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    How psychologists view and engage with competence in their practice : 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, 2018) Taylor, Kristin
    The purpose of this study was to gain insight into how psychologists view and engage with competence and identify the factors that they determine as supporting or inhibiting competent practice. To date, few studies have examined the elements psychologists identify as shaping the development of their professional competence. It is hoped by doing so, strategies can be implemented that develop, maintain, and enhance competence and encourage active participation in the Continuing Competence Programme (CCP). Having an agreed definition of the qualities required to be competent is essential to evaluate, improve, and ensure quality assurance in psychological practice. Ten psychologists from the clinical and industrial organisational scopes participated. Semi-structured interviews were used; questions were designed to act as prompts and to ensure no relevant themes were overlooked. The interviews were recorded then transcribed and analysed using thematic analysis. Results indicated that while the participants understood the meaning of competent practice, how they relate that to their practice and how this influences their participation in the CCP varies. The participants discussed the value of, and the challenges associated with, achieving, demonstrating, and measuring competence and the consequences this has on their practice, their clients and themselves. They also identified factors that encourage, develop, and maintain competence and those factors that are threats to competence. It is essential to understand how an individual perceives competence as this will determine how they view and engage with competence in their practice. Understanding this will assist with competency development, maintenance, measurement and demonstration across the professional lifespan.
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    Why am I here, and what is here anyway? : a social constructionist window into clinical psychology : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2001) Adam, Dean
    Understandings of why people enter into careers as clinical psychologists are underdeveloped. This thesis uses a social construction perspective to explore the question of how clinical psychology students explain their career choice, and in particular how expectations and understandings of a career in clinical psychology are constructed as influencing such a decision. Interview transcripts from six clinical psychology students were analysed using a combined methodology of Heideggerian hermeneutics and discourse analysis of a thematic nature. The themes developed outline how the participants constructed clinical psychology, the process of choosing such a career, related professions, what it meant to 'be' a clinical psychologist, and other peoples' perceptions of clinical psychology. The conclusion of these findings suggest the need for multidisciplinary awareness in the training of clinical psychologists, the need for an increased focus on long term career satisfaction and goal achievement, and attention to the education of the public about the role and utility of clinical psychology.
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    An investigation of the outcomes of psycho-oncology interventions : a thesis presented as partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2010) Croy, Philippa
    Cancer can have a significant psychological impact on those diagnosed, and their families. The ability of psychotherapy to reduce this impact has been extensively studied internationally. However, New Zealand-based research in this area remains limited. The present study aimed to investigate the effectiveness of psycho-oncology interventions, provided by a New Zealand psycho-oncology service, in reducing distress and improving quality of life for cancer patients and their families/whanau. Eighteen clients (patients/family members) of the service (intervention group) were recruited and matched for initial distress and wellbeing with patients/family members located in an area without a psycho-oncology service (control group). Wellbeing, wairua (spirituality), distress, impact and coping were measured pre- and posttherapy, and at follow-up. In addition, eight intervention group participants were interviewed to examine their experiences of cancer and the psychooncology service. Possible key factors influencing the effectiveness of service interventions were also investigated. The results showed that participants who had access to the psycho-oncology service showed significant improvements in all outcome measures by the end of therapy. The majority of these were maintained 3 months later. Improvements were also observed in the control group. Reasons for accessing therapy centred on diagnosis/prognosis concerns, communication with family, and talking to a non-family member about their worries. Although clients had no specific expectations prior to therapy, previous psychotherapy experiences influenced their perceptions of its potential effectiveness. Therapists’ personal and professional qualities were also viewed as crucial. Five key themes were identified as most beneficial - receiving individualised support, talking to someone who was not family, receiving expert/professional support, regaining a sense of control, and service availability/flexibility. Overall, psycho-oncology interventions had a significantly positive impact on clients’ lives, and were viewed as being extremely beneficial for those experiencing cancer-related distress. This research provides a unique contribution to the limited psycho-oncology research in New Zealand.
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    The expectations of experienced and novice clinical psychologists regarding course of change for clients undertaking successful cognitive behavioural psychotherapy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2011) Fletcher, Amber; Fletcher, Amber
    The present study explored the expectations of both experienced clinicians and clinical psychology students when predicting the course of change for both a depressed client and an anxious client undertaking successful cognitive behavioural therapy (CBT). Experienced clinicians and clinical psychology students were asked to complete a task based on case study scenarios. A specially designed graph enabled participants to plot scores for three separate measures: an inventory for mood, an inventory for symptoms and a behavioural record of activities. The course of change in psychotherapy, whilst being an important component to understanding the process of outcome in psychotherapy, has received little attention from researchers. Although there has been a growing emphasis on the need to measure outcomes and provide feedback, a unified understanding of the course of change has not been identified. A number of theories have suggested stages of motivation and an individual‘s likely process of assimilating problematic experiences, however these are largely based on group data, and do not take into account individual characteristics. This study therefore aimed to explore the course of change expected in successful CBT (the dominant theoretical orientation used amongst New Zealand clinicians) to identify the expected change patterns between clinicians and students, and their meaning. It also aimed to identify relationships between mood, symptom and behaviour during the therapeutic process, and determine key aspects that act as a basis for future research in this area. Findings showed that overall participants predicted a gradually declining linear progression, although differences in variance and trends were found between and within the clinician and student groups. Limitations, implications and future directions of this study are also discussed.
