Psychological and Social Perspectives on Malingering and Symptom Exaggeration: Conceptualization and Interventions Using Acceptance and Commitment Therapy

Malingering and the production of false symptoms seen in such disorders as Factitious Disorder are an ongoing mystery to medical and mental health professionals. Historically, these presentations have been difficult to identify and treat. As might be expected, individuals with such symptomology rarely agree to participate in research, possibly because of a reluctance to admit to the feigning or exaggerating behaviors and a fear of reprisals. Many different etiologies have been proposed, including the assumption of roles in order to manage impressions, taking control of symptoms in order to gain attention or other rewards or avoid aversive events, and even the production of symptoms that is largely out of awareness such as is seen in conversion or somatoform presentations. By examining historical and present-day beliefs about etiology and treatment interventions, professionals can explore what new types of effective treatment might look like. The behaviorist philosophy that underlies Acceptance and Commitment Therapy proposes a perspective emphasizing effective working in context. This philosophy also suggests individuals sometimes engage in behavior in order to escape from or avoid aversive experiences. Utilizing case examples and fresh behavioral perspectives provides insight and ideas for conceptualization of these behaviors of interest. Using the above conceptualizations, an ACT based treatment of those who produce false symptoms is introduced.

The Impact of Sexual Boundary Violations in Supervision and Therapy: A Qualitative Study of a Trainee's First-Hand Account

This study involves a qualitative analysis of a doctoral-level psychology trainee's first-hand account of sexual attraction and boundary violations that occurred in her clinical supervision and psychotherapy. Concepts of power, gender, social performance theory, and relational framing are applied to two case examples, illustrating the differing demands on a trainee when her relationships were sexualized in two distinct professional contexts. Ramifications of supervisory exploitation and the impact of such an experience on a trainee's professional development are discussed. Recommendations are provided for improving psychology training programs' prevention and response efforts.

A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

Background: Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods: A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results: We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions: Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Apoyo social formal a un grupo de madres con hijos menores de un año

Objetivo: este trabajo pretende analizar el apoyo social formal a un grupo de madres con hijos menores de un año. Método: estudio cualitativo, descriptivo interpretativo, en el cual participaron diez mujeres en un grupo focal que se reunió en siete ocasiones. Resultados: a partir del análisis de contenido de las dinámicas grupales se detecta que el apoyo formal informativo es el más frecuente y resulta difícil separarlo del emocional. Los profesionales, a través del apoyo informativo, tratan temas relacionados con la promoción de la salud y prevención de la enfermedad y acompañan a las madres en este rol. Conclusión: para las madres el apoyo formal brindado por el personal de enfermería es positivo y percibido como un refuerzo en su vivencia de la maternidad, y debe estar enmarcado en un contexto cultural.

Satisfacción en la provisión de redes de apoyo social en grupos de acompañamiento a la maternidad

Objetivos: Conocer la percepción del grado de satisfacción que tienen las madres, con hijos menores de un año y que participan en las dinámicas grupales que los CAP ofrecen, en relación al contenido y redes de provisión del Apoyo Social (AS) así como las causas que disminuyen la satisfacción en el receptor de este apoyo. Material y métodos: Estudio con diseño cualitativo y enfoque fenomenológico. La población objeto de estudio estaba constituida por madres participantes en dinámicas grupales de cinco CAP de la provincia de Barcelona. Como instrumento de recogida de datos se empleó la entrevista semiestructurada, entre julio de 2011 y julio de 2012; todas fueron grabadas, transcritas y analizadas. Resultados: AS informal: la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional y evaluativo procedente de las enfermeras; identificándose 4 categorías que contribuyen en esta percepción: contacto profesional/accesibilidad, disparidad y/o actualización, confianza y no procede. AS formal, la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional, evaluativo y técnico procedente de la pareja y madre (abuela materna); identificándose 8 categorías en esta percepción: disparidad y/o actualización en los consejos, exigencia, empatía, confianza, inseguridades, tiempo, distancia y no procede. Conclusiones: Los factores identificados deberían considerarse en los planes de mejora de la satisfacción y acompañamiento de las madres en este momento de profundos cambios en su vida; dado que aportar un AS satisfactorio repercute en la promoción de la salud y prevención de la enfermedad.

