A successful cognitive-behavioural intervention that failed : a case study of adolescent conduct disorder at a school for the disadvantaged
- Mashalaba, Eugenia D, Edwards, David J A
- Authors: Mashalaba, Eugenia D , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6273 , http://hdl.handle.net/10962/d1008273
- Description: Conduct Disorder (CD) is a widespread problem in southern Africa. The aim of the study was to design, implement and evaluate a multi-modal cognitive-behavioural intervention based on treatments developed overseas, in order to investigate whether this approach can be transported to a South African school for deprived children. The target adolescent had a history of severely disruptive behaviour and was facing expulsion from a shelter for homeless children and his school. A thorough assessment served as the basis for a case formulation and treatment plan. Intervention included 23 individual sessions focussing on bereavement and the learning of self-control skills and prosocial behaviours, as well as contingency management training for school and shelter staff. Progress was tracked with a behaviour checklist completed daily by the teacher and regular interviews with school and shelter staff. After four months, the disruptive behaviour was eliminated. However, he was involved in stealing with some other learners and expelled anyway. Nevertheless the case study provides evidence for the transportability of the cognitive-behavioural approach to this kind of setting and documents the way in which a comprehensive intervention can be tailored to the needs of a child with a severely deprived background and little social support.
- Full Text:
- Date Issued: 2005
- Authors: Mashalaba, Eugenia D , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6273 , http://hdl.handle.net/10962/d1008273
- Description: Conduct Disorder (CD) is a widespread problem in southern Africa. The aim of the study was to design, implement and evaluate a multi-modal cognitive-behavioural intervention based on treatments developed overseas, in order to investigate whether this approach can be transported to a South African school for deprived children. The target adolescent had a history of severely disruptive behaviour and was facing expulsion from a shelter for homeless children and his school. A thorough assessment served as the basis for a case formulation and treatment plan. Intervention included 23 individual sessions focussing on bereavement and the learning of self-control skills and prosocial behaviours, as well as contingency management training for school and shelter staff. Progress was tracked with a behaviour checklist completed daily by the teacher and regular interviews with school and shelter staff. After four months, the disruptive behaviour was eliminated. However, he was involved in stealing with some other learners and expelled anyway. Nevertheless the case study provides evidence for the transportability of the cognitive-behavioural approach to this kind of setting and documents the way in which a comprehensive intervention can be tailored to the needs of a child with a severely deprived background and little social support.
- Full Text:
- Date Issued: 2005
Critical perspectives on research on post-traumatic stress disorder and implications for the South African context
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6228 , http://hdl.handle.net/10962/d1007778
- Description: This article introduces a special issue of the Journal of Psychology in Africa on post-traumatic stress disorder (PTSD) in Africa and particularly in South Africa and examines the critical debate that has surrounded PTSD research. It begins with an examination of the meaning of the term trauma, and of its specialised use within the clinical context and with respect to the concept of PTSD. The diagnostic approach to the detection of PTSD is presented, criteria in the DSM-IV-TR and the ICD-10 are summarised and differences between the two manuals are discussed. Arguments presented by critics of the concept of PTSD are presented and discussed. These concern the historical evolution of the concept, concerns about the universality of PTSD cross-culturally, and problems arising from understanding human suffering from a narrow medical perspective. It is concluded that while there are dangers in thinking of the sequelae of trauma as a medical/psychiatric problem, and while the alarming rate of traumatic events needs to be addressed at the political, economic and societal level, there is an important place for the provision of assessment and treatment of PTSD within a psychiatric/psychological clinical setting.
- Full Text:
- Date Issued: 2005
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6228 , http://hdl.handle.net/10962/d1007778
- Description: This article introduces a special issue of the Journal of Psychology in Africa on post-traumatic stress disorder (PTSD) in Africa and particularly in South Africa and examines the critical debate that has surrounded PTSD research. It begins with an examination of the meaning of the term trauma, and of its specialised use within the clinical context and with respect to the concept of PTSD. The diagnostic approach to the detection of PTSD is presented, criteria in the DSM-IV-TR and the ICD-10 are summarised and differences between the two manuals are discussed. Arguments presented by critics of the concept of PTSD are presented and discussed. These concern the historical evolution of the concept, concerns about the universality of PTSD cross-culturally, and problems arising from understanding human suffering from a narrow medical perspective. It is concluded that while there are dangers in thinking of the sequelae of trauma as a medical/psychiatric problem, and while the alarming rate of traumatic events needs to be addressed at the political, economic and societal level, there is an important place for the provision of assessment and treatment of PTSD within a psychiatric/psychological clinical setting.
