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Nasl. z nasl. zaslona. Opis vira z dne 14. 9. 2022. Bibliografija: str. 52-55. Abstract.

One of the most common problems for veterans suffering from PTSD is the disturbance of interpersonal relationships or attachments. These types of interpersonal impairments in abilities to love and feel loved (unable to have loving feelings, feelings of detachment or estrangement from others, and a sense of foreshortened future) result in significant problems in social, family, sexual, and work functioning. The wives of war veterans are the most vulnerable group after their return from war, and marital relations often become damaged. The interactive nature of the marital relationship, cultural norms, expectations, and a sense of obligation are just some factors that contribute to the wife's increased sensitivity to the stress experienced by her. In addition, wives often "take over" the symptoms of the traumatized person as a result of close emotional connection with and care for that person, thus resulting in the so-called process of secondary traumatization. The main aim of doctoral research was to investigate the relationships between PTSD symptoms, marital relationship quality, and partner attachment in Croatian veterans and their wives. Specifically, we want to investigate the answer to the following research questions: (1) Do veterans with PTSD and their wives have lower marital quality than veterans without PTSD and their wives? (2) Do anxious and avoidant attachment contribute to PTSD symptom levels in veterans and their spouses? Does veterans' anxious and avoidant attachment contribute to their wives' PTSD symptom levels, or does veterans' spouses' anxious and avoidant attachment contribute to veterans' PTSD symptom levels? (3) Are anxious and avoidant attachments a transmission mechanism of PTSD symptoms between the veterans and their spouses? Methodology The sample consisted of two groups: (1) 75 veterans diagnosed with PTSD and their wives and (2) 75 veterans without PTSD diagnosis and their wives. They have answered questions from several questionnaires: The Cognitive non-verbal test (CNT Sučević et al., 2004), The Combat Exposure Questionnaire (CES Keane et al., 1989), Posttraumatic Stress Disorder Checklist for DSM-5 -PCL-5 (Weathers et al., 2013), Experiences in close relationship scale (ECR-12 Lafontaine et al., 2015). They also fulfill a sociodemographic questionnaire. Using t-test for independent samples we tested if two groups of veterans and two groups of their wives differ in marital quality. Using dyadic methodology, we have tested four separate actor-partner inderdependence models with anxious/avoidant attachment as a predictor, and symptoms of PTSD as a criteria. At the end, we conducted eight mediation analytes to test direct and indirect effects of anxious and avoidant attachment of an individual partner on the relationship between PTSD symptoms of veterans' wives and PTSD symptoms of veterans, and vice versa. Results and discussion Wives of veterans diagnosed with PTSD report higher levels of PTSD symptoms, higher levels of anxious attachment, and higher levels of marital cohesion than wives of veterans without PTSD diagnosis did. Veterans diagnosed with PTSD report higher levels of PTSD symptoms and higher levels of marital cohesion than veterans without PTSD diagnosis. Although 25 years have passed between the end of the war and our study, and other postwar stressful events may have influenced PTSD, the results of high levels of PTSD symptoms among veterans diagnosed with PTSD, and their wives suggest long-term consequences of war trauma and the existence of chronic PTSD Taking into account the weaknesses and vulnerabilities of their husbands, women alternate between the roles they take on in the family. Family dynamics are generally such that women are careful not to anger them with their behavior, monitor their mood, and take on all responsibilities. It is possible, therefore, that due to the woman's great adaptability to his wishes and activities, veterans with PTSD estimate the degree of cohesion with their spouse higher than veterans without a diagnosis of PTSD. Results from two models which test anxious attachment as a predictor of PTSD symptoms shows a significant dyadic “only actor” pattern for