Medfølelsesfokusert terapi. På hvilken måte har Medfølelsesfokusert terapi (CFT) fått betydning for faglig utvikling hos behandlere innen psykisk helsevern?

Jeg har i denne kvalitative studien hatt til hensikt å finne ut hvilke erfaringer mine informanter har ved å praktisere medfølelsesfokusert terapi, og hvordan denne metoden har hatt betydning for deres faglige og personlige utvikling i arbeidet som terapeut i psykisk helsevern. Studien er vitenskapsfilosofisk forankret i en fenomenologisk-hermeneutisk tradisjon. Det kvalitative forskningsintervjuet er blitt brukt, og funnene analysert ved hjelp av Kirsti Malteruds systematiske tekstkondensering (STC). Funnene er drøftet opp mot teorien bak Medfølelsesfokusert terapi (CFT), utviklet av Paul Gilbert. Supplert med teori om nyere psykodynamisk relasjonsforståelse, Katie Erikssons vårdvitenskap og Kari Martinsens omsorgsetikk. Funnene avdekker tre hovedtema: Å ta vare på seg selv, Å være et medmenneske i relasjonen og Likeverd. Behandleres egen erfaring med medfølelsesfokusert terapi har ført til at de er mer bevisst på å støtte seg selv, de er mindre selvkritiske og modigere i terapirommet. De beskriver at de møter pasienten med mer nærvær, ømhet og kjærlighet. Pasient-behandlerforholdet blir betegnet som å møtes i felles menneskelighet, noe som bidrar til at avstanden mellom behandler og pasient reduserer. Metoden oppleves av behandleren som en integrert tenke- og handlemåte. Det tas stilling til samfunnet vi lever i, og betydningen av å utøve medfølelse og kjærlighet både i terapirommet og utenfor

«Sterkere sammen» En kvalitativ studie av foreldres opplevelse av eventuelle endringer i parforholdet etter deltakelse på foreldrekurset Emosjonsfokusert ferdighetstrening for foreldre

«Emosjonsfokusert ferdighetstrening for foreldre (EFST)» er et kurs for foreldre hvor fokus er å understøtte barns emosjonelle utvikling, blant annet gjennom kunnskap om emosjoner og viktigheten av å validere følelsene. I denne kvalitative studien undersøkes om foreldre erfarer påvirkning på parforholdet etter deltakelse på foreldrekurset. Studiens problemstilling er: «Hva forteller par om deres parforhold etter deltakelse på foreldrekurset Emosjonsfokusert ferdighetstrening for foreldre?» Følgende forskningsspørsmål vil belyse problemstillingen: o Hva beskriver paret med tanke på eventuell påvirkning av deres emosjonelle forhold? o Hvordan beskriver paret deres kommunikasjon etter deltakelse? o Hvilke refleksjoner/erfaringer beskriver paret om eventuelle endringer i seg selv eller ved partner? For å belyse problemstillingen og forskningsspørsmålene ble det gjennomført analyse inspirert av systematisk tekstkondensering, modifisert av Malterud (Malterud, 2017). I studien er det gjennomført semistrukturerte intervju med fire foreldrepar, som alle hadde avsluttet kurset Emosjonsfokusert ferdighetstrening for foreldre (EFST) i løpet av det siste året. Funnene beskrives med en systemisk og sosialkonstruksjonistisk tilnærming til teori og epistemologi, med en vitenskapsteoretisk forankring innen fenomenologi og hermeneutikk. Det ble analysert frem tre resultatkategorier: 1) Oppvåkning - en oppvåkning med tanke på betydningen av å utvikle et felles språk som har bidratt til økt forståelse og meningsdannelse, en økt følelsesbevissthet og forståelse av egne tilknytningshistorier 2) En utvidelse av parets narrativ 3) Å skape felles mening. Studien diskuterer det empiriske materialet ut fra tidligere aktuell forskning, og utvalgt teori med hovedfokus på sosialkonstruksjonisme, kommunikasjonsteori, narrativer og diskurser, tilknytning og emosjonsfokusert terapi. Funnene tyder på at parene som deltok på kurs opplevde en positiv effekt på parforholdet, både i forhold til kommunikasjon, emosjonell inntoning og tilgjengelighet. Diskusjonen er ment å utvide forståelsen av funnene, og vise hvorvidt et tiltak hvis siktemål er en dypere forståelse av barnet sitt, også kan ha en overføringsverdi til parforholdet. Informantenes erfaringer ses i lys av det som ses på som sentrale og virksomme elementer fra parterapeutisk praksis i familieterapifeltet

