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Transforming evidence: A discursive evaluation of narrative therapy case studies
(The Australian Psychological Society Limited, 2007) Busch, Robbie
A recent shift in American Psychological Association policy for what constitutes as evidence in psychotherapy has resulted in the inclusion of qualitative methodologies. Narrative therapy is a discursive therapy that is theoretically incongruent with the prevailing gold standard of experimental methodology in psychotherapy outcome evaluation. By using a discursive evaluation methodology that is congruent with narrative therapy this study of six peer-reviewed narrative therapy case articles found shifts in client positioning in the transformation from medical pathology discourses to strength-based discourses. It is concluded that five out of six case studies coherently demonstrated the effectiveness of narrative therapy with positive outcomes for clients and that a discursive evaluation has utility in producing a thick description of therapeutic outcome.
Tracing monsters : the textual constitution of woman-mother-childkiller, or, A reading of the non-origin of the monstrous feminine in the specific instance of a case of child murder : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand
(Massey University, 2000) Coombes, Leigh
This project begins with a story of my encounter with a sense of the similarities and differences between my own experience of motherhood and that of another woman charged, convicted and sentenced to life imprisonment for child murder, and a question about how it is possible for our experience to be so similar and different. My understanding of this encounter is informed by theories of 'écriture féminine' and the assumption that the diversity of women's lived experiences is delimited by discourses through which 'woman' is constituted culturally and historically. In relation to poststructuralist assumptions about the constitution of subjectivity, my initial question is transformed into a problematic. This transformation is performed through a theoretical engagement with work by Foucault, Lyotard, White and Lacan. In reading these theories the problematic of woman-mother-childkiller becomes a question of how specific women are positioned within a phallocentric system of signification through narratives legitimated by a phallocentric moral order and told through discourses of legitimated knowledge of subjectivity: the 'psy' discourses. The complicity of women's positioning within moral order and social power relations demands attention to the ethics of the problematic and its mode of address. To address the possibility of an ethical response, I make use of Derrida's work on deconstruction as ethics. After reading Derrida the general question of women's positioning becomes a specific deconstructive reading of a narrative told at the site of coarticulation of legal practice and psychological discourse: a reading of the judge's summation in the trial of R v Lisé Turner. The deconstruction is practised through reading for the traces of sexual difference in the constitution of the subject in Law and psychological discourse, the legitimation of knowledge practised as a delimitation of psychological discourse in relation to Law, the constitution of crime, disease, mental disorder, disease of the mind, insanity, defect of reason, criminal responsibility and diminished responsibility. Of particular concern are the traces of sexual difference in the iterations of psychological discourse incorporated into the body of the judge's summation. This reading is prefaced by an historical account of the relationship between psychological discourse and legal practice. This is followed by readings of the judge's summation for its instruction on legal doctrine, practices of exclusion and inclusion, constitution of legal subjects, and its narrative endpoint. Since the trial was defended through a plea of insanity, expert testimony on the accused's 'mental condition' was iterated in the judge's summation. Readings of the judge's summation on the plea of insanity are prefaced by a reading of relevant definitions and caveats from The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): the legitimate text of psychological knowledge privileged by Law here. The testimony of psychological expert witnesses is also read as prefacing the particular iterations of psychological discourse in the Judge's summation. From these readings I then return to the problematic constitution of woman-mother-childkiller as a problematic of justice.
