The changes in psychological functioning problems during Solution-Focused Brief Therapy among adolescents in health care settings ; Sveikatos priežiūros įstaigose gydomų paauglių psichologinio funkcionavimo problemų kitimas į sprendimus sutelkto trumpalaikio konsultavimo metu
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VYTAUTAS MAGNUS UNIVERSITY Rytis Pakrosnis THE CHANGES IN PSYCHOLOGICAL FUNCTIONING PROBLEMS DURING SOLUTION–FOCUSED BRIEF THERAPY AMONG ADOLESCENTS IN HEALTH CARE SETTINGS Summary of Doctoral Dissertation Social Sciences, Psychology (06 S) Kaunas, 2008 The dissertation was carried out at Vytautas Magnus University during the period of 2001 – 2005. The dissertation is defended by extern. Scientific consultant: Prof. Dr. Habil. Antanas Goštautas (Vytautas Magnus University, biomedical sciences, medicine – 07 B, psychiatry – B 650; social sciences, psychology – 06 S) The dissertation is defended at the Council of Psychology Sciences of Vytautas Magnus University: Chairperson: Prof. Dr. Habil. Vytautas Gudonis (Academician of the Academy of Education and Social Sciences of Russia, Academician of New York Academy of Sciences, Siauliai University, social sciences, psychology – 06 S, educology – 07 S) Members: Assoc. Prof. Dr. Bronislava Grigait ė (Vytautas Magnus University, social sciences, psychology – 06 S) Prof. Dr. Habil. Apolinaras Zaborskis (Kaunas University of Medicine, biomedical sciences, public health – 10 B) Prof. Dr. Habil. Rimantas Želvys (Vilnius Pedagogical University, social sciences, educology – 07 S) Assoc. Prof. Dr.
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| Publié par | vytautas_magnus_university |
| Publié le | 01 janvier 2008 |
| Nombre de lectures | 81 |
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VYTAUTAS MAGNUS UNIVERSITY
Rytis Pakrosnis THE CHANGES IN PSYCHOLOGICAL FUNCTIONING PROBLEMS DURING SOLUTIONFOCUSED BRIEF THERAPY AMONG ADOLESCENTS IN HEALTH CARE SETTINGS
Summary of Doctoral Dissertation Social Sciences, Psychology (06 S)
Kaunas, 2008
The dissertation was carried out at Vytautas Magnus University during the period of 2001 2005. The dissertation is defended by extern. Scientific consultant: Prof. Dr. Habil. Antanas Gotautas (Vytautas Magnus University, biomedical sciences, medicine 07 B, psychiatry B 650; social sciences, psychology 06 S) The dissertation is defended at the Council of Psychology Sciences of Vytautas Magnus University: Chairperson: Prof. Dr. Habil. Vytautas Gudonis (Academician of the Academy of Education and Social Sciences of Russia, Academician of New York Academy of Sciences, Siauliai University, social sciences, psychology 06 S, educology 07 S) Members: Assoc. Prof. Dr. Bronislava Grigait(Vytautas Magnus University, social sciences, psychology 06 S) Prof. Dr. Habil. Apolinaras Zaborskis (Kaunas University of Medicine, biomedical sciences, public health 10 B) Prof. Dr. Habil. Rimantas elvys (Vilnius Pedagogical University, social sciences, educology 07 S) Assoc. Prof. Dr. Nida emaitien University of Medicine, biomedical (Kaunas sciences, public health 10 B; social sciences, psychology 06 S) Opponents: Assoc. Prof. Dr. Aura Gricit(Lithuanian Academy of Physical Education, social sciences, psychology 06 S) Prof. Dr. Rita ukauskien Romeris University, social sciences, (Mykolas psychology 06 S) The public defense of the dissertation will be held in The Small Hall at Vytautas Magnus University on May 26, 2008 at 10 a.m. Address: Daukanto st. 28, LT-44246 Kaunas, Lithuania. The summary of the dissertation was sent out on April 25, 2008. Copy of the dissertation is available at the library of Vytautas Magnus University and Martynas Mazvydas National Library of Lithuania.
