Dissertations / Theses on the topic 'Therapeutic communication'

Magister Artium (Psychology) - MA(Psych)
This dissertation reviews the construct of projective identification and the ways in which it is used as a powerful form of communication by the patient within the therapeutic relationship. The particular model of projective identification explored in this dissertation is that of Bion (1962)_ who, through his model of containment, brought the subtle interactive processes between the mother and infant into the foreground. This has been used as a metaphor for the therapeutic relationship. Some of the theoretical constructs central to an understanding of projective identification are introduced and discussed. Clinical case material from psychodynamic child psychotherapy is used in an attempt to illustrate the patient's use of and therapist's experience of projective identification. The method used is the single case study and material is drawn from 14 sessions. Through an analysis of the therapist's experiences in the countertransference, with the help of ongoing supervision and personal psychotherapy, it is shown that patient's induce feelings and experiences in the therapist in an attempt to communicate aspects of their internal worlds. Self reflection and retrospective analysis has been highlighted with the hope that this may be useful to future neophyte psychotherapists working psychodynamically.

Background: A low adherence is one of the reasons for the development of drug resistant Tuberculosis. One of the identified factors connected to adherence is the relations between health care personal and patient. Nurses all over the world daily work close to the patient supporting them to achieve a high adherence to their treatment plan. Still there is an underrepresentation in a scientific view of exploring and evaluating this preformed work. Aim: The aim of this study wad to explore how the Namibian nurses experienced adherence to treatment in patients diagnosed with multidrug-resistant tuberculosis. Method: A qualitative research technic was used to collect data. The interview questions were constructed in a semi-structure with partly opened questions. The data was analysed with Graneheim and Lundman (2004) analysis model. Result: Strategies that was used by the nurses to enable a high adherence was providing information, counselling and education to the patient together with a practical support of delegating DOTS and providing the patient with medicine. There was a divided opinion on how to communicate with the patient depending on the nurse fundamental view of adherence. A doctor centred view resulted in a one way communication by informing the patient. A patient centred view of adherence resulted in a two way communication when the nurse aimed to learn about the patient own point of views. Conclusion: To enable a high adherence there has to be a two way communication which demands high communicational skills from the nurse.

[EN] The present PhD thesis, which is entitled "Design of new bio-gated nanodevices for advanced communication processes and targeted controlled release of therapeutic agents" is focused on the development of new functional hybrid organic-inorganic materials for applications in the field of the controlled delivery of target molecules. The first chapter of the present thesis gives an introduction to the organic-inorganic hybrid materials functionalized with "molecular gates" and its application in controlled release processes. The second chapter of this thesis is focused on the development of a new nanodevice able to deliver its cargo as a function of the glucose concentration. The nanodevice is based on mesoporous silica nanoparticles loaded with a suitable fluorophore and functionalized with propylbenzymidazole moieties on the pore outlets. The mesopores are then capped with an active cyclodextrin modified glucose oxidase enzyme (through the formation of an inclusion complex between the cyclodextrins and the propylbenzymidazole group anchored to the solid support). When glucose is added its enzymatic oxidation produced gluconic acid. This acid induced a decrease in the pH of the medium and the protonation of the benzymidazole group that might result in the inclusion complex dethreading and the subsequent cargo release. The third chapter of the thesis is focused on the development of a new redox-responsive material for the controlled delivery of cytotoxic drugs in cancer cells. The system is based on mesoporous silica nanoparticles loaded with a reporter (safranin O) and functionalized with two different sized polyethylene glycol chains in the pore outlets using a disulfide linkage. In presence of glutathione, the disulfide bonds are cleaved allowing the release of the entrapped cargo. Once confirmed the aperture protocol, the uptake of the gated nanoparticles and their ability to deliver the cargo (fluorophore or cytotoxic agent) in HeLa cells were tested. Moreover, cell viability assays were also performed. The fourth chapter of the thesis is focused on the preparation and the study of a nanodevice for the controlled delivery in senescent cells in a murine model of pulmonary fibrosis. The material is prepared using mesoporous silica nanoparticles (as an inorganic support) and galactoligosaccharide (molecular gate) moieties anchored on the external surface. In presence of senescent cells, which overexpress ß-galactosidase enzyme, the hydrolysis of the galactooligosaccharide capping molecules take place and the cargo release from the inner of the pores is produced (rhodamine B). After the in vitro studies, the ability of nanoparticles to accumulate and release their payload in tissues with abundance of senescent cells was evaluated in vivo. For that purpose, mice with induced pulmonary fibrosis, pathogenesis with associated increased alveolar senescence, were treated with the synthesized material and subsequently examined to assess its ability to accumulate and release its payload (fluorophore) in lung's damaged areas. In the fifth chapter of the thesis it has been explored the concept of cascade chemical communication using different types of nanodevices, each of them loaded with a certain messenger and externally functionalized with a gate-like entity that controls the release of the payload. When the enzyme able to hydrolyze the molecular gate that blocks the pores of the first type of nanoparticles (S1), is added to an aqueous suspension containing the three nanoparticles, the delivery of the chemical messenger 1 is produced. This messenger is able to open the second type of nanoparticles (S2) which delivers the messenger 2. Finally, the messenger 2 triggers the aperture of the third group of gated system (S3), which ultimately delivers its load (a dye) as a final response.
[ES] La presente tesis doctoral titulada "Diseño de nuevos nanodispositivos para procesos avanzados de comunicación y liberación controlada y dirigida de agentes terapéuticos" está centrada en el desarrollo de nuevos materiales híbridos orgánico-inorgánicos funcionales para aplicaciones en el campo de la liberación controlada de moléculas de interés. El primer capítulo de la tesis ofrece una introducción a los materiales híbridos orgánico-inorgánicos funcionalizados con "puertas moleculares" y su aplicación en procesos de liberación controlada. En el segundo capítulo de la tesis se aborda el desarrollo de un nanodispositivo capaz de responder y liberar su carga en función de la concentración de glucosa. Este nanodispositivo está basado en nanoparticulas de sílice mesoporosa funcionalizadas en su superficie externa con grupos benzimidazol y con los poros cargados con un fluoróforo. Los poros se cierran al añadir la enzima glucosa oxidasa funcionalizada con ciclodextrinas (por formación de un complejo de inclusión entre el benzimidazol y los oligosacáridos cíclicos). Al adicionar glucosa se produce su oxidación enzimática dando ácido glucónico. Este ácido induce una bajada del pH del medio con la consiguiente protonación de los benzimidazoles y la ruptura de los complejos de inclusión. Esta ruptura provoca la salida de la enzima de la superficie y la liberación del colorante atrapado en los poros. El tercer capítulo de la tesis se ha centrado en el desarrollo de un material para la liberación controlada de agentes citotóxicos en células cancerosas en respuesta a cambios en el potencial redox. De nuevo se emplean nanopartículas de sílice mesoporosa con los poros cargados con un colorante (safranina O) y la superficie externa funcionalizada con dos polietilenglicoles conteniendo enlaces disulfuro. En presencia de glutatión se produce la reducción del enlace disulfuro con la consiguiente liberación del colorante. Una vez confirmado el protocolo de apertura, se estudió la internalización y la liberación de un fluoróforo y de un agente citotóxico en el modelo celular HeLa, realizando además ensayos de viabilidad. En el cuarto capítulo de la tesis se ha preparado y ensayado un nanodispositivo para la liberación controlada en células senescentes en un modelo murino de fibrosis pulmonar. El material se prepara empleando nanopartículas de sílice mesoporosa y un galactooligosacárido anclado en la superficie externa. En presencia de células senescentes, que sobreexpresan la enzima ¿-galactosidasa, se produce la hidrólisis del oligosacárido con la consiguiente liberación de la carga atrapada en los poros del soporte (rodamina B). Tras los estudios in vitro, la capacidad del nanodispositivo de acumularse y liberar su carga en tejidos ricos en células senescentes se evaluó in vivo. Para ello, ratones con fibrosis pulmonar inducida, patología en la que se ha descrito la aparición de senescencia, se trataron con el material sintetizado y posteriormente fueron examinados para comprobar la capacidad de acumularse y liberar su carga (fluoróforo) en la zona pulmonar dañada. En el quinto capítulo se ha explorado el proceso de comunicación química en cascada empleando tres tipos de nanopartículas mesoporosas de sílice cargadas con diferentes mensajeros y funcionalizadas con tres puertas moleculares distintas. Cuando sobre una suspensión de las tres nanopartículas se añade la enzima capaz de hidrolizar la puerta molecular que bloquea los poros del primer tipo de nanopartículas (S1), se produce la liberación del mensajero 1. Este mensajero es capaz de inducir la apertura del segundo tipo de nanopartículas (S2), que a su vez liberan al medio el mensajero 2. Por último, el mensajero 2 es capaz de abrir la puerta molecular del tercer tipo de nanopartículas (S3), que liberan finalmente su carga (un colorante) como respuesta final.
[CAT] La present tesis doctoral titulada "Disseny de nous nanodispositius per a processos avançats de comunicació i lliberació controlada i dirigida d'agents terapèutics" està centrada en el desenvolupament de nous materials híbrids orgànic-inorgànic funcionals per a aplicacions en el camp de la lliberació controlada de molècules d'interès. El primer capítol de la tesis ofereix una introducció als materials híbrids orgànic-inorgànic funcionalitzats amb "portes moleculars" i la seua aplicació en processos de lliberació controlada. En el segon capítol de la tesis s'aborda el desenvolupament d'un nanodispositiu capaç de respondre i lliberar la seua càrrega en funció de la concentració de glucosa. Este nanodispositiu està basat en nanopartícules de sílice mesoporoses funcionalitzades a la seua superfície externa amb grups benzimidazol i amb els pors carregats amb un fluoròfor. Els pors queden bloquejats al afegir el enzim glucosa oxidasa funcionalitzada amb ciclodextrines (per formació d'un complex d'inclusió entre el benzimidazol i els oligosacàrids cíclics). Al afegir glucosa es produeix la seua oxidació enzimàtica donant lloc a àcid glucònic. Este àcid indueix una baixada del pH del medi amb la consegüent protonació dels benzimidazols i el trencament dels complexes d'inclusió. Este trencament provoca l'eixida del enzim de la superfície i la lliberació del colorant atrapat als pors. El tercer capítol de la tesis s'ha centrat en la preparació d'un material per a la lliberació controlada d'agents citotòxics en cèl¿lules canceroses en resposta a canvis en el potencia redox. De nou s'empren nanopartícules de sílice mesoporoses amb els pors carregats amb un colorant (safranina O) i la superfície externa funcionalitzada amb dos polietilenglicols (de diferent pes molecular) contenint enllaços disulfur. En presència de glutatió es produeix la reducció del enllaç disulfur amb la consegüent lliberació del colorant. Una volta confirmat el protocol d'obertura, es va estudiar la internalització i la lliberació d'un fluoròfor i d'un agent citotòxic en el model cel¿lular HeLa, realitzant ademés assajos de viabilitat. En el quart capítol de la tesis s'ha preparat i s'ha estudiat un nanodispositiu per a la lliberació controlada en cèl¿lules senescents, en un model murí de fibrosis pulmonar. El material es prepara emprant nanopartícules de sílice mesoporoses i un galactooligosacàrid anclat a la superfície externa del material. En presència de cèl¿lules senescents, que sobreexpresen el enzim ¿-galactosidasa, es produeix la hidròlisis del oligosacàrid amb el consegüent alliberament de la càrrega atrapada en els pors del suport (rodamina B). Després dels estudis in vitro, la capacitat del nanodispositiu d'acumular-se i lliberar la càrrega en teixits rics en cèl¿lules senecents es va evaluar in vivo. Amb este propòsit, ratolins amb fibrosis pulmonar induïda, patologia en la que s'ha descrit l'aparició de senescència en els teixits danyats, es van tractar amb el material sintetitzat i posteriorment van ser examinats per a comprovar la capacitat d'acumular-se i lliberar la seua càrrega (fluoròfor) en la zona dels pulmons afectada. En el quint capítol s'ha explorat el procés de comunicació química en cascada utilitzant tres tipus de nanopartícules mesoporoses de sílice carregades amb diferents missatgers i funcionalitzades amb tres portes moleculars diferents. Quan, sobre una suspensió de les tres nanopartícules, s'afegeix l'enzim capaç d'hidrolitzar la porta molecular que bloqueja els pors del primer tipus de nanopartícules (S1), es produeix la lliberació del missatger 1 des de S1. Este missatger és capaç d'induir l'obertura del segon tipus de nanopartícules (S2), les quals lliberen al medi el missatger 2. Per últim, el missatger 2 és capaç d'obrir la porta molecular del tercer tipus de nanopartícules (S3), que lliberen finalment la seua càrr
Giménez Morales, C. (2016). Design of new bio-gated nanodevices for advanced communication processes and targeted controlled release of therapeutic agents [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/62822
TESIS

