Understanding and working with existential information in a Norwegian adolescent psychiatry context: a need and a challenge

This is one of several studies on existential information in psychotherapy in Southern Norway. The aim of this study was to explore how therapists' backgrounds and existential information influence their therapeutic practice and philosophy of care, and the use of existential information in psychotherapy. The method used was qualitative, semi-structured interviews. Through emerging themes from the interviews and clinical case illustrations, information relating to therapists' backgrounds and existential orientations strongly influenced: therapeutic practice, philosophy of care, and if as well as how existential information was used in therapy. Professional and continued education/training in this area were insufficient. However, the area itself was considered essential for understanding clients' psychosocial and sociocultural needs in multicultural Norway. Therapists expressed the importance of communication about existential information. Clinical examples were given that focused on this information's usefulness for identifying strategies addressing both salutogenic and pathogenic aspects of adolescent psychosocial functioning. Clinical educational and training insufficiencies related to working with existential information were noted. Although strategic thinking and organisational framework in the working context permitted existential information to be raised in therapy, many expressed the lacking of methodological confidence and training in this area. Education and training were, therefore, priorities. Accessing this type of information with all clients, whatever their existential information, was emphasised for strengthening the therapeutic alliance.     

Neurobiological and memory models of risky decision making in adolescents versus young adults

Predictions of fuzzy-trace theory and neurobiological approaches are examined regarding risk taking in a classic decision-making task--the framing task--as well as in the context of real-life risk taking. We report the 1st study of framing effects in adolescents versus adults, varying risk and reward, and relate choices to individual differences, sexual behavior, and behavioral intentions. As predicted by fuzzy-trace theory, adolescents modulated risk taking according to risk and reward. Adults showed standard framing, reflecting greater emphasis on gist-based (qualitative) reasoning, but adolescents displayed reverse framing when potential gains for risk taking were high, reflecting greater emphasis on verbatim-based (quantitative) reasoning. Reverse framing signals a different way of thinking compared with standard framing (reverse framing also differs from simply choosing the risky option). Measures of verbatim- and gist-based reasoning about risk, sensation seeking, behavioral activation, and inhibition were used to extract dimensions of risk proneness: Sensation seeking increased and then decreased, whereas inhibition increased from early adolescence to young adulthood, predicted by neurobiological theories. Two additional dimensions, verbatim- and gist-based reasoning about risk, loaded separately and predicted unique variance in risk taking. Importantly, framing responses predicted real-life risk taking. Reasoning was the most consistent predictor of real-life risk taking: (a) Intentions to have sex, sexual behavior, and number of partners decreased when gist-based reasoning was triggered by retrieval cues in questions about perceived risk, whereas (b) intentions to have sex and number of partners increased when verbatim-based reasoning was triggered by different retrieval cues in questions about perceived risk.     

The Sources of Meaning and Meaning in Life Questionnaire in the Norwegian Context: Relations to Mental Health,Quality of Life,and Self-Efficacy

The Sources of Meaning and Meaning in Life Questionnaire (SoMe) offers dimensional measures of meaningfulness, crisis of meaning, and 26 sources of meaning. It allows for a clearer understanding of the variety of existential orientations, which are known to be linked to both mental and physical health. The Norwegian version of the SoMe was validated by testing 925 randomly selected individuals who were representative for the Norwegian population. Reliability scores were satisfactory; factor analyses suggested a 6-factor structure of the sources of meaning scales. Expected patterns of associations with mental health and quality-of-life factors attested the instrument’s construct validity: Meaningfulness showed positive relationships to all quality-of-life factors. There was no relationship with anxiety but negative relationships with depression and distress. Crisis of meaning established a strong positive relationship with anxiety, depression, and distress and a negative relationship with quality-of-life factors. Criterion validity was documented by expected differences in meaningfulness and crisis of meaning between groups with and without presence of depression disorder. Self-efficacy correlated strongly with sources of meaning from the dimension “accomplishment” and moderately negatively with sources of meaning from the dimension “vertical selftranscendence.”     

The illness reframing process in an ethnic-majority population of older people with incurable cancer: variations of cultural- and existential meaning-making adjustments

Increasing numbers of older people in Western countries are living with incurable cancer as a chronic disease, receiving palliative care from specialised healthcare contexts. The study's aim was to understand variations of cultural- and existential meaning-making adjustments in a Norwegian majority population of older people with incurable cancer. Semi-structured interviews from 21 participants, aged 70–88, were analysed according to three identified types of belief frames: atheistic/humanistic, religious, and spiritual. Kleinman's medical anthropology cultural framework was adapted and applied deductively together with a reframing metaphor concept in a four-part analytic process. Independent of the differences among the types of belief frames and heterogeneous illness reframing processes, changes in the existential cultural dimension seemed to facilitate psychosocial adjustments in relation to illness, daily living, relationships, and surroundings. The results point to the need for collecting and assessing the function of this type of patient information for better understanding the patient's framework of interpretation, and for identifying treatment-planning resources.     

Book Review: Cultural Psychotherapy: Working with Culture in the Clinical Encounter. By Karen M. Seeley. London: Jason Aronson,Inc., 2000

Pastoral Psychology -     

Psychological and existential vulnerability among clinical young women: a quantitative comparison of depression-related subgroups

The objective was to explore psychological and existential vulnerability among clinical young women in Sweden. Females (n?=?53) with depression as the most common preliminary diagnosis were investigated through an online questionnaire. Included measures were Karolinska Scales of Personality, Self-concept, Strategies to Handle Negative Emotions, Sense of Coherence, and questions pertaining to existential meaning-making, including religious/spiritual belief. The sample was divided into High (n?=?35) and Low/Inter (n?=?18) groups according to scores on the anxiety- and depression-related personality scale Inhibition of aggression. Using independent samples t-test, the High group showed signs of significantly higher psychological and existential vulnerability than the Low/Inter group. Salutogenic factors being (1) coming from socially and societally engaged families and (2) being in a functional existential meaning-making process. The conclusion is that vulnerabilities in the psychological and existential domains are linked, especially in individuals high on depression-like aspects of personality. However, no significant differences for religion/spirituality were found. Treatment implications were addressed.     

Emotional stressors among volunteers operating a diaconal suicide-prevention crisis line in Norway: a qualitative study

ABSTRACT

Despite the worldwide proliferation of suicide-prevention crisis-line networks, there is limited in-depth knowledge of how the volunteer call responders experience and manage emotional stressors. The study’s purpose was to explore emotional stressors related to operating a diaconal suicide-prevention crisis line, and how these are managed in daily operations. In this qualitative study, 27 volunteers were interviewed in four focus groups. The material was analysed using systematic text condensation. The participants experienced emotional stressors related to being unable to actively intervene, encountering traumatised callers and feeling uncertain about representing the Church. They used a combination of personal coping strategies and organisational support factors. Implications for training and practice are further discussed.