VYTAUTO DIDIOJO UNIVERSITETAS
Rytis Pakrosnis SVEIKATOS PRIEIROSĮSTAIGOSE GYDOMPAAUGLIPSICHOLOGINIO FUNKCIONAVIMO PROBLEMKITIMASĮSPRENDIMUS SUTELKTO TRUMPALAIKIO KONSULTAVIMO METU
Daktaro disertacijos santrauka Socialiniai mokslai, psichologija (06 S)
Kaunas, 2008
Disertacija rengta 2001-2005 metais Vytauto Didiojo universitete Disertacija ginama eksternu Mokslinis konsultantas: Prof. habil. dr. Antanas Gotautas (Vytauto Didiojo universitetas, biomedicinos mokslai, medicina 07 B, psichiatrija B 650; socialiniai mokslai, psichologija 06S) Disertacija ginama Vytauto Didiojo universiteto Psichologijos mokslo krypties taryboje: Pirmininkas: Prof. habil. dr. Vytautas Gudonis (Rusijos pedagogini socialini ir mokslakademijos akademikas, Niujorko moksl akademijos narys, iauli universitetas, socialiniai mokslai, psichologija 06 S, edukologija 07 S) Nariai: Doc. dr. Bronislava Grigait Didiojo universitetas, socialiniai mokslai, (Vytauto psichologija 06 S) Prof. habil. dr. Apolinaras Zaborskis (Kauno Medicinos universitetas, biomedicinos mokslai, visuomens sveikata 10 B) Prof. habil. dr. Rimantas elvys (Vilniaus pedagoginis universitetas, socialiniai mokslai, edukologija 07 S) Doc. dr. Nida emaitien Medicinos universitetas, biomedicinos mokslai, (Kauno visuomens sveikata 10 B; socialiniai mokslai, psichologija 06 S) Oponentai: Doc. dr. Aura Gricit k (Lietuvosno kultros akademija, socialiniai mokslai, psichologija 06 S) Prof. Dr. Rita ukauskien Romerio universitetas, socialiniai mokslai, (Mykolo psichologija 06 S) Disertacija bus ginama vieame Psichologijos mokslo krypties tarybos posdyje 2008 m. gegus mn. 26 d. 10 val. Vytauto Didiojo universiteto Maojoje salje Adresas: Daukanto g. 28, LT-44246 Kaunas, Lietuva Disertacijos santrauka isiuntinta 2008 m. balandio mn. 25 d. Disertaciją galima perirti Vytauto Didiojo universiteto bibliotekoje ir Lietuvos nacionalinje M. Mavydo bibliotekoje.
CONTENT I. INTRODUCTION--------------------------------------------------------------------------------------- 61.1. Scientific novelty, theoretical and practical significance of the dissertation---------- 91.2. The aim and objectives of the research------------------------------------------------------ 101.3. Theses to be defended --------------------------------------------------------------- ---- 10--------1.4. Structure of the dissertation ------------------------------------------------------------------- 11II. CONTENT OF THE DISSERTATION ---------------------------------------------------------- 122.1. Theoretical issues -------------------------------------------------------------------------------- 122.2. Research methods-------------------------------------------------------------------------------- 122.2.1. Study procedure and sample ----------------------------------------------------------------- 12 2.2.2. Assessment methods --------------------------------------------------------------------- - 14 ----2.2.3. Intervention method --------------------------------------------------------------------------- 18 2.3. Results ---------------------------------------------------------------------------------------------- 192.3.1. Differences of psychological functioning between adolescents with mental health and physical health disorders --------------------------------------------------------------------- 19 2.3.2. Changes in problems presented for therapy and psychological functioning during SFBT among adolescents with health disorders ------------------------------------------ 21 2.3.2.1. Changes in problems presented for therapy during SFBT among adolescents with health disorders ------------------------------------------------------------------ 21 2.3.2.2. Changes in psychological functioning during SFBT among patients of primary mental health care centers------------------------------------------------------------ 23 2.3.2.3. Changes in psychological functioning during SFBT among patients of rehabilitation hospital----------------------------------------------------------------- 25 2.3.3. Clinical significance of psychological functioning changes among adolescents with health disorders-------------------------------------------------------------------------------- 26 2.3.4. Analysis of factors influencing the outcome of SFBT among adolescents with health disorders---------------------------------------------------------------------------------------- 27 2.3.4.1. Factors predicting resolution progress of problems presented for therapy ------ 27 2.3.4.2. Factors influencing changes in psychological functioning during the SFBT --- 28 2.4. Discussion------------------------------------------------------------------------------------------ 292.5. Conclusions---------------------------------------------------------------------------------------- 33III. REFERENCES --------------------------------------------------------------------------------------- 35IV. LIST OF PUBLICATIONS ------------------------------------------------------------------------ 38V. REZIUM------------------------------------------------------------------------------------------ 40----
