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    The surviving emotional storms programme : a service user informed programme developed from an exploratory study of help-seeking experiences of NZ tertiary students with Borderline Personality Disorder : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2023-04-11) Beckett, Jennifer Jean
    In this qualitative thesis, 14 university students were interviewed about their lived experience of having Borderline Personality Disorder. Participants discussed arduous journeys in search of effective treatment and described their increasing risk while trying to access help, alongside their experiences when able to access publicly funded treatment. Results from thematic analysis highlighted a super-theme of a continuous invalidation loop, discussed from an ecological and attachment perspective. This started with early help-seeking invalidation in participants’ microsystems, with the loop then broadening across systems over time, and help seeking attempts. This included contact with the mental health system, which was suggested to be a perpetuating factor in the development and maintenance of Borderline Personality Disorder. The help-seeking invalidation loop was briefly interrupted when participants were diagnosed, which occurred for most, directly after a suicide attempt. Diagnosis brought temporary relief, when participants armed themselves with knowledge about the condition including prognosis and treatment. The validation from informed diagnosis aided an externalisation process to occur, enhancing connections with self and others. However, accessing treatment proved difficult, crisis and respite was perceived as invalidating and when in treatment participants’ attempts at connection were often thwarted. Results from the thematic analysis guided the design and delivery of a group intervention. The intervention was administered using an action research methodology to university students either diagnosed with Borderline Personality Disorder or with borderline traits. The intervention, an adaptation from traditional dialectic behavioural therapy, integrated the results from the thematic analysis. To address the super-theme findings, attachment theory was interspersed throughout the intervention, utilizing aspects of narrative and acceptance and commitment therapies. The intervention was adapted and evolved from participant feedback over six cycles of 12-session intervention groups. In each group participants reported reduced severity of borderline symptoms and increased mindfulness ability. The research took place prior to and during the global pandemic and Covid-19 mandatory lockdowns in NZ, during which the research was expanded to finish with an online intervention accessed by students across NZ.
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    Women's Refuge clients' experiences of social responses to domestic violence including interventions informed by response-based practice : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2018) Reedy, Jessica Juliet
    In Aotearoa New Zealand, transformation in thinking about and acting to prevent domestic violence is exigent. Response-Based Practice (RBP) provides a transformational framework for ethical social responses for families experiencing violence. RBP attends to ways discursive practices undermine or support victim safety and dignity. The current research involved developing, delivering, and evaluating a RBP group intervention at Women's Refuge. Evaluation privileged women's accounts of the intervention and entailed comparing discourses clients utilised to inform their understandings of violence and position themselves before and after Group participation. Implications of clients' positioning for enabling or constraining their safety and dignity are also considered. The project's design used feminist collaborative action research principles, and thematic analysis in the first study to develop the intervention. Five advocates were engaged in meetings, semi-structured interviews, document reviews, and focus groups. The second study used discourse analysis of women's pre- and post- intervention accounts of their domestic violence experiences and social responses to them. Four clients engaged in semi-structured interviews. Before Group participation, discourses that minimised and mutualised violence predominated, positioning victims as instrumental in provoking and preventing violence, and victims and perpetrators as pathological. Languaging often represented perpetrators' violence as accidental/uncontrollable and concealed victim resistance. Narratives engaged traditional gender discourses of men's dominance, encompassing coercive control and violence, and women's submission and self-sacrifice, as normative. Women's entrapment by victim-blaming discourses alongside threats of poverty and condemnation from perpetrators, families, church and social agencies was evident. Following Group participation, resistance discourses prevailed. Clients challenged their positioning as pathological or blameworthy and re-positioned themselves as sensible, competent women. Group content and processes were constituted as privileging and legitimating women's unarticulated knowledge of how concealing violence, perpetrator responsibility and gendered social power relations diminish victims' safety. Narratives of domestic violence evinced increased recognition of patterns of coercive control, entrapment and other non-assaultive violence intersecting with harmful social responses and structural violence. Thus, the Group provided a safe and dignifying social and physical space for clients to collectively reconsider their responses to violence; and discover, discuss, and critique discursive practices that reveal violence, perpetrator responsibility, and victim resistances.
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    "Help yourself to CBT" : mechanisms of change within a group guided self-help programme targeting low mood in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Albany, New Zealand
    (Massey University, 2015) Forman, Inga
    This thesis explores the processes of change within a Low Intensity Cognitive Behaviour Therapy (LICBT) intervention targeting low mood in a community sample of adults in New Zealand. Low intensity interventions (e.g. self-help programmes) are a relatively new area of interest in the area of psychological treatment. They aim to increase people’s access to evidence based methods of therapy whilst removing many of the major issues associated with traditional treatment methods, such as long waiting lists, financial limitations, and inaccessibility to many in the wider community (Lovell & Richards, 2000). LICBT interventions have been shown to significantly improve outcomes for mild to moderate depressive symptoms across different samples (McKendree-Smith, Floyd & Scogin, 2003). The current study assessed change processes within the guided self-help programme ‘Living life to the Full’ (LLTTF, Williams, 2008). Due to methodological issues, the study was not able to soundly address hypotheses regarding the effectiveness of the programme. However, the statistical significance of changes across outcome measures were examined along with their clinical significance at an individual level. Participants showed statistically significant reductions in psychological distress from baseline to post-programme. Results for depression and quality of life were not significant. When results were examined at a single case level for clinical significance, a number of participants showed clinically significant change across the three main outcome measures. An analysis of individual change processes was also completed, with the examination of early rapid response patterns for individual participants. Early rapid response patterns occurred for a number of participants, supporting preliminary evidence that certain change patterns apparent in CBT research may also occur in LICBT interventions. A link was also found between early rapid responding and more positive post programme outcomes. Group process results showed that as predicted, the low intensity nature of the programme is likely to have affected the perceived group environment and relationship to the group facilitator. The LLTTF programme was positively evaluated by the majority of programme completers and though the sample size was small, results suggest this type of intervention is an effective platform from which to further develop low intensity therapeutic paradigms in New Zealand.
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    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.
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    Comparing group-based interventions in older adults with subjective memory difficulties : a dissertation presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology, Massey University, Wellington, New Zealand
    (Massey University, 2014) Sothieson, Veena
    The trend internationally and within New Zealand is of an increasing aging population, with numbers of those with dementia projected to increase rapidly. One way to address this issue is to consider the practical and clinical benefits of running memory intervention groups for older adults with memory difficulties/impairment. The current study intended to address some of the limitations found in memory intervention literature by (a) using a social control group as a control comparison, which has not been done before, and (b) separating out components of memory training interventions (i.e., memory strategies and lifestyle education). Therefore, the aim was to determine the extent to which receiving Memory intervention separately from a Lifestyle Education intervention would affect memory functioning in older adults with subjective memory difficulties, when compared with a social control condition. Participants for the intervention group were recruited from rest homes and retirement villages, while social control participants were community-dwelling older adults already taking part in weekly community group activities. A brief cognitive screen and subjective outcome measures were administered at baseline, post Phase 1, post Phase 2, and at six month follow-up. Quantitative and qualitative information from a total of 13 participants were analysed. Results from each of the outcome measures across the four time points indicated that there were no significant benefits of receiving Memory and/or Lifestyle Education interventions, when compared with a social control condition. However, a small sample size, non-equivalent groups, and lack of random assignment were some of the limitations which made it difficult to reach definite conclusions. Content analysis of qualitative information following intervention sessions provided some valuable considerations for running memory groups in future. In light of its limitations, the current study highlights practical considerations and recommendations for future research in this area. In particular, it identifies the value of conducting memory intervention research with older adults in residential care settings.