Journal articles on the topic 'Counsellor�s self'

Despite the recognized value of an experiential training group in major counselling program accrediting and governing institutions, there is a paucity of research investigating the effectiveness of such a training group for counsellors-in-training (CITs). The present study examined the effects of a wellness-themed training group conducted in Hong Kong on CITs’ psychological wellness and group leader self-efficacy. The Five Factor Wellness Inventory (5F–Wel) and the Group Leader Self-Efficacy Instrument (GLSI) were administered to forty-three CITs of a Hong Kong master’s degree program in counsellor education. A pretest–posttest design was employed to compare psychological wellness and group leader self-efficacy before and after a 12-hour experiential training group. Two research aims were addressed. The findings showed significant increases in group leader self-efficacy and psychological wellness among CIT participants. Further investigation showed that Coping Self, Creative Self and Life Satisfaction improved significantly following the experiential training group. The foci of promoting an awareness of personal resources and identifying personal-fit positive coping strategies in the current group intervention might contribute to the positive results. The present findings have important implications for counsellor educators who have an important role in preparing competent and resilient CITs. The mandatory participation of the CITs as group members in an authentic, feedback experiential training group is recommended in a professional counselling program.

Videoconferencing at a bandwidth of 384 kbit/s was used in open sessions for subjects with alcohol use disorders (AUD). Study participants received eight sessions of group therapy over a four-week period from an accredited addictions counsellor. Outcome assessment included self-report measures, a qualitative interview and a chart review. Of the 18 subjects who started the study, 14 attended at least four sessions of therapy, completed self-report assessments and the thematic interview. The participants reported high levels of satisfaction with telepsychiatry, found the intervention to be highly credible, had good session attendance and attrition comparable to that expected with conventional same-room treatment. In all, 82% of subjects reported that they would recommend the service to a friend or family member. The results demonstrate the feasibility of using videoconferencing for service delivery to adults with AUD, and encourage the future performance of randomized controlled trials.

A case in the Hong Kong Chinese context is presented in this paper to illustrate the use of both quantitative (Holland's SDS) and qualitative career assessment (Card Sorts) to help a 16-year-old girl overcome career indecision. Guided by both Holland's Hexagonal Career Types Theory and Socio-Cognitive Career Theory, a career counsellor can promote a client's positive changes after two counseling sessions. This case supports Tracey's (2002) and Nauta et al.'s (2002) postulated bidirectional causal path between self-efficacy and interests. In addition, it highlights that partial match instead of perfect match between Self-directed search (SDS) scores and choice of academic major is more pragmatic or effective while performing quantitative assessment. Finally, it points to the need for establishing local SDS norms, examining the Holland codes for occupations in Hong Kong, and researching the link between congruence and maximal career outcomes in future research.

Purpose: This article developed from a presentation at the national Conference of Nigerian Psychological Association which took place at the Ile-Ife under the auspices of IfePsychologia Centre, Department of Psychology, Obafemi Awolowo University in 2014. The theme of the conference was on mentoring and development. Consequently, this research paper was aimed at portraying how mentoring mediates in human development as it may lead to job satisfaction and enhanced output.Methodology: An instrument called “Inventory on Mentoring as Correlate of Self-Confidence and Job Satisfaction was used to gather data which was analysed and interpreted, using the arithmetic percentage to calculate the differences in the number of respondents and their implications in job performance.Results: This study has proved that the art of mentoring is inherent in counselling psychology, personnel psychology and human development; this makes the mentor a counsellor, a consultant and a cheerleader, who provides support and enthusiasm for his/her team. S/He provides guidance based on experience and s/he demonstrates problem solving qualities and helps the mentee uncover his/her hidden potential. There is no doubt that mentoring can improve an individual’s job performance and satisfaction since the output is enhanced; nevertheless, a worker that is not self-motivated and has a disposition that undermines the learning process may not benefit much from the process. The mentor at a place of work who wants to maximise effort for optimal outcomes may drive hard on the mentee.Unique contribution to theory, practice and policy: It is recommended that teachers and other facilitators should undergo training in mentoring so that they can better handle the learners. There should be better interrelationship and team spirit when the cheerleader, the mentor is given the room to make an impact. In government, new politicians should be properly mentored by the older ones on the jobs that there can be continuity and projects will be accomplished without rancour or ethnic prejudices as in African countries. In particular, the police force, security operative’s road safety officers should be properly mentored so that they are not sadists who desire to impose on people without a rational justification for doing so.

This study will focus on the professional identity of school counseling, which is a key function in Israeli schools. Forming a professional identity is part of the process of professional development that begins with academic training and continues throughout one’s professional career. Professional identity distinguishes between different occupations and provides practitioners with a safe base that lets them better understand their work and form a team spirit within their field of occupation. The research literature indicates an association between one’s professional identity and her professional functioning and success, sense of stability, confidence, and pride in practicing the occupation. The professional identity of school counseling is related to gender. This is a predominantly female occupation and most of its practitioners in Israel are women. Few studies have been conducted on the professional identity of school counselors (Note 1) and its impact on the quality of their work. It appears that the definition of the school counselor’s role is neither clear nor unambiguous, both in Israel and elsewhere, and this affects the professional identity of counselors and the quality of their work. The current study included semi-structured interviews with 15 school counselors, in which they spoke about the structure of their work, their professional vision, satisfaction, and sense of self-fulfillment as a result of their job, as well as their professional self-efficacy. The research findings show that the structure of the counselor’s work, her role definition and workload, are related to her professional identity, including how she perceives the counseling occupation, her satisfaction and sense of self-fulfillment. Based on the interviews, no differences were found between the narratives of counselors with different levels of seniority in the profession with regard to professional identity, satisfaction, and self-fulfillment. The research findings indicate the need to define the school counseling occupation and its place in the school in order to help school counselors establish a clearer professional identity, with the aim of adapting the role to the challenges of the school system in the 21st century, in the world in general and in Israel in particular.

Continuous professional development refers to maintaining, enhancing, and broadening individuals’ knowledge, skills, and the personal qualities required in their professional lives. The present experimental study attempts to explore the way(s) that the Life Construction intervention: “Constructing my Future Purposeful Life” contributes to career counselors’ sustainable career development. Two groups of career counselors participating in a training program delivered by the National and Kapodistrian University of Athens were involved, namely, an experimental group (N = 33) that received the intervention and a control group (N = 27) that did not receive any intervention. The effectiveness of the intervention was verified through qualitative and quantitative analysis, including the calculation of effect sizes, of the data obtained through the Future Career Autobiography, and the Greek version of the Life Project Reflexivity Scale. The results indicate that the Life Construction Intervention improved career counselors’ reflexivity and self-awareness, while, concurrently, the need for practical training in contemporary interventions to support their sustainable career development is highlighted. The main conclusion refers to the fact that the career counselor needs to construct his or her own Self as a sustainable project beforehand, in order to be able to support individuals in their own Self construction and promote their well-being.

Health-related quality of life (HRQOL) is an important indicator of how a patient perceives hi/her own physical and mental status. Evaluating this dimension in old age patients which are institutionalized for neurocognitive disorders is useful from several perspectives: (1) determination of an initial value for HRQOL parameters could help the case manager in structuring an individualized therapeutic intervention, adapted for psychological, somatic or psychosocial needs of each patient; (2) monitoring the evolution of HRQOL dimensions could help in improving through feedback the quality of therapeutic intervention(s), especially if the case manager is permanently in contact with the patient, as is usually the case of institutionalized subjects; (3) correlation between HRQOL and other important variables, like therapeutic adherence, regression of comorbidities, daily functioning etc. could modulate the therapeutic intervention. We suggest a plan for HRQOL evaluation in institutionalized patients diagnosed with neurocognitive disorder, consisting in monthly scoring of SF-36 or EuroQoL questionnaire, corroborated with MMSE and ADAS-Cog scoring. Psychotherapeutic interventions tailored to the needs identified through HRQOL periodic evaluations could be useful in this population, for example a perceived isolation could be compensated by increasing the rhythm of social interaction by group therapy under the direction of a counsellor, a reduced self-efficacy could be compensated by activation techniques, music or art-therapy, while dissatisfaction with own memory capacities could be mitigated using reminiscence therapy. Switching from a paternalistic way of perceiving the patient as the object of an intervention, to a more interactive style of communication, involves obtaining feed-back through HRQOL instruments.Disclosure of interestCOI: The presenting author was speaker for Bristol Myers Squibb and Servier, and participated in clinical research funded by Janssen Cilag, Astra Zeneca, Eli Lilly, Sanofi Aventis, Schering Plough, Organon, Bioline Rx, Forenap, Wyeth, Otsuka Pharmaceuticals, Dainippon Sumitomo.

Due to limited life experience and lack of proper self-respect criteria, teenagers need discreet counseling and guidance, being helped to form their ideal of life, perfect their moral judgments, and raise their level of conscience and moral conduct. School counseling is a socio-pedagogical and economic instrument of modern society. The activity of school counseling and orientation is to support the fundamental principles of education: the teacher-student relationship, the balance between the formality and the informative, but also the principle of success. The counselor is a person with adequate training such as having studies in psychology, pedagogy or sociology field, who is involved in school counseling and orientation and professional orientation, supporting teachers, parents and pupils in the field of activity. Through this research work, the knowledge and abilities related to school counseling and adolescent orientation were improved.

The influence of ethnic identity development on adolescents’ achievement, self-concept, and behaviors has been reviewed extensively in the literature. However, the role that school counselors play in enhancing middle school students’ ethnic identity development has received little attention. This article reviews the definition of ethnic identity and J. S. Phinney's (1992) model of adolescent ethnic identity development. J. E. Helms’ (1994) model of racial identity interaction theory is used as a basis for understanding how ethnic identity development may influence student-to-student and student-to-teacher interactions in middle schools. And finally, recommendations for middle school counselors are presented.

Background and Purpose: The present study is designed to evaluate the effect of individual psycho-education intervention based on integrated self-awareness and self-determination theories (i-SEAZ) toward self-efficacy among opioid-dependent patients in methadone treatment (MT). Methodology: 75 opioid-dependent participants who were on MT under Ministry of Health Malaysia from five Methadone Clinics in Klang Valley were evaluated on the effectiveness of the i-SEAZ intervention. The experiment group comprised 38 participants, who received ten sessions of individual i-SEAZ alongside MT, while 37 participants of the control group only received MT. The effectiveness of the intervention was assessed by the General Self Efficacy Questionnaire (GSE), with ten items. The assessment was performed two times; the first was two weeks before the initiation of i-SEAZ (as pretest), and the second was two weeks after i-SEAZ was completed (as posttest). Findings: The extracted data were analysed by ANCOVA using SPSS-20. The findings showed there was a significant improvement in the i-SEAZ scores between experiment and control groups at posttest (p = 0.000). It is concluded that the intervention of i-SEAZ is associated with a significant increase in self-efficacy among substance-dependent patients in Methadone Clinics. Contributions: This study is hoped to contribute to the psychologists and counselors at addiction clinics, treatment institutions and communities in adopting the i-SEAZ module to improve self-efficacy among patients in substance abuse treatment. Keywords: Methadone treatment, psychoeducation, self-efficacy, self-awareness theory, self-determination theory. Cite as: Engku Kamarudin, E. M., Wan Sulaiman, W. S., Sarnon, N., & Amin, A. S. (2020). The effect of individual psychoeducation intervention on self-efficacy among opioid dependent patients in Methadone clinics. Journal of Nusantara Studies, 5(2), 103-128. http://dx.doi.org/10.24200/jonus.vol5iss2pp103-128

Self concept is one’s self identity. It’s a representation of a person’s own perceived beliefs, attitudes, competencies and characteristics. The researcher was motivated to make a study on the effectiveness of guidance and counseling services on adolescent self concept in schools within Khwisero district, in Kakamega County. The study adopted a descriptive survey research design. The district has a total of 24 public and 3 private secondary schools. The study used a target population sample of 240 students, 6 principals, 6 teacher counselors, and 3 education officials from 8 schools. Stratified random sampling and purposive and stratified techniques were used to sample the required schools according to their categories, select students, teachers and principals. The principals, teachers and student s’ questionnaires were administered. An interview schedule for education officials was also given. To establish the reliability of the research instruments of the study, Pearson’s Product Correlation Coefficient was computed; yielding a correlation coefficient of 0.87.The study findings revealed that there was positive correlation between effective guidance and counseling services and promotion of positive adolescent self concept. This study significantly assists education stake holders to develop and improve the self esteem of their learners. It’s hoped that the Ministry of Education should provide guidelines on the implementation of effective guidance and counseling strategies and their relevance.

The present study aims to identify the motivations of those who move to the teaching profession from pre-existing careers in other areas, and to explore the transferrable skills and experiences they bring with them to the classroom. Participants were selected from among students in a teacher-training program, all of whom had previous careers—in the military, as counselors, as security staff, and in other areas—and all of whom were in the final stages of their in-classroom practical teaching experience. The study used a semi-structured focus group method to elicit self-reports of these student-teachers’ experiences of classroom management, student interactions, and actual approach to pedagogy, as well as their motives for seeking a change of career. The study revealed that the most important factors motivating the switch were a combination of economic ones, such as career stability and salary, and personal, social factors such as the desire to transmit one’s values to the next generation. The results also pointed strongly toward the utility, relevance, and usefulness of prior experience in other careers, and participants noted their own preparedness to manage chaotic social situations or draw on real-world experiences to explain complex or morally difficult ideas. The study supports recommendations that teacher training programmes focus on practical aspects of second-career teacher preparation, and support them in adjusting to their new roles and new identities.