veterans. On the other hand, when it comes to veterans’ wives without PTSD diagnosis, we found significant partner effect. In other words, women's anxious attachment significantly positively predicts their level of PTSD symptoms and their partner's level of PTSD symptoms. Results from two models which test avoidant attachment as a predictor of PTSD symptoms shows a significant dyadic “only actor” pattern for veterans and their wives. Difficulties in emotional regulation during and immediately after a traumatic event are potential mechanisms through which anxious and avoidant attachments can influence the development and maintenance of PTSD symptoms (Mikulincer & Shaver 2012, 13). An indirect effect of veterans' PTSD symptoms on women's PTSD symptoms and an indirect effect of wives’ PTSD symptoms on veterans' PTSD symptoms via wives’ anxious attachment were obtained. Specifically, higher PTSD symptoms in veterans indirectly—through a positive effect on wives’ anxious attachment—contribute to higher PTSD symptoms in wives. That is higher levels of PTSD symptoms in veteran spouses indirectly—through a positive effect on veteran spouses' anxious attachment—contribute to higher PTSD symptoms in veterans. Mediation models that tested the avoidant attachment of veterans or their wives and the anxious attachment of veterans as mediators did not prove to be statistically significant that is, only direct effects of PTSD symptoms of veterans on PTSD symptoms of their wives were obtained, and vice versa. Significant mediation effect of wives’ anxious attachment could be due to the socialization process and social roles that emphasize women's focus on the relationships, which makes them more empathetic and more sensitive to their partner's behaviour and interpersonal skills behaviour which enables the transmission of PTSD symptoms between herself and her husband. Conclusion The results of our research also provide valuable implications for counseling and psychotherapy work with traumatized individuals. Although 25 years have passed since the war's end, veterans diagnosed with PTSD in the post-war period are currently experiencing very high levels of post-traumatic stress disorder symptoms. The combination of the complex clinical picture of PTSD and high comorbidity with other psychiatric and somatic disorders requires a complex or integrative treatment approach that includes biological, psychological, and social dimensions. Moreover, it is essential to include in the therapeutic work with traumatized individuals the spouses and working on the attachment to the partner. Integrating the concept of partner attachment into the treatment of PTSD can enable positive change in mental models of self and others. Therefore, it is important to pay special attention to the anxious attachment of wife and, in therapeutic work with anxiously attached individuals, to focus on her feeling of helplessness and fear of abandonment, to strengthen more effective emotional regulation, which will then lead to the reduction in the level of PTSD symptoms at the individual level, that is, to the reduction of secondary traumatization of the partner. Ena najpogostejših težav veteranov s posttravmatsko stresno motnjo je motnja medosebnih odnosov oziroma navezanosti. Te vrste medosebnih motenj v sposobnosti ljubiti in čutiti ljubljenega (nezmožnost čutiti ljubeče občutke, občutke ločenosti ali odtujenosti od drugih in občutek skrajšane prihodnosti) povzročijo znatne težave v socialnem, družinskem, spolnem in delovnem delovanju. Žene vojnih veteranov so po vrnitvi iz vojne najbolj ranljiva skupina, zakonski odnosi pa se pogosto skrhajo. Interaktivna narava zakonskega odnosa, kulturne norme, pričakovanja in občutek obveznosti so le nekateri dejavniki, ki prispevajo k povečani občutljivosti žene na stres, ki ga doživlja. Poleg tega žene pogosto »prevzamejo« simptome travmatizirane osebe zaradi tesne čustvene povezanosti in skrbi za to osebo, kar povzroči tako imenovani proces sekundarne travmatizacije. Glavni cilj doktorske raziskave je bil raziskati povezave med simptomi PTSM, kakovostjo zakonskih odnosov in navezanostjo na partnerja pri hrvaških veteranih in njihovih ženah. Natančneje, želimo raziskati odgovor na naslednja raziskovalna vprašanja: (1) Ali imajo veterani s PTSM in njihove žene slabšo zakonsko kakovost