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I. INTRODUCTION
Research data in Lithuania and other countries indicate that approx 10 15% of adolescents experience mental or physical health difficulties and these numbers are constantly increasing (Garralda, 2004; Mash, Wolfe, 2002; Jacobson, Churchill, Donovan, Garralda, Fay, 2002; Suris, Michaud, Viner, 2004). The bio-psycho-social health model and empirical data suggest that health disorder affects both physical and psychosocial functioning (Garralda, 2004; LeBovidge, Lavigne, Donenberg, Miller, 2003; Mash, Wolfe, 2002; Suris, Michaud, Viner, 2004) accordingly reducing wellbeing in all three domains mentioned in the health definition provided by World Health Organization (Marks, Murray, Evans, Willig, Woodall, Sykes, 2005). A level of psychological functioning is often conceptualized as a result of this process, expressed by the severity of problems in such areas as mood, behavior, relationships etc. (Bishop, 2005; Cigularova, 2005; Livneh, Antonak, 1997; Shanahan, Davey, Brooks, 2003). Thus, a health disorder, as a risk factor, creates a situation where adolescents can experience increased threat (symptoms, hospitalization, and other limitations) and lack of resources available which can jeopardize emergence of new or severity of existing problems of psychological functioning (Bishop, 2005; Compas, 2004; Eyberg, Schuhmann, Rey, 1998; McMahon, Grant, Compas, Thurm, Ey, 2003; Schmidt, Petersen, Bullinger, 2003). The question of specificity of the effect of a particular health disorder (e.g. mental or physical health disorder) on the adolescences psychological functioning is discussed broadly in last decades (Compas, 2004; Grant, 2003, cited from Compas, 2004; McMahon, Grant, Compas, Thurm, Ey, 2003). Existing data (that is still very limited) show, that mental health disorder is related to more severe problems of psychological functioning than physical health disorder, but the type of health disorder is a weak predictor of the adolescents psychological functioning problems (Bishop, 2005; Kyngäs, 2000; McMahon, Grant, Compas, Thurm, Ey, 2003; Schmidt, Petersen, Bullinger, 2003; Williams, Colder, Richards, Scalzo, 2002). However, this question needs special attention and is touched in the dissertation. Research data reveal that problems of adolescents with health disorders, unless addressed at the early stage, can grow into psychopathology (Jacobson, Churchill, Donovan, Garralda, Fay, 2002; Schmidt, Petersen, Bullinger, 2003), lead to decreased
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motivation to contribute to the treatment (Kyngäs, 2000; Putman, Adams, 1992) and decreased satisfaction with the services (Michaud, Suris, Viner, 2004; Schmidt, Petersen, Bullinger, 2003). However, the lack of attention to psychosocial factors and especially to psychological help in the health care is often highlighted in the literature (Bauman, Drotar, Leventhal, Perrin, Pless, 1997). Effectiveness and suitability of psychological help methods for different client groups have been often discussed in last decade. In this context, literature analysis has enabled to raise several problems that are touched in the dissertation (Kazdin, 2002; 2003; Smith, 2002). First, the need for evidence base in the field of psychological help in health care is often stressed worldwide (Bertolino, 2003). However, there still exists a lack of well-designed research works in adolescents population the results of which often being contradictory (Kazdin, 2003). Besides, very few works of the Lithuanian scholars in this research field can be mentioned (Dvarionis, 1999; Markeviciute, Gostautas, Pilkauskiene, 2004; Selmistraitiene, 1999; Zelvys, 1988). Furthermore, all of the aforementioned studies analyze group interventions; therefore we have not found any Lithuanian studies exploring effectiveness of the individual mode of psychological help. Second, influenced by the positive psychology movement the research area dealing with effectiveness of psychological interventions seems to change direction from raising questions about effects of interventions on the symptoms or problems presented for the therapy towards the evaluation of how the intervention can help the client to