<p><em>HIV / AIDS patients experience complex problems both physically, psychologically, socially, and spiritually. Psychosocial problems experienced include depression, anxiety, despair, and worry, and affect the destruction of social life such as isolating themselves and getting stigmatized. These various problems make HIV / AIDS patients feel useless and worthless. In dealing with psychological problems such as low self-esteem, HIV / AIDS patients desperately need social support from both partners, parents, children, friends, counselors and health teams. Unfortunately during this time the expected social support, rarely HIV / AIDS patients were found, including from their own families. To facilitate these needs, hospitals that become a reference center for HIV / AIDS patients form Peer Support Groups (</em><em>P</em><em>S</em><em>G</em><em>). </em><em>PSG </em><em> activities include group guidance and peer counseling for HIV / AIDS patients. These activities provide opportunities for HIV / AIDS patients to increase knowledge about their illness, exchange experiences with each other, even help each other solve problems. The various positive benefits of peer support groups in turn can increase the self-esteem of HIV / AIDS patients</em>.</p><p> </p><p align="center">****</p>Pasien HIV/AIDS mengalami problem yang kompleks baik fisik, psikologis, sosial, dan spiritual. Problem psikososial yang dialami antara lain depresi, cemas, putus asa, dan khawatir, serta berpengaruh pada rusaknya kehidupan sosial seperti mengisolasikan diri dan mendapat stigmatisasi. Berbagai masalah tersebut membuat ODHA merasa tidak berguna dan tidak berharga. Dalam menghadapi problem psikologis seperti rendahnya harga diri, ODHA sangat membutuhkan dukungan sosial baik dari pasangan, orang tua, anak, teman, konselor dan tim kesehatan. Sayangnya selama ini dukungan sosial yang diharapkan tersebut, jarang ODHA didapatkan termasuk dari keluarganya sendiri. Untuk memfasilitasi kebutuhan tersebut, rumah sakit yang menjadi pusat rujukan bagi ODHA membentuk Kelompok Dukungan Sebaya (KDS). Kegiatan KDS diantaranya bimbingan kelompok dan konseling sebaya bagi ODHA. Kegiatan tersebut memberikan peluang bagi ODHA untuk menambah pengetahuan tentang sakitnya, bertukar pengalaman dengan sesamanya, bahkan saling membantu memecahkan masalah. Berbagai manfaat positif KDS tersebut pada gilirannya mampu meningkatkan harga diri ODHA.

Abstract STUDY QUESTION What is the likelihood of having a child within 4 years for men and women with strong short-term reproductive intentions, and how is it affected by age? SUMMARY ANSWER For women, the likelihood of realising reproductive intentions decreased steeply from age 35: the effect of age was weak and not significant for men. WHAT IS KNOWN ALREADY Men and women are postponing childbearing until later ages. For women, this trend is associated with a higher risk that childbearing plans will not be realised due to increased levels of infertility and pregnancy complications. STUDY DESIGN, SIZE, DURATION This study analyses two waves of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. The analytical sample interviewed in 2011 included 447 men aged 18–45 and 528 women aged 18–41. These respondents expressed a strong intention to have a child in the next 3 years. We followed them up in 2015 to track whether their reproductive intention was achieved or revised. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Multinomial logistic regression is used to account for the three possible outcomes: (i) having a child, (ii) not having a child but still intending to have one in the future and (iii) not having a child and no longer intending to have one. We analyse how age, parity, partnership status, education, perceived ability to conceive, self-rated health, BMI and smoking status are related to realising or changing reproductive intentions. MAIN RESULTS AND THE ROLE OF CHANCE Almost two-thirds of men and women realised their strong short-term fertility plans within 4 years. There was a steep age-related decline in realising reproductive intentions for women in their mid- and late-30s, whereas men maintained a relatively high probability of having the child they intended until age 45. Women aged 38–41 who planned to have a child were the most likely to change their plan within 4 years. The probability of realising reproductive intention was highest for married and highly educated men and women and for those with one child. LIMITATIONS, REASONS FOR CAUTION Our study cannot separate biological, social and cultural reasons for not realising reproductive intentions. Men and women adjust their intentions in response to their actual circumstances, but also in line with their perceived ability to have a child or under the influence of broader social norms on reproductive age. WIDER IMPLICATIONS OF THE FINDINGS Our results give a new perspective on the ability of men and women to realise their reproductive plans in the context of childbearing postponement. They confirm the inequality in the individual consequences of delayed reproduction between men and women. They inform medical practitioners and counsellors about the complex biological, social and normative barriers to reproduction among women at higher childbearing ages. STUDY FUNDING/COMPETING INTEREST(S) This research was partly supported by a Research School of Social Sciences Visiting Fellowship at the Australian National University and an Australian Research Council Discovery Project (DP150104248). Éva Beaujouan’s work was partly funded by the Austrian Science Fund (FWF) project ‘Later Fertility in Europe’ (Grant agreement no. P31171-G29). This paper uses unit record data from the HILDA Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services (DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research (Melbourne Institute). The findings and views reported in this paper, however, are those of the authors and should not be attributed to either DSS or the Melbourne Institute. The authors have no conflicts of interest.

Abstract STUDY QUESTION Which chemotherapeutic agents and body site-specific radiation fields are dose-dependently associated with an increased risk of fertility impairment in long-term female childhood, adolescent and young adulthood (CAYA) cancer survivors? SUMMARY ANSWER Busulfan, lower abdominal radiotherapy (RT) and total body irradiation (TBI) seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (&gt;140 mg/m2) or high dose (&gt;5600 mg/m2) therapy, respectively. WHAT IS KNOWN ALREADY Several treatment-related fertility deficits, as assessed by both self-reported outcomes and hormonal markers are known to occur following treatment of CAYA cancer. However, knowledge regarding precise dose-related estimates of these treatment-related risks are scarce. STUDY DESIGN, SIZE, DURATION The current case–control study was nested within the PanCareLIFE cohort study. In total, 1332 CAYA survivors from 8 countries, 9 institutions and 11 cohorts, participated in and contributed data to the study. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants were female 5-year CAYA cancer survivors. In total, 450 cases (fertility impaired survivors) and 882 matched controls (not fertility impaired survivors) were included. Fertility impairment was defined using both questionnaire data (primary or secondary amenorrhea; use of artificial reproductive techniques; unfulfilled wish to conceive) and hormonal data (FSH and anti-Müllerian hormone (AMH)). Multivariable logistic regression models were used to investigate the effect of (i) alkylating agent exposure, and (ii) dose categories for individual chemotherapeutic agents and for RT-exposed body sites. MAIN RESULTS AND THE ROLE OF CHANCE A positive dose–effect relationship between cyclophosphamide equivalent dose (CED) score and fertility impairment was found, with survivors with a CED score &gt; 7121 mg/m2 being at a significantly increased risk of fertility impairment (odds ratio (95% CI) = 2.6 (1.9–3.6) P &lt; 0.001). Moreover, cumulative dose variables of the following treatments were significantly associated with fertility impairment: busulfan, carmustine, cyclophosphamide, melphalan, procarbazine, lower abdominal RT and TBI. Busulfan, lower abdominal RT and TBI seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (&gt;140 mg/m2) or high dose (&gt;5600 mg/m2) therapy, respectively. LIMITATIONS, REASONS FOR CAUTION Our study may have been subject to selection bias since data from about half of the original base cohorts were available for the current study. This could impact the generalizability of our study results. WIDER IMPLICATIONS OF THE FINDINGS We identified survivors at high risk for fertility impairment and, consequently, for a reduced or even absent reproductive life span. Both girls and young women who are about to start anti-cancer treatment, as well as adult female survivors, should be counselled about future parenthood and referred to a reproductive specialist for fertility preservation, if desired. STUDY FUNDING/COMPETING INTEREST(S) This study has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 602030. There are no competing interests. TRIAL REGISTRATION NUMBER n/a