Being the Instrument of Change : Staff Experiences in Developing Trauma-informed Practice in a Norwegian Child Welfare Residential Care Unit

The overall aim of this project is to contribute to the development of interventions that benefit children and adolescents in residential care. Research shows that this is a particularly vulnerable population, typically with histories of detrimental care and traumatic experiences, and which is institutionalised as an additional burden. Many of them display severe emotional, interpersonal, and behavioural problems. Meeting their needs in a residential care setting is challenging, and there has been a general call for models of care that can encompass the complexity of their life histories and problems and the institutional context. Along with the growing understanding of the effects of developmental trauma, trauma-informed practice (TIP) has emerged as a theoretical framework guiding residential treatment and care. TIP was introduced in Norway around 2010 and has since become widespread, especially in child welfare settings. TIP is a theoretical framework or model, rather than a standardised or operationalised method, that must be operationalised within each concrete context. In Norway, TIP has mainly been based on the Three Pillars Model advanced by the Australian psychologist Howard Bath. The objective of this project was to gain information on how Bath’s TIP model was operationalised and experienced by staff at a child welfare institution for adolescents in Buskerud County, Norway. The institution was among the first in Norway to start operating in accordance with a TIP framework, starting with the implementation of Bath’s Three Pillars model in 2014. The regional resource centre on violence, traumatic stress, and suicide prevention in southern Norway (RVTS-south) facilitated the implementation process. The qualitative research project this thesis is based upon was initiated as part of this process. In the project, the following main research question was explored: how do staff in a residential care unit in Norway transform the TIP framework into practice, and how do they experience and reflect upon this practice? The project comprised three studies examining the research question from different angles with a qualitative phenomenological research methodology. Over the course of six years, a total of 27 individual in-depth interviews were conducted with 19 informants. Data were analysed in accordance with the principles of thematic analysis, thematic network analysis, and narrative inquiry. The findings of the three studies are presented in three separate papers. The focus of the first study (presented in Paper I) was how the TIP framework of Howard Bath was translated into concrete practices. Using thematic network analysis of data from interviews with all 19 informants, we identified three global themes: self-awareness, including self-reflection, other-regulation, and authenticity; intended actions, including building strength, building mentalisation skills, providing staff availability, setting safe limits, and collaborating with youth; and organisational and cultural practices, including having a commonly shared mindset, stability and routines, and cultural safety. We suggest that the described practices, in general, reflect shared ideas across TIP models and resonate with informants' training. However, some practices also seemed to be influenced by other, and perhaps partly conflicting perspectives. In particular, the results indicate confusion and the need for clarification regarding the roles of authenticity and boundary setting within TIP. The second study (presented in Paper II) focused on prerequisites for staff members’ capacity to maintain an emotionally regulated state when faced with disruptive emotional and behavioural expressions. Providing other-regulation through one’s own emotional state is considered a core element of TIP. Using thematic analysis of data from interviews with 15 of the informants, we found that informants experienced their self-regulation capacity as depending on critical self-reflection, self-acceptance, being part of a regulating work environment, and having a trustworthy theoretical model to be guided by. The findings point to the importance of organisational cultures and procedures that encourage critical self-reflection and self-acceptance, which promote self-compassion and shame-resilience, and where investments are made to ensure staff identification with the chosen model of care. The third study (presented in Paper III) explored informants’ experiences with situations and interactions that could potentially threaten their capacity to maintain an emotionally regulated state. Data from interviews with eight of the informants were analysed using narrative inquiry, with an interest in how informants made sense of their experiences. We identified three major narrative themes: Are we doing the right things?, My childhood issues surfaced, and Missing togetherness with trusted others. The themes reflect that situations and interactions were seen as particularly challenging due to their complexity and confusing character, their potential to trigger painful childhood memories, and their potential to evoke fear of disconnection from colleagues. Findings were discussed in terms of what strain working within a TIP framework may imply for staff members – a strain that we suggest should be acknowledged and addressed at an organisational and structural level. An overarching interpretation is that informants, in their ways of practicing TIP, experienced themselves as ‘the instruments of change’. They engaged in a reflexive self-scrutinising endeavour, where they tended to attribute successes and failures in interactions with residents to factors within themselves. Although informants were generally in favour of working in accordance with TIP principles, the results revealed that working this way comes at a cost and may be deeply personally and emotionally challenging. Findings of the project point to the importance of acknowledging these costs and of establishing cultural and organisational practices that enable staff to endure the strain they face as the 'instruments of change'. This may include a particular focus on the management of shame by working with self-compassion, for example, by applying standardised procedures developed for this purpose. To be able to face potentially dysregulating situations on a day-to-day basis, based on the project findings, the work environment should entail a culture of other-regulation, wherein cultural safety, transparency, and collegial support are emphasised. In addition, to be able to invest so much of themselves in their work, both personally and emotionally, staff would need an understanding of why they are doing it and confidence in the productivity of the approach. Additionally, based on project results, it is recommended that services practising or implementing TIP clarify to the greatest possible extent what TIP is and what it is not, including a clarification of what is unique or generic to the model. Clarifying the role of authenticity and boundary setting within TIP might be of particular importance.Doktorgradsavhandlin

