3 resultados para process- outcome relationships

em Research Open Access Repository of the University of East London.


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Variability management is one of the major challenges in software product line adoption, since it needs to be efficiently managed at various levels of the software product line development process (e.g., requirement analysis, design, implementation, etc.). One of the main challenges within variability management is the handling and effective visualization of large-scale (industry-size) models, which in many projects, can reach the order of thousands, along with the dependency relationships that exist among them. These have raised many concerns regarding the scalability of current variability management tools and techniques and their lack of industrial adoption. To address the scalability issues, this work employed a combination of quantitative and qualitative research methods to identify the reasons behind the limited scalability of existing variability management tools and techniques. In addition to producing a comprehensive catalogue of existing tools, the outcome form this stage helped understand the major limitations of existing tools. Based on the findings, a novel approach was created for managing variability that employed two main principles for supporting scalability. First, the separation-of-concerns principle was employed by creating multiple views of variability models to alleviate information overload. Second, hyperbolic trees were used to visualise models (compared to Euclidian space trees traditionally used). The result was an approach that can represent models encompassing hundreds of variability points and complex relationships. These concepts were demonstrated by implementing them in an existing variability management tool and using it to model a real-life product line with over a thousand variability points. Finally, in order to assess the work, an evaluation framework was designed based on various established usability assessment best practices and standards. The framework was then used with several case studies to benchmark the performance of this work against other existing tools.

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This thesis examines the impact on child and adolescent psychotherapists within CAMHS of the introduction of routine outcome measures (ROMs) associated with the Children and Young People’s Improving access to Psychological Therapies programme (CYP-IAPT). All CAMHS therapists working within a particular NHS mental health Trust1 were required to trial CYP-IAPT ROMs as part of their everyday clinical practice from October 2013-September 2014. During this period considerable freedom was allowed as to which of the measures each therapist used and at what frequency. In order to assess the impact of CYP-IAPT ROMs on child psychotherapy, I conducted semi-structured interviews with eight psychotherapists within a particular CAMHS partnership within one NHS Trust. Each statement was coded and grouped according to whether it related to initial (generic) assessment, goal setting / monitoring, monitoring on-going progress, therapeutic alliance, or to issues concerning how data might be used or interpreted by managers and commissioners. Analysis of interviews revealed greatest concern about session-by session ROMs, as these are felt to impact most significantly on psychotherapy; therapists felt that session-by-session ROMs do not take account of negative transference relationships, they are overly repetitive and used to reward / punish the therapist. Measures used at assessment and review were viewed as most compatible with psychotherapy, although often experienced as excessively time consuming. The Goal Based Outcome Measure was generally experienced as compatible with psychotherapy so long as goals are formed collaboratively between therapist and young person. There was considerable anxiety about how data may be (mis)used and (mis)interpreted by managers and commissioners, for example to end treatment prematurely, trigger change of therapist in the face of negative ROMs data, or to damage psychotherapy. Use of ROMs for short term and generic work was experienced as less intrusive and contentious.

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Therapistsʼ process notes - written descriptions of a session produced shortly afterwards from memory - hold a significant role in child and adolescent psychoanalytic psychotherapy. They are central in training, in supervision, and in developing oneʼs understanding through selfsupervision and forms of psychotherapy research. This thesis examines such process notes through a comparison with audio recordings of the same sessions. In so doing, it aims to generate theory that might illuminate the causes of significantly patterned discrepancies between the notes and recordings, in order to understand more about the processes at work in psychoanalytic psychotherapy and to explore the nature of process notes, their values and limitations. The literature searches conducted revealed limited relevant studies. All identified studies that compare process notes with recordings of sessions seek to quantify the differences between the two forms of recording. Unlike these, this thesis explores the meaning of the differences between process notes and recordings through qualitative data analysis. Using psychoanalytically informed grounded theory, in total nine sets of process notes and recordings from three different psychoanalytic psychotherapists are analysed. The analysis identifies eight core categories of findings. Initial theories are developed from these categories, most significantly concerning the role and influence of a ʻcore transference dynamicʼ between therapist and patient. Further theory is developed on the nature and function of process notes as a means for the therapistʼs conscious and unconscious processing of the session, as well as on the nature of the influence of the relationships – both internal and external – within which they are written. In the light of the findings, a proposal is made for a new approach for learning about the patient and clinical work, ʻthe comparison methodʼ (supervision involving a comparison of process notes and recordings), and, in particular, for its inclusion within the training of psychoanalytic psychotherapists. Further recommendations for research are also made.