kot veterani brez PTSM in njihove žene? (2) Ali tesnobna in izogibajoča navezanost prispevata k ravni simptomov PTSM pri veteranih in njihovih ženah? Ali anksiozna in izogibajoča navezanost veteranov prispeva k stopnji simptomov posttravmatske stresne motnje pri njihovih ženah ali tesnobna in izogibajoča se navezanost ženah veterana prispeva k ravni simptomov posttravmatske stresne motnje pri veteranih? (3) Ali so anksiozna in izogibajoča navezanost mehanizem prenosa simptomov PTSM med veterani in njihovimi ženami? Metodologija Vzorec sta sestavljali dve skupini: (1) 75 veteranov z diagnozo PTSM in njihove žene ter (2) 75 veteranov brez diagnoze PTSM in njihove žene. Odgovorili so na vprašanja iz več vprašalnikov: The Cognitive non-verbal Test (CNT Sučević et al., 2004), The Combat Exposure Questionnaire (CES Keane et al., 1989), Posttraumatic Stress Disorder Checklist for DSM-5 -PCL -5 (Weathers et al., 2013), Experiences in close relationship scale (ECR-12 Lafontaine et al., 2015). Izpolnili su tudi sociodemografski vprašalnik. S t-testom za neodvisne vzorce smo testirali, ali se dve skupini veteranov in dve skupini njihovih žena razlikujeta v kakovosti zakonske zveze. Z diadično metodologijo smo testirali štiri ločene modele neodvisnosti med akterjem in partnerjem z anksiozno/izogibno navezanostjo kot napovednikom in simptomi PTSM kot merilom. Na koncu smo izvedli osem mediacijskih analiza za testiranje neposrednih in posrednih učinkov anksiozne in izogibajoče se navezanosti posameznega partnerja na razmerje med simptomi PTSP žena veteranov in simptomi PTSM veteranov in obratno. Rezultati in razprava Žene veteranov z diagnozo PTSD poročajo o višjih stopnjah simptomov PTSM, višjih stopnjah anksiozne navezanosti in višjih stopnjah zakonske kohezije kot žene veteranov brez diagnoze PTSM. Veterani z diagnozo PTSD poročajo o višjih stopnjah simptomov PTSM in višjih stopnjah zakonske kohezije kot veterani brez diagnoze PTSM. Čeprav je med koncem vojne in našo študijo minilo 25 let in so drugi povojni stresni dogodki morda vplivali na PTSP, rezultati visokih stopenj simptomov PTSP med veterani z diagnozo PTSD in njihovimi ženami kažejo na dolgoročne posledice vojne travme in obstoj kronične posttravmatske stresne motnje. Ob upoštevanju slabosti in ranljivosti svojih mož ženske izmenjujejo vloge, ki jih prevzemajo v družini. Družinska dinamika je na splošno taka, da ženske pazijo, da jih ne razjezijo s svojim vedenjem, spremljajo njihovo razpoloženje in prevzemajo vse odgovornosti. Možno je torej, da veterani s posttravmatsko stresno motnjo zaradi velike prilagodljivosti ženske njegovim željam in dejavnostim ocenjujejo stopnjo kohezije z zakoncem višje kot veterani brez diagnoze posttravmatske stresne motnje. Rezultati dveh modelov, ki preizkušata anksiozno navezanost kot napovedovalec simptomov posttravmatske stresne motnje, kažejo pomemben diadičen vzorec „only actor“ za veterane. Po drugi strani pa, ko gre za žene veteranov brez diagnoze PTSP, smo ugotovili pomemben „partner effect“. Z drugimi besedami, anksiozna navezanost žensk pomembno pozitivno napoveduje njihovo raven simptomov PTSM in raven simptomov PTSM pri njihovem partnerju. Rezultati dveh modelov, ki preizkušata izogibajočo se navezanost kot napovedovalec simptomov posttravmatske stresne motnje, kažejo pomemben diadičen vzorec »only actor« za veterane in njihove žene. Težave pri čustveni regulaciji med travmatičnim dogodkom in takoj po njem so možni mehanizmi, prek katerih lahko anksiozna in izogibajoča se navezanost vplivata na razvoj in vzdrževanje simptomov PTSP (Mikulincer & Shaver 2012, 13). Dobljen je bil posredni učinek simptomov PTSD veteranov na simptome PTSD pri ženskah in posredni učinek simptomov PTSD pri ženah na simptome PTSD veteranov prek anksiozne navezanosti žena. Natančneje, višji simptomi PTSM pri veteranih posredno – s pozitivnim učinkom na anksiozno navezanost žena – prispevajo k večjim simptomom PTSM pri ženah. To pomeni, da višje ravni simptomov PTSM pri zakoncih veteranih posredno – s pozitivnim učinkom na anksiozno navezanost zakoncev veteranov – prispevajo k višjim simptomom PTSM pri veteranih. Modeli mediacije, ki so testirali izogibajočo se navezanost veteranov ali njihovih žena in anksiozno navezanost veteranov kot mediatorjev, se niso izkazali za statistično značilne to pomeni, da