Refleksyvumo fenomenas psichoterapinėje supervizijoje: sisteminė literatūros analizė

Reflexivity is a concept that is increasingly gaining prevalence in the literature of professional practice and it has been defined in a variety of ways; however, the differences in definition largerly depend on the context. Therefore, reflexivity development is the main goal of supervision; it is a powerful instrument that can impede the psychotherapist’s connection with his client, but there is no answer on what specifically enhances or decreases reflexivity during the supervision process. In the scientific articles analyzing supervision, there is no clear definition of the phenomenon of reflexivity and there is also a lack of empirical studies of reflexivity in supervision. The aim of this paper is to present our own definition and theoretical model of reflexivity in the psychotherapy supervision process as well as distinguish reflexivity between adjacent concepts like “reflection,” “self-reflection,” and “self-reflexivity.” We carried out a systematic review of literature within three databases and created a theoretical model of reflexivity in psychotherapy supervision. We also discuss the guidelines and methods for further empirical investigations of this phenomenon in psychotherapy supervision. Refleksyvumas (angl. reflexivity) laikomas vienu iš pagrindinių žmonių bendravimo įgūdžių ir svarbiausia praktikuojančio specialisto profesine kompetencija (Bruno et al., 2011; Schön, 1983). Mokslinėje literatūroje, analizuojančioje supervizijas, nėra aiškios šio fenomeno apibrėžties, taip pat stokojama empirinių refleksyvumo tyrimų supervizijos kontekste. Šiame straipsnyje, atlikę refleksyvumo fenomeno analizę ir apžvelgę empirinius tyrimus, pateikiame savo sukurtą refleksyvumo fenomeno apibrėžimą ir refleksyvumo teorinį modelį, taip pat šio fenomeno empirinių tyrimų gaires ir būdus. Šiuo straipsniu norime akcentuoti refleksyvumo tyrimų supervizijų kontekste praktinę vertę

Nevilties lygis, nuostatos savižudybių atžvilgiu ir suicidinė rizika

Objectives: There is a substantial level of evidence that affirmative attitudes towards suicide are connected to suicidality (suicide ideation, suicide attempts and completed suicide). Hopelessness is proved to be one of the best available predictors of the suicide risk. A hypothesis that attitudes can serve as mediating variable between hopelessness and suicidality was proposed in recent studies (Gibb et al., 2006). The main aim of this study is to test the hypothesis that interaction between attitudes towards suicide and hopelessness will be a better predictor of suicidality than hopelessness.Methods: Different aspects of attitudes towards suicide and suicidality were measured with Questionnaire on Attitudes Towards Suicide (ATTS). Hopelessness level was assessed with Beck Hopelessness Scale (BHS). The study was conducted in the sample of Lithuanian army conscripts (N = 368) aged between 18 and 26 (mean age was 20.46; SD = 1.29).Results: Suicidality index significantly correlated both with hopelessness (r = .45, p < .01) and various aspects of attitudes towards suicide. The strongest correlation was between acceptance of suicide and suicidality index (r = .36, p < .01), but we have also found significant correlations between five other aspects of attitudes and suicidality. Significant correlations between hopelessness and various aspects of attitudes towards suicide were found. Variables using hierarchical stepwise model were entered into multiple regression model. Hopelessness accounted for 21.1% of suicidality variance. Attitudes towards suicide, added into regression model on second step, increased prediction of suicidality to 34.2%.Conclusions: Results of this study show that different aspects of attitudes towards suicide correlate with the suicide risk. Correlation between hopelessness and suicidality was confirmed as well. Finally, the results indicate that attitudes towards suicide are significant predictors of suicide risk. Interaction of attitudes towards suicide and hopelessness predicts suicide risk better than hopelessness. Results of present study have confirmed, that attitudes towards suicide are significant mediators between hopelessness and suicidality.Remdamiesi ankstesnių tyrimų rezultatais keliame prielaidą, kad nuostatos savižudybių atžvilgiu yra svarbus kintamasis įvertinant savižudybės riziką (suicidiškumą) – nevilties lygis ir nuostatos savižudybių atžvilgiu geriau prognozuoja tiriamųjų savižudybės riziką negu tik nevilties lygis. Hipotezė yra tikrinama jaunų vyrų, atliekančių privalomąją karinę tarnybą, imtyje (N = 368). Tyrimo metu nustatyta, kad įvairūs nuostatų savižudybių atžvilgiu aspektai ir nevilties lygis yra reikšmingai susiję su tiriamųjų suicidiškumu. Stipriausiai su suicidiškumu koreliavo savižudybės priimtinumas (r = 0,36, p < 0,01). Taikant hierarchinę daugiamatę regresiją nustatyta, kad nevilties lygis prognozuoja 21,1 proc. suicidiškumo kintamojo variacijos, o nevilties lygis kartu su nuostatomis savižudybės atžvilgiu – 34,2 proc. Gauti rezultatai patvirtino prielaidą, kad nevilties lygio ir nuostatų savižudybių atžvilgiu sąveika vyrų suicidiškumą prognozuoja geriau, negu nevilties lygis atskirai