The Interactive and Discursive View of Violence and Resistance proposes the existence of four-discursive-operations that “(i) conceal violence, (ii) mitigate perpetrators’ responsibility, (iii) conceal victims’ resistance, and (iv) blame or pathologize victims” (Coates & Wade, 2004, p.500). These linguistic operations produce incorrect representations of violence that ignore the unilateral nature of acts of violence and, instead focus on pathologizing victims (Coates & Wade, 2004). Examining how violence, victims, perpetrators, and responsibility for the violence are represented in therapy transcripts in which the presenting issue is violence, will allow us to see if linguistic strategies that are used to discredit victims in everyday talk are also used in therapy by therapists. Analysis of 19 therapy transcripts found that the four-discursive-operations were used in each of the transcripts and that therapists often initiated the use of these inaccurate representations or encouraged the perpetrator’s use of four-discursive-operations.
xii, 228 leaves ; 29 cm.

Psychoanalysis as it exists today is not constituted by a single theoretical framework describing pathology and indicating a specific set of interventions. Since Freud originally conceptualised psychoanalytic understanding of pathology and psychoanalysis as a mode of intervention, there have been many revisions and reformulations of his theory. This thesis has attempted to integrate some psychoanalytic ideas regarding personality formation, psychopathology and psychotherapeutic intervention (Fairbairn, 1952; Ogden, 1992, 1994), with interpersonal (strategic / structural) ideas regarding intervention (Minuchin, 1974; Sullivan, 1940, 1953, 1964). In order to do so, the thesis used the relational psychoanalytic perspective, as depicted by Aron (1996) and Mitchell and Aron (1999), as an overarching conceptual framework. The focus from these points of view is the patient's internalized relationship patterns and the therapist's participation in their repetition. It is held that internalized relationship patterns are not only based on, but can be changed by, lived experience. From this perspective, the goal of therapy is to enhance the patient's capacity to reflect and think about experience, and therefore, to communicate about it. This means a change in the patient's predominant mode of communication. Ogden's (1994) modes of communication were described. The thesis suggested that Ogden's modes of communication can be stretched or translated into the types of communication outlined by Langs (1978). This thesis aimed to explore the deliberate use of countertransference responses to facilitate communication in the beginning stages of therapy with patients functioning predominantly in the paranoid-schizoid mode (Ogden, 1992). Patients who operate in this mode are often unable to tolerate interpretation and therefore traditional approaches to intervention are not effective. A "strategic / structural relational psychoanalytic" approach to treatment was proposed. It was suggested that therapists utilize joining and accommodation techniques as described by Minuchin (1974) and alter their style of interaction to match that of the various object relational constellations that they have managed to identify within the patient via their countertransference responses. It was hypothesized that patients need their therapists to be similar to their original objects in order to feel safe in the therapeutic environment and that this may facilitate communication in the beginning stages of therapy. The research utilized a qualitative research approach. Qualitative research methods attempt to use data gathered phenomenologically, always acknowledging the researcher's biases when gathering the data. The data gathered is then interpreted according to various theories or hermeneutic lenses. The hypothesis mentioned above has been investigated by analyzing three cases in terms of the research questions based on Langs' (1978) classification of communication. The thesis described the difficulties inherent in collecting clinical data from psychologists working from within a psychoanalytic framework. Eventually three sets of therapy details and verbatim therapy transcripts were obtained, provided in the thesis and analyzed in terms of the research questions. However evidence for the success of the hypothesized alternate approach was not found in this research study. It was suggested that other possible methods might be useful to investigate the hypothesized approach further.

This is a narrative of the Sugarman Project, a community project in Central Australia concerned with research into ancient Mediterranean and Greek traditions of alcohol use and abuse. The project was initiated as a response to a request from an Aboriginal man for a ‘story about alcohol’ which would fill a missing link in traditional Aboriginal conceptualisation of alcohol. The ‘story’ would have a role in indigenous treatment of alcohol abuse, put in a symbolic form consistent with oral teaching methods of indigenous custom. The project is centred around the development of an original performance script. The thesis describes the origin, context, development, rationale and implications of the project, especially with a view to considering the potential of the mythologem of Dionysos as a therapeutic paradigm in intercultural substance abuse work. Particular attention is given to the relationship between Aboriginal and European therapeutic practitioners and the use of myth, metaphor, symbolic function and specific Aboriginal ‘dreaming stories’ as a source and backup to therapeutic practice. Principal themes include the role of mythopoetic symbol formation in the development of thinking; reflections on the presence of theriomorphic serpentine imagery in the work; the role of stories as mental containers of therapeutic theory; reflections on the ‘milieu’ needed for implementing intercultural therapeutic procedures; examples of positive indigenous responses to alcohol work; preliminary notions on cross cultural transference communications; and reflections on primal states associated with alcohol intoxication. The conclusion is that the experience of developing a Western myth in concert with Aboriginal colleagues confirms the value of the initial, seminal suggestion that ‘dreaming stories’ have an authentic place in the repertoire of alcohol treatment and education
Doctor of Philosophy (PhD)

In this dissertation, I explore a quite unique legal situation, namely administrative court hearings relating to coercive interventions: the Care of Young Persons Act (LVU), Care of Abusers (Special Provisions) Act (LVM), and the Compulsory Psychiatric Care Act (LPT). There are three central participatory roles in the court hearings: The official party is the authority who files the application for coercive intervention – either a chief psychiatrist or a social welfare board (typically represented by a social worker or sometimes a lawyer assisted by a social worker), whereas the citizen party is the person about whom the application is brought. The citizen party is represented by a legal representative. The professionals represent two different logics: therapeutic and judicial.

The purpose of this dissertation has been to study the tension between therapeutic and judicial logic in court hearings relating to compulsory care. With theoretical concepts from Scott (1995) and Wetherell & Potter (1998), it is possible to say that the therapeutic and judicial logics are built up by institutional elements that are communicated through interpretative repertoires. Three questions are central:

1. How do professional participators handle the different role expectations embedded in therapeutic and judicial logic? In this case, I am particularly interested in role conflicts faced by social workers and psychiatrists.

2. How do different institutional elements (regulative, normative/cognitive) play out in the court hearings?

3. To what extent can these court hearings be considered a scrutinizing order of discourse, where the arguments of official party are subjected to critical examination?

In my analysis I am inspired by both critical discourse analysis and organizational theory, more precisely, new institutionalism. These two perspectives provide useful insights and make it possible to combine the micro- and macro levels in the analysis. Data for the analysis consist of 43 court hearings and 31 interviews, gathered from two different county administrative courts in Sweden. All written documents used and produced by the courts are also part of our data.

The dissertation consists of five studies that indicate that the court hearings hardly can be described as a scrutinising order of discourse. In spite of this, the court constantly finds that the legal criteria for coercive intervention are satisfied. Neither the official party nor the legal representative argue according to a judicial logic. Instead, therapeutic logic dominates the order of discourse. When the arguments for compulsory care are therapeutic, they are not explicitly related to the criteria in the law. In my interpretation, the reason why the conflict between therapeutic and judicial logic is not realised can be found in the existence of a logic of normalisation. This ideological logic of normalisation can be found in most of the institutions in the Swedish society and are built on the idea of traditional welfare norms.