- Full Text:
- Date Issued: 2005
From trauma debriefing to trauma support: a South African experience of responding to individuals and communities in the aftermath of traumatising events
- Van Wyk, G, Edwards, David J A
- Authors: Van Wyk, G , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6267 , http://hdl.handle.net/10962/d1008266
- Description: This paper documents the approach and experience of Traumaclinic, a Cape Town based organisation offering a trauma support service. The controversy over single session debriefing interventions is examined and it is concluded that interventions that invite intense emotional expression should not be offered indiscriminately or forced on those who do not want them. When they do occur, they need to be carefully managed and take place over several sessions. A review of contemporary approaches to intervention following trauma highlights their comprehensive and flexible nature and the inclusion of multiple components that are introduced in a manner responsive to the needs of the situation. This is the basis of the current model used by Traumaclinic. The principles of that model are summarised and examples given of the application of the approach to specific cases.
- Full Text:
- Date Issued: 2005
- Authors: Van Wyk, G , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6267 , http://hdl.handle.net/10962/d1008266
- Description: This paper documents the approach and experience of Traumaclinic, a Cape Town based organisation offering a trauma support service. The controversy over single session debriefing interventions is examined and it is concluded that interventions that invite intense emotional expression should not be offered indiscriminately or forced on those who do not want them. When they do occur, they need to be carefully managed and take place over several sessions. A review of contemporary approaches to intervention following trauma highlights their comprehensive and flexible nature and the inclusion of multiple components that are introduced in a manner responsive to the needs of the situation. This is the basis of the current model used by Traumaclinic. The principles of that model are summarised and examples given of the application of the approach to specific cases.
- Full Text:
- Date Issued: 2005
Post-traumatic stress disorder as a public health concern in South Africa
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6229 , http://hdl.handle.net/10962/d1007779
- Description: This article briefly surveys the extent to which traumatic events are a feature of life all over Africa and provides a comprehensive review of research that documents the pervasiveness of traumatic events in South Africa and the prevalence of PTSD symptoms. The material reviewed includes statistics on crime, violence and accidents, research from clinical settings, and surveys. Several provide evidence for the causal link between traumatic events and the development of PTSD. These studies show that PTSD has been and continues to be a significant problem for public health in South Africa, affecting individuals in all sectors of society and as much a concern with respect to children as to adults.
- Full Text:
- Date Issued: 2005
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6229 , http://hdl.handle.net/10962/d1007779
- Description: This article briefly surveys the extent to which traumatic events are a feature of life all over Africa and provides a comprehensive review of research that documents the pervasiveness of traumatic events in South Africa and the prevalence of PTSD symptoms. The material reviewed includes statistics on crime, violence and accidents, research from clinical settings, and surveys. Several provide evidence for the causal link between traumatic events and the development of PTSD. These studies show that PTSD has been and continues to be a significant problem for public health in South Africa, affecting individuals in all sectors of society and as much a concern with respect to children as to adults.
- Full Text:
- Date Issued: 2005
The experiences and needs of HIV/AIDS counsellors at a South African hospital
- Nulty, Maria, Edwards, David J A
- Authors: Nulty, Maria , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6269 , http://hdl.handle.net/10962/d1008268
- Description: To increase the availability of HIV/AIDS counselling in South Africa, nurses have been trained to serve as counsellors within hospital services. The aim of the study was to document the experiences and needs of nurse HIV/AIDS counsellors at a small South African hospital (with 279 beds and 10 medical doctors on the staff). The design was a qualitative, multiple-case study. The sample consisted of four nurse counsellors and the co-ordinator of HIV/AIDS services at the hospital. Three semi-structured interviews with the counsellors were used as the basis for case narratives of their experiences. These narratives were in turn subjected to content analysis to determine the range and nature of the concerns identified by the counsellors. The counsellors found their HIV/AIDS counselling work to be emotionally demanding and identified several significant problems. These were related to confidentiality, stigmatisation, motional responses to informing clients of their HIV-positive status, cultural and contextual factors and situational stressors related to the organisation of the work environment. They did not feel sufficiently supported by their work infrastructure. It is recommended that in setting up counselling services of this sort, managers need to be aware of the need for ongoing support in the form of facilitated groups, professional supervision, managerial attention to problems in the working environment, and regular in-service training.