Nuostatų savižudybių atžvilgiu klausimyno (ATTS) lietuviškoji versija

Several psychological models explaining formation of attitudes towards suicide and their influence on suicidal behaviour have been developed recently. Reliable an valid instruments measuring attitudes towards suicide are needed to test these models. There are several well known questionnaires in this field: Suicide Opinion Questionnaire (SOQ; Domino et al., 1982), Suicide Attitude Questionnaire (SUIATT; Diekstra & Kerkhof, 1988). Both these questionnaires have methodological or practical disadvantages that were taken into account when developing a new instrument – Attitudes Towards Suicide Questionnaire (ATTS; Salander Renberg & Jacobsson, 1998).Objective: Lithuanian version of ATTS was created in 2001 and was used in a number of studines since then. Availability of large data pool (N = 1259) collected with Lithuanian version of ATTS has created a good opportunity for examining reliability and validity issues of the instrument, which is the aim of this study.Method: The data for the present study was taken from studies conducted in the framework of European multicenter research project SUPPORT. Sample consisted of 16 target groups that were studied with the Lithuanian version of ATTS: army conscripts (N = 368), army sergeants (N = 106), army officers (N = 44), medicine students (N = 103), students of priest seminaries (N = 68), catholic religion students (N = 63), psychology students (N = 137), members and mayors of Municipality Councils (N = 55), students of journalism (N = 43), journalists (N = 43), volunteers of psychological help-line (N = 43), suicide attempters (N = 40), personnel of emergency hospital (N = 39), homosexual and bisexual men (N = 30), alcohol dependant patients (N = 38), alcohol dependant patients undergoing Minnesota rehabilitation program (N = 39). A test-retest survey was performed in a sample of medicine students (N = 30) in order to evaluate temporal stability of ATTS Lithuanian version.Results: Confirmatory factor analysis (implemented through SEM) hasn’t confirmed the original ATTS factor model obtained by developers in Sweden. However, an exploratory factor analysis produced 5 factor model (explaining 53.5% of total variance), which is very similar at face value to other proposed ATTS factor models. Internal consistency of this model is satisfactory (Cronbach alpha – 0.68). Differences between attitudes of suicidal and non-suicidal individuals are regarded as support for criterion validity of the instrument. ICC coefficients from test-retest study are satisfactory (ranging from 0.62 to 0.87) for three ATTS factors. The remaining have demonstrated low testretest reliability (ICC coefficients are 0.48 and 0.59).Conclusions: psychometric properties of Lithuanian ATTS version were found to be satisfactory, although structural validity indicators were somewhat controversial and two factors have demonstrated low test-retest coefficients. Lithuanian ATTS version can be used for scientific research of attitudes towards suicide.Tyrimu siekiama nustatyti ir įvertinti nuostatų savižudybių atžvilgiu klausimyno ATTS lietuviškosios versijos psichometrines charakteristikas. Tyrime naudojama imtis (N = 1259) sudaryta iš 16 tikslinių grupių, tirtų ATTS metodikos lietuviškąja versija nuo 2001 m. Patvirtinančioji faktorinė analizė nepatvirtino metodikos autorių Švedijoje nustatyto faktorinio modelio. Tačiau atlikus tiriamąją faktorinę analizę, gautas 5 faktorių modelis (paaiškinantis 53,5 proc. bendrosios kintamųjų dispersijos), išoriškai yra panašesnis į kitus taikomus ATTS faktorinius modelius. Šio modelio vidinis suderinamumas – geras (Cronbacho alpha – 0,68). Tyrimo metu aptiki skirtumai tarp suicidiškų ir nesuicidiškų tyrimo dalyvių nuostatų yra traktuojami kaip vienas iš kriterinio metodikos validumo patvirtinimų. Siekiant įvertinti ATTS lietuviškosios versijos stabilumą bėgant laikui, buvo atliktas pakartotinis tyrimas (angl. test-retest) – tirta medicinos studentų imtis (N = 30). Šio tyrimo rezultatai parodė, kad trijų faktorių stabilumas yra pakankamas (koreliacijos koeficientai nuo 0,62 iki 0,87), tačiau likusių dviejų faktorių stabilumo rodikliai – menki (0,48 ir 0,59). Apibendrinus visus tyrimo rezultatus daroma išvada, kad lietuviškosios ATTS versijos patikimumas bei validumas laikomi patenkinamais ir metodika gali būti toliau naudojama mokslinių tyrimų tikslais.&nbsp