Essa pesquisa tem como objetivo central apresentar contribuições de uma Intervenção Assistida por Cão (IAC) para a facilitação do processo comunicativo de uma criança com paralisia cerebral associada à deficiência intelectual, no contexto de uma APAE (Associação dos Pais e Amigos dos Excepcionais). Como aporte teórico, a pesquisa valeu-se dos estudos de Vigotski, em especial dos conceitos de mediação, zona de desenvolvimento proximal (ZDP) e interação. O delineamento metodológico teve caráter exploratório com abordagem qualitativa, baseado num estudo de caso. Os dados para o estudo foram gerados no ambiente de uma escola APAE, de uma cidade da região da serra gaúcha, com uma criança de 12 anos com paralisia cerebral e deficiência intelectual. Foram realizadas videogravações de atividades pedagógicas com a criança na presença de um cão, na sala de aula, totalizando 15 sessões. O corpus assim constituído foi analisado a partir de um processo de análise das imagens, inspirado nas ideias da análise textual discursiva, articulados com os conceitos já referidos de Vigotski, e tendo a pergunta de pesquisa como norteadora. Dessa análise, originaram-se duas categorias emergentes: Sinais de Fala Egocêntrica e Mediação. Os resultados indicam que a intervenção da pesquisadora associada ao elemento cão, durante a interação com a criança, pareceu interferir na ZDP dessa criança, possibilitando sinais de comunicação, que foram desde uma fala egocêntrica até uma fala consciente e autônoma, permeados pelo elemento de afetividade, contribuindo para uma facilitação da aprendizagem.
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The central purpose of this research is to present contributions from a canine assisted intervention (CAI) for the facilitation of the communication process of a child with cerebral paralysis associated with intellectual disability, within the context of an APAE (Associação dos Pais e Amigos dos Excepcionais). As for a theoretical support, this research has made use of studies by Vygotsky, particularly the concepts of mediation, the zone of proximal development (ZPD) and interaction. The methodological design has an exploratory and qualitative approach, based on a case study. The data for the study was generated in an APAE school environment, in a city from the Gaucho highlands, with a twelve-year old child with cerebral paralysis associated with intellectual disability. Video recorded pedagogical activities have taken place in a classroom with a child in the presence of a dog, amounting to 15 sessions. The constituted corpus was therefore analyzed through a process of analysis of the images, inspired by the textual discursive analysis, articulated with the aforementioned Vygotsky concepts, and encompassing the research question as guidance. Two emergent categories were originated from the analysis: signs of egocentric speech and mediation. The results indicated that the researcher’s intervention associated to the canine element, during the interaction with the child, seemed to interfere with the child’s ZPD enabling speech signs, which ranged from egocentric speech to autonomous and conscious speech, permeated by the effectiveness element, contributing to learning facilitation.

Female breast cancer patients are often confused, frustrated, and devastated by changes occurring in their bodies and the treatment process. Many women express frustration and concern with the inability to know what the next phases of their life will bring. Previous research also states that many women struggle to communicate with others about treatment as well as side effects. This research examined how woman are use metaphors to describe their experience with breast cancer, specifically throughout the treatment period related to body image struggles. I qualitatively conducted interviews with women who were either currently in treatment or just finishing. My interview questions related to their uncertainties, as well as the changes occurring to their bodies. After conducting the interviews I transcribed the conversations and coded for specific metaphors. The results were consistent with previous research, in that that the interviewees used at least four major metaphors to describe what they are going through. The four most prominent metaphors were (1) journey, (2) game, (3) struggle/fight, (4) grasping. The findings could benefit patients, nurses, physicians as well as family and friends to reduce stress and help with coping. The findings may also help female patients struggling with identity issues due to lumpectomies or mastectomies. Understanding how patients comprehend the disease can ultimately help others to understand and hopefully reduce some of the concerns of all those involved in such situations.

The prevailing speech therapy techniques for treating hypokinetic dysarthria in individuals with Parkinson's disease (PD) yields improvements within the clinical setting, however, maintenance and generalization of acquired behaviors continue to be a challenge. The purpose of this study was to investigate the effects of portable therapeutic devices including Ambulatory Phonation Monitor with biofeedback (APM) and auditory masker in maintenance and carryover of improved speech. Our participant was an individual diagnosed with PD for the past 25 years who continued to display speech disturbances despite undergoing several behavioral speech therapy programs and neurosurgical procedures. Speech intelligibility and average intensity measures under automatic, elicited, and spontaneous speech tasks were recorded pre- and postusage of APM and auditory masker for a period of 1 week each. Preliminary findings showed no significant difference in the measures between means (P>0.05) across all tasks for both the devices. Suggestions for future research on therapeutic devices are discussed.

Le théâtre thérapeutique est une espèce de spectacle vivant qui augmente la sensibilité des participants afin qu’ils puissent améliorer leur habileté à exprimer des émotions et des pensées verbales et gestuelles. Comme genre hybride, il fonctionne de la même manière que le théâtre pour le changement social (TPCS) dans lequel la praxis théâtrale est utilisée pour le changement des participants et des communautés ainsi que pour la promotion du bien-être. Cette pratique (le TPCS) est donc utilisée pour le changement social, mental, et surtout émotionnel. Au cours de ces dernières décennies, ces deux pratiques ont été considérées et traitées distinctement. Contrairement à cette perception historique, cette thèse prétend qu’il existe un paradigme dans lequel ces formes se rejoignent. Appelé théâtre thérapeutique, il est beaucoup plus appliqué au Cameroun dans des communautés. Ce cas hypothétique est examiné sous le titre :« Pour un Développement du Théâtre Thérapeutique au Cameroun :enquête sur sa pratique et sa réception à travers une évaluation de cas. » Trois productions du TPCS/théâtre thérapeutique sont donc utilisées :The Boomerang, Ndop et SOS Village Mbalmayo workshops.

Le cadre théorique convoqué à cet effet est la sémiologie théâtrale telle que vue et énoncée par André Helbo. Développée de la pragmatique, sa sémiologie théâtrale est basée sur l’émission et la réception d’un message dans le spectacle. À cet égard, il existe des fonctions réciproques d’acteurs et de spectateurs dans l’événement théâtral. Ceci signifie que la distinction entre la production et la réception est tout simplement considérée comme une « distinction pédagogique ».

Le langage du théâtre dans sa production et/ou sa réception fonctionne dans un contexte d’expérience sociale partagée. Dans cette perspective, Helbo parle de « codes de spectacle (conventions spécifiquement applicables au spectacle, au genre, à la période historique), de codes généraux (linguistiques, idéologiques/culturels, perceptuels), et de codes mixtes (codes généraux fonctionnant dans un contexte spécifique de spectacle) » .Néanmoins, dans la démarche sémiologique d’Helbo tout comme dans ce travail, le privilège est accordé au dépassement de la division précédemment mentionnée, pour aboutir à ce qu’il nomme « l’énonciation collective » et la « notion d’observateur actant ».

Ces concepts dépassent le modèle de la communication linéaire évoqués par Mounin, pour souligner que les participants dans un phénomène théâtral sont impliqués dans le processus de création collective ou de l’énonciation collective sous des normes culturelles spécifiques. Dans ce processus, l’observateur représente une fonction spécifique, l’une des conditions de l’existence de l’énoncé spectaculaire. La notion de l’observateur actant « raffine considérablement l’analyse de l’identification initiée par Brecht », notion qui a été incorporée ou prolongée dans le théâtre thérapeutique de la même manière que le processus de co-création. Ce qui est central dans l’application de la sémiologie théâtrale dans cette thèse, c’est le postulat selon lequel le destinataire d’aujourd’hui deviendra le destinateur de demain.

À la fin de cette étude, nous montrons (sans chercher une reproduction du modèle occidental), que le théâtre thérapeutique est pratiqué au Cameroun. L’utilisation des techniques théâtrales favorise le bien-être des participants et contribuent au changement à tous les niveaux de la vie. Cette approche est orientée vers la communauté et par conséquent constitue un paradigme thérapeutique à visé communautaire nommé « théâtre communautaire à visé thérapeutique ». Considéré comme tel, ce paradigme peut être utilisé concomitamment dans le cadre de la santé mentale et de la santé communautaire au Cameroun. Dans ce cas, il sert comme une modalité thérapeutique intégrée et établit un lien entre le spectacle vivant, la santé en générale et la santé mentale en particulier.

Therapeutic theatre is an improvisational method of performing arts that heightens participants' sensitivity to improve their ability to communicate feelings and thoughts verbally and by gestures. As a hybrid form, it functions in the same way as theatre for social change (TFSC) wherein theatre praxis is used to change participants or communities and promote wellbeing. TFSC is seen as an articulated intention to use theatre praxis in the service of change (social, mental, and emotional). Tradition has held these practices distinctly for the past decades. This thesis however, contends that despite these historic perceptions, there is a paradigm where these forms, previously viewed as distinctly different, come together in a spectacle that is therapeutic and applied to mental health in hospitals and community settings in Cameroon. This hypothetical case is examined under the general topic: ‘Towards the development of a therapeutic theatre in Cameroon: investigating its practice and reception through a cross-case evaluation.’ This thesis is based on the analysis of three TFSC/therapeutic theatre productions from the same practitioner: The Boomerang, Ndop and SOS Village Mbalmayo workshop productions respectively.

The research is inserted under theoretical considerations of theatre semiology and particularly, André Helbo's semiotic concepts. Developed from pragmatics, this method of theatre semiology focuses on the manner in which a message is sent and received. In this respect, there are reciprocal functions of actor and spectator in the theatrical event. From this, semiology is applied to understand the theatrical phenomenon in its entirety: production and reception. This implies, the division between production and reception is viewed as “a pedagogical distinction” only. Privilege in this thesis therefore is given to the surpassing of the aforementioned division to what he terms “enunciating collective” (co-creation process), and the “notion of the observer actant”.

These concepts go beyond the linear form of communication in theatre evoked by Mounin to highlight that the participants in a theatrical phenomenon are involved in a collective creation process or enunciating collective under specific cultural norms, and the observer represents a specific function, one of the conditions of existence of the performance utterance (l’énoncé spectaculaire). The notion of the observer actant in effect “refines considerably the analysis of identification initiated by Brecht” and which has been incorporated or prolonged in therapeutic theatre in the same way as the process of co-creation. Vital therefore to the application of theatre semiology in this work is the postulate that the theatrical phenomenon is an act of interaction wherein today’s receiver can be transformed into tomorrow’s sender.

At the end of this research, it is proven that without seeking a reproduction of a Western form, "therapeutic theatre" is practised in Cameroon. The utilisation of theatrical techniques fosters participants’ wellbeing and enhance change at all levels. It is community centred thereby constituting a community-based therapeutic paradigm which is named "community-based therapeutic theatre". Understood as such, this paradigm can be used concomitantly in cases of mental and community health in Cameroon. In this case, it serves as an integrated therapeutic modality and bridges the gap that exists in the health domain in general and mental health in particular.