Health and health-care use by New Zealand Vietnam War veterans and their wives : an examination of Andersen's model of health-care utilization : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
(Massey University, 2000) Withers, Rody Desmond
Previous research has found that the debilitating physical and psychological sequelae of combat stress experienced by Vietnam War veterans extend also to their wives. The present study has broadened the focus by applying the Andersen model of health services utilization to health-care used by a community sample of 281 couples comprising New Zealand Vietnam war veterans and their wives who had each completed one postal survey. Andersen (1968) proposed that utilization was a function of three components: predisposition, enablement and physical-need. Predisposition represents sociocultural and personal variables such as ethnicity and health beliefs that increase the likelihood of utilization. Enablement represents familial and medical resources such as income and health insurance which facilitate access health-care. Physical-need represents perceived or diagnosed need for health-care. The present study modified Andersen's model to include two further components, psychological-need and multiple-need. Psychological-need represents variables such as distress and trauma, while multiple-need represents co-existing physical-need and psychological-need. The model was applied to a total of thirteen health-care measures which were categorised as either 'contact' or 'volume' measures Contact measured whether a service had been used, while volume measured the amount of contact with a service. Seven measures tapped professional care (treatment by hospitals, general practitioners (GPs) and other professionals), and six tapped self-care (treatment by prescriptions, bedrest or reduced activity). Although veterans reported greater health-need than their wives, they were less frequent in their use of a range of services, including GP services. Five hypotheses tested core propositions of the model. Results supported one hypothesis; namely, that physical-need was more important in explaining the frequency of GP-service use than the likelihood of its use. The other four hypotheses received either limited or no support. Two hypotheses tested the modified model and received limited support. Psychological-need and multiple-need enhanced the explanation of five and two services, respectively. No evidence was found that poor psychological functioning or co-existing health problems were associated with use of GP services. There was evidence that psychological-need was associated with use of hospital services. Findings suggested that veterans and their wives who did not possess specified enabling resources had impeded access to GP-care. Overall, predisposing characteristics accounted for most of the explained variance across the thirteen measures of health-care, and enabling resources accounted for the least. Discussion focused on the need for future research to refine health-care measures so that the reasons for use or non-use of specific services are explicit, to use longitudinal designs in order to examine the process of health-care, and to more clearly explicate the Andersen (1968) model in terms of theoretical relationships among predictors.
Parental utilisation of child medical care : a grounded theory approach : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
(Massey University, 2002) Martin, Melanie F.
Within New Zealand, child medical care use is a prevalent source of concern with current medical care utilisation rates considered inadequate to achieve optimal child health. Although previous research into child medical care use has made a valuable contribution to understanding in this area, such research is plagued by various limitations that indicate the need for further research adopting a different approach. This study draws on a social constructionist perspective and grounded theory methods to investigate parents' talk surrounding child medical care use. The study investigates how parents construct their seeking treatment and prevention of childhood illness and disease from a medical practitioner or nurse looking at, in particular, seeking medical treatment for childhood illness, the use of Well Child checks, and childhood immunization. Individual semi-structured interviews were conducted to explore how parents construct the complex process of child medical care use. The findings indicate that child medical care use, in the form of treatment-seeking and the utilisation of Well Child services, is constructed as two distinct but similar processes. Generally, the findings demonstrate that such child medical care use comprises parents constantly negotiating various issues and concerns characterised by tension, conflict, and dilemma. These issues and concerns consist of doing the 'right' thing, the risk of medicines and immunisations, practical barriers to seeking care, competing demands and priorities, and social expectations and social pressure. These issues and concerns arise - and are resolved - within the wider context of parents trying to be 'good parents', trying to preserve child health (not just treat illness), the immediate environment surrounding treatment-seeking, parents trying to fulfil social roles - and individual and socially shared understandings of, for example, medicines. More broadly, child medical care use is conceptualised as a socially based decision-making process that takes place within a social context in which child health, illness, and disease are medicalised, and within which parents are trying to do the right thing for the child. The findings from this study contribute to knowledge and understanding in this area in a number of ways. These are discussed, along with the implications of these findings, and recommendations for future research are made.
Understanding health and illness : an investigation of New Zealand television and lay accounts : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
(Massey University, 2000) Hodgetts, Darrin
Within contemporary society, television is a prevalent source of health information. This thesis draws on insights from health psychology, media studies, and medical sociology to explore the ways that people of lower socio-economic status draw on television health coverage to construct their views on health and illness. Three primary data sets are used in an interrelated manner to investigate the complexities of this process. First, an analysis of four New Zealand health documentaries investigates the ways contemporary health concerns are covered on television. Second, an analysis of the accounts constructed in twenty individual interviews is used to explore participants' views on health, illness, and these same health concerns. Third, an analysis of four focus group discussions is used to investigate the processes through which participants construct interpretations of the health documentaries and reconstruct their views. Generally, findings indicate that the programmes, individual interviews, and focus group discussions function as cultural forums within which various shared explanations are drawn on in order to make sense of four contemporary health concerns: the health reforms, the privatisation of medical services, men's health, and aging. By exploring these processes, this thesis contributes to knowledge of the shape and focus of health coverage and the role of health communication in the refinement of lay views.