„Kas Jums yra vyriškumas?“: turinčių ir neturinčių minčių apie savižudybę vyrų nuomonių palyginimas

Male suicides are often associated with masculinity norms that encourage certain behaviours that increase the risk of suicide. For example, research shows that restricted emotionality, avoidance of seeking help and self-reliance are associated with higher suicide risk. However, these pre-formulated aspects of masculinity do not necessarily reflect men’s subjective opinions of what masculinity is to them. Researchers argue that it is important to consider personal views about what masculinity is, not only stereotypes about masculinity. The aim of this study is to reveal and compare the subjective opinions about the masculinity of men with and without suicidal ideation. 281 men answered the open-ended question during the survey: “What does masculinity mean to you?”. The answers were analyzed using a content analysis method. We transformed qualitative data into quantitative and compared them statistically between two groups: men with and without suicidal ideation. It turned out that men with suicidal thoughts were more likely to mention that masculinity is the control of emotions, intelligence, and decision-making. Men without suicidal thoughts were more likely to mention family and caring for it as essential aspects of masculinity. The results showed that certain aspects of masculinity might be related to higher risk for suicide, but the study also revealed the masculinity that might be a source of coping.Vyrų savižudybės neretai siejamos su vyriškumo normomis, kurios skatina tam tikrą savižudybės riziką didinantį elgesį. Tačiau mokslininkai taip pat svarsto, kad nagrinėjant vyriškumą svarbu vertinti ne tik vyriškumo stereotipus, bet ir atsižvelgti į asmenines subjektyvias nuomones apie tai, kas yra vyriškumas. Šio tyrimo tikslas yra atskleisti ir palyginti turinčių ir neturinčių minčių apie savižudybę vyrų subjektyvias nuomones apie vyriškumą. Apklausos metu 281 vyras atsakė į atvirą klausimą „Kas Jums yra vyriškumas?“ Atsakymai buvo analizuojami taikant turinio analizės metodą. Įvertinus tyrimo dalyvių mintis apie savižudybę, visa imtis buvo padalyta į dvi grupes: turinčius ir neturinčius minčių apie savižudybę. Šių dviejų grupių atsakymai į atvirą klausimą buvo palyginti pasitelkiant statistinius skaičiavimus. Paaiškėjo, kad turintys minčių apie savižudybę vyrai dažniau minėjo, kad jiems vyriškumas yra emocijų kontrolė, intelektualumas ir orientacija į sprendimus. Neturintys minčių apie savižudybę vyrai dažniau minėjo šeimą ir rūpinimąsi ja kaip svarbius vyriškumo aspektus. Rezultatai parodė, kad tam tikri vyriškumo aspektai gali būti susiję su didesne savižudybės rizika, tačiau tyrimas atskleidė ir tokią vyriškumo dalį, kuri gali būti atsparumo šaltinis