Doctorat en Information et communication
info:eu-repo/semantics/nonPublished

Les bactéries utilisent la communication intercellulaire pour se coordonner afin de réguler des processus bactériens majeurs comme la virulence, la sporulation, la compétence ou la formation de biofilms en fonction de la densité cellulaire. Ce processus repose sur la sécrétion de petites molécules signal appelées phéromones. Chez les bactéries à gram positif, ces phéromones sont de petits peptides qui peuvent être, soit reconnus au niveau de la membrane externe par des systèmes à deux composants dits systèmes indirects, soit être re-internalisés afin de se fixer directement sur un régulateur transcriptionnel cytoplasmique. Dans la recherche de nouveaux agents antimicrobiens, le potentiel thérapeutique d’inhibiteurs ciblant les systèmes de communication intercellulaire est bien étudié chez les bactéries à gram négatif qui utilisent des homosérine lactones comme phéromones. Quelques études s’intéressent aux systèmes indirects de bactéries pathogènes à gram positif mais le potentiel des systèmes directs, plus récemment identifiés, n’a pas encore été explorés.Les récepteurs cytoplasmiques directement régulés par des peptides signal re-internalisés forment la famille des RNPP. Ces récepteurs sont caractérisés par un domaine de fixation du peptide composé d’une répétition de motifs en hélice  appelés TetratricoPeptide Repeats (TPR). La plupart de ces récepteurs sont des régulateurs transcriptionnels contenant un domaine N-terminal de fixation de l’ADN de type Hélice-Tour-Hélice (HTH). Les études précédentes ont montré que, malgré une structure conservée, les modes de régulation des différents membres de la famille RNPP suivent des mécanismes moléculaires distincts. L’un de ces systèmes directs le mieux caractérisé est le système ComRS qui régule la compétence chez les streptocoques. La compétence permet aux bactéries d’internaliser des fragments d’ADN exogènes pour l’acquisition de nouveaux phénotypes tels que la résistance aux antibiotiques ou la virulence. Dans le groupe salivarius, il a été montré que les récepteurs ComR de deux espèces très proches, S. thermophilus et S. vestibularis, ne sont pas capables de coordonner leur état de compétence par échange de leurs peptides ComS respectifs.L'objectif de ma thèse a été d'étudier les déterminants structuraux de la spécificité du système ComRS. J’ai produit, purifié et cristallisé le récepteur ComR de S. vestibularis afin d’en déterminer la structure cristalline, seul et en présence de son peptide signal ComS. La comparaison de ces structures avec celles précédemment résolues chez S. thermophilus, conjointement à une étude fonctionnelle par mutagénèse dirigée réalisée chez nos collaborateurs (P. Hols, UCLouvain, Belgique), a permis d’aller plus loin dans la compréhension du mécanisme de régulation de ComR mais aussi d’identifier les résidus responsables de la spécificité du système ComRS. En parallèle, j’ai également initié la caractérisation structurale de deux paralogues de ComR chez S. salivarius, ScuR et SarF, qui ne sont pas activés par ComS et ne reconnaissent pas les mêmes cibles ADN que ComR malgré des séquences très conservées. Une analyse par SEC-MALS et SAXS m’a permis de montrer que ScuR semble suivre un mécanisme similaire à celui de ComR alors que SarF se comporte différemment en solution. J’ai proposé un modèle par homologie pour ScuR et cristallisé SarF. La résolution de sa structure est en cours. Cette étude permet donc de mieux comprendre la régulation de la compétence chez les streptocoques et ouvre la voie à d’éventuelles applications biotechnologiques ou biomédicales
Bacteria use intercellular communication to coordinate and regulate major bacterial processes such as virulence, sporulation, competence or biofilm formation, as a function of cell density. This process relies on the secretion of small signal molecules called pheromones. In gram-positive bacteria, these pheromones are small peptides that can be either recognized at the outer membrane by two-component systems called indirect systems, or can be re-internalized to directly interact with a cytoplasmic transcriptional regulator. In the search for new antimicrobial agents, the therapeutic potential of inhibitors targeting intercellular communication systems is well studied in gram-negative bacteria that use homoserine lactones as pheromones. Some studies focus on the indirect systems of gram-positive pathogenic bacteria, but the potential of the more recently identified direct systems has not yet been explored.The cytoplasmic receptors directly regulated by re-internalized signal peptides form the RNPP family. These receptors are characterized by a peptide binding domain consisting of repeats of  helical motifs called TetratricoPeptide Repeats (TPR). Most of these receptors are transcriptional regulators containing an N-terminal DNA binding domain of the helix-turn-helix (HTH) type. Previous studies have shown that, despite a conserved structure, the modes of regulation of the different members of the RNPP family follow distinct molecular mechanisms. One of the best characterized direct systems is the ComRS system that regulates competence in streptococci. Competence allows bacteria to internalize exogenous DNA fragments for the acquisition of new phenotypes such as antibiotic resistance or virulence. In the salivarius group, it has been shown that the ComR receptors of two closely related species, S. thermophilus and S. vestibularis, are not able to coordinate their state of competence by exchange of their respective ComS peptides.The aim of my thesis was to study the structural determinants of the specificity of the ComRS system. I produced, purified and crystallized the ComR receptor from S. vestibularis in order to determine its crystal structure, alone and in the presence of its ComS signal peptide. The comparison of these structures with those previously solved with ComR from S. thermophilus, together with a functional study by directed mutagenesis performed by our collaborators (P. Hols, UCLouvain, Belgium), allowed us to go further in the understanding of the regulatory mechanism of ComR but also to identify residues responsible for the specificity of the ComRS system. In parallel, I also initiated the structural characterization of two ComR paralogs from S. salivarius, ScuR and SarF, which are not activated by ComS and do not recognize the same DNA targets as ComR despite highly conserved sequences. SEC-MALS and SAXS analyses allowed me to show that ScuR seems to follow a mechanism similar to that of ComR whereas SarF behaves differently in solution. I proposed a homology model for ScuR and crystallized SarF. The resolution of its structure is in progress. This study therefore provides a better understanding of the regulation of competence in streptococci and opens the way to potential biotechnological or biomedical applications

Tese de Doutoramento em Ciências da Comunicação
Esta investigação responde à pergunta sobre como, na relação terapêutica, as competências de comunicação dos médicos e enfermeiros, concretamente a assertividade, a clareza da linguagem e a positividade, contribuem para a literacia em saúde do paciente relativamente à dimensão da compreensão. Os objetivos específicos visam conhecer a importância que os médicos e os enfermeiros atribuem às suas competências de comunicação, como estas são percecionadas e usadas na relação terapêutica e a importância dada ao modelo ACP (assertividade – clareza – positividade), usado de forma agregado e interdependente na melhoria da literacia em saúde do paciente. A investigação apoia-se, epistemologicamente, na corrente interpretativista e na funcionalista e, teoricamente, na teoria relacional, na teoria situacional dos públicos, na teoria da resolução de problemas, na abordagem da persuasão, no modelo codificaçãodescodificação e na teoria social cognitiva conjugada com a teoria do comportamento planeado.Utilizou-se o método misto, que incluiu as técnicas do focus Group, do inquérito por questionário (Q-COM-LIT), da entrevista e da análise de conteúdo qualitativa. As técnicas de recolha envolveram 484 profissionais de saúde. Os resultados evidenciaram que o uso das competências de comunicação – assertividade, clareza e positividade – facilita a relação terapêutica e as instruções em saúde, contribuindo, de forma relevante, para aumentar a compreensão do paciente e a adesão e que as competências de comunicação são condição indispensável para aumentar a qualidade dos cuidados de saúde e a literacia em saúde do paciente. A análise de componente principais combinada com clusters permitiu reduzir e agregar 39 indicadores A-C-P em sete dimensões. Destacou-se o valor do modelo ACP, na díade em saúde, como um modelo recomendado de comunicação em saúde e para a literacia em saúde.
This research answers the question of how, in the therapeutic relationship, the communication skills of doctors and nurses, namely assertiveness, clarity of language and positivity, contribute to patient health literacy in relation to the understanding dimension. The specific objectives are to understand how doctors and nurses value their communication skills, how they are perceived and used in the therapeutic relationship, and the importance given to the ACP model (assertiveness - clarity - positivity), used in an aggregate and interdependent manner to improve patient health literacy. The research is based, epistemologically, on the interpretativist and functionalist current and, theoretically, on relational theory, the situational theory of the public, the theory of problem solving, the persuasion approach, the codification-decoding model and the cognitive social theory combined with the theory of planned behaviour. The mixed method was used, which included the focus group, questionnaire survey (Q-COMLIT), interview and qualitative content analysis techniques. The collection techniques involved 484 health professionals. The results showed that the use of communication skills - assertiveness, clarity and positivity - facilitates the therapeutic relationship and health instructions, contributing significantly to increase patient understanding and compliance, and that communication skills are an indispensable condition to increase the quality of health care and patient health literacy. The analysis of main components combined with clusters has made it possible to reduce and aggregate 39 A-C-P indicators into seven dimensions. The value of the ACP model in the health dyad was highlighted as a recommended model for health communication and health literacy.
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Contexto: as intervenções mediadas pelo corpo (IMC) com recurso às novas tecnologias serão respostas terapêuticas inovadoras no envelhecimento. Objetivo: conhecer a evidência científica sobre os efeitos das IMC com recurso às novas tecnologias nos domínios cognitivo e psicossocial de pessoas idosas. Metodologia: foram pesquisadas as bases de dados APA PsycNet, Cochrane, PEDro, Portal Regional da BVS, Pubmed, Science Direct, Scopus e Web of Science. A escala de PEDro avaliou a qualidade metodológica dos estudos e a BES a força de evidência. Resultados: 10 estudos investigaram os efeitos das IMC (Artes Criativas, Intervenções Mind-Body, ou combinação das duas) com recurso às novas tecnologias. Os efeitos destas intervenções, nas variáveis cognitivas e psicossociais avaliadas, variaram entre sem evidência a evidencia moderada. Conclusão: Há evidência científica limitada que as IMC com recurso às novas tecnologias induzem efeitos benéficos nas pessoas idosas ao nível do domínio psicossocial e limitada a moderada no domínio cognitivo; Effects of body-mediated interventions using new technologies in the cognitive and psychosocial domains of elderly people: a systematic review Abstract: Background: body-mediated interventions using new technologies will be innovative therapeutic responses in aging. Objective: to know the scientific evidence on the effects of body-mediated interventions using new technologies in the cognitive and psychosocial domains of elderly people. Methodology: the APA PsycNet, Cochrane, PEDro, VHL Regional Portal, Pubmed, Science Direct, Scopus and Web of Science databases were searched. The PEDro scale assessed the methodological quality of the studies and the BES the strength of evidence. Results: 10 studies investigated the effects of body-mediated interventions (Creative Arts, Mind-Body Interventions, or a combination of the two) using new technologies. The effects of these interventions, in the cognitive and psychosocial variables evaluated, ranged from no evidence to moderate evidence. Conclusion: There is limited scientific evidence that body-mediated interventions using new technologies induce beneficial effects in the psychosocial domain of the elderly and limited to moderate in the cognitive domain.

