ‘enacting’ is regarded by some clinicians as ‘living in the second best of worlds’, (where interpretation is preferable to taking part), and again by others as signaling turning points in a therapy, enabling the greatest of affective communication, and leading to dynamic change. A clinical illustration in the form of a vignette of an enactment is central to the dissertation, drawn from the author’s own practice. The powerful unconscious projective and intersubjective process is examined for its component parts. Deep empathy for the patient unfolds in this drama, and the consequent therapeutic action is described. In conclusion, it seems that enactments offer a potent means by which to engage another affectively – perhaps to bring to life (i.e. with feelings) that which has been split off in traumatic times. Allowing such powerful processes to touch us as therapists can be uncomfortable, and can release the potential for deep therapeutic benefits.

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  • The therapist's difficult emotional experience and racism: A modified systematic literature review

    Abels, Carlyn

    Thesis
    Auckland University of Technology

    This dissertation is a modified systematic literature review on the topic of difficult countertransferential feelings and racism in the therapeutic dyad. This paper explores and synthesizes the literature relating to the understanding of the psychodynamic processes that underpin the countertransferential feelings in an inter-racial and similar-racial dyad. Clinical vignettes illustrating difficult countertransferential feelings are explored by examining the theories of Freud and Klein, as well as the literature on race and racism of past and contemporary authors. The aim of this dissertation is to offer a psychoanalytic explanation to help understand the underlying psychodynamic processes that are likely to emerge in an inter-racial and similar-racial therapeutic dyad. The themes which emerged from the literature are grouped and presented using clinical vignettes to illustrate the points discussed. Limitations of the study are identified, as are the implications for further research on the topic of difficult countertransferential feelings and racism in the therapeutic dyad.

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  • The measurement of muscle parameters on the medial gastrocnemius using diagnostic ultrasound

    Gilmour, Roslyn Anne

    Thesis
    Auckland University of Technology

    The Physiotherapy profession has a growing interest in the use of Diagnostic Ultrasound as an adjunct tool for assessment; biofeedback during treatment; rehabilitation evaluation and research. It has not been endorsed as a reliable measurement tool of muscle architecture, and research remains incomplete on the topic. Measurement of muscle architecture is of particular interest and relevance to physiotherapists since it could serve to objectify assessment and treatment practices in current use. The purpose of this study was to recreate the methodology of published authors using Diagnostic Ultrasound to measure parameters of muscle architecture, and to conduct a Pilot study to test reliability when used for this purpose. The methodology of previous researchers was reproduced, and intra-rater reliability tested on three adults using a test-retest design. The medial gastrocnemius muscle was imaged with Diagnostic Ultrasound with the ankle held passively in two different positions. The study demonstrated results similar to other authors, and overall intrarater reliability was demonstrated. Additional methodological aspects were investigated, and results indicated some aspects significantly impacted on reliability. A larger number of participants would be required for results to be statistically significant. The complexity of testing for reliability in all its aspects became apparent, and the study resulted in more questions being raised.

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  • The contribution of medio-lateral balance during activities in sitting and standing in hemiplegic subjects

    Recordon, Anne

    Thesis
    Auckland University of Technology

    Research on balance in the medio-lateral direction is sparse compared to that undertaken in the anterior-posterior direction. There is a correlation between poor medio-lateral balance and falls investigated in elderly and recently in subjects with hemiplegia. Investigations into the muscle activity required for medio-lateral balance in normal and hemiplegic subjects suggest falls may occur as a result of poor timing, modulation and duration of specific muscle activity essential for medio-lateral balance. Further, there is support for retraining medio-lateral balance using task related functional activities. The results of a single subject design experiment undertaken as part of this dissertation indicated that medio-lateral balance in a hemiplegic subject, can be retrained using body weight support treadmill training, two years after stroke. Results from this study therefore provide support for this physiotherapy technique being effective in improving medio-lateral balance in subjects with hemiplegia.

