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An investigation of the factors relating to attendance of psychological appointments : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
(Massey University, 2021) Yelavich, Brooke
Background Psychological therapy is an important tool to improve mental health concerns. However, the high prevalence of mental health concerns is not reflected by mental health service use. Many individuals who are referred to a service do not attend or do not complete therapy. Methods A quantitative cross-sectional survey design was used to investigate psychological and practical factors which may impact attendance of psychological appointments. The factors investigated included: therapy anxiety, safety behaviours, intrinsic motivation, stigma, fear of disclosure, cultural safety, and practical factors. One qualitative method using an open ended question at the end of the survey was used to elicit further factors beyond the main survey questions that may predict non-attendance. Following exclusions, 669 participants were included in the final sample from Australia, New Zealand, Canada and the United Kingdom. Results The results of the study found statistically significant relationships between non-attendance and the following factors: therapy anxiety, safety behaviours, intrinsic motivation and self-stigma. Among the practical factors investigated, three of the 12 factors demonstrated statistically significant relationships with non-attendance these included, part-time employment, forgotten appointments, and family commitments. The results of the qualitative analysis highlighted five main categories of factors identified by participants. These categories included: psychological factors, practical factors, clinical factors, other commitments, and service factors. Conclusions Of the factors investigated in this study, therapy anxiety was the strongest psychological predictor of not attending therapy across the statistical models. Furthermore, therapy anxiety was one of the most self-reported reasons for not attending psychological appointments. While therapy anxiety was the strongest predictor, the study demonstrated a range of factors which related to individuals’ likelihood of attending psychological appointments. The findings of the current study may suggest that interventions that target a range of the most commonly identified factors would be more effective than trying to target just one of the various factors that cause non-attendance.
Termination of psychotherapy : the relationship between the termination process, judgements of the client's need for further treatment and psychotherapy outcome : a thesis presented in fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
(Massey University, 1994) Kendall, Timothy Edward George
This study was based on the data gained from eighty one terminating clients and their therapists at a university Psychological Services Centre. The study investigated the frequency with which clients and therapists agreed about three components of the termination process and if agreement was related to client outcome. The three components of termination investigated were, the reasons therapy was terminated, the mutuality of termination and the degree of need for further therapy. Client narrative responses to the question "Why is your therapy ending?" were coded into categories of reason and mutuality of termination. Raters reliably coded the majority of narrative answers. No difference in the ability of raters to make a coding with regard to the raters experience in Clinical Psychology was found. In approximately fifty percent of cases, therapists and clients did not agree about these three components of termination. It was also found that in those cases where there was agreement, the clients had better psychological outcomes, than in cases where there was no agreement.
Refocussing therapy : the effectiveness and uniqueness of a God-based therapy method : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Albany, New Zealand
(Massey University, 2005) Sharkey, Jennifer A
Refocussing Therapy (RFT) is a God-based theory and psychotherapy approach. The aim of the present study was to evaluate the effectiveness and uniqueness of RFT using a quasi-experimental mode of investigation. Over a period of four months pre- and post-treatment assessments of 49 RFT clients' mental health status and religious coping were made using the TOP v 4.1 and RCOPE measures. Changes were also assessed for a comparison group of 10 pastoral care (PC) recipients. Significant positive treatment gains were reported by RFT clients, while PC recipients had smaller but generally positive treatment gains. Positive religious coping improved for both the RFT group and the PC group. However, negative religious coping reduced significantly for the RFT group but increased for the PC group. Findings offer preliminary support for the effectiveness of RFT. and indicate that RFT impacts significantly upon clients' clinical status and religious coping. Further research is recommended to determine the efficacy of RFT.
Getting the feel of therapy : understanding therapists' views and experiences regarding social-emotional skills in practice : a thesis presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at Massey University, Albany, New Zealand
(Massey University, 2016) Boshra, Verena
Emotions are arguably at the heart of psychotherapy. While clients’ emotions in therapy have received a great deal of research attention, outside the realm of psychoanalytic and psychodynamic research, therapists’ emotions have largely been neglected. When applied to therapy, the concept of social-emotional skills describes therapists’ ability to be aware of their own and their clients’ emotions and then draw on that information to manage those emotions and in turn, the therapeutic interaction. As therapists’ social-emotional skills are a relatively new area of enquiry, this qualitative study sought to contribute to the literature by exploring therapists’ views and experiences regarding social-emotional skills in practice. Semi-structured interviews were carried out with ten practicing therapist participants between the ages of 31 and 62. Using Thematic Analysis, The Centrality of Emotions in Therapy was determined as a meta-theme and this was further organised into four main themes; Emotional Principles, Emotional Awareness Strategies, Emotional Practices as well as the Learning and Training of Social-Emotional Skills. The findings were visually represented using ‘The Tree of Therapists’ Social-Emotional Interactions’ model. Implications of the findings, limitations of the current study and future research directions are discussed.