Le diabète de type 2 est une pathologie chronique en augmentation galopante à travers le monde. Une alimentation trop riche combinée à une sédentarité conduit à une hyperglycémie chez les patients au cours du temps. L’augmentation de la masse corporelle de ces sujets induit une inflammation chronique. Ce phénomène perturbe à terme la physiologie de la cellule β pancréatique en provoquant la perte de sa fonction sécrétrice d’insuline et en réduisant la masse des îlots pancréatiques, conduisant à une insulino-dépendance, dernier stade du diabète de type 2. Le dialogue inter-organe, dit le « cross-talk » est un phénomène complexe faisant interagir les différents organes par l’intermédiaire de messagers chimiques, est perturbé dans la physiopathologie du diabète de type 2. Dans ce contexte, le muscle est capable d’apporter des réponses grâce à ses sécrétions de myokines. Cette étude s’intéresse à une myokine en particulier, la Décorine, sécrétée principalement par le triceps et possédant des caractéristiques prometteuses dans la protection de la cellule β contre les phénomènes inflammatoires délétères présents dans le diabète de type 2. Nous avons démontré le rôle potentialisateur de la Décorine sur la fonctionnalité de la cellule β chez le rat et chez l’homme. Nous avons également démontré que la Décorine possède un rôle protecteur dans un contexte inflammatoire modélisé par le TNF-α. Ce travail, constituant la première étude sur le rôle bénéfique de la Décorine sur la celllule β, met en lumière son intérêt thérapeutique dans une stratégie de prise en charge pharmacologique du diabète de type 2
Type 2 diabetes is a chronic pathology that is increasing rapidly around the world. An over-rich diet combined with a sedentary lifestyle leads to hyperglycemia over time. The increase in body mass of these subjects induces chronic inflammation. This phenomenon ultimately disrupts the physiology of the pancreatic β cell by causing the loss of its insulin secretoryfunction and reducing the pancreatic islet mass, leading to insulin-dependent, last stage of ype 2 diabetes. The "cross-talk" wich is a complex phenomenon exploring the interaction ofdifferent organs through chemical messengers, is disrupted in the pathophysiology of type 2diabetes. In this context, the muscle is able to provide responses through myokine secretions. This study focuses on one myokine in particular, Decorine, secreted mainly bytriceps and having promising characteristics in the protection of the β cell against the deleterious inflammatory phenomena present in type 2 diabetes. We have demonstrated the potentiating role of Decorin on the functionality of the β cell in rats and humans. We have also demonstrated that Décorin has a protective role in an inflammatory context modeled by TNF-α. This work, constituting the first study on the beneficial role of Decorinon cell β, highlights its therapeutic interest in a pharmacological management strategy fortype 2 diabetes

Syftet med studien var att undersöka behandlares upplevelse av terapeutisk allians vid sessionvia digitalt format. En kvalitativ metod har tillämpats och datainsamlingen har gjorts via semistrukturerade intervjuer. I studien deltog sju respondenter varav fem var kvinnor och två var män. Studiens insamlade material har analyserats utifrån Braun och Clarkes (2006) Tematiska analys. Den Tematiska analysen genererade tre teman: Första temat: Osäkerheten i vad som sker, och vad man inte ser eller hör, vilket beskriver respondenternas upplevelse av hinder i kommunikationen via det digitala mötet. Andra temat: Begränsat handlingsutrymme,beskriver respondenternas känsla av att det digitala formatet minskar deras verktygslåda som behandlare. Det tredje temat: Avsaknad av fysisk närhet, beskriver hur respondenterna saknar den fysiska närheten i det digitala formatet men upplever det digitala formatet vara ett gott komplement till det fysiska rummet, dock ingen fullgod ersättning.
The purpose of the study was to investigate therapists' experience of therapeutic alliance in therapy through digital format. A qualitative method has been applied and data collection has been done through semi-structured interviews. The study involved seven participants, five of whom were women and two were men. The study's collected material has been analyzed based on Braun and Clarke's (2006) Thematic analysis. The Thematic Analysis generated three themes: The first theme: The uncertainty in what happens, and what one does not see or hear, which describes the participants' experience of obstacles in communication through the digital meeting. Second theme: Limited room for maneuver, describes the participants' feeling that the digital format reduces their toolbox as a therapist. The last theme: Lack of physical proximity, describes how the participants lack the physical proximity in the digital format but experience the digital format as a good complement to the physical space, however, no adequate replacement.

Bakgrund: Humor som inslag i mänsklig kultur går att identifiera så långt tillbaka som det finns skriftliga källor. Humor påverkar social interaktion, används för att känna social samhörighet, skapa band människor emellan och stärka relationer. Traditionellt har sjuksköterskans roll haft begränsat medicinskt fokus. Rollen har breddats och innebär nu personligt relationsskapande präglat av engagemang och att se hela människan – en personcentrerad vård.   Syfte: Att beskriva hur humor används i vården och hur detta upplevs ur ett patient- och sjuksköterskeperspektiv. Metod: En litteraturöversikt med datainsamling från databaserna CINAHL Complete, PubMed och Ageline. Resultat: Sjuksköterskeperspektivet beskriver hur sjuksköterskor använder humor i vården för att främja en terapeutisk relation till patienten, bevara patientens identitet samt skapa trygghet och tillit och även som strategi för att klara av sjuksköterskearbetet och för att stärka teamarbetet. Patientperspektivet beskriver hur patienter avsiktligt använder humor för att få bättre vård och underlätta för sjuksköterskan. I vården är humorn oftast patientinitierad och används av patienten som skydd och för att lätta upp i svåra situationer. Både patienter och sjuksköterskor ansåg att det finns situationer då humor är opassande. Diskussion: Resultatet diskuteras utifrån Katie Erikssons omvårdnadsteori och relateras till konsensusbegreppet hälsa. Humor spelar en central roll i vårdandet och tycks ha effekter på psykiskt välmående. Humorn är dock oftast patientinitierad och för att ge personcentrerad vård borde sjuksköterskor i högre grad använda humor som ett verktyg i den dagliga professionen.
Background: As far back as there are written sources there is possible to identify humour elements in human culture. Humour affects social interactions, is used to show appreciation, create feelings of social connectedness, form bonds between people and maintain and strengthen relationships. Traditionally the nurse’s role has been relatively limited and the focus has been strictly medical. The nurse’s role has expanded and involves personal relationship building characterized by commitment and to see the whole person – a person-centered care. Aim: To describe how humour is used in health care and how it is perceived, from a patient and nurse perspective. Method: A literature review of data collection from databases CINAHL Complete, PubMed and Ageline. Results: The Nurse Perspective describes how nurses use humour in healthcare to promote a therapeutic relationship with the patient and preserve the patients' identity and create a sense of security and trust. Further, humour was used as a strategy to cope with the heavy work the nurse carries out and to improve teamwork. The Patient Perspective describes how patients deliberately use humour to receive better care and to aid the nurse. Mostly, humour in health care was patient initiated and is also used by patients as protection and to lighten up difficult situations. Both patients and nurses believed that humour is inappropriate in some situations. Discussion: The results are discussed on the basis of Katie Eriksson nursing theory and was related to the consensus concept health. Humour plays a central role in nursing and to deepen the nurse-patient relationship. It seems to have effects on psychological well-being. Despite this, humour is usually patient initiated and in order to provide person-centered care nurses should make greater use of humour as a tool used in their profession.

This thesis reports an ethnomethodological, conversation analytic study of communication between stroke patients and physiotherapists. The study sought to describe and explicate patterns of conduct by which therapists and patients communicate about treatment activities during therapy sessions. Analysis included a comparison between practices observed in the data and current published recommendations for good practice. The data consist of 74 treatment sessions that were video-recorded in four English hospitals. The 21 patient participants were undergoing inpatient rehabilitation for stroke. Most were recorded on four occasions over a two-week period. Their disabilities varied, but all could speak and understand at least short sentences in English. Each of the ten therapist participants was employed at senior level and used treatment approaches that are prevalent in the UK. Analysis involved repeated viewing of data and transcription of talk and body movement. It focused on three areas that emerged as central to physiotherapy interactions: The nature of treatment activities and of participation in them Achievement (success and failure) in these activities Reasons, goals and purposes underlying them Consistent with conversation analytic studies in other settings, we found that each communication practice in physiotherapy has a range of interactional effects, and that these are locally constructed and accomplished. Therefore, rather than generating „blanket prescriptions‟ about „good‟ and „bad‟ interactional practices, our study contributes to enhancing practitioners‟ understanding of the contingencies and underlying orientations that shape communication conduct, and raising their awareness of the effects of different means of achieving various interactional tasks in physiotherapy. We argue that these understandings can contribute to improvements in the practice and training of physiotherapy communication. Our study contributes to ethnomethodological and conversation analytic knowledge regarding methodological strategies for researching lay professional interactions, and to sociological understandings about the organisation of conduct in clinical interactions, particularly the role of orientations to managing physical incompetence and its implications.

The emerging health care culture of accountability for patient outcomes compounds problems for already overwhelmed clinicians struggling to fit everything entailed in complicated office visits into 15-minute appointments. Unprocessed frustrations tempt clinicians to use ineffective and outdated methods for trying to get their patients to comply or adhere to their care plans, undermining effective health care management. The intention of this project was to evaluate whether educating medical assistants in the health coaching method of motivational interviewing can improve the patient care approach while simultaneously assisting clinicians struggling with insufficient time. Several individual scheduling conflicts limited the target population into two primary care medical assistants and two auxiliary primary care office staff who voluntarily chose to learn the new approach. Guided by the adult learning theory, an educational lecture project was designed to capture the spirit of motivational interviewing through basic descriptions and strategies that will assist learners to focus on person-centered conversation skills, helping to balance both the needs of the patient and clinician. Following the education, participants filled out an anonymous post-lecture evaluation questionnaire to provide immediate feedback about learner understanding. Responses indicated the project met its stated objectives, and results showed the versatility of the motivational interviewing method which can be learned and effectively applied by health care workers from a wide range of professional backgrounds. Motivational interviewing is an innovative approach that utilizes therapeutic communication to promote behavior changes that lead to improved health of our communities and country.