Subjektyvus trauminės Černobylio avarijos likvidavimo patirties poveikis nuo katastrofos praėjus 27 metams

A long-term psychological trauma is considered to be a possible consequence of being informed of radioactive contamination. In the case of the Chernobyl disaster, various circumstances possibly have led to even more serious psychological damage. For example, the socio-political context of the accident could be linked to extremely restricted information given out to the public. This disaster particularly affected clean-up workers, some of whom were brought from Lithuania, part of the Soviet Union at the time. This study thus is aimed to reveal the perceived impact of the traumatic experience of clean-up workers 27 years after the Chernobyl Disaster. Semi-structured 32 interviews with clean-up workers (age varying from 47 to 77 years), who are currently living in Lithuania, were conducted. A thematic analysis of the responses reveals that the clean-up workers are still feeling influenced by what they have experienced in Chernobyl. First of all, they link various health problems, which they are suffering from, to their presence in Chernobyl and express anxiety about the possible future illnesses, as they believe their bodies are irreversibly damaged by radiation. Secondly, the clean-up workers express a lot of anger towards the government for insufficiently supporting them financially and not showing enough gratitude for the work that they have done. Also, they experience a feeling of injustice as they believe that the government considers their experience in Chernobyl to be voluntary and not significantly influencing their present physical and psychological condition. Finally, post-traumatic stress symptoms were also found to be manifested. As the most distressing of those symptoms the clean-up workers name general irritability and anxiousness, although symptoms of intrusion and avoidance can also be detected as well as helplessness and a feeling of constantly living under threat. All these findings raise the awarness of how important it is that the government and society would validate the clean-up workers’ experiences – at least symbolically recognizing the long-term impact of being in Chernobyl as well as its involuntary nature. This recognition should also lead to the necessary physical and psychological help in consideration of the clean-up workers’ traumatic experiences and the psychological component of their physical illnesses.Susidūrimas su radiaciniu pavojumi yra laikomas galima ilgalaikio psichologinio traumavimo priežastimi. Černobylio avarijos aveju tokio susidūrimo poveikį sustiprino ir įvairios specifinės aplinkybės, pavyzdžiui, sociopolitinis avarijos kontekstas, su kuriuo galima sieti ir tuo metu pasireiškusią išskirtinę informacijos stoką. Vieni iš labiausiai šios katastrofos paliestųjų yra jos likvidatoriai, kurių suvoktą trauminės patirties poveikį praėjus 27 metams nuo avarijos ir yra siekiama atskleisti šiame straipsnyje. Buvo atlikti 32 pusiau struktūruoti interviu su Lietuvoje gyvenančiais likvidatoriais (47–77 m.). Teminė šių interviu analizė atskleidė tyrimo dalyvių jaučiamą ilgalaikį Černobylio poveikį. Būtent su šia patirtimi likvidatoriai sieja įvairias sveikatos problemas ir nerimauja dėl dar galinčių iškilti ligų, nes jaučiasi negrįžtamai paveikti radiacijos. Taip pat jiems būdingas pyktis ant politikų dėl rūpesčio likvidatoriais trūkumo ir išskirtinai dėl jų prievartos patyrimo nuvertinimo. Atsiskleidė ir įvairių potrauminio streso sutrikimo simptomų. Iš šių simptomų patys tyrimo dalyviai labiausiai pabrėžia padidėjusį irzlumą ir nervingumą, tačiau galima pastebėti ir jų jaučiamus invazinius bei vengimo simptomus, taip pat nuolatinio grėsmės jausmo ir bejėgiškumo išgyvenimą. Tyrimo rezultatai atskleidžia svarbą to, kad valdžia ir visuomenė pripažintų likvidatorių prievartos patirtį ir reikšmingą Černobylio avarijos padarinių ilgalaikiškumą. Toks pripažinimas ilgainiui turėtų paskatinti ir reikalingą fizinę bei psichologinę pagalbą likvidatoriams, atsižvelgiant į jų trauminę patirtį ir psichologinį somatinių ligų komponentą