learn new more adaptive behavior strategies or move towards better psychological functioning (Kazdin, 2002; 2003; Kovacs, Kohr, 1995). Third, having discovered that intervention method used and such factors as therapists personality, experience, skills or working alliance do not fully predict the outcome of an intervention, the field of outcome research is slowly moving towards the study of agents of psychological help effectiveness, involving other factors such as different groups of the clients and their characteristics together with the impact they make on the outcome (Kazdin, 2002; 2003; Mann, Borduin, 1991). However, all mentioned aspects still need more attention, especially in the outcome studies conducted among youth population. Following these assumptions, the present dissertation deals with two main questions regarding psychological functioning of adolescents having health disorders: first, do the different types of health disorders affect adolescents psychological
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functioning specifically; second, does participation in the course of Solution-Focused Brief Therapy have a positive effect on psychological functioning of adolescents having health disorders? The Solution-Focused Brief Therapy (SFBT) as an intervention method has been chosen because it is one of the methods emphasizing a positive attitude towards a client and therapeutic process that builds the cooperation between the therapist and the client, avoids confrontation, and is oriented towards brief process. The characteristics of SFBT help to minimize adolescents resistance and enhance therapeutic alliance, decrease adolescents self-blame and increase satisfaction and motivation to continue the therapy, stimulates adolescents thinking and helps to name and clearly understand what changes he/she desires (Corcoran, Stephenson 2000; Lethem, 2002; Simon, Berg, 2004) thus allowing the model to gain more and more popularity among mental health professionals working with adolescents (Corcoran, Stephenson 2000; Gingerich, Wabeke, 2001; Kazdin, 2003). Besides, SFBT interventions and procedures are easy to define and analyze, the therapeutic process is well structured. Accordingly, their application and fulfillment with the model can be recorded and monitored which is crucial while conducting outcome studies. Finally, literature analysis has revealed clear links between change mechanisms proposed by SFBT and adaptation mechanisms leading to arousal of psychological functioning problems (see Figure 1). Research and theoretical assumptions suggest that in order for an intervention to be able to be effective in correction of psychological functioning, it is important to address four main factors, related to formation and maintenance of psychological functioning problems. THERAPIST E T SOCIAL SYSTEM (responsFSPTBesponsibleforreac(s,tion(rNLICDiUbRleROfCoErtherapeutic Cooperation content and changes) Changes in reinforcement) proc)sseeahpremtsoproblem severity Behavior Goal setting changes Changes in reactions Perception Plannin of actions changes gChangesinpsychological Track of positive functioning h c an es Figure 1.between SFBT process and therapeutic changeRelations
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Orientation towards helping clients in discovering alternative perceptions of a problem situation, systemic view, accent on ones resources and help to utilize them while reaching for a goal, stress on finding and activating adaptive behavior strategies, embedded in SFBT, deal with these key factors potentially influencing the level of psychological functioning problems (Biggs, 2004; McMahon, Grant, Compas, Thurm, Ey, 2003). However, there is an obvious lack of research addressing SFBT effectiveness for adolescence in health settings; especially regarding models potential to increase psychological functioning. Besides, there is no data on factors influencing effectiveness of SFBT in this clients group (Macdonald, 2003; McKeel, 2000). 