Women's experiences of equine assisted psychotherapy : a thesis presented in partial fulfilment of the requirement for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand
(Massey University, 2016) Rance, Jessica
Equine assisted psychotherapy has received little research attention within psychology. This research explores the way women experience this modality. Working alongside Renee, an EAP practitioner, from HorsePower Aotearoa and three of her clients I undertook a photovoice project. Renee participated in both the planning aspects and as a key participant, informing the research through her knowledge of EAP in practice. Drawing on photovoice techniques to gather data with hard to reach groups the information was gathered from participants’ images and their photo elicitation interviews. This allowed the narratives of the women’s experiences to be communicated on more than one level. The narratives demonstrated the processes of EAP in action as well as revealing some of the fundamental attributes that make this therapy efficacious. The analysis showed that the interrelationships between the therapist, the horses, the space, the place and the client create a complex ecology. What was evidenced was that for meaningful change to be made, the clients need to feel safe to make those changes. EAP seems to provide a space and place that enables this. The implications of this are the spreading awareness of EAP as an effective modality especially for clients with previous difficulties engaging with therapy.
Understanding alliance ruptures : what do they look like? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
(Massey University, 2013) Rosenblatt, Sara Elisabeth
The Therapeutic Alliance (TA) has a significant impact on treatment outcome. 'Ruptures' - rifts in the client-therapist relationship - threaten TA and carry a number of subsequent risks, including: further drops in TA, interrupted therapeutic progress and a greater likelihood of unilateral client termination. Successfully recognising a rupture may not only prevent these risks, but can provide a target for therapeutic work, and, when accompanied by successful repair, may produce TA levels that surpass prerupture levels. Despite knowledge that ruptures are common to treatment, research has not addressed whether therapists are skilled at recognising and understanding ruptures. This question is thwarted by the more foundational gap in knowledge: there is no description of what a therapist should be looking to recognise. The present research identifies a sampling of rupture indicators (72 items) using an emotion language context. These indicators are stimuli in a card-sorting task completed by two groups of participants: a New Zealand sample (N=33) and a native Japanese one (N=37). Similarity data derived from this task were analyzed using multidimensional scaling (MDS) to produce a unified three-dimensional model that sufficiently represents both samples. The identified dimensions on which rupture indicators are likely to vary are: Interaction Type (i.e. are the indicators a withdrawal or confrontational type), Derivation of Meaning (i.e. is the indicator biologically based or does it convey a socially constructed meaning?), and Subject Focus (is the indicator directed at the other, interpersonal, or at the self, intrapersonal). Also identified in the model were 12 different clusters, or kinds, of rupture indicators (e.g. physically aggressive, verbally defiant, submissive speech content, physiological distress). Conclusions are drawn from this analysis and recommendat5ions follow on ways to further validate this model. Also discussed are applications of this model to enhance training programs for rupture recognition, to improve recognition ability in practice and also to facilitate consistent rupture recognition strategies for research purposes. This may precipitate future research exploring correlations between rupture incidence rates, and presentation types according to therapist and client variables.
An investigation into the effectiveness of a manualised group treatment programme for chronic health conditions : a thesis presented in partial fulfillment of the requirements for the degree of Doctorate in Clinical Psychology at Massey University, Manawatu Campus
(Massey University, 2014) Aranas, Evelyn Myra Friel
Chronic health conditions (CHC) such as cardiovascular disease, diabetes, asthma and chronic obstructive pulmonary disease can have a significant psychological impact. Group interventions designed to treat a heterogeneous range of chronic health conditions that are implemented in a naturalistic clinical setting are scarce. Two manualised group interventions were developed based on a biopsychosocial model framework. The pilot manual was amended from participant and staff feedback, and changes were incorporated into the main well-being manual. The present study aimed to explore the effectiveness of the Manualised Group Treatment Programme. A mixed methods approach was used to investigate whether the Manualised Group Treatment Programme was effective in improving quality of life and reducing distress in clients with a chronic health condition. Participant and clinician experiences of the therapeutic groups were studied. Participants’ quality of life and distress as measured by the Hospital Anxiety and Depression Scale, Outcome Rating Scale and Short Form-12 remained stable. A thematic analysis was conducted following semi structured interviews with six clients who attended either the pilot group or main well-being group and the three clinicians who facilitated the programme. The results identified that participants benefited from realising they were not alone with having a CHC and could relate to others who faced difficulties managing their CHC. Participants implemented skills they learned in the group and improved their communication with their health care professionals. However, they were apprehensive about attending the groups and how they would be perceived by others. Participants used downward social comparisons as a way of feeling better. They perceived other group members to be worse off than them. The clinicians’ beliefs about therapeutic groups’ effectiveness changed from considering one-on-one treatment as the only optimum method for therapy delivery. Their core belief remained focused on meeting client needs. Feedback from the clinicians regarding the effectiveness of the manualised programme was positive. They evaluated the programme as fit for its intended use. This study highlights some of the difficulties in implementing evidence based efficacious therapy as it is applied and practiced in a naturalistic clinical setting. The study’s limitations included the low number of participants, as well as the fact that several participants had previous ongoing individual therapy. This affected group processes and how participants regarded each other and their illness. This study has added to the limited health or psychological treatment group literature within New Zealand as well as contributing to the international knowledge base on group centred treatments for chronic health conditions.