Background and Objective: Suicide attempts are 10-20X more common than completed suicide and an important risk factor for death by suicide, yet most people who attempt suicide do not die by suicide. The process of recovering after a suicide attempt has not been well studied. The Reasons to go on Living (RTGOL) Project, a narrative web-based study, focuses on experiences of people who have attempted suicide and made the decision to go on living, a process not well studied. Narrative research is ideally suited to understanding personal experiences critical to recovery following a suicide attempt, including the transition to a state of hopefulness. Voices from people with lived experience can help us plan and conceptualize this work. This paper reports on a secondary research question of the larger study: what stories do participants tell of the positive role/impact of the mental health system. Material and Methods: A website created for The RTGOL Project (www.thereasons.ca) enabled participants to anonymously submit a story about their suicide attempt and recovery, a process which enabled participation from a large and diverse group of participants. The only direction given was “if you have made a suicide attempt or seriously considered suicide and now want to go on living, we want to hear from you.” The unstructured narrative format allowed participants to describe their experiences in their own words, to include and emphasize what they considered important. Over 5 years, data analysis occurred in several phases over the course of the study, resulting in the identification of data that were inputted into an Excel file. This analysis used stories where participants described positive involvement with the mental health system (50 stories). Results: Several participants reflected on experiences many years previous, providing the privilege of learning how their life unfolded, what made a difference. Over a five-year period, 50 of 226 stories identified positive experiences with mental health care with sufficient details to allow analysis, and are the focus of this paper. There were a range of suicidal behaviours in these 50 stories, from suicidal ideation only to medically severe suicide attempts. Most described one or more suicide attempts. Three themes identified included: 1) trust and relationship with a health care professional, 2) the role of friends and family and friends, and 3) a wide range of services. Conclusion: Stories open a window into the experiences of the period after a suicide attempt. This study allowed for an understanding of how mental health professionals might help individuals who have attempted suicide write a different story, a life-affirming story. The stories that participants shared offer some understanding of “how” to provide support at a most-needed critical juncture for people as they interact with health care providers, including immediately after a suicide attempt. Results of this study reinforce that just one caring professional can make a tremendous difference to a person who has survived a suicide attempt. Key Words: web-based; suicide; suicide attempt; mental health system; narrative research Word Count: 478 Introduction My Third (or fourth) Suicide AttemptI laid in the back of the ambulance, the snow of too many doses of ativan dissolving on my tongue.They hadn't even cared enough about meto put someone in the back with me,and so, frustrated,I'd swallowed all the pills I had with me— not enough to do what I wanted it to right then,but more than enough to knock me out for a good 14 hours.I remember very little after that;benzodiazepines like ativan commonly cause pre- and post-amnesia, says Google helpfullyI wake up in a locked rooma woman manically drawing on the windows with crayonsthe colors of light through the glassdiffused into rainbows of joy scattered about the roomas if she were coloring on us all,all of the tattered remnants of humanity in a psych wardmade into a brittle mosaic, a quilt of many hues, a Technicolor dreamcoatand I thoughtI am so glad to be able to see this. (Story 187)The nurse opening that door will have a lasting impact on how this story unfolds and on this person’s life. Each year, almost one million people die from suicide, approximately one death every 40 seconds. Suicide attempts are much more frequent, with up to an estimated 20 attempts for every death by suicide.1 Suicide-related behaviours range from suicidal ideation and self-injury to death by suicide. We are unable to directly study those who die by suicide, but effective intervention after a suicide attempt could reduce the risk of subsequent death by suicide. Near-fatal suicide attempts have been used to explore the boundary with completed suicides. Findings indicated that violent suicide attempters and serious attempters (seriousness of the medical consequences to define near-fatal attempts) were more likely to make repeated, and higher lethality suicide attempts.2 In a case-control study, the medically severe suicide attempts group (78 participants), epidemiologically very similar to those who complete suicide, had significantly higher communication difficulties; the risk for death by suicide multiplied if accompanied by feelings of isolation and alienation.3 Most research in suicidology has been quantitative, focusing almost exclusively on identifying factors that may be predictive of suicidal behaviours, and on explanation rather than understanding.4 Qualitative research, focusing on the lived experiences of individuals who have attempted suicide, may provide a better understanding of how to respond in empathic and helpful ways to prevent future attempts and death by suicide.4,5 Fitzpatrick6 advocates for narrative research as a valuable qualitative method in suicide research, enabling people to construct and make sense of the experiences and their world, and imbue it with meaning. A review of qualitative studies examining the experiences of recovering from or living with suicidal ideation identified 5 interconnected themes: suffering, struggle, connection, turning points, and coping.7 Several additional qualitative studies about attempted suicide have been reported in the literature. Participants have included patients hospitalized for attempting suicide8, and/or suicidal ideation,9 out-patients following a suicide attempt and their caregivers,10 veterans with serious mental illness and at least one hospitalization for a suicide attempt or imminent suicide plan.11 Relationships were a consistent theme in these studies. Interpersonal relationships and an empathic environment were perceived as therapeutic and protective, enabling the expression of thoughts and self-understanding.8 Given the connection to relationship issues, the authors suggested it may be helpful to provide support for the relatives of patients who have attempted suicide. A sheltered, friendly environment and support systems, which included caring by family and friends, and treatment by mental health professionals, helped the suicidal healing process.10 Receiving empathic care led to positive changes and an increased level of insight; just one caring professional could make a tremendous difference.11 Kraft and colleagues9 concluded with the importance of hearing directly from those who are suicidal in order to help them, that only when we understand, “why suicide”, can we help with an alternative, “why life?” In a grounded theory study about help-seeking for self-injury, Long and colleagues12 identified that self-injury was not the problem for their participants, but a panacea, even if temporary, to painful life experiences. Participant narratives reflected a complex journey for those who self-injured: their wish when help-seeking was identified by the theme “to be treated like a person”. There has also been a focus on the role and potential impact of psychiatric/mental health nursing. Through interviews with experienced in-patient nurses, Carlen and Bengtsson13 identified the need to see suicidal patients as subjective human beings with unique experiences. This mirrors research with patients, which concluded that the interaction with personnel who are devoted, hope-mediating and committed may be crucial to a patient’s desire to continue living.14 Interviews with individuals who received mental health care for a suicidal crisis following a serious attempt led to the development of a theory for psychiatric nurses with the central variable, reconnecting the person with humanity across 3 phases: reflecting an image of humanity, guiding the individual back to humanity, and learning to live.15 Other research has identified important roles for nurses working with patients who have attempted suicide by enabling the expression of thoughts and developing self-understanding8, helping to see things differently and reconnecting with others,10 assisting the person in finding meaning from their experience to turn their lives around, and maintain/and develop positive connections with others.16 However, one literature review identified that negative attitudes toward self-harm were common among nurses, with more positive attitudes among mental health nurses than general nurses. The authors concluded that education, both reflective and interactive, could have a positive impact.17 This paper is one part of a larger web-based narrative study, the Reasons to go on Living Project (RTGOL), that seeks to understand the transition from making a suicide attempt to choosing life. When invited to tell their stories anonymously online, what information would people share about their suicide attempts? This paper reports on a secondary research question of the larger study: what stories do participants tell of the positive role/impact of the mental health system. The focus on the positive impact reflects an appreciative inquiry approach which can promote better practice.18 Methods Design and Sample A website created for The RTGOL Project (www.thereasons.ca) enabled participants to anonymously submit a story about their suicide attempt and recovery. Participants were required to read and agree with a consent form before being able to submit their story through a text box or by uploading a file. No demographic information was requested. Text submissions were embedded into an email and sent to an account created for the Project without collecting information about the IP address or other identifying information. The content of the website was reviewed by legal counsel before posting, and the study was approved by the local Research Ethics Board. Stories were collected for 5 years (July 2008-June 2013). The RTGOL Project enabled participation by a large, diverse audience, at their own convenience of time and location, providing they had computer access. The unstructured narrative format allowed participants to describe their experiences in their own words, to include and emphasize what they considered important. Of the 226 submissions to the website, 112 described involvement at some level with the mental health system, and 50 provided sufficient detail about positive experiences with mental health care to permit analysis. There were a range of suicidal behaviours in these 50 stories: 8 described suicidal ideation only; 9 met the criteria of medically severe suicide attempts3; 33 described one or more suicide attempts. For most participants, the last attempt had been some years in the past, even decades, prior to writing. Results Stories of positive experiences with mental health care described the idea of a door opening, a turning point, or helping the person to see their situation differently. Themes identified were: (1) relationship and trust with a Health Care Professional (HCP), (2) the role of family and friends (limited to in-hospital experiences), and (3) the opportunity to access a range of services. The many reflective submissions of experiences told many years after the suicide attempt(s) speaks to the lasting impact of the experience for that individual. Trust and Relationship with a Health Care Professional A trusting relationship with a health professional helped participants to see things in a different way, a more hopeful way and over time. “In that time of crisis, she never talked down to me, kept her promises, didn't panic, didn't give up, and she kept believing in me. I guess I essentially borrowed the hope that she had for me until I found hope for myself.” (Story# 35) My doctor has worked extensively with me. I now realize that this is what will keep me alive. To be able to feel in my heart that my doctor does care about me and truly wants to see me get better.” (Story 34). The writer in Story 150 was a nurse, an honours graduate. The 20 years following graduation included depression, hospitalizations and many suicide attempts. “One day after supper I took an entire bottle of prescription pills, then rode away on my bike. They found me late that night unconscious in a downtown park. My heart threatened to stop in the ICU.” Then later, “I finally found a person who was able to connect with me and help me climb out of the pit I was in. I asked her if anyone as sick as me could get better, and she said, “Yes”, she had seen it happen. Those were the words I had been waiting to hear! I quickly became very motivated to get better. I felt heard and like I had just found a big sister, a guide to help me figure out how to live in the world. This person was a nurse who worked as a trauma therapist.” At the time when the story was submitted, the writer was applying to a graduate program. Role of Family and Friends Several participants described being affected by their family’s response to their suicide attempt. Realizing the impact on their family and friends was, for some, a turning point. The writer in Story 20 told of experiences more than 30 years prior to the writing. She described her family of origin as “truly dysfunctional,” and she suffered from episodes of depression and hospitalization during her teen years. Following the birth of her second child, and many family difficulties, “It was at this point that I became suicidal.” She made a decision to kill herself by jumping off the balcony (6 stories). “At the very last second as I hung onto the railing of the balcony. I did not want to die but it was too late. I landed on the parking lot pavement.” She wrote that the pain was indescribable, due to many broken bones. “The physical pain can be unbearable. Then you get to see the pain and horror in the eyes of someone you love and who loves you. Many people suggested to my husband that he should leave me in the hospital, go on with life and forget about me. During the process of recovery in the hospital, my husband was with me every day…With the help of psychiatrists and a later hospitalization, I was actually diagnosed as bipolar…Since 1983, I have been taking lithium and have never had a recurrence of suicidal thoughts or for that matter any kind of depression.” The writer in Story 62 suffered childhood sexual abuse. When she came forward with it, she felt she was not heard. Self-harm on a regular basis was followed by “numerous overdoses trying to end my life.” Overdoses led to psychiatric hospitalizations that were unhelpful because she was unable to trust staff. “My way of thinking was that ending my life was the only answer. There had been numerous attempts, too many to count. My thoughts were that if I wasn’t alive I wouldn’t have to deal with my problems.” In her final attempt, she plunged over the side of a mountain, dropping 80 feet, resulting in several serious injuries. “I was so angry that I was still alive.” However, “During my hospitalization I began to realize that my family and friends were there by my side continuously, I began to realize that I wasn't only hurting myself. I was hurting all the important people in my life. It was then that I told myself I am going to do whatever it takes.” A turning point is not to say that the difficulties did not continue. The writer of Story 171 tells of a suicide attempt 7 years previous, and the ongoing anguish. She had been depressed for years and had thoughts of suicide on a daily basis. After a serious overdose, she woke up the next day in a hospital bed, her husband and 2 daughters at her bed. “Honestly, I was disappointed to wake up. But, then I saw how scared and hurt they were. Then I was sorry for what I had done to them. Since then I have thought of suicide but know that it is tragic for the family and is a hurt that can never be undone. Today I live with the thought that I am here for a reason and when it is God's time to take me then I will go. I do believe living is harder than dying. I do believe I was born for a purpose and when that is accomplished I will be released. …Until then I try to remind myself of how I am blessed and try to appreciate the wonders of the world and the people in it.” Range of Services The important role of mental health and recovery services was frequently mentioned, including dialectical behavioural therapy (DBT)/cognitive-behavioural therapy (CBT), recovery group, group therapy, Alcoholics Anonymous, accurate diagnosis, and medications. The writer in Story 30 was 83 years old when she submitted her story, reflecting on a life with both good and bad times. She first attempted suicide at age 10 or 12. A serious post-partum depression followed the birth of her second child, and over the years, she experienced periods of suicidal intent: “Consequently, a few years passed and I got to feeling suicidal again. I had pills in one pocket and a clipping for “The Recovery Group” in the other pocket. As I rode on the bus trying to make up my mind, I decided to go to the Recovery Group first. I could always take the pills later. I found the Recovery Group and yoga helpful; going to meetings sometimes twice a day until I got thinking more clearly and learned how to deal with my problems.” Several participants described the value of CBT or DBT in learning to challenge perceptions. “I have tools now to differentiate myself from the illness. I learned I'm not a bad person but bad things did happen to me and I survived.”(Story 3) “The fact is that we have thoughts that are helpful and thoughts that are destructive….. I knew it was up to me if I was to get better once and for all.” (Story 32): “In the hospital I was introduced to DBT. I saw a nurse (Tanya) every day and attended a group session twice a week, learning the techniques. I worked with the people who wanted to work with me this time. Tanya said the same thing my counselor did “there is no study that can prove whether or not suicide solves problems” and I felt as though I understood it then. If I am dead, then all the people that I kept pushing away and refusing their help would be devastated. If I killed myself with my own hand, my family would be so upset. DBT taught me how to ‘ride my emotional wave’. ……….. DBT has changed my life…….. My life is getting back in order now, thanks to DBT, and I have lots of reasons to go on living.”(Story 19) The writer of Story 67 described the importance of group therapy. “Group therapy was the most helpful for me. It gave me something besides myself to focus on. Empathy is such a powerful emotion and a pathway to love. And it was a huge relief to hear others felt the same and had developed tools of their own that I could try for myself! I think I needed to learn to communicate and recognize when I was piling everything up to build my despair. I don’t think I have found the best ways yet, but I am lifetimes away from that teenage girl.” (Story 67) The author of story 212 reflected on suicidal ideation beginning over 20 years earlier, at age 13. Her first attempt was at 28. “I thought everyone would be better off without me, especially my children, I felt like the worst mum ever, I felt like a burden to my family and I felt like I was a failure at life in general.” She had more suicide attempts, experienced the death of her father by suicide, and then finally found her doctor. “Now I’m on meds for a mood disorder and depression, my family watch me closely, and I see my doctor regularly. For the first time in 20 years, I love being a mum, a sister, a daughter, a friend, a cousin etc.” Discussion The 50 stories that describe positive experiences in the health care system constitute a larger group than most other similar studies, and most participants had made one or more suicide attempts. Several writers reflected back many years, telling stories of long ago, as with the 83-year old participant (Story 30) whose story provided the privilege of learning how the author’s life unfolded. In clinical practice, we often do not know – how did the story turn out? The stories that describe receiving health care speak to the impact of the experience, and the importance of the issues identified in the mental health system. We identified 3 themes, but it was often the combination that participants described in their stories that was powerful, as demonstrated in Story 20, the young new mother who had fallen from a balcony 30 years earlier. Voices from people with lived experience can help us plan and conceptualize our clinical work. Results are consistent with, and add to, the previous work on the importance of therapeutic relationships.8,10,11,14–16 It is from the stories in this study that we come to understand the powerful experience of seeing a family members’ reaction following a participant’s suicide attempt, and how that can be a potent turning point as identified by Lakeman and Fitzgerald.7 Ghio and colleagues8 and Lakeman16 identified the important role for staff/nurses in supporting families due to the connection to relationship issues. This research also calls for support for families to recognize the important role they have in helping the person understand how much they mean to them, and to promote the potential impact of a turning point. The importance of the range of services reflect Lakeman and Fitzgerald’s7 theme of coping, associating positive change by increasing the repertoire of coping strategies. These findings have implications for practice, research and education. Working with individuals who are suicidal can help them develop and tell a different story, help them move from a death-oriented to life-oriented position,15 from “why suicide” to “why life.”9 Hospitalization provides a person with the opportunity to reflect, to take time away from “the real world” to consider oneself, the suicide attempt, connections with family and friends and life goals, and to recover physically and emotionally. Hospitalization is also an opening to involve the family in the recovery process. The intensity of the immediate period following a suicide attempt provides a unique opportunity for nurses to support and coach families, to help both patients and family begin to see things differently and begin to create that different story. In this way, family and friends can be both a support to the person who has attempted suicide, and receive help in their own struggles with this experience. It is also important to recognize that this short period of opportunity is not specific to the nurses in psychiatric units, as the nurses caring for a person after a medically severe suicide attempt will frequently be the nurses in the ICU or Emergency departments. Education, both reflective and interactive, could have a positive impact.17 Helping staff develop the attitudes, skills and approach necessary to be helpful to a person post-suicide attempt is beginning to be reported in the literature.21 Further implications relate to nursing curriculum. Given the extent of suicidal ideation, suicide attempts and deaths by suicide, this merits an important focus. This could include specific scenarios, readings by people affected by suicide, both patients themselves and their families or survivors, and discussions with individuals who have made an attempt(s) and made a decision to go on living. All of this is, of course, not specific to nursing. All members of the interprofessional health care team can support the transition to recovery of a person after a suicide attempt using the strategies suggested in this paper, in addition to other evidence-based interventions and treatments. Findings from this study need to be considered in light of some specific limitations. First, the focus was on those who have made a decision to go on living, and we have only the information the participants included in their stories. No follow-up questions were possible. The nature of the research design meant that participants required access to a computer with Internet and the ability to communicate in English. This study does not provide a comprehensive view of in-patient care. However, it offers important inputs to enhance other aspects of care, such as assessing safety as a critical foundation to care. We consider these limitations were more than balanced by the richness of the many stories that a totally anonymous process allowed. Conclusion Stories open a window into the experiences of a person during the period after a suicide attempt. The RTGOL Project allowed for an understanding of how we might help suicidal individuals change the script, write a different story. The stories that participants shared give us some understanding of “how” to provide support at a most-needed critical juncture for people as they interact with health care providers immediately after a suicide attempt. While we cannot know the experiences of those who did not survive a suicide attempt, results of this study reinforce that just one caring professional can make a crucial difference to a person who has survived a suicide attempt. We end with where we began. Who will open the door? References 1. World Health Organization. Suicide prevention and special programmes. http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/index.html Geneva: Author; 2013.2. Giner L, Jaussent I, Olie E, et al. Violent and serious suicide attempters: One step closer to suicide? J Clin Psychiatry 2014:73(3):3191–197.3. Levi-Belz Y, Gvion Y, Horesh N, et al. Mental pain, communication difficulties, and medically serious suicide attempts: A case-control study. Arch Suicide Res 2014:18:74–87.4. Hjelmeland H and Knizek BL. Why we need qualitative research in suicidology? Suicide Life Threat Behav 2010:40(1):74–80.5. Gunnell D. A population health perspective on suicide research and prevention: What we know, what we need to know, and policy priorities. Crisis 2015:36(3):155–60.6. Fitzpatrick S. Looking beyond the qualitative and quantitative divide: Narrative, ethics and representation in suicidology. Suicidol Online 2011:2:29–37.7. Lakeman R and FitzGerald M. How people live with or get over being suicidal: A review of qualitative studies. J Adv Nurs 2008:64(2):114–26.8. Ghio L, Zanelli E, Gotelli S, et al. Involving patients who attempt suicide in suicide prevention: A focus group study. J Psychiatr Ment Health Nurs 2011:18:510–18.9. Kraft TL, Jobes DA, Lineberry TW., Conrad, A., & Kung, S. Brief report: Why suicide? Perceptions of suicidal inpatients and reflections of clinical researchers. Arch Suicide Res 2010:14(4):375-382.10. Sun F, Long A, Tsao L, et al. The healing process following a suicide attempt: Context and intervening conditions. Arch Psychiatr Nurs 2014:28:66–61.11. Montross Thomas L, Palinkas L, et al. Yearning to be heard: What veterans teach us about suicide risk and effective interventions. Crisis 2014:35(3):161–67.12. Long M, Manktelow R, and Tracey A. The healing journey: Help seeking for self-injury among a community population. Qual Health Res 2015:25(7):932–44.13. Carlen P and Bengtsson A. Suicidal patients as experienced by psychiatric nurses in inpatient care. Int J Ment Health Nurs 2007:16:257–65.14. Samuelsson M, Wiklander M, Asberg M, et al. Psychiatric care as seen by the attempted suicide patient. J Adv Nurs 2000:32(3):635–43.15. Cutcliffe JR, Stevenson C, Jackson S, et al. A modified grounded theory study of how psychiatric nurses work with suicidal people. Int J Nurs Studies 2006:43(7):791–802.16. Lakeman, R. What can qualitative research tell us about helping a person who is suicidal? Nurs Times 2010:106(33):23–26.17. Karman P, Kool N, Poslawsky I, et al. Nurses’ attitudes toward self-harm: a literature review. J Psychiatr Ment Health Nurs 2015:22:65–75.18. Carter B. ‘One expertise among many’ – working appreciatively to make miracles instead of finding problems: Using appreciative inquiry as a way of reframing research. J Res Nurs 2006:11(1): 48–63.19. Lieblich A, Tuval-Mashiach R, Zilber T. Narrative research: Reading, analysis, and interpretation. Sage Publications; 1998.20. Braun V and Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006:3(2):77–101.21. Kishi Y, Otsuka K, Akiyama K, et al. Effects of a training workshop on suicide prevention among emergency room nurses. 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Supplemental Instruction (SI) has been a successful implementation into institutions worldwide. It serves as a means of reducing attrition and increasing the overall learning of course material. The City College of New York (CCNY) has recently implemented SI to General Chemistry I courses to examine whether or not SI would help students succeed in the course and understand and grasp the course material better. SI was made available several times a week during flexible times to students who are struggling in the course. Our method of data collection is a Likert-type and open-ended questionnaire that was distributed at the end of each of the semesters to SI participants in an anonymous fashion. Furthermore, we compared the grades and performance of students participating in SI with those who did not. The collected data enabled us to examine the impact of implementing Supplemental Instruction (SI) in General Chemistry I at CCNY. Our data show that SI was beneficial, contributed to improving students’ understanding of course material, and increased their success rate. About 80 percent of students who failed the first exam and participated in SI obtained a passing grade compared to 11 percent of those who did not.Keywords: supplemental instruction, chemistry education research, student learningINTRODUCTION Supplemental instruction is derived from the term developmental education and stems from a branch of Learning Assistance Centers or LACS [1]. To better understand the origins of Supplemental Instruction, we must first understand the framework that set up this type of education. Developmental education originates in the 1600s and focuses mainly on the assumption that each student has multifaceted talents that can be developed academically, opposed to focusing on the deficits of a student [1]. The main goal was to naturally adapt the students’ population to higher education through means of social and academic domains allowing the students to grow in multiple dimensions in their academic skills [1].Developmental education later paved the way for academic programs such as Learning Assistance Centers (LACs). It was viewed as an extension of the classroom and did not discriminate between faculty and students, and within the student population did not discriminate between students who performed to standard and those who performed below par. LACs were for everyone who wanted to be academically enriched [1]. As a new program, LACs had six main objectives: “higher course grades for participating students; central location for students to receive tutorial assistance; a referral source to other helping agencies; a comprehensive library of basic study aids; a training agency for paraprofessionals, peer counselors, and tutors; and a center for faculty development.” [1]. These goals made it very clear that this service was not to be mislabeled as remedial, which was a main topic of interest when it comes to implementing new services, like this one, in schools. LACs are essentially a tool used to attain higher education, not provide a remedial course. Another important reason as to why LACs were adopted into other higher education institutions is to increase student retention [1]. LACs jump-started improved learning across campuses not only in the United States but across the world.In the 1990’s developmental or remedial courses were not allowed to be offered at public four-year universities, thus making supplemental instruction a very attractive candidate to solving the issue with students’ academic integrity and attrition [1]. College faculty members were drawn to SI due to its minute fiscal commitment and that it strongly promoted individual self-learning for the students, this meant less time spent teaching for instructors [1].SI or supplemental instruction is as it states - supplemental instruction offered to the students enrolled in a course. SI gives the students the opportunity to work in a cooperative setting on problems and is supported by peer instructors [2]. SI works to increase academic performance and retention but utilizing both collaborative studying in addition to independent studying and analysis of study strategies. SI sessions are offered for traditionally difficult high risk course; ‘historically difficult’ courses are also identified by analyzing the grade distribution of courses throughout each academic division, “courses in which 30% or more of the students receive D or F grades or withdraw, become targets” [3]. One of the main factors that attribute to the individuality of SI programs is that it focuses on historically difficult courses [4] and large classes where students have little opportunity for interaction with the professor or other students [5]. Labeling a course as historically difficult allows you to categorize the class as challenging without placing blame on the professor or the students.SI sessions are scheduled on a weekly basis and all students enrolled in the course are encouraged to join. SI sessions act as a continuation of the lesson learned during in-class lecture with the instructor. Being that SI sessions are not tied down to class time, students can attend whenever and however many times they wish without the restriction of a required course preventing them. Constant feedback will be given based on the student’s grasp of the material taught in class, thus giving them ample time and motivation to alter their study methods to adapt, if need be. Research on SI suggests that problem-solving skills and study strategies learned in SI courses are transferable to other courses which leads to improved performance [6]. Supplemental instruction sessions are typically led by an SI leader, who would be a former student that succeeded in the same course, however it is not uncommon for a professor to join an SI session for a course. SI may improve students’ retention and graduation because it offers the students the opportunity to network socially which speeds up the acclimatization to the college experience [7].SI provides a way to combine “how do I teach myself this” with “what do I need to know”. While SI helps students gain a more thorough understanding of the material, it also helps students to condition themselves and alters their thinking to accommodate for the type of information they are processing. SI differs from a remedial tutoring course because it is created based on the course versus the students [1]. This potentially makes attending SI sessions more attractive to students who are afraid or shy to ask for help.SI is not a remedial course, it is considered a mediator connecting the gap between the new information presented to students and the students current knowledge and practices, “SI bridges the gap between the current knowledge base and the acquisition of new knowledge by focusing on the refinement of the learning skills indispensable for acquiring new knowledge” [8]. Successfully implemented SI programs were able to track those students who attended and the impact it made towards their grade, for data that was collected institutionally [9]. SI can be effectively used to develop study skills, increase motivation and improve performance in participants [10].According to Wolfe, “…there appear to be benefits of SI in courses where students are being newly introduced to chemical concepts and methods, but these benefits seem to drop off when students are more experienced with the material.” [5]. The results further go on to conclude that SI is most beneficial to entry level science courses such as, General Chemistry I and Organic Chemistry I. It seems as though SI is a great addition into institutions to overall help attrition rates and more generally help students improve within their courses. More research has been done to give us a wider range of knowledge on SI within Chemistry courses [9]. SI can be used to address the continuous decline of fundamental chemical knowledge noticed in recent college graduates [11].In large lecture classes, there is a disconnect between the lecturer and the student. Supplemental Instruction (SI) is often offered in a more intimate setting where the SI instructors can have one-on-one time with students to individually hone in on their specific problems, whether it is conceptual or problem-solving. As for learning environment, SI is usually held in a smaller more accommodating room where it is a less intimidating more inviting space. This setting provides a social interaction component in which usual Chemistry lectures don’t provide. In addition to the more personal tutoring time available, students are also encouraged to interact in a common social setting. This allows for an opportunity of collaborative learning and may help foster a sense of community [12].The attraction to SI in a college setting is due to its short and long-term effects. The short-term effects of SI sessions are to instill a deeper understanding of the coursework within students. Whereas the long-term goals are two-fold, the academic goal is to change the way students learn, study, and understand information so that the knowledge stays with them. Students who participate in SI earn higher grades not only the course but in subsequent semesters, which is due to improved study habits and is considered a long-term positive outcome of SI [13]. The second long-term goal is to develop better social interaction skills within these students.Many public institutions have implemented SI and thus have uncovered several significant findings. Findings that were previously mentioned pertaining to the outcomes of SI includes achieving higher percentages of passing grades [1, 14]. Some studies also found higher graduation rates among participants [1]. Despite their better performance, SI takers often score lower on academic success predictors such as the SAT and ACT exams [14]; increases in performance, therefore, appear to not occur because stronger students use SI. SI helps promote problem-solving skills because it involves the learner in the construction of knowledge and information processing based on their prior experiences which could contribute to cognitive development [15-16]. Furthermore, SI has been shown to improve motivation and enhance study habits and understanding difficult concepts [17]. Participants in SI have been found to have better control on their achievement, self-esteem, and confidence [18]. SI has also been found to higher academic self-efficacy and grades [19]. Studies have reported that students who participated in SI in introductory courses in Biology or Chemistry courses tended to continue onto upper level courses in the field; SI has a positive effect on students’ enrollment in upper level courses [20-21]. We should note that Rabitoy and co-authors reported that SI enhanced students’ achievement in STEM fields and this was greater for females and students of color [22]. METHODS While researching the topic of SI as a whole, we were able to uncover many studies that were in favor of this new implementation in institutions. Our research study is unique because it targets only at risk students and provides an added value to the curriculum. SI was implemented into The City College of New York (CCNY) as a test run in the Department of Chemistry and Biochemistry. The CCNY is an urban minority serving institute that offers a diverse selection of classes, which vary from the arts to the sciences and everything in between. We wanted to try implementing SI into the sciences to see if at risk science students can benefit from it. Grasping the S in stem, our main goal is to use the successful methods of SI to see what benefits it can bring to general science courses.Beginning during the Spring semester of 2018, SI was implemented at The CCNY’s General Chemistry I course which is composed of lecture, lab, and Peer-Led Team Learning (PLTL) workshop. PLTL is implemented as an integrated part of the course [23]. In the General Chemistry course, after exam one was distributed and grades were given back, an announcement was made introducing SI. The lecture professor would encourage students who received a failing grade, classified as a grade below a 65 out of 100 on exam one, to attend SI as means of improving in the course. This makes our study unique since we are only targeting students who are struggling the course and are not likely to earn a passing grade. It is noteworthy that PLTL offers a collaborative learning experience for all students. SI instructors targeted weaknesses in study habits, socialization, conceptual-understanding, and problem-solving skills.SI was made available for five days a week and on those days, SI was scheduled around classes times which makes it easier for students with busy schedules involving work and class to attend. During SI sessions there are instructors that have been hand-picked by instructors from a cohort of recitation leaders and who have successfully completed the course and have received a grade of A in the course. SI attendance was not mandatory.Throughout the first session available after the Supplemental Instruction announcement was made to the lecture class, those who chose to attend, because SI was not mandatory and it was strongly recommended for struggling students. Students brought their first exam with them to be discussed. This initial discussion is a one-on-one between the student and instructor, which serves as a more social component to learning whereas that isn’t available during class time. The first exam was then discussed so that the instructor can now sift through the student’s strengths and weaknesses to later target them in the weeks to come. The overall composition of our Supplementary Instruction sessions was influenced by the previous studies done and researched, hand-picking methods that seemed to work and leaving off ones that were less successful. SI sessions included cooperative learning activities, and addressed students’ misconceptions and difficulties, explored difficult concepts in depth, and enhanced problem-solving skills [24].Every week during Supplementary Instruction sessions students were encouraged to come back to further work through their weaknesses. During this trial specifically, it was noticed by the SI instructors that a lot of students actually struggle with basic problem-solving skills and reasoning. To help combat this, worksheets were made each week based on the lecture topics covered in class, based on problem-solving to help build their skills. Aside from doing the worksheets, students were encouraged to bring in topics or questions they have on the material so the SI instructors can further clarify and explain. Furthermore, students came to SI with questions that they were struggling with. Students provided questions for the SI instructor to explain which created a mutually beneficial relationship [11, 25].Our research question is: How does Supplemental Instruction in General Chemistry I impact students’ learning, conceptual understanding, retention, and attitudes?In order to properly assess how beneficial SI is to the way students learn Chemistry, data were collected at the end of the Spring and Fall of 2018 semesters, as well as Spring 2019. We used a combination Likert-type and open-ended questionnaire, as well as, grade comparisons. The Likert-type section included a five-point scale, where (1) Strongly Disagree, (2) Disagree, (3) Neutral, (4) Agree, (5) Strongly Agree. For each question, the average was taken which helps make sense of the data. For the open ended questions, questions 1 through 3, we created and used a rubric to score the questions on a scale from 1 to 5 similar to what was mentioned above. For question 4, we compiled the answers and created pie charts based on the type and number of responses.As previously stated, at the end of the semester surveys were printed and distributed to each SI session. Students that attended SI were all encouraged to participate in this survey. A total of 44 out of 60 students were available and willing to participate in the optional survey.RESULT AND DISCUSSION Graphical depictions of each Likert-type question along with average responses are shown in Figure 1. FIGURE 1. Averages for the answers for each of the Likert-type questionnaire. Our data clearly shows that students overall had a positive learning experience with SI. The students agree that SI improved their basic problem-solving skills, understanding of concepts covered, and attaining a better grade in the course. Furthermore, SI participation encouraged students to practice problems and tackle their weaknesses in the course. SI participants believe that the SI instructors targeted their weak areas and helped them improve. Finally, students felt that SI was worth the time and effort they put into it and that it was beneficial and contributed to improvements in grades.FIGURE 2. Averages of the short-answer responses were numerically scaled using a rubric.Figure 2 shows that students overall had a positive learning experience with SI and that it helped them better understand the concepts. Furthermore, the participants would enthusiastically would recommend SI to other Chemistry students.FIGURE 3. The pie chart above shows the beneficial components of SI to studentsFigure 3 shows the parts of SI that students found beneficial. Overall, there were many useful features of the SI program that facilitated students’ learning and succeeding in the course. The students appreciated the time spent on problem-solving, the flexibility of the offerings – refers to the times and days, the individualized learning experience, and the one-on-one support, guidance, and tutoring. From the Likert-type questions given in part one of the survey, responses were broken down for each given question in order to visualize the impact of SI for the students/participants. The average of the responses can be seen above and was about 4.8. The corresponding results can be viewed above as shown in Figure 1. To turn our attention to Figure 1 ‘SI has helped me to improve my basic problem solving skills’, upon meeting with the SI instructor team at The CCNY we were made aware that students have trouble with basic problem-solving which leads to the disconnect in understanding how to build upon this knowledge. When students lack this basic skill, it is difficult for them to move on and build upon this skill as the course progresses, which ultimately leads to their failure to meet the level of understanding for each lecture exam. From the responses, we can see that majority of the students feel as though their problem solving skills have developed as a result of participating in SI. Questions 6-8 deal with an overall belief about the experience of SI participation. Based on Figure 1, SI helped students better understand the course material, and had an overall positive response as 100% of students felt like they did have a better understanding of the course material after attending SI. Students overwhelmingly agree that SI is very beneficial to the way they learn Chemistry. Our data show that SI is well received by the participants which is consistent with other researchers [11]. Short answer questions 1-3 were made in order to have a more in-depth understanding of the student experience with SI this past semester. These questions were formed as short answer so students were more inclined to share their opinions of SI. The collected data shows that the students strongly agree that SI has been very beneficial for ways unique to each student. Some students enjoyed the SI instructors and their way of teaching and helping the students understand the material. While others enjoyed how personal the experience was. It wasn’t a ‘one size fits all’ experience but an experience that was personalized to each student’s needs, strengths, and weaknesses. Short answers for question 4 also had very personalized responses. Question 4 in particular – ‘What features of SI did you find to be most beneficial to you?’ was very helpful in understanding what students appreciate most about SI, and served as a standard to which should be upheld. Responses ranged from the flexible times SI was offered to the small class setting which is extremely different than the lecture, and more comfortable. Students also enjoyed and benefited from the one-on-one attention they received in SI session. For that reason, students would make time to attend the SI section of their ‘favorite instructor’. Furthermore, the individualized learning experience was appealing to SI participants. The overall goal is to get each student to understand complex concepts and if one instructor can better help someone to reach this goal; SI is a success. The overall responses show that SI is very beneficial and contributed a great deal to the way that students learn Chemistry. One main issue we have encountered during this initial phase of implementation is low number of students who self-select to participate in SI. Only about 10 percent of students who failed the first exam, participated in SI. One reason could be that students might not buy into the philosophy of SI. A second reason might be that students do not think that SI would help them better understand the content and succeed on the course. A third reason could be due to lack of motivation in these students. Another reason could be attributed to the lack of maturity in students who are taking General Chemistry I. We use the term ‘lack of maturity’ loosely in this sense to mean the lack of knowledge of how to conduct oneself in a college setting [26]. Most commonly, freshman students come straight from high school where they have not yet acquired good study techniques or methods which work best for them. These reasons combined with the hardship required to understand such complex concepts that they’re learning for the very first time can deter students. Our data show that students who participated in SI after failing the first exam achieved a success rate of about 80%. Students who failed the first exam and did not participate in SI had an 11% chance of passing the course. This data is consistent with several research in the field indicating that students who participate in SI have a higher chance of successfully completing the course with a passing grade [14, 27]. We feel these data make powerful statement for the added value of SI in General Chemistry courses and its impact on students learning and attitudes.CONCLUSION In conclusion, our research study on SI provided valuable data into students’ learning and conceptual understanding of content in General Chemistry. Furthermore, our findings provide insights into students’ attitudes about SI implementation and its benefits to the participants. Our research data supports the introduction of SI into General Chemistry courses and provides students with learning skills, socialization competencies, problem-solving skills, and the knowledge required to successfully complete the course. We believe that our data supports the notion that SI had a significantly affected the participants grades in a positive manner and it should be noted that that majority of SI participants earned a passing grade in the course. Our results and data on the implementation of SI in General Chemistry courses improved students’ attitudes towards the subject matter, learning, socialization, and study habits. We are confident we can reach a larger population and improve our recruitment so more students can experience SI and increase their chances of successful completion of the course. As an implication for curriculum, we would recommend supplemental instruction for all introductory courses STEM fields. ACKNOWLEDGMENT We also would like to thank the Department of Psychology at the CCNY and CUNY Coordinated Undergraduate Education (CUE) for funding our Supplemental Instruction program.

