Browsing by Author "Marshall, Jerome"

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    Case study of a schizophrenic patient during social skills training in a forensic psychiatry ward
    (Stellenbosch : Stellenbosch University, 1987) Marshall, Jerome; Stellenbosch University. Faculty of . Dept. of .
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    An informational support programme within the context of health psychology and its impact on aspects of psychological functioning of parents of children with cystic fybrosis
    (Stellenbosch : Stellenbosch University, 2006-04) Marshall, Jerome; Meyer, J. C.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT: This thesis focuses on the emergence of the psychologist in health psychology and the application of psychological skills in a multidisciplinary context, with particular reference to cystic fibrosis. Modem health care provision is being influenced by the consequences of improved medical treatment as well as a move away from the model of medical dominance. The concept of parental empowerment (Melnyk, Feinstein, Moldenhouer, & Small, 2001) is being promoted in an age of biomedical reductionism (Campbell, 1994). With pressure to innovate in a climate of cost-containment, health care is taking on new forms of service delivery, with the psychologist experiencing greater acceptance in general hospital environments but, at the same time, needing to adapt to an emerging psychosocial model (Jasnoski & Schwartz, 1985) of medical treatment. The aim of this study is twofold. It firstly contextualises the role of the psychologist in a developing health psychology and medical environment. It then examines if a particular, informational support programme for parents of children with cystic fibrosis may be successful in achieving its objectives of empowering parents and reducing at least some of their distress. The shortcomings of psychological involvement alongside general medicine, as well as the historical structural barriers inherent in the dominance of the medical model (Parsons, 1970; Karabus 1994) is discussed. Attention is also drawn to the role of collaborative training (Gallo & Coyne, 2001; Kainz, 2002; Waters, 2001) as a facilitating force in the promotion of greater multidisciplinary co-operation. In the context of a serious illness such as cystic fibrosis, the disturbances in normal family life is noted. Since the usual patterns of parent-child attachment (Bowlby, 1969) are affected by an anticipated death of the child before the parent, the concept of ~hronic sorrow (Olshansky, 1962) is also mentioned. Consequently, in this strained domestic environment, difficulties in measuring parental functioning are discussed. A pilot study, in the form of a needs analysis on a small group of parents, precedes the main research, directed at a group of parents of pre-school children who had been diagnosed with cystic fibrosis. In the main research, an informational support package is provided to parents and aspects of their psychological functioning is measured on the General Health Questionnaire (Goldberg, 1978), Beck Depression Inventory (Beck & Steer, 1987), StateTrait Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1970) and Brief Symptom Inventory (Derogatis, 1993). Bivariate analysis, multivariate analysis and nonparametric comparisons were made to determine the effect of the informational support programme on aspects of the psychological functioning of parents. The results were mixed, with parents in the experimental group showing lower levels of depression, but not anxiety, after use of the support programme. While depression and anxiety ordinarily coexist (Lader, 1994; Stavrakaki & Vargo, 1986), it is speculated that the different nature of anxiety experienced by parents, entrusted with a demanding daily medical treatment regime, may account for these results. Positive results on the General Health Questionnaire, a measure which assesses stress responses in the health domain, are also reported. In an environment where the United Kingdom Department of Health (2001) is promoting the concept of the expert patient, knowledge and empowerment may not be enough. Placing the research in this study in context, it is argued that innovation and cost-containment will contribute towards both opportunities and stresses for the psychologist working in a biopsychosocial model incorporating multidisciplinary teams. Shaw and Baker (2004) ask "Expert patient - dream or nightmare?" while Strawbridge (2002) remarks on the pitfalls of what she calls, the emergence of 'McDonaldization or fast food therapy' in psychology, in which we find ourselves doing 'McJobs'. This study positions itself in the midst of the new concepts and demands of multidisciplinary service delivery and finds that its objectives are compromised by pressures of time, money and health care policy.