so bili pridobljeni samo neposredni učinki simptomov PTSM veteranov na simptome PTSM žena in obratno. Pomemben mediacijski učinek anksiozne navezanosti žena je lahko posledica socializacijskega procesa in družbenih vlog, ki poudarjajo osredotočenost žensk na odnose, zaradi česar postanejo bolj empatične in bolj občutljive na partnerjevo vedenje in vedenje medosebnih veščin, kar omogoča prenos simptomov PTSP med sebe in svojega moža. Zaključek Rezultati naše raziskave dajejo tudi dragocene implikacije za svetovalno in psihoterapevtsko delo s travmatiziranimi posamezniki. Čeprav je od konca vojne minilo že 25 let, veterani, ki so jim v povojnem obdobju diagnosticirali PTSD, trenutno doživljajo zelo visoke stopnje simptomov posttravmatske stresne motnje. Kombinacija kompleksne klinične slike PTSM in visoke komorbidnosti z drugimi psihiatričnimi in somatskimi motnjami zahteva kompleksen ali integrativen pristop k zdravljenju, ki vključuje biološke, psihološke in socialne razsežnosti. Poleg tega je nujno, da v terapevtsko delo s travmatiziranimi posamezniki vključimo zakonca in delo na navezanosti na partnerja. Vključevanje koncepta navezanosti na partnerja v zdravljenje posttravmatske stresne motnje lahko omogoči pozitivne spremembe v mentalnih modelih sebe in drugih. Zato je pomembno, da posebno pozornost posvetimo anksiozni navezanosti žene in se pri terapevtskem delu z anksiozno navezanimi posamezniki osredotočimo na njen občutek nemoči in strahu pred zapuščenostjo, da okrepimo učinkovitejšo čustveno regulacijo, ki bo nato privedla do zmanjšanje stopnje simptomov PTSM na individualni ravni, to je do zmanjšanja sekundarne travmatizacije partnerja.

Multipla skleroza (MS) je kronična vnetna demielinizacijska bolezen osrednjega živčevja domnevno z avtoimunskim izvorom, ki prizadene posameznika v njegovih najbolj produktivnih letih življenja. Večinoma zbolijo ljudje med 20. in 40. letom starosti, ženske 2- do 4-krat pogosteje kot moški. To je čas, ko si posameznik poišče partnerja, si želi ustvariti družino in je na višku svoje poklicne kariere. Bolezen zaznamuje partnerski odnos in vpliva na celotno družino. Zaradi same bolezni, njenih simptomov, neželenih učinkov zdravil, psihičnih, socialnih in kulturnih razlogov se lahko pojavijo spremembe v spolnosti, za katero pa je znano, da je pomemben del partnerskega odnosa. V literaturi nismo zasledili raziskav o tem, ali je zadovoljstvo z zdravljenjem z zdravili povezano s partnerskim odnosom in spolno disfunkcijo, zato smo želeli v doktorski disertaciji odgovoriti prav na to vprašanje, saj vemo, da morajo bolniki z MS več let in desetletij jemati imunomodulatorna zdravila, ki lahko imajo neželene učinke. Ti vplivajo na kvaliteto njihovega življenja in vsakodnevno funkcioniranje. Raziskava je razdeljena na tri dele. V prvem nas je zanimalo, koliko bolnikov z multiplo sklerozo, ki prejemajo enega od imunomodulatornih zdravil, je v partnerski zvezi, koliko je ločenih in koliko samskih. V drugem delu smo iskali morebitno povezanost med zadovoljstvom z zdravljenjem, partnerskim odnosom in stopnjo spolne disfunkcije. Pri tem smo upoštevali tudi stopnjo nevrološke prizadetosti in trajanje bolezni. Prav tako nas je zanimalo, ali so bolniki z enostavnejšim načinom zdravljenja v obliki tablet in infuzij bolj zadovoljni, imajo kvalitetnejši partnerski odnos in manj pogosto spolno disfunkcijo kot bolniki, ki si sami vbrizgavajo zdravilo v podkožje ali mišico. S tretjim, kvalitativnim delom raziskave pa smo nadgradili kvantitativne rezultate. V kvantitativni del raziskave je bilo vključenih 588 bolnikov. Uporabili smo tri merske pripomočke: Vprašalnik o zadovoljstvu zdravljenja z zdravili (angl. Treatment Satisfaction Questionnaire for Medication – TSQM, verzija 1.4), Kvaliteta partnerskega odnosa, lestvica diadne regulacije (angl. Dyadic adjustment scale – DAS) in Vprašalnik o intimnosti in spolnosti (angl. Multiple Sclerosis Intimacy and Sexuality Questionnaire – MSISQ-19). Ugotovili smo, da je večina bolnikov, ki prejemajo imunomodulatorno terapijo, poročenih ali pa živijo v izvenzakonski partnerski zvezi, da so bolniki z enostavnejšim načinom zdravljenja, ki smo ga definirali kot jemanje tablet ali prejemanje infuzij, v primerjavi z zapletenejšim načinom zdravljenja v obliki injekcij bolj zadovoljni ter da je bila pri enostavnejšem načinu