Supplemental nursing staff´s experiences at a Spanish hospital: Qualitative phenomenology research

The objective of this study was to describe the Supplemental Nursing Staff´s experiences at different hospital units. A qualitative phenomenological approach was conducted; a purposeful and theoretical sampling was implemented with supplemental nursing staff at Santa Barbara Hospital of Soria (Spain), to gain a more in-depth understanding of the Supplemental Nursing Staff ´s experience. Data were collected by in-depth interviews and through a field notebook. Data were analyzed using the Giorgi proposal. Twenty-one nurses with a mean age of 46 years were included. Three main topics emerged from the data analysis: building the first contact, carving out a niche and establishing interprofessional/interpersonal relationships. We conclude that the experience of hosting the supplemental nursing staff in changing clinical environments is conditioned by various factors. It is necessary for nurses and hospital managers to establish clear objectives with regard to the supplemental nursing staff´s role in the units.

Social Impact of Coca Crops in Colombia. : From socio-territorial processes to new social configurations: the role of land tenure, armed conflict, environment and coca crops.

This paper explores alterations in social dynamics caused by coca crops in Curvaradó and Jiguamiandó, at Choco department in the Colombian Pacific region. The research analyzes the role of armed actors such as paramilitaries and guerrillas in the conformation of new social spaces where local people find resistance as the main tool to survive in chaotic environments. Local power as a politics of resistance is also analyzed. Non-governmental organizations are a key tool to comprehend new social configurations. By doing the analysis and comparison using political ecology as the theoretical background along with concepts of moral economy and everyday resistance, with qualitative research methods. The paper aims to interpret and provide a better understanding of those changes considering social-environmental relations. Findings suggest that those changes in social structure are leading to an understanding, not just of the organization of the area, but also that social dynamics and coca crops cannot be generalized in the country. 

Views of general practitioners and benzodiazepine users on benzodiazepines: A qualitative analysis

Effectively assisting benzodiazepine users to cease use requires a greater understanding of general practitioners' (GPs) and benzodiazepine users' views on using and ceasing benzodiazepines. This paper reports the findings from a qualitative study that examined the views of 28 GPs and 23 benzodiazepine users (BUs) in Cairns, Australia. A semi-structured interview was conducted with all participants and the information gained was analysed using the Consensual Qualitative Research Approach, which allowed comparisons to be made between the views of the two groups of interviewees. There was commonality between GPs and BUs on reasons for commencing benzodiazepines, the role of dependence in continued use, and the importance of lifestyle change in its cessation. However, several differences emerged regarding commencement of use and processes of cessation. In particular, users felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before commencing benzodiazepines. Cessation could be discussed with all patients who use benzodiazepines for longer than 3 months, strategies offered to assist in management of withdrawal and anxiety, and referral to other health service providers for additional support. Lifestyle change could receive greater focus at all stages of treatment. (c) 2005 Elsevier Ltd. All rights reserved.

ENTRADA NA PROFISSÃO: ESCOLHA PESSOAL OU IMPOSIÇÃO SOCIAL?

O estudo procura identificar os fatores que contribuem para que os alunos, ao final do Ensino Médio, façam sua escolha profissional, se a escolha que fazem se baseia em algum programa de orientação profissional específico, se seguem uma orientação da família, de amigos, professores ou profissionais da área, ou se é uma imposição situacional, em função da classe social da qual o jovem faz parte. Pode-se encontrar várias respostas, a depender da classe socioeconômica ocupada pelo indivíduo; para cada parcela da população, talvez ocorra a reprodução de seu quadro socioeconômico, visto que os fatores que influem naquela escolha podem variar entre as diferentes camadas da sociedade. A pesquisa bibliográfica inclui autores como Pierre Bourdieu, Jean-Claude Passeron, Maria Alice Nogueira e Alípio Casali, entre outras. O estudo se completa com uma pesquisa de campo, em que foram entrevistados alunos de duas instituições de Ensino Médio, uma da rede pública e outra da rede privada, ambas situadas na cidade de São Bernardo do Campo. Trata-se, portanto, de uma pesquisa bibliográfica e qualitativa. Os dados empíricos foram coletados por meio de questionário para respostas diretas, e também com uma questão aberta, para que os alunos envolvidos pudessem contribuir com novos elementos para a análise final.