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  • Managing disequilibrium: A grounded theory study of therapists working in groups with people with eating disorders

    Brinkman, Robyn

    Thesis
    Auckland University of Technology

    This study has used a qualitative grounded theory research methodology to systematically identify what happens for therapists who facilitate groups for people with eating disorders. Eight therapists who had worked in groups with people with eating disorders were interviewed about their group experiences. A conceptual model of ‘managing disequilibrium’ emerged as the core concern of participants in this study, and this involved three stages. In the first stage therapists experienced shifting self-equilibrium during the group session that included a diverse range and intensity of experiences. In the second stage therapists subsequently engaged in a process of counterbalancing to manage disequilibrium while still in a group session. In the third stage therapists sought to re-establish equilibrium after a group session had ended. Therapists’ self-relationship, personal issues, clinical experience, and cognitive processes have been demonstrated to play a significant role in therapists’ management of disequilibrium; and strategies for in-group and post-group management have been described. Disequilibrium and countertransference have been compared and understood to bring different perspectives to therapists experiences in groups. Where countertransference emphasises theory and clinical practice, disequilibrium emphasises therapists’ subjective experiences and their instinctive need to compensate for difficult experiential phenomena during their clinical practice.

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  • Living with motor neurone disease: An interpretive study

    Brott, Tamzin

    Thesis
    Auckland University of Technology

    While there have been many aspects of Motor Neurone Disease explored in previous studies, none have captured the experience from the perspective of people who live with it. This study has asked the question “What is the meaning of living with Motor Neurone Disease?” with the reply being the direct voice of people who have been diagnosed and live with Motor Neurone Disease day in, day out. The philosophy informing this study and the analysis is that of Heideggerian hermeneutic phenomenology. Its domain of inquiry is lived experience, the individual’s experiences within their life-world. This approach, along with van Manen’s four life world existentials, lived body, lived space, lived other, and lived time, reveals the impact of living with a body that is increasingly becoming unready-to-hand, and the impact this has on participation in occupations, and on being-in-the-world. Seven participants where interviewed to obtain rich narratives of the experience of living with Motor Neurone Disease. These narratives informed the findings of this study and uncovered the initial impact of living with an increasingly ‘wobbly body’. A body that is changing, the journey of understanding why, and learning to manage the wobbly body at home and in public is an initial finding. A further finding is that of the challenge to remaining a vital being. A further focus was on the need of roles and occupations in our lives to define who we are, and what happens when the roles that used to define us are no longer available, due to a changing body. The impact of strangers involved in care, the numbers who arrive, and the trust issues that are inherent in those relationships are another aspect of the findings. Healthcare professionals, and others involved in the care of people living with Motor Neurone Disease, become both trusted others and at times experts. It is important for this group of people to understand the impact of this relationship failing or when the trust is broken. All of the above areas highlighted are important for healthcare professionals, and others who live and work alongside people who experience life with Motor Neurone Disease, to be cognisant of and integrate them into education and practice. By attempting to understand what it is like to live with a body that is not ready-to-hand, the number of strangers and others who enter their lives and the trust issues alongside this, the relationship between healthcare professionals and those they work alongside will be enhanced.

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  • Serious illness in the psychotherapist: Denial, disclosure and the therapeutic relationship: A review of the literature

    Mitchell, Christopher D.

    Thesis
    Auckland University of Technology

    The objective was to examine and discuss, by means of a systematic literature review, the experience of serious illness in the psychotherapist and its implications for the therapeutic relationship. Consistent with evidence-based practice in the allied health professions, the study admitted quantitative, qualitative and illustrative evidence and applied a rigorous systematic research methodology. The research showed that, there was a division between those authors who attempted to maintain a neutral and anonymous stance, in respect of their serious illness, in order to minimise its impact upon the therapeutic process, and those who allowed disclosure of and feelings about their serious illness, to be used as a therapeutic tool. The former adhered to a non-relational understanding of psychotherapeutic healing, whilst the latter placed the therapeutic relationship at the heart of this process. The research revealed a paucity in the literature and the recommendation is, that further research be undertaken, particularly in relation to intersubjective approaches to the therapeutic relationship in the face of serious illness, and to the phenomenon of mental illness in the therapist.