Young women, power, intimate relationships and wellbeing : the circumstances that enable young women's resistant subjective desires : "a pash and a dash" : a thesis presented in partial fulfillment of the requirements for the degree of Doctorate in Philosophy at Massey University, Wellington, New Zealand
(Massey University, 2010) Fisher, Prudence
This research explored gendered power, young women and resistance. I examined Cromby’s (2006) social constructionist theory of ‘embodied knowing’, Davies and colleagues’ (2001; 2002) theory of subjectivity and Braidotti’s (2003) theory of material embodiment to explore the silences present in feminist poststructuralist theory in the area of young women, subjective desire and wellbeing. The primary aim was to identify resistant ways young women could be within and outside of heterosexual relationships that increases, not decreases, their wellbeing. I conducted discussions with 6 friendship groups of 16-18 year old women, and 13 interviews with a subset of these participants. Critical discourse analysis (Parker, 1999) was employed to identify 7 main discourses in the data, namely: security; developmental; balance; risk and pleasure; girlfriends are fun; female friends negotiating ‘abject’ other and being a nomad. I examined the intersection between the corporeal body, discourse and material resources to identify the circumstances that enabled resistance. Access to resistant forms of female subjectivity was also promoted through the use of mimesis and my intentional positive positioning of the participants within research conversations. Cromby’s ideas of referential difference identified that participants desired the positive visibility of early heterosexual relationships but not the critical visibility of dominating and ‘clingy’ boyfriends. Cromby’s (2006) theory of embodied knowing accessed ‘feelings’ and more corporeal sensations and identified that the ideology of ‘might is right’ is still operating in participants’ lives and silences resistance to male dominance. All participants talked about experiences of empathy and pleasure within female friendships which enabled resistance to heterosexual discourses and promoted care for other females in private and public spaces. Braidotti’s notions of women’s pre-linguistic and linguistic drive ‘to be’ enables theorizing that resistant subjective desires are partially co-constituted through reiterative practices. Future research needs to explore: 1) how boys can be raised in the presence of a legitimate authoritative maternal presence in order to establish reiterative practices of an ethics of care for an equal different female others prior to being a boyfriend; 2) how girls can establish reiterative practices of desiring not to be constantly visible to others and to ‘know’ at an embodied location that not to be visible is not not to be.
Beyond training : an evaluation of transfer from the tertiary setting to the corporate environment : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
(Massey University, 2000) Collinson, Catherine Anne
This evaluation research investigated the extent to which work-related knowledge, skills, abilities and attitudes transferred from a post-graduate level, university-based training course back into the workplace. Respondents were rehabilitation case managers employed by a large public sector organisation concerned with all levels of rehabilitation provision and associated financial compensation. The longitudinal, multiple cohort study was designed to investigate not only the extent to which participants learned new work-related skills and attitudes on the course but also the organisational factors which facilitated or impeded the transfer and maintenance of new behaviours within the workplace. Participants in the study included: (1) four cohorts of case managers; (2) their workplace supervisors, and, (3) a group of case managers not enrolled in the training programme who comprised a randomly selected no-training control group. Cohort 1 was used as the pilot study group. Five surveys, linked to the different stages of the training programme, were administered to the trainees. There were significant problems associated with collecting reliable control group and supervisory data. These problems are discussed in terms of the various organisational barriers to effective learning which existed within the respondents' workplace. The main results showed that trainee characteristics were not associated with transfer; there were differences between the cohorts in their perceptions of their levels of occupational self-efficacy; over time the trainees increased their understanding of the course modules; during training the modules were perceived as relevant to their work but this was not sustained over time. The course content was sometimes transferred to the workplace through self-reported behavioural changes affecting clients, colleagues, stakeholders and caseload management. However, the trainees were somewhat dissatisfied with the level of support they received from their managers in transferring their training in rehabilitation into the workplace. According to the trainees organisational support for the training was not strong and management practices impeded the implementation of new ideas and did not provide on-going support or encouragement. These findings are interpreted using the perspectives on organisational learning provided by theorists such as Argyris and his colleagues and Dixon (1994, 1999). The discussion contextualises the research and provides reflections on the design and the process of the evaluation research and offers possible reasons for the lack of clear outcomes.