Om å vokse opp på barnehjem og på sykehus En undersøkelse av barnehjemsbarns opplevelser på barnehjem sammenholdt med sanatoriebarns beskrivelser av langvarige sykehusopphold – og et forsøk på forklaring

Before as well as after the 2nd World war -, to put children into children’s homes was often the ultimate solution to the practical problem that was facing the social authorities when private care failed and mother and father proved incompetent. The incompetency might involve sickness and death, poverty, mental retardation, drug abuse and alcoholism, as well as violence and physical/psychical abuse. This remained so even if the first choice, according to Children’s Act of 1953, was fostercare. The actual period of institutionalization in this study runs from about 1940 to about 1980. The present study is one where 37 children from earlier children’s homes were interviewed about their daily life during their stay. This stay was supposed to last for at least 2 years. The actual range of stay was from 3 years to 19. The interviews were compared to those of 11 children who had been taken into hospital care in the first part of the period mentioned above, as the tuberculosis hospitals were settled in the midsixties. The children from the sanatoriums were chosen as a quasi-control group, as they were supposed to be the only group(except for the asthmatics and those with poliomyelitis1) which might match the situation of being removed from home; brought up by strangers for years, and having the least possible contact with their own parents or family. The main aim of the study was to bring to daylight the experiences of children in children’s homes. The second was to see if – when compared – the daily life of a children’s home might as well have been one lived in a sanatorium. If so, the national and international critique directed towards children’s homes might as well have been directed against hospitals and may be against any institution where children were brought up. If not so, may be these instituitons were built on quite different grounds developing attitudes and ways of handling children which were unrelated From unstructured interviews that lasted from one to four hours, the transcripts were searched for the most prominent themes of the daily lives of the children, in a manner inspired by the the Grounded theory approach. However, the children’s stories are presented narratively to illustrate the themes found, and as a result the comparison showed them to be more alike than different in the two institutions. This was a surprise but not unexpected. Rumours, written documents and autobiographies have indicated that the way children were handled in hospitals that accommodated patients for years resembled the routines that have been criticised in children’s public care. Thus we are faced with a reality that tells us that the criticised suppressive routines of institutional child care are not restricted to these institutions but have their parallel ways in hospitals as well. One troubling fact of this investigation was that the persons who seemed responsible for the import and maintenance of these suppressive routines were those in charge; the educated and the Christians among the staff. The people who had made a vow to serve their fellow men, more often than not, were those called “evil” by the children. This situation is explained on the background that hundreds of years with repressive upbringing have created people who do not recognize their tendencies to act violently when met with other people’s –especially children’s – resistance to the adult’s will. Thus we are caught in a stream of acts which overrides the pure cognitive knowledge that we have, telling us what to do and even overrides our ethical principles. Reference is made to the thoughts of Alice Miller. However, this goes not without saying that the children also met women who were described as nice and kind and observant to the children’s needs, and some children have responded: “she became my mother”. Another finding has been called “the collective blindness”; an expression that describes the situation when adult personnel recognize a colleague abusing a child without himself (the personel) acting. These situations have two typical consequences: a) the children, who always are aware of what is happening, lose their trust in the adult(s); and b) this kind of non-responsiveness is cementing these situations and thereby increasing the probability that they will reappear on the daily scene. Conclusively, lines are drawn to the impossibility of acting professionally when in close contact with patients or clients, without being trained to recognize the above mentioned mechanisms in your own mind