The increasing diversity of the United States creates a pressing public health need to investigate methods to increase the engagement, retention, and efficacy of mental health services for racial/ethnic minority (REM) youth. Evidence from the adult psychotherapy treatment literature suggests that enhancing therapist cultural competence leads to increases in client satisfaction, alliance, and retention (Constantine, 2002; Sodowsky, Kuo-Jackson, Richardson, & Corey, 1998; Worthington, Soth-McNett, & Moreno, 2007). However, this relationship has not been adequately explored in youth mental health services, due in part, to a lack of valid and reliable measurement. This research project included measure development and initial validation of the Youth Therapist Observational Cultural Competence Scale (YTOCCS) with the aim of creating an observer-rated measure of youth therapist cultural competence. The measure was developed from a review of the theoretical and empirical literature and integrated the surveyed opinions of practicing child therapists, caregivers of REM children involved in the mental health system, and experts in therapist cultural competence. The study used an extreme group design based on child-therapist alliance selecting 32 recordings of 8 unique child-therapist dyads. Three coders were trained using a standardized manual and independently double coded early treatment sessions from an effectiveness trial for individual child cognitive-behavioral therapy conducted in community clinics. The measure demonstrated good reliability as measured by intraclass correlation coefficient, adequate internal consistency, and evidence supported initial validity through demonstrated significant between-group differences. Future studies are warranted to refine the measure and to explore the factor structure of the measure.

A series of four studies examined the emotional climate of elite sport, and tested the utility of an emotional disclosure intervention during sport injury rehabilitation. Overall, results from the investigations indicated that athletes' usual coping mechanism during injury rehabilitation was to inhibit and suppress felt emotions, while displaying mock emotions that were considered acceptable within their sport climate. Pennebaker's (1989) written disclosure paradigm was shown to address athletes' emotionally inhibitive coping style and encourage psychological and physical well-being. It was found to be a viable alternative to psychotherapy within the sport injury context. Athletes showed improvements in stress and mood disturbance, and fewer grief responses towards their injury. Affective and cognitive linguistic markers also showed changes during the 3-day intervention period, leading to the informed assumption that there was a likely association between changes in athletes' psychological responses to injury post-intervention and changes among the linguistic markers of interest. Results were discussed in the context of the broader sport psychology of injury research and limitations of the present investigations were discussed. Recommendations were made for future research into intervention research targeting the psychological experience of long-term injury.

This action research project examines the researcher’s journey of establishing a therapeutic relationship with a child with autism spectrum disorder during her practicum. Children with ASD present difficulty in communication and social relationship skills. As a student in training with a limited experience, the researcher had uncertainty and low confidence with regard to her clinical and professional skills which affected her work. In this project, the researcher has examined her own process of music therapy with a child with ASD and shows how she was able to improve her practice and therefore establish meaningful and effective therapeutic relationships with this client population and obtain valuable learning through the training. The study was conducted at a dedicated therapy centre in New Zealand where the researcher was in placement. A total of seven, thirty-minute weekly individual music therapy sessions and four supervision sessions were employed. This process was adapted into the design of action cycles which involved the repeated process of planning, action and evaluation. In-depth analysis of the researcher’s work was carried out throughout the cycles, using clinical notes, journal excerpts, supervision notes and video recordings of the sessions. The findings suggest that the researcher was able to improve her practice while attempting to build a therapeutic relationship with the client. Various clinical and personal issues arose such as uncertainty about improvisation, and lack of confidence in professional skills including communicating with parents, which led to disjunction and burnout symptoms. Discussions in supervision aided in in-depth reflection of the researcher’s work as well as emotional support. The researcher could ultimately develop ‘internal supervisor’ and was able to use independent strategies to help develop her work. Implications for training include making personal therapy a compulsory course requirement, providing training on professional skills, and student support groups. Future research may investigate the effectiveness of verbal input in music therapy and the emotional stages of parents.

Therapeutic conversation represents a continuous and dynamic activity of meaning construction turn by turn, based on a two-way interpretative process between therapist and patient. In particular, verbal structures and intents, vocal characteristics, and speech interruptions are indivisible and fundamental elements of therapeutic discourse; they convey psychological and emotional processes that transform the internal organization of individuals into more complex structures, fostering change. During this activity, verbal and non-verbal components interact with each other, forming a non-linear communication field that expresses the therapeutic process and the clinical function of the therapeutic relationship and fosters the development and regulation of factors such as the therapeutic alliance. This relational dimension, influenced by communicative coordination processes underlying the mutual regulation between participants, is predictive of change, especially in the early stages of psychotherapy. During the therapeutic interaction, patients experience alliance construction by manifesting different verbal and non-verbal behaviors whereby they express their psychological processes and symptoms. In particular, depressed patients present verbal, vocal, and interruption behaviors that are an expression of their symptomatology and impact on communicative exchanges with the therapist, hindering the development and maintenance of the therapeutic alliance and change. In literature, the predominance of verbal communication over the above-stated components resulted in a fragmented communicative field with distinct theories and measurement tools, which prevented the understanding of therapist-patient dynamics and their role in the construction of the early therapeutic alliance at the process level. Studies analyzing the dynamics between communication (as a single and interacting communicative field) and relational aspects in the therapist-patient interplay are absent, especially in the Italian context and in brief focal psychotherapy with depressed patients. Therefore, this doctoral thesis as a collection of two publications aims to identify the verbal, vocal, and interruption behaviors emerging turn by turn between the therapist and depressed patient within psychodynamic psychotherapy and investigate those communicative modes of each participant that foster the alliance construction by the other during mutual regulation processes. A particular case of indirect observational methodology was implemented; as a mixed method in itself, it was able to provide a fuller picture of the therapeutic interaction by supporting it with objective measures. Thirty audio recordings and transcripts of brief focal psychotherapy sessions with ten depressed patients treated by the same therapist (8,327 speaking turns) were considered. The observational design selected to guide and organize the investigation was nomothetic/follow-up/multidimensional, given its greater wealth of information and complexity among low-intensity evaluation designs. Study 1, focused on identifying communicative behaviors through a theory that unify the communicative field, resulted in the construction of an ad hoc indirect observation instrument of the therapeutic conversation based on the performative function of the Speech Act Theory. This classification system showed high intra-and inter-observer reliability and made it possible to describe the participants’ communicative modes trend. Study 2 aimed to investigate the communicative modes of the therapist and depressed patients that, according to the literature, foster the mutual construction of the early therapeutic alliance: asking, exploring, elaborating, and interrupting cooperatively for the former; affirming, exploring, expressing emotions, and interrupting cooperatively for the latter. The study showed the presence of sequential patterns and significant relationships between the selected communicative behaviors and this relational dimension during the mutual regulation processes. All this allows increasing knowledge about these dynamics, providing professionals with useful information to improve the treatment effectiveness and to advance in the application of the mixed-methods approach in the field of psychotherapy research.
Durante la psicoterapia psicodinámica, los componentes verbales (estructuras e intenciones) y no verbales (voz e interrupciones) interactúan entre sí, transmitiendo procesos psicológicos y emocionales y formando un campo comunicativo no lineal en la base de la alianza terapéutica. Esta dimensión relacional predice el cambio, influenciada por los intercambios paciente-terapeuta desde las etapas iniciales del encuentro. Los pacientes deprimidos presentan comunicación verbal y no verbal específica y muestran dificultades para desarrollar y mantener la alianza terapéutica. Esta tesis doctoral tiene como objetivo identificar las conductas verbales, vocales y de interrupción que emergen turno tras turno entre el terapeuta y el paciente deprimido dentro de la psicoterapia psicodinámica e investigar aquellos modos comunicativos de cada participante que fomentan la construcción de la alianza durante la regulación mutua. Se aplicó un caso particular de metodología observacional indirecta como método mixto en sí mismo y se consideraron 30 grabaciones de audio y transcripciones de sesiones de psicoterapia con diez pacientes deprimidos tratados por la misma terapeuta (8,327 turnos de habla). El diseño observacional fue nomotético, de seguimiento y multidimensional. El estudio 1, centrado en la identificación de las conductas comunicativas a través de una teoría unificadora del campo comunicativo, produjo un instrumento de observación indirecta ad hoc de la conversación terapéutica basado en la función performativa de la Teoría de los Actos del Habla. Este sistema de clasificación mostró una alta fiabilidad intra e inter-observador y permitió describir la tendencia de los modos comunicativos de los participantes. El estudio 2 investigó los modos comunicativos del terapeuta y de los pacientes deprimidos que, según la literatura, fomentan la construcción mutua de la alianza terapéutica temprana: preguntar, explorar, elaborar e interrumpir cooperativamente para el primero; afirmar, explorar, expresar emociones e interrumpir cooperativamente para el segundo. Se detectaron patrones secuenciales y relaciones significativas entre las conductas comunicativas seleccionadas y la dimensión relacional durante los procesos de regulación mutua. Todo ello permite aumentar el conocimiento de estas dinámicas, proporcionando a los profesionales información útil para mejorar la eficacia del tratamiento y avanzar en la aplicación del enfoque de mixed methods en el campo de la investigación en psicoterapia.

Thesis (Ph. D.)--West Virginia University, 2007.
Title from document title page. Document formatted into pages; contains vi, 149 p. Includes abstract. Includes bibliographical references (p. 117-125).