The management of stress amongst professional carers within a social services department

This thesis considers four broad areas:(i) ANALYSIS OF THE STRESS FIELD.(a) research studies, relevant to the British Social Services considering the cultural setting, and the rigor with which they were conducted; (b) models of stress, specifically examining the theoretical soundness and practical application of the Medical, Engineering and Transactional models;(c) organisational models of stress relating specifically to human service organisations.(ii) QUALITATIVE AND QUANTITATIVE RESEARCH METHODOLOGIES.(a) the appropriate application of each respective methodology and the particular usefulness of qualitative research designs; (b) the relevance of understanding the language and terminology associated with the subject area prior to the implementation of survey methods; (iii) FIELDWORK.(a) Phase 1. By use of focus groups, in-depth interviews and diary keeping amongst a small range of teams and managers, the Researcher develops a basic conceptual framework of stress within a Social Services context. In addition a small scale personality inventory was administered to participants.(b) Phase 2. This consisted of three key elements: 6 case studies in which the Researcher implements and appraises the impact of a range of intervention strategies designed to assist teams and their managers in dealing more effectively with stress; the administration of a large scale survey to all the field social work teams within the Social Services Department; an analysis of the user role within the stress process by way of two focus groups.(iv) THEORETICAL DEVELOPMENT.

Shifting accountability:a longitudinal qualitative study of diabetes causation accounts

We undertook a longitudinal qualitative study involving of 20 patients from Scotland who had type 2 diabetes. We looked at their perceptions and understandings of why they had developed diabetes and how, and why, their causation accounts had changed or remained stable over time. Respondents, all of whom were white, were interviewed four times over a 4-year period (at baseline, 6, 12 and 48 months). Their causation accounts often shifted, sometimes subtly, sometimes radically, over the 4 years. The experiential dimensions of living with, observing, and managing their disease over time were central to understanding the continuities and changes we observed. We also highlight how, through a process of removing, adding and/or de-emphasising explanatory factors, causation accounts could be used as “resources” to justify or enable present treatment choices. We use our work to support critiques of social cognition theories, with their emphasis upon beliefs being antecedent to behaviours. We also provide reflections upon the implications of our findings for qualitative research designs and sampling strategies.

Pleasure, pain and procrastination:reflections on the experience of doing memory-work research

The focus of this article is the process of doing memory-work research. We tell the story of our experience of what it was like to use this approach. We were enthused to work collectively on a "discovery" project to explore a method with which we were unfamiliar. We hoped to build working relationships based on mutual respect and the desire to focus on methodology and its place in our psychological understanding. The empirical activities highlighted methodological and experiential challenges, which tested our adherence to the social constructionist premise of Haug's original description of memory work. Combined with practical difficulties of living across Europe, writing and analyzing the memories became contentious. We found ourselves having to address a number of tensions emanating from the work and our approach to it. We discuss some of these tensions alongside examples that illustrate the research process and the ways we negotiated the collective nature of the memory-work approach. © 2012 Copyright Taylor and Francis Group, LLC.

A tale of two analyses: the use of archived qualitative data

This article provides a unique contribution to the debates about archived qualitative data by drawing on two uses of the same data - British Migrants in Spain: the Extent and Nature of Social Integration, 2003-2005 - by Jones (2009) and Oliver and O'Reilly (2010), both of which utilise Bourdieu's concepts analytically and produce broadly similar findings. We argue that whilst the insights and experiences of those researchers directly involved in data collection are important resources for developing contextual knowledge used in data analysis, other kinds of critical distance can also facilitate credible data use. We therefore challenge the assumption that the idiosyncratic relationship between context, reflexivity and interpretation limits the future use of data. Moreover, regardless of the complex genealogy of the data itself, given the number of contingencies shaping the qualitative research process and thus the potential for partial or inaccurate interpretation, contextual familiarity need not be privileged over other aspects of qualitative praxis such as sustained theoretical insight, sociological imagination and methodological rigour. © Sociological Research Online, 1996-2012.

Using the framework method for the analysis of qualitative data in multi-disciplinary health research

Background: The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion. The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary. Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research. © 2013 Gale et al.; licensee BioMed Central Ltd.