- Full Text:
- Date Issued: 2005
- Authors: Nulty, Maria , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6269 , http://hdl.handle.net/10962/d1008268
- Description: To increase the availability of HIV/AIDS counselling in South Africa, nurses have been trained to serve as counsellors within hospital services. The aim of the study was to document the experiences and needs of nurse HIV/AIDS counsellors at a small South African hospital (with 279 beds and 10 medical doctors on the staff). The design was a qualitative, multiple-case study. The sample consisted of four nurse counsellors and the co-ordinator of HIV/AIDS services at the hospital. Three semi-structured interviews with the counsellors were used as the basis for case narratives of their experiences. These narratives were in turn subjected to content analysis to determine the range and nature of the concerns identified by the counsellors. The counsellors found their HIV/AIDS counselling work to be emotionally demanding and identified several significant problems. These were related to confidentiality, stigmatisation, motional responses to informing clients of their HIV-positive status, cultural and contextual factors and situational stressors related to the organisation of the work environment. They did not feel sufficiently supported by their work infrastructure. It is recommended that in setting up counselling services of this sort, managers need to be aware of the need for ongoing support in the form of facilitated groups, professional supervision, managerial attention to problems in the working environment, and regular in-service training.
- Full Text:
- Date Issued: 2005
Trauma, imagery and the therapeutic relationship : Langu's story
- Karpelowsky, Belinda J, Edwards, David J A
- Authors: Karpelowsky, Belinda J , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6268 , http://hdl.handle.net/10962/d1008267
- Description: This paper, a phenomenological case study, describes the psychotherapy of Langu (pseudonym), a 21-year-old student, who presented with Acute Stress Disorder following a series of motor accidents that affected him and his family. Langu's most distressing experience was having to identify his brother's mutilated and severely burned body. Because of the intensity of the intrusive re-experiencing of traumatic imagery and the degree of dissociative numbing, Langu participated in four intensive guided imagery sessions, which involved reliving the incident, and imaginal dialogues with his dead brother. Session records and supervision notes from the therapy process that unfolded over 22 sessions served as the basis for a thematically selective case narrative. Additional material was obtained from several research interviews with Langu over the following months. The narrative highlights the impact of the imagery work as well as relational aspects of the therapy. The case narrative provides a source for examining many aspects of the psychological impact of trauma and the path to healing, as well as the dilemmas and challenges faced by therapists working with traumatised individuals.
- Full Text:
- Date Issued: 2005
- Authors: Karpelowsky, Belinda J , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6268 , http://hdl.handle.net/10962/d1008267
- Description: This paper, a phenomenological case study, describes the psychotherapy of Langu (pseudonym), a 21-year-old student, who presented with Acute Stress Disorder following a series of motor accidents that affected him and his family. Langu's most distressing experience was having to identify his brother's mutilated and severely burned body. Because of the intensity of the intrusive re-experiencing of traumatic imagery and the degree of dissociative numbing, Langu participated in four intensive guided imagery sessions, which involved reliving the incident, and imaginal dialogues with his dead brother. Session records and supervision notes from the therapy process that unfolded over 22 sessions served as the basis for a thematically selective case narrative. Additional material was obtained from several research interviews with Langu over the following months. The narrative highlights the impact of the imagery work as well as relational aspects of the therapy. The case narrative provides a source for examining many aspects of the psychological impact of trauma and the path to healing, as well as the dilemmas and challenges faced by therapists working with traumatised individuals.
- Full Text:
- Date Issued: 2005
Trauma, resilience and vulnerability to PTSD : a review and clinical case analysis
- Edwards, David J A, Sakasa, P, Van Wyk, G
- Authors: Edwards, David J A , Sakasa, P , Van Wyk, G
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6230 , http://hdl.handle.net/10962/d1007780
- Description: This article begins with two case examples of a girl and an adolescent who were raped and developed chronic PTSD. These are used as a basis for understanding the role of a range of factors that are associated with resilience and vulnerability in the face of traumatic events. A literature review examines the proportion of individuals who develop PTSD following trauma and the factors associated with vulnerability and resilience. These include gender, developmental factors, social support and personality factors. Psychological factors associated with maintenance of chronic PTSD are also briefly reviewed. This material is used as a basis for reconsidering the case examples. Each case is formulated within a framework based on sources of vulnerability and qualities of resilience. Approaches to intervention are suggested that could address the range of factors making the individuals vulnerable to chronic psychological problems and support resiliency and recovery.