Under pandemin COVID-19 har hälsovården tvingats till hastiga anpassningar i form av användning av vård via videolänk för kontinuitet, vilket berör även psykoterapi. Trots omfattande evidens för effektiviteten av terapi via videolänk finns fortfarande myter hos kliniker att den terapeutiska alliansen äventyras i det digitala forumet, vilket kan försvåra implementeringen. Studiens syfte var att utforska psykoterapeuters upplevelser av psykoterapi via videolänk, med särskilt fokus på den terapeutiska alliansen (TA). Genom semi-strukturerade intervjuer undersöktes psykoterapeuters föreställningar, anpassningar samt erfarenheter av denna omställning. Data analyserades utifrån kvalitativ innehållsanalys och resulterade i tre kategorier; Kommunikation, Den bärande relationen samt KBT-interventionerna. Huvudresultatet indikerar att klinikerna har behövt anpassa behandlingen kontextuellt, kommunikativt samt innehållsmässigt för att främja alliansen, och att TA går att utveckla över videolänk. Detta sammanfaller med tidigare internationella studiers resultat.  Utvecklingsområden som framkommit är aspekter självexponering som nytt fenomen och förändringar i maktstrukturen inom terapin. Omställningen har gått över förväntan positivt och delvis förändrat respondenternas inställning till videolänkterapi. Inom begränsningarna för denna studie beskrivs konsekvenserna och framtida forskningsriktningar.
During the pandemic COVID-19 the health care has suddenly been forced to adjust their work and start using video conference to keep the continuity, which also impacts psychotherapy. Despite extensive evidence of the efficiency of video conference psychotherapy there are still myths among clinicians that the therapeutic alliance can be endangered by the digital format, which can complicate the implementations. The aim of this study is to examine the psychotherapists' experiences of psychotherapy via video conference, with particular focus on the therapeutic alliance (TA). Through semi-structured interviews we examined the psychotherapists conceptions, adaptations and the experiences of this readjustment. Data were analyzed based on qualitative content analysis; Communication, The solid relation and the CBT-interventions. The main results indicated that the clinicians needed to adapt the treatment contextually, communicatively and in terms of content to frame TA, and that TA can be developed via video conference. This coincides with previous international research. Areas of development is the new phenomenon self-exposure and transformation/change of equalization of power.  The conversion has positively exceeded the expectations and has partly changed the respondents attitudes to therapy via video conference. Within the limitations of this study, implications and further directions for research are described.

An analysis of over 34,000 free-text messages assigned by pharmacists to prescription orders over a 12-month period showed a sub-optimal exchange of information with the physician. Focus groups and observational research were conducted to provide a more in-depth understanding of the factors involved. The use of CPOE did not reduce opportunities for personal interaction. The capability to communicate electronically facilitated a non-interruptive workflow, beneficial for staff time and for limiting distractions. It also improved clinical documentation, which helped coordinate care of patients between members of the pharmacy team. However, the research identified several barriers to the effectiveness of communication via the CPOE system, including: the increased frequency of messages sent; poor display characteristics of the message; poor access to information to inform decision-making; one-way communication; and no assigned responsibility to respond. These factors need to be considered in the design of systems and supported by interprofessional training to optimise communication between the professionals.

Using Heideggerian interpretive phenomenology, this study illuminates the lived experience of an adapted dance program for individuals with Down syndrome and their family members. The overall pattern from both dancers and family members was adapted dance: connecting mind, body and soul. The primary theme from dancer interpretations was expressing a mosaic of positive experiences, and the primary theme from family member interpretations was experiencing pride in their loved ones. The dance program provided dancers an opportunity to express their authentic self while experiencing moments of full embodiment in the connection of their mind, body and soul. While dancers experienced the connection of mind-body-soul, family members recognized the importance of this connection in their loved one. This research is instrumental in advocating for opportunities for individuals with Down syndrome to experience dance as a social, physical and intellectual activity that results in learning and increasing social interactions. The research findings from this study can support future initiatives for dance programs that may influence a population that has limited access to physical activity and dance. The study's teaching strategies, dance activities, class procedures and sequences, and feedback techniques can be used by other professionals who teach individuals with intellectual disabilities.

Introdução: No curso de Fisioterapia, na disciplina de Recursos Terapêuticos Manuais, o aluno estará na situação de aprendizagem onde atuará como fisioterapeuta, aprenderá os recursos terapêuticos manuais e exercitará a aplicação de anamnese e de testes de avaliação funcional direcionados para aplicação de massagem. O conteúdo referente ao treinamento técnico do aluno deve focar os recursos terapêuticos e suas bases, mas não deve excluir a promoção de habilidades profissionalizantes envolvidas na relação fisioterapeuta - paciente. Objetivos: verificar a eficácia de um programa de treinamento de habilidades profissionalizantes envolvidas na relação fisioterapeuta-paciente durante sessão de massoterapia e identificar a opinião dos alunos sobre a experiência realizada. Sujeitos: Vinte e cinco graduandos em Fisioterapia. Método: I. Identificar as habilidades envolvidas na relação fisioterapeuta-paciente a partir da literatura e observação de 120 sessões de massoterapia. II. Validar a definição operacional das habilidades junto a dez peritos; III. Organizar a forma de ensino e aplicar o programa de treinamento das 21 habilidades selecionadas. IV. Analisar o desempenho dos alunos nas habilidades treinadas, classificadas em adequada, parcialmente adequada, inadequada ou não realizada durante prova prática. V. Analisar o relato escrito dos alunos sobre o programa proposto. Resultados: Todos os alunos realizaram 12 das 21 habilidades treinadas de forma adequada. As habilidades: acomodar o paciente sentado, mensurar a freqüência cardíaca pré intervenção, questionar sobre intercorrência física ou emocional, fornecer feedback verbal foram realizadas de forma parcialmente adequada por 5 alunos, sendo que os demais as realizaram de forma adequada. Não ocorreu situação de execução inadequada de habilidade. Os relatos escritos, analisados e categorizados, mostraram que 19 dos 25 alunos afirmaram ser a atividade treinada importante e necessária. Destes, 15 citaram que o treinamento facilitou a relação com o paciente e a compreensão da realidade clínica. O treinamento do autocuidado físico foi destacado como importante para o desenvolvimento profissional e apropriado para o contexto de ensino por dez alunos. Conclusão: o programa mostrou-se eficiente em capacitar os alunos para as habilidades propostas tendo sido bem aceito e recomendado pelos alunos.
Introduction: In the discipline of Manual Therapeutic Resources of the Physiotherapy course, the students will be in a learning setting in which they will act as a physical therapist, will learn the manual therapeutic resources and will exercise the application of anamnesis and functional evaluation tests targeted to massage application. The contents referring to the technical training of the student should focus on the therapeutic resources and their bases, but should not exclude the promotion of the professionalizing abilities involved in the physical therapist-patient relation. Objectives: To check the efficacy of a training program of professionalizing abilities involved in the physical therapist-patient relation during the massotherapy session and identify the students’opinions about the experiment carried out. Participants: Twenty-five physicaltherapy undergraduate students. Methods:I. Identify the abilities involved in the physical therapist-patient relation starting from the literature and observation of 120 massotherapy sessions. II. Validate the operating definition of the abilities with ten experts: III. Organize the teaching manner and employ the training program of the 21 abilities selected. IV. Analyse the students’ performance as to the trained abilities, ranked as adequate, partially adequate, inadequate or not undertaken during the practical test. V. Analyse the students’ written report on the proposed program. Results: All the students undertook 12 out of the 21 trained abilities in an adequate manner. The abilities — accommodate the patient in a sitting position, measure the preintervention heart rate, question about intercurrent physical or emotional conditions, supply an oral feedback — were undertaken in a partially adequate manner by 5 students, and the others undertook them in an adequate manner. There wasn’t any situation of inadequate ability execution. The written reports, analysed and categorized, showed that 19 out of the 25 students stated that the trained activity is relevant and necessary. Out of those, 15 mentioned that the training facilitated the relation with the patient and the understanding of the clinical reality. The training of the physical self-care was pointed out as relevant to the professional development and appropriate to the teaching context by 10 students. Conclusions: The program proved to be efficient at enabling the students to the proposed abilities; it was well accepted and recommended by the students.

RESUMO: Em 2006, foi aprovada uma nova política governamental para a saúde mental intitulada “Uma Visão para a Mudança”, a qual está neste momento no sétimo ano de implementação. A política descreve um enquadramento para o desenvolvimento e promoção da saúde mental positiva para toda a Comunidade e para a prestação de serviços acessíveis, baseados na comunidade, serviços especializados para pessoas com doença mental. A implementação da política e o tornar a “Vision for Change” uma realidade têm sido problemáticos, com críticas consideráveis por parte dos intervenientes, relativas à lenta e desconexa implementação. Este estudo fornece informação sobre as características dos serviços de três importantes tipos de instituições de saúde mental comunitária a nível nacional, nomeadamente Hospitais de Dia, Centros de Dia e residências comunitárias operantes 24 horas. A pesquisa analisa objetivos e funções, perfis dos pacientes, atividades terapêuticas, a eficácia das redes de comunicação e beneficia da perspectiva dos funcionários sobre o que mudou no terreno ao longo dos últimos sete anos. As questões identificadas a partir das características dos três serviços dizem respeito a todos. Os participantes indicaram que o ethos da recuperação parece ter alcançado um papel mais central no tratamento do paciente na comunidade mas reconheceram que o desafio de integrar os princípios de recuperação na prática clínica se mantém presente. Parece ser reconhecida a importância da planificação do cuidado individual nos serviços comunitários e os entrevistados indicaram que existe um empenho para garantir o envolvimento do usuário do serviço. Há diferenças entre os „pontos de vista do pessoal‟ e os „pontos de vista dos representantes‟ sobre uma série de aspetos da prestação de serviços. Este é o primeiro estudo irlandês deste género a examinar a prestação de serviços das três principais instituições comunitárias de saúde mental num só estudo. Estes serviços representam um enorme investimento em recursos, quer a nível monetário, quer humano. O estudo examinou os desafios e as questões fundamentais que lhe são aplicáveis e que têm impacto nestes três tipos de prestação de serviços. Também forneceu informações sobre os elementos de mudança positiva, os quais se começam a focar lentamente na prestação do serviço, assim como na importância da centralidade do utilizador do serviço e na promoção de um ethos da recuperação.----------ABSTRACT: In 2006, a new Government policy for mental health “A Vision for Change” was endorsed and is currently in the seventh year of implementation. The policy describes a comprehensive framework for building and fostering positive mental health across the entire community and for providing accessible, community based, specialist services for people with mental illness. The implementation of the policy and turning “Vision for Change” into reality has been problematic with considerable criticism from stakeholders concerning slow and disjointed implementation. This study provides information on three key community mental health service settings, namely Day Hospitals, Day Centres and 24 Hour Community Residences at a national level. The research looks at aims and functions, patient profiles, therapeutic activities, effectiveness of key communication networks and gains an insight from staff on what has changed on the ground over the past seven years. Issues identified from the three service settings pertain to all. Participants indicated that the recovery ethos appears to have moved to a more central role in patient care in the community but acknowledged that the challenge of integrating recovery principles in clinical practice remains present. The importance of individual care planning appears to be recognised in community services and respondents indicated that efforts are being made to ensure service user involvement. There were differences between „staff views‟ and „advocate views‟ on a number of aspects of service provision. This is the first Irish study of its kind to examine service provision across the three main community mental health settings in one study. These services represent a huge investment in resources both on a monetary and human level. This study has examined the challenges and key issues which are applicable and impacting on all three types of service provision. It has also provided information on the elements of positive change, which are slowly embedding themselves in service provision such as the importance of the centricity of the service user and the promotion of a recovery ethos.