This study investigated the influence of the phases of identity development as identified by the Optimal Theory Applied to Identity Development (OTAID) framework on multicultural counselling competencies among the counsellor trainees in Universiti Malaysia Sarawak. This proposed research utilized correlational research design. 93 counsellor trainees were recruited for data collection by using purposive sampling. Three instruments were implemented in this study, which are Self-Identity Inventory (SII), Multicultural Awareness/ Knowledge/ Skills Survey (MAKSS), and Marlowe-Crowne Social Desirability Scale- Short (MCSDS-S). SII was used to measure the phases of identity development, which are Individuation, Dissonance, Immersion, Internalization, Integration, and Transformation. MAKSS was utilized to measure self-perceived multicultural counselling competencies from 3 dimensions, which are Multicultural Awareness, Multicultural Knowledge, and Multicultural Skills. While MCSDS-S was used as measure for social desirability. The collected data were analyzed using Pearson Coefficient Correlation and Multiple Regression. The findings revealed that there is no relationship between identity development and multicultural counselling competencies. Likewise, no significant influence was found between identity development and multicultural counselling competencies. Among the six phases of identity development, the phase of Integration was a sole predictor of counsellor trainee’s perceived Multicultural Awareness and Multicultural Knowledge. Integration is positively correlated with Multicultural Awareness, with r(93)=0.25, p=0.02. Integration is also positively correlated with Multicultural Knowledge, with r(93)=0.25, p=0.02. Moreover, Integration predicted 6% of Multicultural Awareness, with F(1.92)=6.04, R2 =0.06, p<0.05. Integration also predicted 6% of Multicultural Knowledge, with F(1.92)=6.19, R2=0.06, p<0.05. While Multicultural Skills did not predict by any phase of identity development, for no significant influence of identity development was found on Multicultural Skills. The researcher suggested that training and supervision that involve immersion with people from diverse background to be considered in promoting multicultural counselling competencies of counsellor trainees. Further studies are encouraged to explore the significant factors that contribute to multicultural counselling competencies.