1.1. Scientific novelty, theoretical and practical significance of the dissertation Results of this dissertation will broaden pool of knowledge on the specificity of the influence of mental and physical health disorders on adolescents psychological functioning. The results will lead the practitioners to better understanding and forecast of the problems they can face while working in different health settings and think of appropriate interventions or programs for adolescents with different health disorders. The main significance of the results of the present work will contribute to the field of SFBT research. In literature, international SFBT conferences and other sources we have found only six studies, exploring models effectiveness for adolescents in health care settings (Gingerich, Wabeke, 2001; Macdonald, 2003; McKeel, 2000). They suggest that participating in SFBT leads to decrease of psychopathology symptoms (Perkins, 2006), severity of the problems presented for the therapy (Burr, 1993; Lee, 1997; Seagram, 1997, all cited by Macdonald, 2003), manifestations of antisocial behavior (Seagram, 1997, cited by Macdonald, 2003), behavior and self esteem problems (Corcoran, Stephenson, 2000). However, this number is obviously too small to claim the effectiveness of the model, especially changes in the clients psychological adjustment still lack the attention of the researchers. Besides, most of SFBT outcome research relies on the level of therapeutic goal achievement as perceived by the client. We assessed both, changes in the subjective evaluation of the severity of problems presented for the therapy and psychological functioning, evaluated by standardized measures. This will enable us to compare these measures and evaluate whether changes
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in psychological functioning is related to changes in presented problems and gain some insight into therapeutic change mechanisms. Possibility to compare SFBT outcome between adolescents experiencing mental and physical health problems, evaluation of the factors, potentially influencing outcome, will allow us to evaluate the limits or agents of SFBT effectiveness for adolescents in health care settings. 1.2. The aim and objectives of the research The aim of the research is to estimate the changes in the severity of psychological functioning problems during Solution-Focused Brief Therapy among in-patient and out-patient adolescents experiencing mental or physical health disorders. In support of the research aim, the following objectives have been set: 1. To select or compose and validate measures for evaluation of the severity and changes of psychological functioning problems among adolescents. 2. To compose SFBT manual and protocol for recording and evaluation of the contents of therapeutic process and clients therapeutic progress. 3. To evaluate severity of psychological functioning problems among adolescents in health care setting and assess differences of their severity between adolescents with mental and physical health disorders. 4. To evaluate changes in the severity of treatment group adolescents problems presented for the therapy and problems of psychological functioning during the SFBT as compared to a control group. 5. To assess relationship between positive changes in the severity of problems presented for the therapy and psychological functioning and such factors as clients gender, age, family status, the type of health disorder, in-patient and out-patient conditions, the type of the problem presented for the therapy and willingness to solve the problem.
1.3. Theses to be defended 1. Mental health disorders have a higher degree of negative effect on adolescents psychological functioning than physical health disorders. 2. Adolescents in health care settings participating in the Solution-Focused Brief Therapy experience positive changes in the severity of the problems presented
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for the therapy and in the broader functioning context (psychological functioning). 3. Positive changes in the psychological functioning of adolescents in health care setting participating in the Solution-Focused Brief Therapy are related to the decrease in the severity of the problems, presented for the therapy. 4. Positive changes in the severity of the problems presented for the therapy and psychological functioning of adolescents in health care setting participating in the Solution-Focused Brief Therapy are related to such factors as participants socio-demographic characteristics, the type of health disorder, in-patient and out-patient conditions, the type of the problem presented for the therapy and willingness to solve the problem. 1.4. Structure of the dissertation The dissertation contains theoretical and empirical parts. The theoretical part consists of three chapters, contents of which will be described briefly later in this text. Research methods, results of the research, discussion, conclusions and recommendations based on the results make a content of the empirical part of the dissertation and will be presented in the next chapter of the present summary. The results of the research in the dissertation are presented in 27 figures and 18 tables. The list of references contains 159 sources.
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