Inledning: Psykodynamisk parterapi handlar om interaktion mellan tre personer. Möten som syftar till förändring i samspel och att finna ny förståelse för varandras livsberättelse. Syftet med detta arbete var att undersöka psykodynamiska parterapeuters upplevelser och erfarenheter av förändring i parterapi. Frågeställningar: Vilka terapeutiska egenskaper är av betydelse för mötet i parterapin? Vilka terapeutiska egenskaper påverkar att parrelationens samspel förändras? Vilka möjligheter och svårigheter ställs en parterapeut inför? Metod: Fem terapeuter intervjuades utifrån en kvalitativ metod och en tematisk metod användes i analysen. Resultat: Det intersubjektiva mötet mellan terapeut och par var av betydelse för förändringsarbetet i psykodynamisk parterapi. Personlig hållning och receptiv förmåga att uppfatta kommunikativ allians skapade ett terapeutiskt rum där accepterande av olikheter och förmåga att stå ut med motsatser utvecklades. Diskussion: Den terapeutiska ramen, och informanternas simultanförmåga att upprätta och bevaka allians, var faktorer av särskild betydelse för parterapins tre parallellt pågående relationer. Informanternas samtidiga förmåga att uppfatta och undersöka kommunikativ allians var en faktor som påverkade den terapeutiska relationen positivt. Informanterna skapade sådana samspel att parets engagemang ökade. Genom att vara personliga och använda sig av primärt mjuka känslor engagerades paret till att vara personliga och nå djupare känslomässiga upplevelser. Dessa intersubjektiva möten ledde till en förändrad relation med tryggare emotionella band och en ökad psykisk närhet.
Introduction: Psychodynamic couple therapy is about the interaction in between three people. Meetings which aim to change the interaction and find new understanding of each other’s life experiences. The purpose of this study was to analyse psychotherapists’ understanding and experience of changes in couple therapy. Topics of discussion: Which therapeutic factors are relevant for couple therapy? Which therapeutic factors affect the interaction of the couple? What benefits or difficulties is a therapist posed to? Method: Five therapists were interviewed with respect to both qualitative and thematic methods. Conclusion: The intersubjective interaction between therapist and couples has relevance for implementing changes in psychodynamic couple therapy. Personal attitude and receptive ability to perceive communicative alliance created through a therapeutic environment in which acceptance of inequalities and difference of opinions was developed. Discussion: The therapeutic framework, and the informants’ simultaneous ability to establish and monitor the alliance, were factors of particular significance for the three parallel ongoing relationships of the couple therapy. The informants’ simultaneous ability to perceive and investigate communicative alliance was a factor that positively affected the therapeutic relationship. The therapists’ application of such interactions increased the couple's engagement in the therapy. By being personal and making use of primarily soft emotions, the couple became more open and were able to reach deeper emotional experiences. These intersubjective meetings led to a changed relationship with more secure emotional ties and an increased psychological presence.

A research report submitted to the Wits School of Arts in partial fulfilment of the requirements for the degree of Masters of Arts by coursework and research report in the field of Drama Therapy, in the faculty of Humanities, University of the Witwatersrand, Johannesburg. March 2017
This qualitative research study examines the ways in which embodiment in drama therapy can be an effective intervention aimed at enhancing intercultural communication amongst South Africans. South Africa is a multicultural society owing to the diverse cultures people belong to. Communication is required in order for multiculturalism to succeed and peaceful coexistence to be stimulated. This study involved six participants who engaged in a series of six drama therapeutic group sessions focused on embodiment. Using interpretative phenomenological analysis the study found that the participants were able to enhance the intercultural communication amongst them as well as develop cross-cultural relationships. This research report consists of an exploration of the South African context. Thereafter embodiment, culture and communication are discussed to understand how these aspects influence the participants and their daily lives. Chapter three is the exploration of both globalisation and intercultural communication. Chapter four gives an explication of embodiment as a drama therapy approach and what embodiment offers the individual, followed by chapter five which demonstrates the methodology applied to investigate the method of embodiment. The main chapter of this study is chapter six and discusses the embodied drama therapy process and how it became a comfort zone for the participants in which they could communicate and develop meaningful relationships with the fellow participants. Chapter seven concludes and discusses the limitations and recommendations for the research. The drama therapy methodologies empowered participants and enabled them to think about themselves, their behaviour and how they communicate in a different way. It further enabled unconscious material to surface to the conscious mind, thereby evoking introspection and reflection.
MT 2018

Communication can be divied into two broad areas namely, the verbal and nonverbal levels. While attention has been paid to nonverbal communication in the literature, few studies address the nonverbal communication that takes place in the natural setting of a therapeutic session. The present study provides such a naturalistic study, where the verbal content of actual therapy sessions are integrated with the nonverbal content to yield a holistic view of the session. An ecosystemic epistemology is adopted in this study, and represents a move away from more traditional approaches to nonverbal behaviour which are largely confined to a positivistic framework of thought and design. Symlog Interaction Scoring is employed as a practical method of assisting observers in distinguishing nonverbal behaviours, which are usually perceived unconsciously, and lifting them into consciousness, allowing this infonnation to be integrated with the meanings and hypotheses generated during therapy. By deliberately including descriptions of nonverbal behaviour, the descriptions of therapy were broadened, thereby providing a more holistic approach to therapy.
Psychology
M.A. (Clinical Psychology)

Thesis (M.M.) Florida State University, 2008.
Advisor: Alice-Ann Darrow, Florida State University College of Music. Title and description form dissertation home page (viewed 4-7-2009). Document formatted into pages; contains 117 pages.

In this study, the intersections between Equine Assisted Psychotherapeutic interventions and adolescence are explored. Equine Assisted therapeutic work has recently gained much popularity in the field of psychology, due to many reported benefits, which include the value of the use of the horse as a tool in psychotherapy. Adolescence is acknowledged to be a difficult transitional phase, punctuated with many challenges, such as identity development. As this study is conducted by a trainee psychotherapist and researcher, the work also contains a reflexive exploration of these fields, with personal reflections regarding the researcher‟s own experience in the fields. This study is framed as a transtheoretical bricolage, which includes elements of reflexivity, heuristics, transpersonal, and phenomenological research approaches. Data was gathered from individual interviews with co-researchers, focus group interviews, personal reflections, and inclusion of non-verbal information from the horses who formed part of this study. Data analysis was done by means of a Thematic Data Analysis. The research findings reflect themes on different levels, which are: content themes, process themes, meta-reflections on the research process, and a meta-analysis of the research and individual developmental process which took place in the production of this work
Psychology
M. A. (Clinical Psychology)

In this study, the intersections between Equine Assisted Psychotherapeutic interventions and adolescence are explored. Equine Assisted therapeutic work has recently gained much popularity in the field of psychology, due to many reported benefits, which include the value of the use of the horse as a tool in psychotherapy. Adolescence is acknowledged to be a difficult transitional phase, punctuated with many challenges, such as identity development. As this study is conducted by a trainee psychotherapist and researcher, the work also contains a reflexive exploration of these fields, with personal reflections regarding the researcher‟s own experience in the fields. This study is framed as a transtheoretical bricolage, which includes elements of reflexivity, heuristics, transpersonal, and phenomenological research approaches. Data was gathered from individual interviews with co-researchers, focus group interviews, personal reflections, and inclusion of non-verbal information from the horses who formed part of this study. Data analysis was done by means of a Thematic Data Analysis. The research findings reflect themes on different levels, which are: content themes, process themes, meta-reflections on the research process, and a meta-analysis of the research and individual developmental process which took place in the production of this work
Psychology
M.A. (Clinical Psychology)

Thesis (Ph.D.)--University of Alberta, 2009.
A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Faculty of Nursing . Title from pdf file main screen (viewed on October 11, 2009). Includes bibliographical references.

Este estudo teve como finalidade verificar se crianças com o espectro de Autismo, com significativas limitações, nas formas de comunicação verbal e não-verbal respondem positivamente à intervenção da musicoterapia, a qual envolve interacção, métodos de improvisação e técnicas da abordagem activa. A actividade de improvisação musical com fins terapêuticos tem demonstrado facilitar a motivação, competências comunicacionais e a interacção social, tal como desenvolver a atenção. Foram realizadas 15 sessões, com a duração de 30 min. cada, num período de 5 meses, com periodicidade semanal. Todas as sessões foram filmadas de modo a proceder à sua descrição detalhada para preencher posteriormente a Escala de Observação de comportamentos. Verificou-se que os efeitos da improvisação em musicoterapia activa melhoraram significativamente o comportamento comunicativo, o desenvolvimento da linguagem a resposta emocional, atenção e o controlo ao nível do comportamento. Para alcançar este objectivo, fiz o estudo de caso, inserindo-me na relação como co-terapeuta, com uma musicoterapeuta.
ABSTRACT: This study has as purpose to verify if children with the spectrum of Autism, with significant limitations, in the forms of verbal and not-verbal communication, answer positively to the intervention of music therapy, which involves interaction, methods of improvisation and techniques of the boarding of the active music therapy. The activity of musical improvisation with therapeutically ends, has demonstrated to facilitate the motivation for communicate, abilities and the social interaction, as developing the attention. Fifteen sessions had been carried through, with the duration of 30 min. each, in a period of 5 months, every week. All the sessions had been filmed in order to proceed to its detailed description to fill the Observation Scale of Behaviours later. It was verified that the effect of the improvisation in active musicoterapia had significantly improved the communicative behaviour, the development of the language the emotional reply, attention and the control to the level of the behaviour. To reach this goal, I made the case study, inserting me in the relation as co-therapist, with one music therapist.