The main handbook on online counseling used in the Netherlands recommends counselors to use metacommunication, i. e. to state what happens during the interaction, in case of interactional trouble. The aim of this study was to explore this interactional strategy by describing how counselors may use metacommunication to respond to interactional problems in online counseling of the “helpline” type (single chat sessions). Data were derived from a corpus of 197 sessions of the Dutch information chat service on alcohol and drugs and 348 sessions from a Dutch general chat help service. The theoretical and analytical framework of (digital) conversation analysis (CA) was used to analyze the data. The analyses show that metacommunication is used, but only rarely. Clients tend to log out from problematic sessions, often even before the counselor is able to identify interactional trouble at all. This means online counselors operate under the constant risk of clients’ disengagement. Second, we identified and described three metacommunicative practices counselors use to respond to problematic interaction: 1) Self-criticizing; the counselor is regretting (s)he was not able to help due to a lack of useful advice or to the boundaries of the institutional context. This strategy seems to elicit client acknowledgement followed by an aligned closing; 2) Accusing: the counselor is questioning the client’s advice recipiency. This strategy seems to elicit even more client resistance. 3) Explaining: the counselor explains the institutional tasks and responsibilities and/or suggests the client has unrealistic expectations. We conclude that although metacommunication can be useful to restore the relationship with the client when it is apologetic, it can also be counterproductive to deal with problematic interaction when the counselor questions the client’s willingness or ability to accept the advice. For this reason, our analysis warrants the advice to avoid metacommunication as a strategy in single session counseling.

Traditional concepts of sexuality and intimacy contain normative assumptions that limit the fluidity and creativity with which individuals’ relational, gender, and affectional identities can be expressed. This theoretical article applies the seven axioms of Hammack et al.’s paradigm of queer intimacy to a case study of a client who identifies as queer, kinky, poly, transmasculine, and neurodivergent. The resulting conceptualization illustrates ways in which kink and bondage/domination and sadomasochism can contribute to identity development, congruence, and self-actualization. Implications for counseling are provided along with humanistic themes found within the case study. Humanistic counselors can connect more authentically with queer, kinky, polyamorous clients by acknowledging the diversities of clients’ identities and behaviors and increasing counselor competencies related to queer, kink, and poly cultures and practices.