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  • Who needs who?: Therapist dependency and its impact on the therapeutic relationship: A modified systematic review with clinical illustrations

    McMillan, Meg

    Thesis
    Auckland University of Technology

    This dissertation takes an alternative view of dependency in the therapeutic relationship. Instead of viewing dependency as a client problem to be addressed by the omnipotent, healthful, altruistic therapist, this modified, systematic, literature review conceptualizes dependency as a core relational dynamic, common to therapist and client. It is proposed that the tension between strivings for dependency and connection on the one hand and for autonomy and independence on the other, is life long and will be present in the therapy both as material brought by the client and as part of the therapeutic relationship. The premise is that both client and therapist will bring their own dependency issues into the therapeutic relationship and that this material may be either conscious or unconscious. Five dependency styles are theorized; with successful maturation following a progress from dependency to independency, to a mature dependency. Mature dependency allows the individual, to move freely and appropriately between independence and dependence, separation and connection and is seen as essential for intimate relationships. Co-dependence and counter-dependence are viewed as defensive styles arising out of the frustration of early developmental needs for dependence and separation. The potential impact of varying dependency styles on the therapeutic relationship is discussed, with particular reference to how counter-dependent and dependent or co-dependent styles may challenge or limit the therapy relationship. It was found that unless therapists are aware of their own dependency issues these may be projected onto clients or adversely affect their clinical decisions. Clinical examples illustrate the points made. Central to the discussion are the ways in which therapists may be dependent on clients. The potential conflict in acknowledging these dependency needs is explored and the importance of the therapist being conscious of her dependency is stressed. It is concluded that it is essential for psychotherapists to acknowledge their dependency, both to safeguard the integrity of the profession and to ensure safe clinical practice. Further areas for associated research are suggested.

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  • Building into the dark: Psychoanalytic explorations into psychosis, dream and cinema

    Ladd, Emma

    Thesis
    Auckland University of Technology

    This dissertation is an investigation into the relationship between the experiences of psychosis, dreaming, and watching a film. Freud’s original idea that we might be able to subject both dream and delusion to analysis and interpretation in the clinical situation has also been extensively applied in the field of psychoanalytic film criticism. It has been argued, though, that this approach is influenced by our fear of the darkness and uncertainty associated with these regressive areas, and may thus be seen as somewhat limiting. This dissertation takes the form of a modified systematic review - with clinical illustrations - of the three areas: psychosis, dreaming and film spectatorship. The literature suggests that through an understanding and exploration of their own regressive shifts in consciousness, both psychotherapist and film spectator may become able to ‘stay with the dream a little longer’. Through accessing a state of reverie, the psychotherapist is able to dream with, and dream for, the psychotic client, and to attempt to create a space in which a client may begin to dream for herself. Conclusions are drawn that inform clinical practice, and implications for further research are considered.

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  • Maternal request for an elective caesarean section: An interpretive descriptive study of primigravid women's request for an elective caesarean section

    Arthur, Dianne

    Thesis
    Auckland University of Technology

    This research explores and identifies primigravid women’s reasons for requesting an elective caesarean section when there is no medical reason for them to give birth this way. The issue of women requesting caesarean section is a complex topic being debated worldwide and is full of contradictions. A review of the literature related to maternal request for an elective caesarean section reveals an abundance of papers covering the topic from medical journals to the tabloid press. Few studies have focused on the women and why they are choosing this method of birth. Five women who had experienced a caesarean section without medical indication were interviewed over a two-month period. Interpretive description was used as the method of data analysis because it involves description about a shared health or illness phenomenon from the perspective of those who have lived it. Six themes were identified from the study. The two predominant themes were, influencing voices and safety of the unborn child. Each woman in the study related stories from friends and families that considered vaginal birth as being risky and unpredictable. The safety of the child was paramount for four out of the five women. They perceived that a caesarean section was best method of delivery to ensure a normal healthy child. The remaining four themes voiced by the participants were, vaginal birth as hazardous to the mother, feelings of guilt, the right to choose and staying in control. These findings all helped to answer my question of why primigravid women chose to birth by caesarean section.

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  • Equations for predicting maximal muscle strength after a lower limb injury

    Lovelace, Claire M.

