Therapist intervention factors that influence therapeutic alliance events in family therapy with multi-problem families : a qualitative study

Background and Aims. The study investigates the therapist factors that influence the therapeutic alliance in family therapy with multi-problem families, from the perspectives of the child and family and structured commentary of the therapist. Due to the lack of research done with this client group and the adapted use of qualitative approaches applied, the methodology is also subject to scrutiny. Design and Participants. A qualitative small-case design is used, to enable the collation of rich and detailed data of the meanings and experiences of the participants to emerge. Four family therapy cases at a child clinic are followed, using therapeutic alliance events as the units of investigation. Measures. Interpersonal Process Recall, an interview method developed by Elliott (1984), gains the views of the participants, with Interpretative Phenomenological Analysis as the method of transcript analysis. The dual role of researcher and therapist is studied reflexively on various levels. An adapted Family Therapy Alliance Scale is also administered. Results. A number of prominent themes emerged, namely, child therapy stance and technique, the children's communication style and a shift from an individual to systemic meaning of the difficulties. Others were being heard and listened to versus the experience of not being heard, working alongside the family, benefits and motivation in therapy and the experience of safety. Implications. The study gives a useful account of the participants' views of which therapist intervention factors influenced the alliance and links with current research and theory. Prominent implications were the full participation of children, shifts in the meanings families ascribe to their difficulties and ways for therapists to collaborate with them. Evidence of the viability and limitations of the method used is provided. Directions of further research are suggested

Quasi dynamical symmetry in an interacting boson model phase transition

The oft-observed persistence of symmetry properties in the face of strong symmetry-breaking interactions is examined in the SO(5)-invariant interacting boson model. This model exhibits a transition between two phases associated with U(5) and O(6) symmetries, respectively, as the value of a control parameter progresses from 0 to 1. The remarkable fact is that, for intermediate values of the control parameter, the model states exhibit the characteristics of its closest symmetry limit for all but a relatively narrow transition region that becomes progressively narrower as the particle number of the model increases. This phenomenon is explained in terms of quasi-dynamical symmetry.Comment: 4 figure

Relapsing fever, a disappearing cause of fever and maternal death in Sengerema, Tanzania, east Africa

Objective: To study the incidence of tick borne relapsing fever (TBRF) during the last 50 years, once like malaria an endemic disease in Sengerema, Tanzania.Design: By analyzing the annual reports, focusing on the number of admissions, maternal deaths, blood smears of patients with fever for Borrelia.Setting: Sengerema district, Tanzania.Subject: Admissions in Sengerema Hospital due to TBRF.Main Outcome Measures: From 1960 to 2010, we analyzed the incidence of TBRF.Result: Forty annual admissions in the sixties/seventies, 200 in the eighties (range from 37 in 1964 to 455 in 1988), dropping to 30 in the nineties. For the last nine years no Borrelia spirochetes were found in blood smears at the laboratory anymore and no admissions for TBRF were  registered. The number of maternal deaths due to relapsing fever  decreased simultaneously; the last one recorded was in 2002.Conclusion: During the last century, we have witnessed the disappearing of tick borne relapsing fever in Sengerema. Increase of gold mining,  improved local economy, housing and standards of living after the nineties resulted in an almost complete eradication of the incidence of TBRF

Staffing needs for quality perinatal care in Tanzania

In Tanzania maternal and perinatal mortalities and morbidities are problems of public health importance, and have been linked to the shortage of skilled staff. We quantified the available workforceand the required nursing staff for perinatal care in 16 health institutions in Dar es Salaam. WHO safe motherhood needs assessment instruments were used to assess the availability of human resources,WHO designed Workload Indicators for Staffing Need (WISN) and Tanzanian standard activities and components of the workload for labour ward nursing were used to calculate nurse staffing requirementsand WISN ratios. There was a severe shortage of essential categories of health staff for perinatal care in all institutions. The ranges of WISN ratios for nursing staff working in the municipal hospitals’ labourwards were; nurse officers 0.5 – 1, trained nurses/midwives 0.2 - 0.4 and nurse assistants 0.1. These findings reflect extremely huge perinatal care workload pressure and suggest the urgent need for morestaff in order to achieve the global millennium development goals set for maternal and infant survival (Afr J Reprod Health 2008; 12[3]:113-124)