zdravljenja manj pogosta sekundarna in terciarna spolna disfunkcija, vrsta zdravljenja pa ni vplivala na kvaliteto partnerskega odnosa. V tretjem delu smo zbrane podatke, ki smo jih pridobili s poglobljenimi intervjuji, analizirali po metodologiji osnovane teorije. Izpostavili smo pomembne vidike življenja bolnikov z MS, ki so v partnerskem odnosu. Oblikovali smo pet kategorij: partnerski odnos, prosti čas, bolezen in zdravljenje, fizične spremembe v funkcioniranju in spolnost. Razvili smo osnutek modela MS DANES, ki bi nam lahko pomagal pri obravnavi bolnikov v centrih za MS. S pomočjo tega bi dobili širšo sliko o tem, kako bolnik živi z boleznijo, kako prenaša zdravljenje, kašen je njegov odnos s partnerjem ter kakšen je njegov socialni in ekonomski status. Rezultati bodo prispevali nova znanja za razvoj in oblikovanje intervenc v relacijski družinski in zakonski terapiji ter bodo v pomoč kako v terapevtskem procesu pristopiti k bolnikom z multiplo sklerozo. Multiple sclerosis is chronic inflammatory disease with presumed autoimmune ethology which typically occurs during the most productive period of life. It mostly affects people between 20 and 40 years old and has 2-4 times greater incidence in women. This is also a period in life when a person looks for a partner, establish a family and is usually also at the top of professional carrier. Multiple sclerosis has thereby strong influence of partner relationship and family life as such. Symptoms, possible side effects of medical treatment, psychological, social and cultural issues may influence sexual activity which represents very important component of partner relationship. Since there are, to our knowledge, no studies investigating relationship between satisfaction with multiple sclerosis treatment, partner relationship and sexual dysfunction, we addressed this topic which is even more important in view of long-term immunomodulatory treatment with significant side effects influencing every day quality of life. Our study is divided into the three parts. We initially addressed marital status of patients with multiple sclerosis on immunomodulatory treatment and determined the proportions of patients who were in either partner relationship, divorced or single. We then investigated possible relationship between satisfaction with multiple sclerosis treatment, quality of partner relationship and sexual dysfunction considering the degree of neurological disability and duration of the disease. We further investigated if patients with more simple treatment including tablets and infusions were more satisfied, have better partner relationship and less frequent sexual dysfunction compared to patients with more complex treatment including administration of the drug by subcutaneous/intramuscular injections. The third part of our study was qualitative and aimed to complement quantitative research. We included 588 patients and use three questionnaires: Treatment Satisfaction Questionnaire for Medication – TSQM, Dyadic adjustment scale – DAS and Multiple Sclerosis Intimacy and Sexuality Questionnaire – MSISQ-19. We found that majority of patients with multiple sclerosis on immunomodulatory treatment were married or had extramarital relationship. Patients receiving more simple treatment with tablets and infusions were more satisfied compared to patients on subcutaneous/intramuscular injections. More simple treatment was associated also with less secondary and tertiary dysfunction. There was, however, no association between mode of treatment and quality of partner relationship. Herein presented qualitative analysis was based on grounded theory. We exposed important aspects of life in patients with multiple sclerosis who are in partner relationship. We established 5 categories including partner relationship, spare time, disease and treatment, changes in physical status and sexuality. We developed a model »MS TODAY« aimed to facilitate treatment of patients in centres for multiple sclerosis. This would enable more comprehensive view on patient life with multiple sclerosis, tolerance of immunomodulatory treatment, partner relationship and social as well as economic status. Our results are expected to contribute new evidence which will facilitate target interventions in relationship and family therapy in patients with multiple sclerosis.