Bandymas nusižudyti : paauglių merginų išgyvenimų kokybinis tyrimas

Background. Different aspects of adolescent suicidal behaviour are explored, however, they are interpreted in terms suitable mostly for adult suicidal behaviour. Knowledge on adolescent suicidality is far from comprehensive. Aims. To describe the lived experience of attempted suicide among young females and to unfold distinctiveness of such experience. Method. Three adolescent females aged 13 to 17, who attempted suicide within one year period while not in the state of psychosis, took part in the study. Research was conducted using interpretative phenomenological analysis –a qualitative research method which aims to explore both experience of a person and one’s trying to make sense of it. Data was collected during semi-structured interviews which allowed setting a closer contact with respondents. Results. Data analysis showed that though a fair amount of attempted suicide experiences of adolescent females is similar to those of adults, there are some distinct features: sense of overwhelming experience and amassing bothers, liveliness of past experiences in the present, great lack of support in close relationships, difficulties reflecting and controlling emotions and thoughts. Conclusions. These results support the huge importance of appropriate responses of the surrounding people and mental health care professionals to the state of suicidal adolescent female. Also, it is necessary to teach adolescent females to effectively manage their emotions and impulses, and to develop mature ego defense mechanisms. Further research could contribute to the creation of guidelines to such behaviour or training and a deeper understanding of the psychological state of suicidal adolescents.Problema. Įvairūs paauglių savižudiško elgesio aspektai nagrinėjami plačiai, tačiau jie dažniausiai interpretuojami suaugusiesiems tinkamais terminais. Paauglių suicidiškumo specifika dar nėra pakankamai ištirta. Tyrimo tikslai. Tyrimu siekiama aprašyti merginų išgyvenimus, susijusius su bandymu nusižudyti, ir atskleisti šio patyrimo ypatumus. Metodai. Tyrime dalyvavo trys 13–17 metų merginos, per pastaruosius vienerius metus bandžiusios nusižudyti ne psichozės epizodo metu. Tyrime taikytas vienas iš kokybinių tyrimų metodų – interpretacinė fenomenologinė analizė, kurios tikslas yra tyrinėti asmeninę žmogaus patirtį ir tai, kaip jis bando su tuo susidoroti. Duomenys rinkti pusiau struktūruotų interviu metu, todėl buvo galimybė užmegzti artimesnį kontaktą su respondentėmis. Rezultatai. Duomenų analizė atskleidė, kad nors nemaža dalis bandžiusių nusižudyti paauglių merginų išgyvenimų panašūs į suaugusiųjų, yra keletas svarbių skirtumų: patyrimo neaprėpiamumo ir sunkumų kaupimosi išgyvenimas, praeities įvykių gyvumas dabartyje, stiprus artimųjų palaikymo trūkumas, sunkumai reflektuojant ir kontroliuojant emocijas bei mintis. Išvados. Šio tyrimo rezultatai rodo didžiulę deramo aplinkinių ir psichikos sveikatos specialistų rea-gavimo į savižudiškai besielgiančios paauglės būseną svarbą. Taip pat išryškėja būtinybė mokyti pačias paaugles efektyviai tvarkytis su emocijomis, impulsais ir taikyti brandesnius ego gynybos mechanizmus. Tolesni tyrimai galėtų padėti kurti tokias elgesio ar mokymų gaires ir giliau suprasti savižudiškai besielgiančių paauglių psichologinę būseną