Cognitive determinants of treatment choice among cancer patients : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
(Massey University, 2001) Haddon, Glen Leonard
Decisions about whether or not to include non-conventional therapies in a cancer treatment regimen are potentially critical. An illness such as cancer, perceived to be life-threatening, inevitably raises existential questions which, in the present study, were posited to underlie the cognitive approach to treatment choice for cancer patients. The hypotheses tested in the study were that those who use non-conventional medicine will be more knowledgeable and have a more positive belief system about cancer, will be more interested in and motivated about health matters, will desire more personal control and assume more responsibility for their health and its treatment, and will be more intrinsically oriented in terms of meaning in illness and life. It was further hypothesised that the differences between those who use only conventional treatments and those who include non-conventional treatments will become more marked as the boundary between the two is altered to incorporate more non-conventional treatments in the conventional category, suggesting that patients' perceptions of the distinction varies from the medical establishment's view. An important underlying objective of the study included the exploration of the conceptualisation of meaning in life and its events in terms of intrinsic and extrinsic orientations. 212 adult participants, all having been diagnosed with any form of cancer for at least three months, volunteered and completed a postal survey. Overall, the results indicated that the conceptualisation of meaning as intrinsically or extrinsically oriented was an appropriate basis for exploring the role of existential issues in treatment decision making. The combination of constructs in the study was also confirmed as appropriate. In terms of the specific hypotheses, the expectation that users of non-conventional medicine would be more knowledgeable and more positive in their beliefs about cancer was supported only when conventional treatment was deemed to include certain physical and natural types of treatment usually labelled as non-conventional. Users of non-conventional medicine were found to be more interested in and more motivated to be involved in health matters than those who used only conventional medicine. They were also found to be those who desired more personal control over their health and its treatment and were also prepared to assume more responsibility. The results also supported the hypothesised difference between conventional only and non-conventional users in terms of intrinsic life meaning, but results for extrinsic life meaning only partially supported the expectation that this would be associated with conventional medicine use. These were discussed in terms of measurement issues and the reconceptualisation of the religious, spiritual and philosophical derivations of extrinsic meaning. No difference was found between users of conventional only and users of non-conventional medicine in terms of illness meaning, suggesting that conceptualisation in intrinsic and extrinsic terms was inappropriate for this sub-construct. There was also support for the view that treatments are viewed by many as being on a continuum from conventional to non-conventional, rather than being in defined dichotomous groups. Multivariate results (from a series of 2-group discriminant analyses) confirmed that health interest and motivation, attributions of control, responsibility and blame, and intrinsic and extrinsic meaning in life were the most important contributors to discrimination. Internal control attributions were consistently the most important relative discriminator. These results also showed that the influence of the discriminating variables in combination, including sociodemographic control variables, explained variances ranging from 25.4% to 33.6% across the altered groupings of treatment type. The results are discussed in relation to the conceptualisation of meaning and attributions of control and responsibility as pivotal concepts, and in relation to the indication that the greatest separation between conventional and non-conventional use was found when certain physical and natural treatments were classified as conventional rather than non-conventional. Psychometric, and conceptual limitations of the study are discussed, suggestions for future research are made, and some applications of the findings for health professionals are offered.