V doktorski disertaciji z naslovom »Učinkovitost razreševanja posledic izgub v izvorni družini in zapletenega žalovanja v okviru relacijske družinske terapije« smo se poglobljeno posvetili izgubam v izvorni družini, saj smo želeli prispevati k razumevanju odraslega funkcioniranja, ki lahko sledi tovrstnim izgubam ter zapletenemu žalovanju kot klinični motnji, ki se lahko pojavi po smrti bližnjega. V kvantitativnem delu raziskave, v katero je bilo vključenih 210 posameznikov, smo s pomočjo vprašalnikov oziroma lestvic: zapletenega žalovanja (ICGR), panične motnje (PDQ), strahu pred intimnostjo (FIS), soočanja s stresnimi dogodki (COPE), lestvico samopodobe (RSES) in vprašalnikom kronično samodestruktivnega vedenja (CSDS), ugotovili, da je večina posameznikov z doživetimi izgubami v izvornih družinah pomembno bolj izražali kronično samodestruktivno vedenje v odrasli dobi. Prav tako je bila pomembno slabša njihova samopodoba ter so izražali manj funkcionalne načine soočanja s stresnimi dogodki. Pri nekaterih izgubah je večina udeležencev z več izgubami izražala pomembno več strahu v intimnih odnosih. Ugotovili smo, da v naši raziskavi ne obstaja statistično pomembna razlika med udeleženci, ki so doživeli izgube in udeleženci, ki jih niso doživeli, na področju zapletenega žalovanja. Tu se nam pojavi pomislek, da na zaplete v žalovanju lahko bistveno vplivajo drugi dejavniki, ki pa jih nismo preverjali, med drugim tudi način navezanosti in prisotnost doživetja drugih izgub. V pretežno kvalitativnem delu raziskave smo se osredotočali na značilnosti udeležencev pred terapevtskim procesom in spremembe po terapevtskem procesu za več raziskovalnih področij. V okviru skupine za žalujoče smo se osredotočali na raziskovalno področje zapletenega žalovanja, v okviru individualnih terapij pri posameznikih z izkušnjami izgube v izvorni družini smo pozornost namenili raziskovalnim področjem vedenja do sebe in okolice, samopodobe, intimnih odnosov, soočanja s stresnimi dogodki in simptomov paničnih napadov. Za to smo uporabili zgoraj naštete vprašalnike katere so udeleženci izpolnili pred začetkom terapevtskega procesa in po končanem procesu ter analizo terapevtskih dnevnikov ter zaključnega intervjuja. V obeh skupinah smo na podlagi analize vsebine dnevniških zapisov terapevtov prišli do ugotovitev, da so se v procesu relacijske družinske terapije pojavile spremembe: - V okviru skupine za žalujoče na področju zapletenega žalovanja in sicer so se simptomi pomembno znižali, prav tako pa so udeleženci poročali o zmanjšanju separacijske tesnobe in ločitvene stiske ter o bolj funkcionalnem vsakdanjem življenju. - V okviru individualnih terapij na področju intimnih odnosov (udeleženci so poročali o manj strahu pred zaupanjem partnerju), vedenja do sebe in okolice (udeleženci so predvsem ozavestili nekatera samodestruktivna vedenja in jih poskušali izboljšati), simptomov panične motnje (udeleženci so izražali manj simptomov panične motnje), pri oceni lastne vrednosti in odnosov v primarni družini (udeleženci so poročali o boljši samopodobi in prepoznavanju družinskih vzorcev) ter pri soočanja s stresnimi dogodki (udeleženci so poročali o bolj funkcionalnih odzivih na stresne situacije). Model relacijske družinske terapije se je izkazal za učinkovitega, saj so tako udeleženci skupine za žalujoče kot udeleženci individualnih terapij poročali o izboljšanju funkcioniranja v vsakdanjem življenju. Kot smo ugotovili z analizo terapevtskih dnevnikov in zaključnega intervjuja, so udeleženci z ozaveščanjem in predelavo oziroma novo regulacijo težkih afektov povezanih z izgubo v izvorni družini lahko izboljšali sedanje funkcioniranje, kar lahko bistveno izboljša kvaliteto njegovih odnosov in življenja. In our doctoral dissertation entitled "Effectiveness of resolving the consequences of losses in the original family and complicated grief in relational family therapy" we focused on losses in the original family, and how might that affect adult functioning witch can follow such losses and complicated grief as clinical disorder that can occur after the death of a loved one. In quantitative research, which included 210 individuals, we found that individuals with losses in the original families were significantly more likely to express chronic self-destructive behavior in adulthood, their self-esteem was significantly lower, and less functional ways were expressed in coping with stressful events. For some losses, participants with multiple losses expressed significantly more fear in intimate relationships, which manifested as less trust in relationships. But in our study, there was no statistically significant difference between participants who experienced losses and participants who did not experience them in the area of complicated