    Thesis
    Auckland University of Technology

    The purpose of this study was to review the literature with respect to the outcome measures of muscle strength available in physiotherapy using Achilles tendon rupture patients as an example. Then to, review the prediction methods available for isoinertial one repetition maximum (1RM) testing as a possible alternative clinical measure of muscle strength. Secondly a pilot study was undertaken to compare the accuracy of eight 1RM prediction methods in persons following injury to the plantar flexor unit including patients following an Achilles tendon rupture and to then utilise the most accurate 1RM prediction method in an attempt to predict return to sport in this sample. Achilles tendon rupture is a significant injury. Ongoing plantar flexor muscle weakness has been reported in the literature many years post injury. This weakness may be one factor that limits a person’s return to sport at their pre-injury level. To accurately prescribe a strengthening regime using traditional isoinertial equipment, knowledge of a person’s 1RM is necessary. Prediction methods for 1RM are also available in the literature. These methods have been reviewed with respect to their accuracy with different loads, repetition numbers, training states, exercise modes, gender, age and anthropometric parameters. No previous study has assessed their accuracy following injury. This was the primary aim of this study. Twenty subjects completed the testing procedures which included a familiarisation session, an actual 1RM testing session and a predicted 1RM session. The accuracy of predicted 1RM was determined by establishing the actual 1RM and predicted 1RM for a unilateral calf raise. The unaffected limb was used as a control. Differences between 1RM values (predicted 1RM – actual 1RM) were computed using a paired t-test, Bland and Altman analysis, intraclass correlation coefficients and obtaining measures of typical error. A comparison of relative strength between limbs was also made. A logistical regression analysis was then used in an attempt to predict which subjects had returned to sport. The results showed that all equations displayed high accuracy and low error with respect to both limbs. There was no significant differences (p>0.05) across either limb for any of the prediction methods. Overall the Lander equation displayed the greatest predictive accuracy for the injured limb (bias = 0.09kg (SD 3.66), ICC = 0.985 & typical error = 2%). A significant mean 11% deficit in strength was measured across injured limbs in comparison to the control limb (1RM injured = 131.46kg (SD 19.53); 1RM control = 149.61kg (SD 28.16) p<0.05), with a range of differences between limbs from 6.6% stronger to a 49.8% deficit. Logistical regression suggested that subjects with a less than 15% strength deficit across limbs had a greater chance of returning to sport at their pre-injury level in comparison to those who had a greater deficit (odds ratio 35, CI 3-465). This variable explained 39% of the variability in the regression model. When 1RM was standardised to body mass a ratio of 1.59 provided a 100% accurate cut off for those who had returned to sport. In conclusion the Lander equation appears an accurate method of 1RM prediction for the unilateral calf raise following a lower limb injury.

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  • Balance in netballers

    Weaver, Lisa M.

    Thesis
    Auckland University of Technology

    Ankle sprain is a common injury within the sport of netball and incurs great costs to the taxpayer. Following ankle sprain, a large number of cases are left with residual deficits in balance and proprioception, which leads to a high level of injury recurrence of approximately 80 percent. A lack of balancing ability has been associated with netball injuries and particularly at the ankle. In an attempt to prevent injuries occurring in netball through a loss of balance, it is necessary to have appreciation for what levels of balancing ability exist within netball players, how netball balance can be measured and ultimately improved. While there is extensive research on ankle injury and instability, there is still a lack of consensus regarding the cause of functional ankle instability. Discrepancies exist over the development and involvement of the postural control system as well as the influence of the foot and lower limb. Rehabilitation techniques examined pose unanswered questions and the ability to assess progress is unclead. Balance testing to date has been based around tests for elderly and neurologically impaired populations which are not specific enough to detect alterations in sporting populations. Twelve female subjects all of recreational netball ability volunteered to participate in a pilot study to investigate the reliability of two newly designed netball specific balance tests. The study involved a pseudo-experimental test-retest design with the subjects performing the two newly designed balance tests in the same order on two consecutive days. Three trials of each of the Weaver Anterior Balance Test (WABT) and the Weaver Lateral Balance Test (WLBT) were timed to failure. Both tests were found to be reasonably reliable within trials (CV 6.6-11.3%) and between days (ICC 0.99 and CV 5.3-10.6%). These tests provide some evidence that reliable netball specific balance tests can exist but the context in which they can be applied still warrants further investigation.