The rise of expertise in the lives of women is a complex and prolonged process that began when the old networks through which women had learned from each other were being discredited or destroyed (Ehrenreich and English). Enclosed spaces of expert power formed separately from political control, market logistics and the pressures exerted by their subjects (Rose and Miller). This, however, was not a question of imposing expertise on women and forcing them to adhere to expert proclamations: “the experts could not have triumphed had not so many women welcomed them, sought them out, and … organised to promote their influence” (Ehrenreich and English 28). Women’s continuing enthusiasm for self-help books – and it is mainly women who buy them (Wood) – attests to the fact that they are still welcoming expertise into their lives. This paper argues that a major factor in the popularity of self-help is the reversal of the conventional ‘priestly’ relationship and ethic of confession, in a process of conversion that relies on the enthusiasm and active participation of the reader.Miller and Rose outline four ways in which human behaviour can be transformed: regulation (enmeshing people in a code of standards); captivation (seducing people with charm or charisma); education (training, convincing or persuading people); and conversion (transforming personhood, and ways of experiencing the world so that people understand themselves in fundamentally new ways). Of these four ways of acting upon others, it is conversion that is the most potent, because it changes people at the level of their own subjectivity – “personhood itself is remade” (Miller and Rose 35). While theories of conversion cannot be adequately discussed here, one aspect held in common by theories of religious conversion as well as those from psychological studies of ‘brainwashing’ is enthusiasm. Rambo’s analysis of the stages of religious conversion, for example, includes ‘questing’ in an active and engaged way, and a probable encounter with a passionately enthusiastic believer. Melia and Ryder, in their study of ‘brainwashing,’ state that two of the end stages of conversion are euphoria and proselytising – a point to which I will return in the conclusion. In order for a conversion to occur, then, the reader must be not only intellectually convinced of the truth, but must feel it is an important or vital truth, a truth she needs – in short, the reader must be enthused. The popularity of self-help books coincides with the rise of psy expertise more generally (Rose, "Identity"; Inventing), but self-help putatively offers escape from the experts, whilst simultaneously immersing its readers in expertise. Readers of self-help view themselves as reading sceptically (Simonds), interpretively (Rosenblatt) and resistingly (Fetterly, Rowe). They choose to read books as an educational activity (Dolby), rather than attending counselling or psychotherapy sessions in which they might be subject to manipulation, domination and control by a therapist (Simonds). I have discussed the nature of the advice in relationship manuals elsewhere (Hazleden, "Relationship"; "Pathology"), but the intention of this paper is to investigate the ways in which the authors attempt to enthuse and convert the reader.Best-Selling ExpertiseIn common with other best-selling genres, popular relationship manuals begin trying to enthuse the reader on the covers, which are intended to attract the reader, to establish the professional – or ‘priestly’ – credentials of the author and to assert the merit of the book, presenting the authors as experienced professionally-qualified experts, and advertising their bestseller status. These factors form part of the marketing ‘buzz’ or collective enthusiasm about a particular author or book.As part of the process of establishing themselves in the priestly role, the authors emphasise their professional qualifications and experience. Most authors use the title ‘Dr’ on the cover (Hendrix, McGraw, Forward, Gray, Cowan and Kinder, Schlessinger) or ‘PhD’ after their names (Vedral, DeAngelis, Spezzano). Further claims on the covers include assertions of the prominence of the authors in their field. Typical are DeAngelis’s claim to being “America’s foremost relationships expert,” and Hendrix’s claim to being “the world’s leading marital therapist.” Clinical and professional experience is mentioned, such as Spezzano’s “twenty-three years of counseling experience” (1) and Forward’s experience as “a consultant in many southern California Medical and psychiatric facilities” (iii). The cover of Spezzano’s book claims that he is a “therapist, seminar leader, author, lecturer and visionary leader.” McGraw emphasises his formal qualifications throughout his book, saying, “I had more degrees than a thermometer” (McGraw 6), and he refers to himself throughout as “Dr. Phil,” much like “Dr Laura” (Schlessinger). Facts and SecretsThe authors claim their ideas are based on clinical practice, research, and evidence. One author claims, “In this book, there is a wealth of tried and accurate information, which has worked for thousands of people in my therapeutic practice and seminars over the last two decades” (Spezzano 1). Another claims that he “worked with hundreds of couples in private practice and thousands more in workshops and seminars” and subsequently based his ideas on “research and clinical observations” (Hendrix xviii). Dowling refers to “four years of research … interviewing professionals who work with and study women.” She went to all this trouble because, she assures us, “I wanted facts” (Dowling, dust-jacket, 30).All this is in order to assure the reader of the relevance and build her enthusiasm about the importance of the book. McGraw (226) says he “reviewed case histories of literally thousands and thousands of couples” in order “to choose the right topics” for his book. Spezzano (7) claims that his psychological exercises come from clinical experience, but “more importantly, I have tested them all personally. Now I offer them to you.” This notion of being in possession of important new knowledge of which the reader is unaware is common, and expressed most succinctly by McGraw (15): “I have learned what you know and, more important, what you don't know.” This knowledge may be referred to as ‘secret’ (e.g. DeAngelis), or ‘hidden’ (e.g. Dowling) or as a recent discovery. Readers seem to accept this – they often assume that self-help books spring ‘naturally’ from clinical investigation as new information is ‘discovered’ about the human psyche (Lichterman 432).The Altruistic AuthorOn the assumption that readers will be familiar with other self-help books, some authors find it necessary to explain why they felt motivated to write one themselves. Usually these take the form of a kind of altruistic enthusiasm to share their great discoveries. Cowan and Kinder (xiv) claim that “one of the wonderful, intrinsic rewards of working with someone in individual psychotherapy is the rich and intense relationship that is established, [but] one of the frustrations of individual work is that in a whole lifetime it is impossible to touch more than a few people.” Morgan (26) assures us that “the results of applying certain principles to my marriage were so revolutionary that I had to pass them on in the four lesson Total Woman course, and now in this book.”The authors justify their own addition to an overcrowded genre by delineating what is distinctive about their own book, or what other “books, articles and surveys missed” (Dowling 30) or misinterpreted. Beattie (98-102) devotes several pages to a discussion of Dowling to assert that Dowling’s ‘Cinderella Complex’ is more accurately known as ‘codependency.’ The authors of another book admit that their ideas are not new, but claim to make a unique contribution because they are “writing from a much-needed male point of view” (Cowan and Kinder, back cover). Similarly, Gray suggests “many books are one-sided and unfortunately reinforce mistrust and resentment toward the opposite sex.” This meant that “a definitive guide was needed for understanding how healthy men and women are different,” and he promises “This book provides that vision” (Gray 4,7).Some authors are vehement in attacking other experts’ books as “gripe sessions,” “gobbledegook” (Schlessinger 51, 87), or “ridiculous” (Vedral 282). McGraw (9) writes “it is amazing to me how this country is overflowing with marital therapists, psychiatrists and psychologists, counselors, healers, advice columnists, and self-help authors – and their approach to relationships is usually so embarrassing that I want to turn my head in shame.” His own book, by contrast, will be quite different from anything the reader has heard before, because “it differs from what relationship ‘experts’ tell you” (McGraw 45).Confessions of an Author Because the authors are writing about intimate relationships, they are also keen to establish their credentials on a more personal level. “Loving, losing, learning the lessons, and reloving have been my path” (Carter-Scott 247-248), says one, and another asserts that, “It’s taken me a long time to understand men. It’s been a difficult and often painful journey and I’ve made a lot of mistakes along the way in my own relationships” (DeAngelis xvi). The authors are even keen to admit the mistakes they made in their previous relationships. Gray says, “In my previous relationships, I had become indifferent and unloving at difficult times … As a result, my first marriage had been very painful and difficult” (Gray 2). Others describe the feelings of disappointment with their marriages: We gradually changed. I was amazed to realize that Charlie had stopped talking. He had become distant and preoccupied. … Each evening, when Charlie walked in the front door after work, a cloud of gloom and tension floated in with him. That cloud was almost tangible. … this tension cloud permeated our home atmosphere … there was a barrier between us. (Morgan 18)Doyle (14) tells a similar tale: “While my intentions were good, I was clearly on the road to marital hell. … I was becoming estranged from the man who had once made me so happy. Our marriage was in serious trouble and it had only been four years since we’d taken our vows.” The authors relate the bewilderment they felt in these failing relationships: “My confusion about the psychology of love relationships was compounded when I began to have problems with my own marriage. … we gave our marriage eight years of intensive examination, working with numerous therapists. Nothing seemed to help” (Hendrix xvii).Even the process of writing the relationship manual itself can be uncomfortable: This was the hardest and most painful chapter for me to write, because it hit so close to home … I sat down at my computer, typed out the title of this chapter, and burst into tears. … It was the pain of my own broken heart. (DeAngelis 74)The Worthlessness of ExpertiseThus, the authors present their confessional tales in which they have learned important lessons through their own suffering, through the experience of life itself, and not through the intervention of any form of external or professional expertise. Furthermore, they highlight the failure of their professional training. Susan Forward (4) draws a comparison between her professional life as a relationship counsellor and the “Susan who went home at night and twisted herself into a pretzel trying to keep her husband from yelling at her.” McGraw tells of a time when he was counselling a couple, and: Suddenly all I could hear myself saying was blah, blah, blah. Blah, blah, blah, blah. As I sat there, I asked myself, ‘Has anybody noticed over the last fifty years that this crap doesn’t work? Has it occurred to anyone that the vast majority of these couples aren’t getting any better? (McGraw 6)The authors go to some lengths to demonstrate that their new-found knowledge is unlike anything else, and are even prepared to mention the apparent contradiction between the role the author already held as a relationship expert (before they made their important discoveries) and the failure of their own relationships (the implication being that these relationships failed because the authors themselves were not yet beneficiaries of the wisdom contained in their latest books). Gray, for example, talking about his “painful and difficult” first marriage (2), and DeAngelis, bemoaning her “mistakes” (xvi), allude to the failure of their marriage to each other, at a time when both were already well-known relationship experts. Hendrix (xvii) says: As I sat in the divorce court waiting to see the judge, I felt like a double failure, a failure as a husband and as a therapist. That very afternoon I was scheduled to teach a course on marriage and the family, and the next day, as usual, I had several couples to counsel. Despite my professional training, I felt just as confused and defeated as the other men and women who were sitting beside me.Thus the authors present the knowledge they have gained from their experiences as being unavailable through professional marital therapy, relationship counselling, and other self-help books. Rather, the advice they impart is presented as the hard-won outcome of a long and painful process of personal discovery.Peace and PassionOnce the uniqueness of the advice is established, the authors attempt to enthuse the reader by describing the effects of following it. Norwood (Women 4) says her programme led to “the most rewarding years of my life,” and Forward (10) says she “discovered enormous amounts of creativity and energy in myself that hadn't been available to me before.” Gray (268) asserts that, following his discoveries “I personally experienced this inner transformation,” and DeAngelis (126) claims “I am compassionate where I used to be critical; I am patient where I used to be judgmental.” Doyle (23) says, “practicing the principles described in this book has transformed my marriage into a passionate, romantic union.” Similarly, in discussing the effects of her ideas on her marriage, Morgan (26) speaks of “This brand new love between us” that “has given us a brand new life together.” Having established the success of their ideas and techniques on their own lives, the authors go on to relate stories about their successful application to the lives and relationships of their clients. One author writes that “When I began implementing my ideas … The divorce rate in my practice sharply declined, and the couples … reported a much deeper satisfaction in their marriages” (Hendrix xix). Another claims “Repeatedly I have heard people say that they have benefited more from this new understanding of relationships than from years of therapy” (Gray 7). Morgan, describing the effects of her ‘Total Woman’ classes, says: Attending one of the first classes in Miami were wives of the Miami Dolphin football players … it is interesting to note that their team won every game that next season and became the world champions! … Gals, I wouldn’t dream of taking credit for the Superbowl … (Morgan 188)In case we are still unconvinced, the authors include praise and thanks from their inspired clients: “My life has become exciting and wonderful. Thank you,” writes one (Vedral 308). Gray (6) talks of the “thousands of inspirational comments that people have shared” about his advice. Vedral (307) says “I have received thousands of letters from women … thanking me for shining a beam of light on their situations.” If these clients have transformed their lives, the authors claim, so can the reader. They promise that the future will be “exceptional” (Friedman 242) and “wonderful” (Norwood, Women 257). It will consist of “self fulfilment, love, and joy” (Norwood, Women 26), “peace and joy” (Hendrix xx), “freedom and a lifetime of healing, hope and happiness” (Beattie), “peace, relief, joy, and passion that you will never find any other way” (Doyle 62) – in short, “happiness for the rest of your life” (Spezzano 77).SummaryIn order to effect the conversion of their readers, the authors seek to create enthusiasm about their books. First, they appeal to the modern tradition of credentialism, making claims about their formal professional qualifications and experience. This establishes them as credible ‘priests.’ Then they make calculable, factual, evidence-based claims concerning the number of books they have sold, and appeal to the epistemological authority of the methodology involved in establishing the findings of their books. They provide evidence of the efficacy of their own unique methods by relating the success of their ideas when applied to their own lives and relationships, and those of their clients and their readers. The authors also go to some lengths to establish that they have personal experience of relationship problems, especially those the reader is currently presumed to be experiencing. This establishes the ‘empathy’ essential to Rogerian therapy (Rogers), and an informal claim to lay knowledge or insight. In telling their own personal stories, the authors establish an ethic of confession, in which the truth of oneself is sought, unearthed and revealed in “the infinite task of extracting from the depths of oneself, in between the words, a truth which the very form of the confession holds out like a shimmering mirage” (Foucault, History 59). At the same time, by claiming that their qualifications were not helpful in solving these personal difficulties, the authors assert that much of their professional training was useless or even harmful, suggesting that they are aware of a general scepticism towards experts (cf. Beck, Giddens), and share these doubts. By implying that it is other experts who are perhaps not to be trusted, they distinguish their own work from anything offered by other relationship experts, thereby circumventing “the paradox of self-help books’ existence” (Cheery) and proliferation. Thus, the authors present their motives as altruistic, whilst perhaps questioning the motives of others. Their own book, they promise, will be the one (finally) that brings a future of peace, passion and joy. Conversion, Enthusiasm and the Reversal of the Priestly RelationshipAlthough power relations between authors and readers are complex, self-help is evidence of power in one of its most efficacious forms – that of conversion. This is a relationship into which one enters voluntarily and enthusiastically, in the name of oneself, for the benefit of oneself. Such power enthuses, persuades, incites, invites, provokes and entices, and it is therefore a strongly subjectifying power, and most especially so because the relationship of the reader to the author is one of choice. Because the reader can choose between authors, and skip or skim sections, she can concentrate on the parts of the therapeutic diagnosis that she believes specifically apply to her. For example, Grodin (414) found it was common for a reader to attach excerpts from a book to a bathroom mirror or kitchen cabinet, and to re-read and underline sections of a book that seemed most relevant. In this way, through her enthusiastic participation, the reader becomes her own expert, her own therapist, in control of certain aspects of the encounter, which nonetheless must always take place on psy terms.In many conversion studies, the final stage involves the assimilation and embodiment of new practices (e.g. Paloutzian et al. 1072), whereby the convert employs or utilises her new truths. I argue that in self-help books, this stage occurs in the reversal of the ‘priestly’ relationship. The ‘priestly’ relationship between client and therapist, is one in which in which the therapist remains mysterious while the client confesses and is known (Rose, "Power"). In the self-help book, however, this relationship is reversed. The authors confess their own ‘sins’ and imperfections, by relating their own disastrous experiences in relationships and wrong-thinking. They are, of course, themselves enthusiastic converts, who are enmeshed within the power that they exercise (cf. Foucault History; Discipline), as these confessions illustrate. The reader is encouraged to go through this process of confession as well, but she is expected to do so privately, and to play the role of priest and confessor to herself. Thus, in a reversal of the priestly relationship, the person who ‘is knowledge’ within the book itself is the author. It is only if the reader takes up the invitation to perform for herself the priestly role that she will become an object of knowledge – and even then, only to herself, albeit through a psy diagnostic gaze provided for her. Of course, this instance of confession to the self still places the individual “in a network of relations of power with those who claim to be able to extract the truth of these confessions through their possession of the keys to interpretation” (Dreyfus and Rabinow 174), but the keys to interpretation are provided to the reader by the author, and left with her for her own safekeeping and future use. As mentioned in the introduction, conversion involves questing in an active and engaged way, and may involve joy and proselytising. Because the relationship must be one of active participation, the enthusiasm of the reader to apply these truths to her own self-understanding is critical. Indeed, the convert is, by her very nature, an enthusiast.ConclusionSelf-help books seek to bring about a transformation of subjectivity from powerlessness to active goal-setting, personal improvement and achievement. This is achieved by a process of conversion that produces particular choices and types of identity, new subjectivities remade through the production of new ethical truths. Self-help discourses endow individuals with new enthusiasms, aptitudes and qualities – and these can then be passed on to others. Indeed, the self-help reader is invited, by means of the author’s confessions, to become, in a limited way, the author’s own therapist – ie, she is invited to perform an examination of the author’s (past) mistakes, to diagnose the author’s (past) condition and to prescribe an appropriate (retrospective) cure for this condition. Through the process of diagnosing the author and the author’s clients, using the psy gaze provided by the author, the reader is rendered an expert in therapeutic wisdom and is converted to a new belief system in which she will become an enthusiastic participant in her own subjectification. ReferencesBeattie, M. 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This paper focuses on exam phobia among students. Exam phobia is an irrational fear that leads to avoidance of the feared situation or object which in turn increases the severity of the phobia. Exam phobia refers to the excessive worry about upcoming exams, Lifestyle issues, Negative thinking, self criticism, studying styles, psychological factors, fear of being evaluated, apprehension about the consequences, and is experienced by many normal students. It affects socially and leads to social withdrawal, avoidance of friends and family, self defeating thought, suicidal thoughts, etc. Therefore the management of Examination Phobia has become an essential research topic. The main objective of this paper is to introduce interventions for the Management of Examination Phobia and to assess the results of the same among High School Students using Cognitive Behavioural Therapy (CBT), Progressive Muscular Relaxation Technique, Benson‟s Relaxation Response, Guided Imagery and Recommendations for administrators, teachers, parents, school counsellors and students themselves.