grief. From this result we can conclude that complicated grief can be significantly provoked by other factors, which we have not examined, including the attachment style and the history of other losses and traumatic events. In the qualitative part of the research, we focused on the characteristics of the participants before the therapeutic process and the changes after the therapeutic process for several research areas. As part of the therapeutic grief group, we focused on the research area of complicated grief, as part of individual therapies in individuals with experience of loss in the original family, we focused on research areas of self-behavior, self-esteem, intimate relationships, coping with stressful events and symptoms of panic disorder. In both groups, based on the analysis of the content of diary entries of therapists, we came to the conclusion that changes have occurred in the process of relational family therapy: - Within the therapeutic grief group in the area of complicated grief, the symptoms were significantly reduced, and participants also reported a reduction in separation anxiety and separation distress, as well as a more functional daily life. - As part of individual therapies in the field of intimate relationships (participants reported less fear of trusting their partner), behavior towards themselves and their surroundings (participants were mainly aware of some self-destructive behaviors and tried to improve them), panic disorder symptoms (participants expressed fewer panic symptoms), in assessing self-esteem and relationships in the primary family (participants reported better self-esteem and recognition of family patterns) and in coping with stressful events (participants reported more functional responses to stressful situations). The relational family therapy model has proven to be effective, as both grieving group participants and individual therapy participants reported improved functioning in daily life. By raising awareness and processing or new regulation of severe affects related to loss in the original family, the current functioning of the individual can be improved, which can significantly improve the quality of his relationships and life.

Magistrsko delo obravnava vprašanje, kakšno je doživljanje psihosocialne pomoči ob soočanju posameznikov s težjo kronično diagnozo. Le-ta pomembno vpliva na življenje posameznika in njegove družine. Avtorica magistrskega dela v prvem delu predstavi teoretična izhodišča s področij kroničnih bolezni, soočanja z diagnozo, sprememb v življenju posameznika in psihosocialne pomoči. V drugem delu izvede kvalitativno raziskavo in s pomočjo fenomenološke metode analizira opise doživljanj udeleženk, ki so sodelovale v raziskavi. S pomočjo poglobljene analize izlušči naslednje glavne teme: stiska ob seznanitvi z diagnozo, sprejetje in vključitev v psihosocialno pomoč, doživljanje psihosocialne pomoči, podpora bližnjih v procesu soočanja z diagnozo, doživljanje okolice v procesu soočanja z diagnozo in življenje po diagnozi. Rezultati omogočijo pregled nad doživljanjem udeleženk in ugotovitvami, ki jih lahko izpeljemo. Omogočajo potrditev določenih teoretičnih izhodišč, obenem pa razkrivajo doživljanje udeleženk, ki je pogosto spregledano ali prikrito. Izpostavljene so tudi pomanjkljivosti in dodana vrednost raziskave. V sklepnem delu so predstavljene posebnosti pridobljenih opisov oziroma izkušenj udeleženk. The focus of this master's thesis is the question of how do the individuals who cope with chronic illness, experience psychosocial help. The latter has an important impact on the life of an individual and their family. In the first part, the author presents theoretical standpoints in the area of chronic illness, coping with diagnosis, changes in individual's life and psychosocial help. Next, a qualitative research is conducted and with the help of phenomenological method, the author examines experiences of the people who participated in the research. From this detailed analysis, the following topics are derived: distress when receiving the diagnosis, acceptance and inclusion into psychosocial help, experience of psychosocial help, support of the closed ones in the process of coping with diagnosis, experience of the environment in the process of coping with diagnosis and life after the diagnosis. Results provide an overview of the experiences of participants and conclusions, which can be determined. They enable confirmation of certain theoretical standpoints and bring light to the experiences of participants, which are often overlooked or hidden. Shortcomings and added value of this research is also emphasized. In conclusion, the author presents specificities of the garthered descriptions and experiences of participants.