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  • A conversation beyond words: Exploring somatic countertransference when working with alexithymic clients

    Thesis
    Auckland University of Technology

    This study investigates the impact that the unconscious, non verbal communication of the client with minimal language for feelings has on the body of the therapist and the response that this impact generates in the therapist. This client group is commonly defined as alexithymic, which refers to people who lack words to express emotions, have poor phantasy and recite facts and daily realities with no connection to their internal world. The findings of this study support the idea that clients with alexithymia can communicate their feelings in a non-verbal way which is perceived by the therapist through the somatic aspect of the countertransference. The findings within this research also show that many psychotherapists experience somatic countertransference at some point. Surprisingly, not many psychotherapists have described how these experiences are incorporated within the clinical practice. There is a gap in the literature as little has been written in this area. This presents a difficulty in exploring and acknowledging the bodily feelings of the therapist in the therapy session. Two main uses of somatic countertransference were identified from the research. Firstly, the therapist disclosing what was felt in her/his body. Secondly, the use of somatic responses as a source of information that helps the therapist in the construction of metaphors. Both of these uses of addressing somatic countertransference contribute to further exploration of unspoken feelings. This is particularly important when working with alexithymic clients as one of their main traits is the struggle to verbally express their feelings. This dissertation uses a modified systematic literature review with clinical vignettes to investigate how therapists experience and use their somatic responses within their practice.

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  • Dynamic inventions

    Schipper, Alexander

    Masters thesis
    Auckland University of Technology

    Dynamic Inventions is a practice-based art project about identity. It manifests itself via reflexive video installations that address its questions and concerns by immersing them in the dynamic of my exploratory process as I work to unfold my own identity. It is through this reflexive art-making process that I examine the terms of my question: What might constitute identity? That is, how does identity relate to certain properties or qualities and how might these qualities be essential to identity, and how might they be revealed or represented through art? What the project reveals is that if the subject of investigation is living, growing and continually changing, in part through conducting this project, identity then is not fixed nor is it located in some essential quality, but is contingent, complex, relational and in continual change. Furthermore, a conception of identity is as much a perception from outside as it is a conception from within the subject. What started as an investigation of identity has shifted to being a project about identity that is a process of becoming-being. This process is life-long, so the question of determining identity becomes inappropriate, and redundant. What remains is the question, How am I becoming me?

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  • A lamp to light the way: Public health nurses' perceptions and experiences of professional/clinical supervision

    Farrell, Elizabeth

    Thesis
    Auckland University of Technology

    Clinical supervision is a relatively new concept in nursing with no New Zealand research on the topic to date. However taking a lead from our colleagues in Britain and elsewhere, clinical supervision is gaining momentum in nursing in this country because of the perceived benefits it can have for both nurses and clients. This study sought answers to the question ‘What are Public Health Nurses’ perceptions and experiences of clinical supervision?’ It consisted of a comprehensive literature review and a small qualitative descriptive research project. As part of the study, two focus group interviews involving seven PHNs were conducted. The data analysis uncovered a developmental process that the participant PHNs went through as they began to understand the principles of clinical supervision and began to relate their practice to the peer reciprocal model of supervision, which had recently been introduced to their organisation. Four key themes were identified - ‘needing’, ‘knowing’, ‘learning’, and ‘doing’ clinical supervision. The study also demonstrated how public health nursing practice was inextricably woven throughout. I have called this process a ‘journey of discovery’. From the participants’ perspective, the rationale for clinical supervision revolved around the perceived need to understand the complexity of this nursing speciality, and in the recognition of the impact this practice had on the PHNs’ personal well-being and subsequent ability to provide competent nursing care. Thus, practice became the ‘essence’ of the peer reciprocal clinical supervision sessions that developed after the introduction of this model. As this is a small qualitative descriptive study, limitations are acknowledged. However, it is hoped that the outcome of this research will improve the understanding of clinical supervision from a public health nursing perspective, facilitate more debate, guide others attempts to introduce clinical supervision and influence future research direction.

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  • Cultural matching and the psychotherapeutic relationship

    Patterson, Seilosa W.