Most undergraduate programmes in tourism management in Malaysia and elsewhere include a course on tourism geography. Knowledge of geography is deemed essential on the ground that it will equip travel and tourism professionals with geographic literacy of both the immediate environment at a particular destination and the world outside, regional and international. Travel counsellors, tourist guides and hotel guest contact personnel in particular, need knowledge in geography to be in the position to advise or provide visitor information on numerous geographic aspects of a destination such as weather, distance, time, location, direction, costs, terrain and the physical environment, especially fauna and flora. Mancini wrote Selling Destinations: Geography for the travel professional with this in mind. He begins the textbook with a debatable observation that travel professionals do not sell travel, what they really sell is geography. While it is true that most travellers see the burden of transfer from the place of origin to the destination as the less favored part of leisure travel, many travellers such as the early explorers, pilgrims, globetrotters and nowadays cruise ship passengers, value the transit experience as part of the leisure travel package. Indeed for the more exclusive niche markets such as space travel, overnight ecotourism hiking trails and mountain climbing, the thrill lies in the journey itself rather than any expected ‘eureka’ at the destination. Travel is thus always an inseparable part of a tour package. The book is big and thick, not a user-friendly volume that readers can conveniently pass around or carry in the suitcase. The author tries to cover a long list of places and items, at the expense of useful foci on pertinent elements at the destination. As a result it paradoxically suffers a lack of both depth and breath. In terms of depth the text is hardly academically rigorous as it claims to be (p. vii). For a self-proclaimed bestseller textbook that is used in more than 60 travel schools in Canada the reader expects a list of references at the back of the book if not after each chapter. Unfortunately the author prefers to stray from the familiar by not including features that, he worries, may ‘clutter’ the mind and this includes distractive references. Selling Destinations... seems to be the only travel geography text in the market that strangely omits references to others’ works. Thus it claims without evidence that, “Fifty-two percent of travellers pick the restaurant they will eat in before arriving at their destination” (p. 7), and that the word ‘serendipity’ comes from the Muslim name for Sri Lanka! In the same breadth this is hardly a scientific text which resorts to a tendentious myth (p. 583) that the eruption of Krakatoa in A. D. 535 caused...the rise of Islam (note: the religion of Islam was not founded until A. D. 622). It also claims that Jerusalem is the capital of Israel (p. 440) although this is still contestable. Coverage of the world is fairly comprehensive albeit uneven. For instance while Canada is allotted 72 pages, Malaysia, Indonesia, Philippines, Taiwan and Korea are only allocated one page each, notwithstanding the fact that Malaysia receives far more tourists that Canada. There is a conspicuous absence of Air Asia and Langkawi in the description of inbound airlines and island destinations in Malaysia. That the author refers to eastern Malaysia as Sarawak and Sabah regions rather than states indicates his own lack of geographic literacy. This book nonetheless offers the beginner an adequate descriptive framework which covers the essential geographic elements of a destination, namely location, local weather and climate, time zone, landscape, accessibility and key attractions. To Mancini’s credit students will find the trivia, misgivings and quiz sections enjoyable. As the reader proceeds from continent to continent s/he will be increasingly familiar with a rather formulaic format which details information on how to get to the destination, local weather, tips on getting around, possible itineraries, allied destinations, factors that motivate visitors and sales considerations. The prospective visitor is also alerted to possible misgivings on the destination which the travel counsellor might want to address in his/her advice to the client. This is clearly a book on the geography for travel which aims at equipping students with the core competencies for travel counselling. It contrasts with the less vocational orientation of other tourism geography books which devote some space for the geography of tourism with its key concepts and theories. In the latter emphasis is usually given to explaining why tourists and facilities catering to their needs are concentrated in particular regions and locations. For an understanding of the distribution patterns Ullman’s model on spatial interaction and Butler’s idea on the evolution of a tourist destination are now common knowledge, as are concepts of tourism demand and supply, and more recently ideas on ‘sustainable tourism’. Although Mancini does not delve explicitly into the five themes associated with the above concepts: location, place, human-environment interaction, movement and the character of a region as the destination, the diligent learner would nevertheless be able to connect the dots by the end of the course. His use of side notes and trivia boxes helps to make reading a breezy and enjoyable task. The reader is also provided with a 6.5 cm margin to write whatever noteworthy comments s/he wants to write for future reference and recollection. Selling Destinations...is clearly tailor-made for Canadian undergraduates, hence the disproportionate emphasis on the geography of Canadian destinations. A titular subscript Geography for the Canadian Travel Professional would have been more appropriate given such an emphasis. In view of its vocational orientation one does not expect this expensive book, now in its fifth edition, to be included in scholarly reviews among geographers. It is ironic that such a successful book in the market receives no mention in any scholarly review in the subfields of tourism geography or tourism marketing. The author himself seems oblivious to the existence of a large and growing body of literature on tourism geography and destination marketing. There is thus still a lack of integration in tourism geography literature with one concentration addressing geography for tourism while the other on geography of tourism. For a more comprehensive treatment the two sections clearly ought to come together.