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    Predicting offending within the New Zealand youth justice system : evaluating measures of risk, need, and psychopathy : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Wellington, New Zealand
    (Massey University, 2010) Mooney, Nicholas Patrick
    Youth offending in New Zealand is an often touted problem. The reality is that, although many young people break the law as part of normal adolescent behaviour, the number of youth committing antisocial acts has decreased over the past decade. There is however one exception. The number of young people who exhibit patterns of persistent, chronic and violent offending behaviour is increasing. Recent theoretical approaches have attempted to conceptualise these complex young people by considering the numerous interacting causal factors associated with their offending. These models can inform appropriate assessment, treatment, and prevention strategies. To date, social learning models incorporating risk and need factors have been the best supported. However, new developmental approaches have also been applied, including the downward extension of psychopathy: an adult personality disorder associated with recidivistic offending and treatment non-compliance. Based on these theories, promising new actuarial risk assessment measures have been developed. These measures are being increasingly employed by youth justice systems internationally as a means of identifying and case managing persistent and serious offenders. However, these measures are not widely used in New Zealand, and virtually none have been empirically examined with New Zealand youth. This gap in evidence-based practice is perplexing given the international recognition and respect afforded to New Zealand’s youth justice system. The current study therefore sets a number of objectives. Firstly, it aimed to identify a profile of youth offenders across the New Zealand youth justice system by providing data on demographics, offending behaviours, education/ employment status, and mental health using the Massachusetts Youth Screening Inventory - 2 (MAYSI-2). Secondly, the study evaluated the predictive validity of three assessment measures of youth offending. These measures were the Youth Level of Service/ Case Management Inventory (YLS/CMI), the Youth Psychopathic Traits Inventory (YPI), and the Inventory of Callous/ Unemotional Traits (ICU). Finally, the study explored the utility of these measures within a restorative justice system whereby limited resources could be matched to those most at risk of re-offending. Using a prospective study design, two samples aged between 14 and 17 were selected. These samples represented youth offenders at two opposing ends of the youth justice system. The “Diversion” sample initially consisted of 70 youth offenders whose matters had been diverted by Police Youth Aid Officers in Counties-Manukau. All measures were administered during a 90-minute initial assessment phase. After 6-months, 63 (90%) were followed up to complete a self-report measure of offending behaviour committed since the first assessment. The “Clinical” sample initially consisted of 59 youth offenders who had been referred for a psychological assessment by a Youth Court within the Auckland region. The YLS/CMI was part of the assessment process. A total of 44 (75%) of the clinical participants were followed up after six-months. All measures, including the self-reported offending measure, were administered to this cohort. Male gender, Māori ethnicity, and previous police contact were overrepresented within both samples. Approximately 40% of participants from both samples were either not attending school or were unemployed. Theft and dishonesty index offences were the most prevalent for both samples, however nearly 60% of the clinical sample was charged with a violent offence. The MAYSI-2 mental health screen revealed that approximately half of both samples scored on the Caution range or above for Alcohol/ Drug Use, while over 30% of both samples reported difficulties with Anger and Irritability. Over 60% of the Clinical sample received a formal clinical diagnosis, with conduct disorder and substance use disorders being the most prevalent. The two samples were merged to describe the results of the assessment measures. The YLS/CMI total produced fair internal consistency (α = .79). Total scores from the Clinical sample were significantly higher than the Diversion sample. Internal consistency was excellent for the YPI (α = .92) and fair for the ICU (α = .77). There were no significant differences in scoring between the two samples on these psychopathy measures. All three risk measures correlated with each other; while the re-test reliability of the YLS/CMI was significant (.79). Māori ethnicity was associated with higher total scores on the YLS/CMI and the YPI. Māori youth were also more likely to come into police contact during the six-month follow-up period. Medium to large associations were found between the three risk assessment measures and the seriousness of self-reported offences, contact with police, and contact with the youth court. Binary logistic regression, multiple regression, and Receiver Operator Curve (ROC) analyses confirmed the overall predictive validity of three measures, however the YLS/CMI total score was superior to the psychopathy screening measures across all analyses. Finally, results show that many participants who scored highly on the YLS/CMI received a higher level of intervention service during the follow-up period. However, a similar number of high risk youth received little or no services. It was concluded that the YLS/CMI, the YPI, and the ICU have a high level of predictive validity over a short time frame. These findings have direct implications for assessment, prevention, and intervention practices. However, it is argued that new assessment measures relevant to both restorative justice practices and New Zealand’s youth offenders be developed that compensate for the limitations of these generic international measures. Overall, this research has been successful in adding to the accumulating literature on youth offender risk assessment, as well as the conceptualisation of psychopathic traits within youth.