    Thesis
    Auckland University of Technology

    “Cultural matching and the psychotherapeutic relationship” challenges and explores therapists’ work with cultural otherness. Firstly, it considers the history of psychoanalysis, in terms of Freud, sexism, white blindness, white privilege and racism. Some of these critical white theories continue to oppress, marginalize and colonize the culturally different client. Therapists of Aotearoa are encouraged to culturally match the changing needs of our clientele by privileging culture within the relationship. Writings from Culbertson, Makasiale, Bowden, Seeley, Christopher, Fanon and many more are reviewed to support working with cultural differences within the psychotherapeutic relationship. Case illustrations of working with Polynesian clients are shared to highlight the needs of cultural matching in assessment, diagnosis, treatment planning, and supervision. Cultural issues within training programmes are critiqued for their contemporary monocultural approach, and challenged to consider the literature of cultural knowledge and competency written internationally and also within New Zealand.

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  • The impact of terminal illness and sibling death from cancer, on the latency-aged brother or sister

    Wood, Lorna

    Thesis
    Auckland University of Technology

    This literature review examines the impact of the terminal illness and death on the siblings of children diagnosed with cancer. The aim of this dissertation is to explore the impact on the latency aged child who has experienced the illness and loss of a brother or sister from cancer. A modified literature review was used to source information relating to siblings of children who have cancer, vicarious trauma, the sibling relationship, and childhood grief. Attachment theory is drawn upon to provide a conceptual framework for understanding the issues involved. The diagnosis of childhood cancer in a family is a harrowing event. A child’s death is an unprecedented tragedy which strikes at the very core of our sense of natural order. It is well documented that children who experience a sibling’s death are at risk of suffering long term mental health problems. Bereaved siblings identify the separation from their attachment figure, usually the mother, during hospital treatment, as the most difficult aspect of the illness and death. Parental unavailability following bereavement due to the parents own grief, continues to affect the surviving sibling. Children’s grief differs from that of adults and is likely to be expressed behaviorally over time. Children are likely to grieve for their sibling throughout their life at various ages and stages as they develop. Sibling relationships are recognized as having a significant impact on individual’s emotional and social development. The little literature available suggests the latency aged child will demonstrate notably more behavioral problems after sibling bereavement than younger or older siblings or their comparative norms. Further research is needed in this area. Sibling intervention after bereavement is in its infancy. A broader understanding of the reaction of the latency aged child to their loss could assist professionals to identify children at risk. Evaluation of the various bereavement interventions available could establish the efficacy of intervention and may contribute to healthy management of lifelong grief following sibling loss.

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  • Which edge to work: The use of interpretation in short-term child psychotherapy: A systematic literature review with clinical illustrations

    Thesis
    Auckland University of Technology

    This literature review examines the use of interpretation in short-term child psychotherapy. Interpretation is central to psychodynamic practice work and as such it is thought important to understand its principles and features to assist with applying its best edge. The method used is a modified systematic literature review and draws on a range of theory within the psychodynamic paradigm to understand this topic. Clinical work is also used to illustrate some of the issues that can arise in the application of interpretation in terms of its limits and possibilities within short-term child psychotherapy. Children are increasingly being offered short-term psychotherapy as a way of assisting them with psychological difficulties. It seems important to understand the potentially varied use of interpretation in this context to help with practice. Interpretation has similar principles that apply to both adult and child work. A general discussion of the features of a good interpretation is discussed with reference to the quality of the therapeutic relationship, the features in the client, the timing of the interpretation and the communication that occurs between the client and therapist. The principles of interpretation need to be adapted in short term work with children. The findings are that children require a strong positive therapeutic relationship to make use of interpretation. This relates to their stage of development where they are more dependent on adults, have different ways of understanding and communicating and have less developed egos to assist them when they become overwhelmed by internal forces. The therapist should also take into account the child’s family circumstances and their “safety” inside and outside therapy. It is necessary that the therapist try to understand children’s non verbal material and to at times interpret in other ways such as through the play. Interpretation with children must take account of their ability to assimilate language and what it is they require from the interpretation to assist them back to the path of ordinary development. The task of a child is not to help them know or understand as do adults. What emerges is, interpretation works alongside other aspects of the work and cannot move beyond the child’s capacity to assimilate and make use of the interpretation. It is possible to interpret in short-term therapy with children, but we must be aware that the complex underlying process of therapy cannot be bypassed, and change will continue to be a slow and difficult business. For this reason it may be that only a partial edge of the interpretation will be applied in short-term work because this is all that is required.

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