Is the black dog really a dalmatian? : an investigation into whether stress impact and attributional style lead to different outcomes for individuals receiving 20 sessions of cognitive behavioural therapy for depression : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
(Massey University, 2010) Good, Kimberly Suzanne
There is a need for greater clarity in the relationship between psychosocial stress and depression and its application to outcomes in cognitive behavioural therapy (CBT). A preponderance of research focuses primarily on the causal relationship between stress and depression and is limited by the traditional assumption of homogeneity amongst first-episode sufferers of mild to moderate depression. In actual fact, the perceived intensity and type of stress as well as an individual‘s attributional style may create significant differences in how they respond to therapy and overcome depression. This research had four aims: to develop an understanding about why individuals differ in their CBT recovery trajectories; to examine how the stress-diathesis framework relates to treatment outcomes; to develop a way of effectively assessing and measuring the quantitative impact of stress; and to develop an effective approach towards assessing contextual aspects of stress. The research inquiry was guided by stress-diathesis theory and a reformulated stress-diathesis framework was proposed that specified a quantitative – qualitative stress distinction. This accorded with the study‘s development of two stress measures. A measure for objectively quantifying stress was introduced, along with a therapist questionnaire that identifies precipitating stressors in depression and the qualitative aspects of the stress experience. A final sample of 26 clients experiencing their first episode of Major Depressive Disorder (MDD) was achieved. Clients were recruited for 20 sessions of CBT with 2- and 6-month follow-ups. Depression severity was measured each session with the Beck Depression Inventory (BDI-II) and attributional style was measured at six time points with the Attributional Style Questionnaire (ASQ). Stress impact was measured using the Impact of Event Scale – Video Format (IES-VF) and the Identification of Precipitating Stressors Questionnaire (IPSQ) was developed to assess precipitating stressors of depression. Multilevel analysis suggested that attributional style moderates the relationship between change in stress and change in depression. Clients with predominantly depressogenic attributional styles showed a delay in depression improvement compared to clients with non-depressogenic styles, even when significant stress reductions were achieved. Gender, therapy completion and marital status were also significant predictors of recovery. Preliminary support was achieved for the classification of clients into three recovery subgroups, according to whether they achieved rapid, expected or minimal stress improvements. Post-hoc analyses also indicated that chronicity and impact on autonomy appear to be the most influential stressor characteristics. Implications for future research and clinical considerations are discussed.
Social identity theory and intergroup relations in gender dominated occupations : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand
(Massey University, 2001) Baird, Christina Margaret
Previous research has found that men and women have quite different experiences of working in opposite gender dominated occupations. The effect of societal status on the processes that occur in gender dominated occupations often results in negative outcomes for women and positive outcomes for men. The study aimed to explore the attitudes and beliefs of individuals working in gender dominated occupations. It focussed specifically on how people who work in gender dominated occupations react to their group's position as a numerical majority or minority and the groups' attitudes towards their situation. Social Identity Theory (SIT, Tajfel & Turner, 1979) was adopted as a guiding framework for the research. The sample for the study consisted of male and female volunteers working in gender dominated occupations. 110 male and female nurses and 97 men and women working in two male dominated occupations (engineers and prison officers) participated. To achieve the aims of the study specific areas of SIT were measured. The areas included identification with the gender group, how prominent gender and occupation were in the self-concept, and whether gender was used as a basis for categorisations of others. Also measured were perceptions of the status of the groups and beliefs about how fair and open to change the intergroup situation was. In addition, perceived acceptance of the ingroup and acceptance towards the outgroup, beliefs about changing the groups' position and the support or rejection of outgroups' beliefs were measured. The following specific measures were used: the Spontaneous Self-concept, the Gender Salience Scale, and Hinkle, Taylor, Fox-Cardamone and Crook's (1989) measure of group identification. SIT makes specific predictions about how beliefs about the intergroup situation and identification with the group are related to social change beliefs. Results showed that gender affected choice of social change beliefs for achieving positive distinctiveness, with men being higher on social mobility beliefs, and women higher in social creativity and social competition beliefs. Engineers were higher in social mobility beliefs and social creativity beliefs than nurses. Status also affected social change beliefs with low status groups being more likely to choose social competition strategies than high status groups. Women showed less support for social competition and social creativity beliefs in the outgroup than men. Women showed more support for social mobility beliefs in the outgroup than men. Nurses showed less support for social mobility beliefs in the outgroup than engineers. Nurses had lower social competition (maintaining status) beliefs than did engineers. Status also affected support of the outgroup's social change beliefs. The low status group showed higher support of social mobility beliefs in the outgroup than the high status group, and higher social competition beliefs than the equal and high status groups. The equal group showed less support for outgroup social competition than did the high status group. The results of regression analysis showed that gender was the best predictor of ingroup social mobility beliefs and ingroup social competition beliefs. Gender also was the best predictor of attitudes towards outgroup social mobility beliefs and ingroup social competition (to maintain status) beliefs. Gender identification was the best predictor of ingroup social creativity beliefs, and support for social creativity beliefs in the outgroup. Legitimacy beliefs were the best predictor of support or rejection of the outgroup's social competition beliefs. The results of this study highlight the importance of using an approach that explores the different variables that predict each social change belief rather than focussing on the relationship between identification and differentiation as previous studies have done.

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