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    The role of homework assignments in cognitive and behavioral therapies : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
    (Massey University, 2000) Kazantzis, Nikolaos; Kazantzis, Nikolaos
    Homework assignments have long been considered crucial within cognitive and behavioral treatment formulations. A large number of commentary articles have suggested that when homework is administered systematically, client homework adherence and successful therapy outcome can be enhanced over and beyond the effects in cognitive and behavioral therapies. However, despite the apparent importance of homework, the relationship between homework assignments and outcome is a relatively uninvestigated aspect of therapy. Only a few studies have examined homework's effect on outcome in therapy, and little is currently known about its use in everyday clinical practice. This dissertation is an attempt to evaluate the findings of prior research, determine methodological limitations, and examine the role of homework assignments in promoting positive change in cognitive behavioral therapies. This dissertation starts with a description of the theoretical and practical rationale for the use of homework assignments in therapy. The results of a practitioner survey designed to investigate the use of homework assignments in clinical practice are next presented (Study 1). This is followed by a power survey of the statistical sensitivity among prior empirical research designed to examine the relationship between homework assignments and outcome (Study 2), and a meta-analytic aggregation designed to quantify the magnitude of homework's effect in cognitive and behavioral therapies (Study 3). Finally, the dissertation describes the results of an empirical study designed to examine the role of systematic homework administration and homework performance in predicting therapeutic change (Study 4).
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    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.
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    Client and clinician experiences of dialectical behaviour therapy : a discourse analysis : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, New Zealand
    (Massey University, 2010) Simons, Melanie K M
    Dialectical Behaviour Therapy (DBT) is recommended as the treatment of choice for people with borderline personality disorder (BPD) in New Zealand. This research presents four studies examining the experience of DBT. Discourse analysis was used to examine 27 clinical journal articles with the aim of identifying discourses about BPD and DBT likely to be read by practising clinicians. A second study examined interview data from five practising DBT clinicians in a New Zealand District Health Board (DHB). The third study looked at interview data from five clients, who were undertaking the DBT programme at the same DHB. A fourth study used three case studies to discuss client changes in mindfulness and quality of life, as they participated in DBT. The discourses associated with BPD were of BPD as an illness, as a stigmatising label with connotations of a difficult client group, as a means of ‘making sense’ of the clients’ experience, and as emotion dysregulation and a skills deficit. DBT was constructed as providing skills which enabled clients (and clinicians) to manage distress in their lives. Clients described themselves as changing in a fundamental way, and assuming new identities, which was a frightening (albeit positive) process. DBT was constructed as well researched and theory based, and as a coherent whole which was also divisible into functional elements. Clients and clinicians were found to utilise different discourses to position themselves and to validate their behaviour in various situations. DBT was constructed as helpful within all the studies, and was promoted as a worthwhile therapy by all participants.
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    Te huanga o te ao Maori : Cognitive Behavioural Therapy for Maori clients with depression : development and evaluation of a culturally adapted treatment programme : a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2009) Bennett, Simon Te Manihi
    A manualised cognitive behavioural therapy (CBT) programme was culturally adapted for use with adult Maori clients with depression who were receiving treatment from Te Whare Marie, a Maori Mental Health service that covers the greater Wellington region. The manual was developed in consultation with local and international literature pertaining to CBT with minority groups and the recommendations of an advisory team. The treatment programme integrated significant Maori concepts with the traditional strategies associated with CBT. The intervention was trialled with 16 Maori clients from Te Whare Marie with a primary diagnosis of depression. Case study and group analysis indicated that the adapted intervention was effective in reducing depressive symptomatology and negative cognition, and increasing general wellbeing in four culturally relevant dimensions. Differences between pre- and post- treatment scores were statistically significant in each of these areas. The intervention did not have a significant impact on the construct of cultural identity. Participants expressed high levels of satisfaction with the treatment, and in general the adaptations were positively received. Treatment was characterised by particularly low dropout rates with 15 of the 16 participants attending seven or more sessions. These results were discussed with reference to their implications for effective delivery of clinical service delivery to Maori consumers of mental health services in New Zealand.