Deconstructing narrative therapy in practice : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
(Massey University, 1999) Nicholl, Patricia Marie
Narrative therapists have made claims as to how a narrative interview or series of interviews should be best structured. This thesis shows, through the analysis of a narrative interview, that these claims represent the practice of narrative therapy. However, several processes that narrative therapists have not explicitly noted as being critical for the successful attainment of the goals of this approach, have emerged as being of fundamental importance. These are the use of positioning, metaphor, indirectness and scaffolding. Their importance lies in that they facilitate an alliance between therapist and client and also minimise the possibility of opposition to the therapeutic process. In addition, they maximise the potential for the development and acceptance of alternative conceptualisations of the self and reality. Furthermore, they actively engage the person in the co-construction of meaning. This increases the likelihood that the newly constructed narrative will be conceptualised as reflecting reality, and as a consequence of this, that it will be acted on as such.
An information system for psychotherapy research using expert commentary of videotaped expertise : a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Information Systems at Massey University
(Massey University, 1997) Carter, Philip Desmond
This project looked at the domain of psychotherapy research and asked the question - How can Information System's technology and methods be applied and developed to serve this domain's current needs? Review of the psychotherapy research literature identified 'astute observation and careful description' as the most productive next step in research efforts. As one response, EXpert Commentary of Videotaped Expertise (EXCOVE) was developed as a Knowledge Elicitation (KE) approach. EXCOVE aims to maximise the quality of observation and description of psychotherapy processes. EXCOVE is the collection of expert commentary on specific videotaped, expertexecuted events. This strategy aims to retain the advantages of open questioning, minimise the possibility of copious and inaccurate data, and trigger and bring to consciousness the viewing expert's cognitive processes. Psychodrama was chosen as the psychotherapy of focus. Six psychodrama sessions totalling seven hours were videotaped and at least four expert commentaries on each session were collected using the EXCOVE approach. A computer system was then required to manage this data and to assist in the various qualitative-type analyses envisaged for the data. However, Computer-Assisted Qualitative Data Analysis Software (CAQDAS) were limited in their abilities to meet these requirements. Therefore, a computer system called Flexible Environment for Research And Learning (FERAL) was developed. FERAL's behaviour was modelled on a sheets-of-paper metaphor which is proposed as an improvement to some aspects of existing CAQDAS. The collected data was managed in a FERAL application and various analysis tasks were completed with facilities developed in FERAL. Five psychodrama topics were investigated - phases, doubling, mirroring, unpredictability, and action. Results of the investigations appeared to provide some useful contributions to the understanding of psychodrama. The results also indicated that data collected using EXCOVE and its various mechanisms were useful. FERAL was found to be useful during analysis, particularly the data co-ordination facilities and the sheets-of-paper interface. The project resulted in a working information system for psychodrama that contained a sufficient amount of data to be useful for analysis of various psychodrama topics. The process of developing an information system for this application domain also resulted in the identification of innovations in KE and CAQDAS and their initial verification in a live application.
In search of the master therapist : emotional competence and client outcome : a thesis submitted in partial fulfilment of the requirements for the degree of Master in Psychology, Massey University, Palmerston North, New Zealand
(Massey University, 2012) de Vries, Ivor
Psychotherapy for clients is an interpersonal, often emotional, process facilitated under guidance from their therapist. Whilst the literature offers some tantalising clues as to which therapist-emotional qualities are beneficial for establishing good working relationships, which tend to lead to positive client change, little is known about which specific emotional skills successful therapists use to achieve this process. The purpose of the present study was to gain insight into how excellent therapists use their emotion in therapy to help clients achieve positive outcomes. Three therapists with high client outcome ratings engaged in semi-structured interviews, and resulting transcripts were analysed using interpretative phenomenological analysis. Participants spoke of genuine congruence in warmth and caring characteristics; sensitivity to client needs; harbouring positive expectations of their therapeutic methods and clients; possessing strong self-reflective and emotion regulation skills; often experiencing strong empathy but moderating their empathic expression; balancing the client relationship and therapeutic process; working collaboratively with their clients; and prioritising client emotional needs over their own. Implications, study limitations and future directions for research are discussed.

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