Attitudes towards suicide in alcohol abusers

Mental disorders, previous suicide attempts and addiction to alcohol or tranquillisers are considered the factors that may have the biggest influence on the phenomenon of suicide. 47% of suicide attempters were addicted to alcohol or used it intensively (Goldney, 2002; Ingvar, 1997). Furthermore, attitudes towards suicide are also one of the factors that may have influence on self-destructive thoughts or decision to end one's own life (Gailienė, 2000). More positive attitudes towards suicide may have impact on that alcohol abusers quite often choose voluntary death or try to commit suicide - greater tolerance ofsuicidal behaviour can enhance the probability to choose it (Žemaitienė, 2000; Gailienė, 2000). Research aim was to investigate if alcohol abusers who drink alcohol intensively differ from the alcohol abusers who do not drink alcohol for longer than one year or who do not have addiction to alcohol at all, and to compare their attitudes towards suicide. 117 respondents took part in this research. They were divided into three groups: alcohol abusers who drink alcohol (38 persons), alcohol abusers who do not drink alcohol for longer than one year (39 persons) and control group of respondents who do not have addiction to alcohol (40 persons). All the alcohol abusers at the time of research were hospitalized in Vilnius Center for Addictive Disorders, Department of Treatment of the Alcohol Withdrawal Syndrome or have finished In-patient 28 day "Minnesota" Program. All the respondents filled in a questionnaire about attitudes towards suicide. The questionnaire was given to them directly or by their doctor. It was found that attitudes towards suicide differed among three researched groups.Alcohol abusers who drink alcohol were inclined to have more negative attitudes towards suicide than alcohol abusers who do not drink alcohol for longer than one year and respondents without addiction to alcohol. The two latter groups expressed similar and more positive attitudes towards suicide. Furthermore, alcohol abusers who drink alcohol intensively had attempted suicide more often in their lives than other respondents did

Bandymas nusižudyti: paauglių merginų išgyvenimų kokybinis tyrimas

Background. Different aspects of adolescent suicidal behaviour are explored, however, they are interpreted in terms suitable mostly for adult suicidal behaviour. Knowledge on adolescent suicidality is far from comprehensive. Aims. To describe the lived experience of attempted suicide among young females and to unfold distinctiveness of such experience. Method. Three adolescent females aged 13 to 17, who attempted suicide within one year period while not in the state of psychosis, took part in the study. Research was conducted using interpretative phenomenological analysis – a qualitative research method which aims to explore both experience of a person and one’s trying to make sense of it. Data was collected during semi-structured interviews which allowed setting a closer contact with respondents. Results. Data analysis showed that though a fair amount of attempted suicide experiences of adolescent females is similar to those of adults, there are some distinct features: sense of overwhelming experience and amassing bothers, liveliness of past experiences in the present, great lack of support in close relationships, difficulties reflecting and controlling emotions and thoughts. Conclusions. These results support the huge importance of appropriate responses of the surrounding people and mental health care professionals to the state of suicidal adolescent female. Also, it is necessary to teach adolescent females to effectively manage their emotions and impulses, and to develop mature ego defense mechanisms. Further research could contribute to the creation of guidelines to such behaviour or training and a deeper understanding of the psychological state of suicidal adolescents

What is spirituality for women bereaved by a partner’s suicide: a qualitative study

Spirituality is often significant for those undergoing suicide bereavement. Our study aimed to explore how women, who are bereaved by their partner’s suicide, describe spirituality. 11 semi-structured interviews have been conducted with female participants using reflexive thematic analysis. Six themes were identi-fied: Spirituality as a resource, Spirituality as a relationship; Spirituality is universal; Spirituality is a changing phenomenon; Spirituality requires effort; Spirituality is between knowing, sensation, and feeling. Female participants who experience bereavement following a partner’s suicide described their understanding of spiri-tuality as a multidimensional phenomenon. Interpretations and practical guidelines are formed. Keywords: spirituality; suicide bereavement; qualitative research; thematic analysis

The Role of Spirituality during Suicide Bereavement: A Qualitative Study

Background: A loved one’s loss due to suicide can be a traumatic experience and trigger a complex grief process. Although spirituality, defined as a search for the Sacred in a broad sense, can be a resource and an obstacle in coping with the suicide bereavement process, there is a gap in scientific understanding of the role spirituality plays during the process. Methods: To explore the role of spirituality in people bereaved by suicide, we recruited 11 women who lost a life partner due to suicide. We conducted semi-structured interviews and analyzed the data using reflexive thematic analysis. Results: We identified the following three themes: spirituality is a supportive resource that can be reached for or achieved without conscious involvement; spirituality provides helpful ways to cope with grief; spirituality makes the grief process more difficult. Conclusions: Spirituality, if personally meaningful and supported by others, can function as a resource after a loved one’s suicide and even add to post-traumatic growth after the loss. On the contrary, spirituality-related issues, such as stigmatization and a lack of personally meaningful traditions, can distress the bereaved. Difficult spiritual experiences and questions can become an intricate part of the grief process