- Full Text:
- Date Issued: 2005
- Authors: Edwards, David J A , Sakasa, P , Van Wyk, G
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6230 , http://hdl.handle.net/10962/d1007780
- Description: This article begins with two case examples of a girl and an adolescent who were raped and developed chronic PTSD. These are used as a basis for understanding the role of a range of factors that are associated with resilience and vulnerability in the face of traumatic events. A literature review examines the proportion of individuals who develop PTSD following trauma and the factors associated with vulnerability and resilience. These include gender, developmental factors, social support and personality factors. Psychological factors associated with maintenance of chronic PTSD are also briefly reviewed. This material is used as a basis for reconsidering the case examples. Each case is formulated within a framework based on sources of vulnerability and qualities of resilience. Approaches to intervention are suggested that could address the range of factors making the individuals vulnerable to chronic psychological problems and support resiliency and recovery.
- Full Text:
- Date Issued: 2005
Treating PTSD in South African contexts : a theoretical framework and a model for developing evidence-based practice
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6231 , http://hdl.handle.net/10962/d1007781
- Description: Several psychological factors contribute to the development and maintenance of post-traumatic stress disorder (PTSD) because they interfere with the emotional processing of the traumatic event. These include problematic and painful emotions such as anxiety, shame, guilt and grief, distorted or dysfunctional cognitions, and cognitive, emotional, and behavioural avoidance mechanisms. Analysis of these maintaining factors provides the basis for current approaches to treatment which support traumatised individuals in facing emotional pain, working to resolve shame, grief and guilt, and expanding existing schemas to accommodate the traumatic event(s). Randomised controlled trials (RCTs) are reviewed in which the efficacy of some of these treatments have been evaluated. While many South African practitioners are familiar with current evidence-based approaches and are skilled at adapting them to local cultural and contextual conditions, a great deal still needs to be done to build a sound research base for local practice in the treatment of PTSD and disseminating that research to practitioners in the field. It is recommended that a case-based evaluation strategy be used to complement the findings of international RCT studies in order to build a foundation of locally contextualised and applicable scientific knowledge.
- Full Text:
- Date Issued: 2005
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6231 , http://hdl.handle.net/10962/d1007781
- Description: Several psychological factors contribute to the development and maintenance of post-traumatic stress disorder (PTSD) because they interfere with the emotional processing of the traumatic event. These include problematic and painful emotions such as anxiety, shame, guilt and grief, distorted or dysfunctional cognitions, and cognitive, emotional, and behavioural avoidance mechanisms. Analysis of these maintaining factors provides the basis for current approaches to treatment which support traumatised individuals in facing emotional pain, working to resolve shame, grief and guilt, and expanding existing schemas to accommodate the traumatic event(s). Randomised controlled trials (RCTs) are reviewed in which the efficacy of some of these treatments have been evaluated. While many South African practitioners are familiar with current evidence-based approaches and are skilled at adapting them to local cultural and contextual conditions, a great deal still needs to be done to build a sound research base for local practice in the treatment of PTSD and disseminating that research to practitioners in the field. It is recommended that a case-based evaluation strategy be used to complement the findings of international RCT studies in order to build a foundation of locally contextualised and applicable scientific knowledge.
- Full Text:
- Date Issued: 2005
Unconscious influences on discourses about consciousness : ideology, state-specific science and unformulated experience
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6226 , http://hdl.handle.net/10962/d1007776
- Description: Discussions about consciousness are complicated by the fact that participants do not share a common underlying “ordinary” consciousness. Everyday experience is founded on what Teasdale calls implicational cognition, much of which is not verbally formulated. An unacknowledged aspect of debate is individuals’ attempts to negotiate the expression of their unformulated experience. This is further complicated by the way in which a discourse, based on particular ontological assumptions, exercises an ideological control which limits what underlying aspects of experience can be formulated at all. Tart’s concept of state specific sciences provides a framework within which the role of unformulated experience can be acknowledged and taken into account. Unless this is done, debates will be vitiated by participants engaging in ideological struggles and talking at cross-purposes.
- Full Text:
- Date Issued: 2005
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6226 , http://hdl.handle.net/10962/d1007776
- Description: Discussions about consciousness are complicated by the fact that participants do not share a common underlying “ordinary” consciousness. Everyday experience is founded on what Teasdale calls implicational cognition, much of which is not verbally formulated. An unacknowledged aspect of debate is individuals’ attempts to negotiate the expression of their unformulated experience. This is further complicated by the way in which a discourse, based on particular ontological assumptions, exercises an ideological control which limits what underlying aspects of experience can be formulated at all. Tart’s concept of state specific sciences provides a framework within which the role of unformulated experience can be acknowledged and taken into account. Unless this is done, debates will be vitiated by participants engaging in ideological struggles and talking at cross-purposes.
- Full Text:
- Date Issued: 2005
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