In this paper we explore the rise of anti-gambling apps in the context of the massive expansion of gambling in new spheres of life (online and offline) and an acceleration in strategies of anticipatory and individualised management of harm caused by gambling. These apps, and the techniques and forms of labour they demand, are examples of and a mechanism through which a mode of governance premised on ‘self-care’ and ‘self-control’ is articulated and put into practice. To support this argument, we explore two government initiatives in the Australian context. Quit Pokies, a mobile app project between the Moreland City Council, North East Primary Care Partnership and the Victorian Local Governance Association, is an example of an emerging service paradigm of ‘self-care’ that uses online and mobile platforms with geo-location to deliver real time health and support interventions. A similar mobile app, Gambling Terminator, was launched by the NSW government in late 2012. Both apps work on the premise that interrupting a gaming session through a trigger, described by Quit Pokies’ creator as a “tap on the shoulder” provides gamblers the opportunity to take a reflexive stance and cut short their gambling practice in the course of play. We critically examine these apps as self-disciplining techniques of contemporary neo-liberalism directed towards anticipating and reducing the personal harm and social risk associated with gambling. We analyse the material and discursive elements, and new forms of user labour, through which this consumable media is framed and assembled. We argue that understanding the role of these apps, and mobile media more generally, in generating new techniques and technologies of the self, is important for identifying emerging modes of governance and their implications at a time when gambling is going through an immense period of cultural normalisation in online and offline environments. The Australian context is particularly germane for the way gambling permeates everyday spaces of sociality and leisure, and the potential of gambling interventions to interrupt and re-configure these spaces and institute a new kind of subject-state relation. Gambling in Australia Though a global phenomenon, the growth and expansion of gambling manifests distinctly in Australia because of its long cultural and historical attachment to games of chance. Australians are among the biggest betters and losers in the world (Ziolkowski), mainly on Electronic Gaming Machines (EGM) or pokies. As of 2013, according to The World Count of Gaming Machine (Ziolkowski), there were 198,150 EGMs in the country, of which 197,274 were slot machines, with the rest being electronic table games of roulette, blackjack and poker. There are 118 persons per machine in Australia. New South Wales is the jurisdiction with most EGMs (95,799), followed by Queensland (46,680) and Victoria (28,758) (Ziolkowski). Gambling is significant in Australian cultural history and average Australian households spend at least some money on different forms of gambling, from pokies to scratch cards, every year (Worthington et al.). In 1985, long-time gambling researcher Geoffrey Caldwell stated thatAustralians seem to take a pride in the belief that we are a nation of gamblers. Thus we do not appear to be ashamed of our gambling instincts, habits and practices. Gambling is regarded by most Australians as a normal, everyday practice in contrast to the view that gambling is a sinful activity which weakens the moral fibre of the individual and the community. (Caldwell 18) The omnipresence of gambling opportunities in most Australian states has been further facilitated by the availability of online and mobile gambling and gambling-like spaces. Social casino apps, for instance, are widely popular in Australia. The slots social casino app Slotomania was the most downloaded product in the iTunes store in 2012 (Metherell). In response to the high rate of different forms of gambling in Australia, a range of disparate interest groups have identified the expansion of gambling as a concerning trend. Health researchers have pointed out that online gamblers have a higher risk of experiencing problems with gambling (at 30%) compared to 15% in offline bettors (Hastings). The incidence of gambling problems is also disproportionately high in specific vulnerable demographics, including university students (Cervini), young adults prone to substance abuse problems (Hayatbakhsh et al.), migrants (Tanasornnarong et al.; Scull & Woolcock; Ohtsuka & Ohtsuka), pensioners (Hing & Breen), female players (Lee), Aboriginal communities (Young et al.; McMillen & Donnelly) and individuals experiencing homelessness (Holsworth et al.). While there is general recognition of the personal and public health impacts of gambling in Australia, there is a contradiction in the approach to gambling at a governance level. On one hand, its expansion is promoted and even encouraged by the federal and state governments, as gambling is an enormous source of revenue, as evidenced, for example, by the construction of the new Crown casino in Barangaroo in Sydney (Markham & Young). Campaigns trying to limit the use of poker machines, which are associated with concerns over problem gambling and addiction, are deemed by the gambling lobby as un-Australian. Paradoxically, efforts to restrict gambling or control gambling winnings have also been described as un-Australian, such as in the Australian Taxation Office’s campaign against MONA’s founder, David Walsh, whose immense art collection was acquired with the funds from a gambling scheme (Global Mail). On the other hand, people experiencing problems with gambling are often categorised as addicts and the ultimate blame (and responsibility) is attributed to the individual. In Australia, attitudes towards people who are arguably addicted to gambling are different than those towards individuals afflicted by alcohol or drug abuse (Jean). While “Australians tend to be sympathetic towards people with alcohol and other drug addictions who seek help,” unless it is seen as one of the more socially acceptable forms of occasional, controlled gambling (such as sports betting, gambling on the Melbourne Cup or celebrating ANZAC Day with Two-Up), gambling is framed as an individual “problem” and “moral failing” (Jean). The expansion of gambling is the backdrop to another development in health care and public health discourse, which have for some time now been devoted to the ideal of what Lupton has called the “digitally engaged patient” (Lupton). Technologies are central to the delivery of this model of health service provision that puts the patient at the centre of, and responsible for, their own health and medical care. Lupton has pointed out how this discourse, while appearing new, is in fact the latest version of the 1970s emphasis on the ‘patient as consumer’, an idea given an extra injection by the massive development and availability of digital and interactive web-based and mobile platforms, many of these directed towards the provision of health and health-related information and services. What this means for patients is that, rather than relying solely on professional medical expertise and care, the patient is encouraged to take on some of this medical/health work to conduct practices of ‘self-care’ (Lupton). The Discourse of ‘Self-Management’ and ‘Self-Care’ The model of ‘self-care’ and ‘self-management’ by ‘empowering’ digital technology has now become a dominant discourse within health and medicine, and is increasingly deployed across a range of related sectors such as welfare services. In recent research conducted on homelessness and mobile media, for example, government department staff involved in the reform of welfare services referred to ‘self-management’ as the new service paradigm that underpins their digital reform strategy. Echoing ideas and language similar to the “digitally engaged patient”, customers of Centrelink, Medicare and other ‘human services’ are being encouraged (through planned strategic initiatives aimed at shifting targeted customer groups online) to transact with government services digitally and manage their own personal profiles and health information. One departmental staff member described this in terms of an “opportunity cost”, the savings in time otherwise spent standing in long queues in service centres (Humphry). Rather than view these examples as isolated incidents taking place within or across sectors or disciplines, these are better understood as features of an emerging ‘discursive formation’ , a term Foucault used to describe the way in which particular institutions and/or the state establish a regime of truth, or an accepted social reality and which gives definition to a new historical episteme and subject: in this case that of the self-disciplined and “digitally engaged medical/health patient”. As Foucault explained, once this subject has become fully integrated into and across the social field, it is no longer easy to excavate, since it lies below the surface of articulation and is held together through everyday actions, habits and institutional routines and techniques that appear to be universal, necessary and/normal. The way in which this citizen subject becomes a universal model and norm, however, is not a straightforward or linear story and since we are in the midst of its rise, is not a story with a foretold conclusion. Nevertheless, across a range of different fields of governance: medicine; health and welfare, we can see signs of this emerging figure of the self-caring “digitally engaged patient” constituted from a range of different techniques and practices of self-governance. In Australia, this figure is at the centre of a concerted strategy of service digitisation involving a number of cross sector initiatives such as Australia’s National EHealth Strategy (2008), the National Digital Economy Strategy (2011) and the Australian Public Service Mobile Roadmap (2013). This figure of the self-caring “digitally engaged” patient, aligns well and is entirely compatible with neo-liberal formulations of the individual and the reduced role of the state as a provider of welfare and care. Berry refers to Foucault’s definition of neoliberalism as outlined in his lectures to the College de France as a “particular form of post-welfare state politics in which the state essentially outsources the responsibility of the ‘well-being' of the population” (65). In the case of gambling, the neoliberal defined state enables the wedding of two seemingly contradictory stances: promoting gambling as a major source of revenue and capitalisation on the one hand, and identifying and treating gambling addiction as an individual pursuit and potential risk on the other. Risk avoidance strategies are focused on particular groups of people who are targeted for self-treatment to avoid the harm of gambling addiction, which is similarly framed as individual rather than socially and systematically produced. What unites and makes possible this alignment of neoliberalism and the new “digitally engaged subject/patient” is first and foremost, the construction of a subject in a chronic state of ill health. This figure is positioned as terminal from the start. They are ‘sick’, a ‘patient’, an ‘addict’: in need of immediate and continuous treatment. Secondly, this neoliberal patient/addict is enabled (we could even go so far as to say ‘empowered’) by digital technology, especially smartphones and the apps available through these devices in the form of a myriad of applications for intervening and treating ones afflictions. These apps range fromself-tracking programs such as mood regulators through to social media interventions. Anti-Pokie Apps and the Neoliberal Gambler We now turn to two examples which illustrate this alignment between neoliberalism and the new “digitally engaged subject/patient” in relation to gambling. Anti-gambling apps function to both replace or ‘take the place’ of institutions and individuals actively involved in the treatment of problem gambling and re-engineer this service through the logics of ‘self-care’ and ‘self-management’. Here, we depart somewhat from Foucault’s model of disciplinary power summed up in the institution (with the prison exemplifying this disciplinary logic) and move towards Deleuze’s understanding of power as exerted by the State not through enclosures but through diffuse and rhizomatic information flows and technologies (Deleuze). At the same time, we retain Foucault’s attention to the role and agency of the user in this power-dynamic, identifiable in the technics of self-regulation and in his ideas on governmentality. We now turn to analyse these apps more closely, and explore the way in which these articulate and perform these disciplinary logics. The app Quit Pokies was a joint venture of the North East Primary Care Partnership, the Victorian Local Governance Association and the Moreland City Council, launched in early 2014. The idea of the rational, self-reflexive and agentic user is evident in the description of the app by app developer Susan Rennie who described it this way: What they need is for someone to tap them on the shoulder and tell them to get out of there… I thought the phone could be that tap on the shoulder. The “tap on the shoulder” feature uses geolocation and works by emitting a sound alert when the user enters a gaming venue. It also provides information about each user’s losses at that venue. This “tap on the shoulder” is both an alert and a reprimand from past gambling sessions. Through the Responsible Gambling Fund, the NSW government also launched an anti-pokie app in 2013, Gambling Terminator, including a similar feature. The app runs on Apple and Android smartphone platforms, and when a person is inside a gambling venue in New South Wales it: sends reminder messages that interrupt gaming-machine play and gives you a chance to re-think your choices. It also provides instant access to live phone and online counselling services which operate 24 hours a day, seven days a week. (Google Play Store) Yet an approach that tries to prevent harm by anticipating the harm that will come from gambling at the point of entering a venue, also eliminates the chance of potential negotiations and encounters a user might have during a visit to the pub and how this experience will unfold. It reduces the “tap on the shoulder”, which may involve a far wider set of interactions and affects, to a software operation and it frames the pub or the club (which under some conditions functions as hubs for socialization and community building) as dangerous places that should be avoided. This has the potential to lead to further stigmatisation of gamblers, their isolation and their exclusion from everyday spaces. Moreland Mayor, Councillor Tapinos captures the implicit framing of self-care as a private act in his explanation of the app as a method for problem gamblers to avoid being stigmatised by, for example, publicly attending group meetings. Yet, curiously, the app has the potential to create a new kind of public stigmatisation through potentially drawing other peoples’ attention to users’ gambling play (as the alarm is triggered) generating embarrassment and humiliation at being “caught out” in an act framed as aberrant and literally, “alarming”. Both Quit Pokies and Gambling Terminator require their users to perform ‘acts’ of physical and affective labour aimed at behaviour change and developing the skills of self-control. After downloading Quit Pokies on the iPhone and launching the app, the user is presented an initial request: “Before you set up this app. please write a list of the pokies venues that you regularly use because the app will ask you to identify these venues so it can send you alerts if you spend time in these locations. It will also use your set up location to identify other venues you might use so we recommend that you set up the App in the location where you spend most time. Congratulation on choosing Quit Pokies.”Self-performed processes include installation, setting up, updating the app software, programming in gambling venues to be detected by the smartphone’s inbuilt GPS, monitoring and responding to the program’s alerts and engaging in alternate “legitimate” forms of leisure such as going to the movies or the library, having coffee with a friend or browsing Facebook. These self-performed labours can be understood as ‘technologies of the self’, a term used by Foucault to describe the way in which social members are obliged to regulate and police their ‘selves’ through a range of different techniques. While Foucault traces the origins of ‘technologies of the self’ to the Greco-Roman texts with their emphasis on “care of oneself” as one of the duties of citizenry, he notes the shift to “self-knowledge” under Christianity around the 8th century, where it became bound up in ideals of self-renunciation and truth. Quit Pokies and Gambling Terminator may signal a recuperation of the ideal of self-care, over confession and disclosure. These apps institute a set of bodily activities and obligations directed to the user’s health and wellbeing, aided through activities of self-examination such as charting your recovery through a Recovery Diary and implementing a number of suggested “Strategies for Change” such as “writing a list” and “learning about ways to manage your money better”. Writing is central to the acts of self-examination. As Jeremy Prangnell, gambling counsellor from Mission Australia for Wollongong and Shellharbour regions explained the app is “like an electronic diary, which is a really common tool for people who are trying to change their behaviour” (Thompson). The labours required by users are also implicated in the functionality and performance of the platform itself suggesting the way in which ‘technologies of the self’ simultaneously function as a form of platform work: user labour that supports and sustains the operation of digital systems and is central to the performance and continuation of digital capitalism in general (Humphry, Demanding Media). In addition to the acts of labour performed on the self and platform, bodies are themselves potentially mobilised (and put into new circuits of consumption and production), as a result of triggers to nudge users away from gambling venues, towards a range of other cultural practices in alternative social spaces considered to be more legitimate.Conclusion Whether or not these technological interventions are effective or successful is yet to be tested. Indeed, the lack of recent activity in the community forums and preponderance of issues reported on installation and use suggests otherwise, pointing to a need for more empirical research into these developments. Regardless, what we’ve tried to identify is the way in which apps such as these embody a new kind of subject-state relation that emphasises self-control of gambling harm and hastens the divestment of institutional and social responsibility at a time when gambling is going through an immense period of expansion in many respects backed by and sanctioned by the state. Patterns of smartphone take up in the mainstream population and the rise of the so called ‘mobile only population’ (ACMA) provide support for this new subject and service paradigm and are often cited as the rationale for digital service reform (APSMR). Media convergence feeds into these dynamics: service delivery becomes the new frontier for the merging of previously separate media distribution systems (Dwyer). Letters, customer service centres, face-to-face meetings and web sites, are combined and in some instances replaced, with online and mobile media platforms, accessible from multiple and mobile devices. These changes are not, however, simply the migration of services to a digital medium with little effective change to the service itself. Health and medical services are re-invented through their technological re-assemblage, bringing into play new meanings, practices and negotiations among the state, industry and neoliberal subjects (in the case of problem gambling apps, a new subjectivity, the ‘neoliberal addict’). These new assemblages are as much about bringing forth a new kind of subject and mode of governance, as they are a solution to problem gambling. This figure of the self-treating “gambler addict” can be seen to be a template for, and prototype of, a more generalised and universalised self-governing citizen: one that no longer needs or makes demands on the state but who can help themselves and manage their own harm. Paradoxically, there is the potential for new risks and harms to the very same users that accompanies this shift: their outright exclusion as a result of deprivation from basic and assumed digital access and literacy, the further stigmatisation of gamblers, the elimination of opportunities for proximal support and their exclusion from everyday spaces. References Albarrán-Torres, César. “Gambling-Machines and the Automation of Desire.” Platform: Journal of Media and Communication 5.1 (2013). Australian Communications and Media Authority. “Australians Cut the Cord.” Research Snapshots. Sydney: ACMA (2013) Berry, David. Critical Theory and the Digital. Broadway, New York: Bloomsbury Academic, 2014 Berry, David. 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"Distinctive Features of the Australian Gambling Industry and Problems Faced by Australian Women Gamblers." Tourism Analysis 14.6 (2009): 867-876. Lupton, D. “The Digitally Engaged Patient: Self-Monitoring and Self-Care in the Digital Health Era.” Social Theory & Health 11.3 (2013): 256-70. Markham, Francis, and Martin Young. “Packer’s Barangaroo Casino and the Inevitability of Pokies.” The Conversation 9 July 2013. ‹http://theconversation.com/packers-barangaroo-casino-and-the-inevitability-of-pokies-15892›. Markham, Francis, and Martin Young. “Who Wins from ‘Big Gambling’ in Australia?” The Conversation 6 Mar. 2014. ‹http://theconversation.com/who-wins-from-big-gambling-in-australia-22930›.McMillen, Jan, and Katie Donnelly. "Gambling in Australian Indigenous Communities: The State of Play." The Australian Journal of Social Issues 43.3 (2008): 397. 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Humans are different individuals by nature and have diverse personality traits, cognitive powers, thinking speeds, timelines, and live spaces for thinking, searching, and learning. Despite this psycho-educational logical approved fact, massive curriculum pedagogies are observed throughout hundreds of years of the Common Era. The Author believes ‘putting "whole" students or massive groups together in one large 'container' hall for one-way instruction with no regard to their understanding powers is in itself non-educating, non-dignifying and a gross violation of human rights and values. To understand the status quo of this everlasting schooling problem and to offer effective solutions for learning generations in the Info Digital Age; the descriptive ‘Causal Comparative/ Ex Post Facto techniques and the 'Action developmental' method’ were used. While the Author searched the accumulated massive groups’ literature since the Greek Sophists 500 BCE up to the period of Guttenberg large paper printing and the educational setbacks of the Factory Educational Model, coupled with the implications and possibilities of ICTs' integrations for reforming the concepts and methodologies of schooling and higher education. The Author concluded the article by offering a reforming paradigm "Inclusive Quality Education System for a Sustainable Glocal Learning." This 'system', when applied according to proposed descriptions and criteria, will lead to profound progressive changes, such as paradigms of learners-centered-growth, interests and hobbies needs; ICTs' non-directive 'Blend-Digit' pedagogies; learner self and collaborative peer groups; learners' torturing one other(s); and blended school personnel, e.g., Teachers and support services who are indirect leaning guide counselors and standby collaborators.

IntroductionThis article addresses the experience of designing and conducting life-writing workshops for a group of clients with severe mental illness; the aim of this pilot study was to begin to determine whether such writing about the self can aid in individual ‘recovery’, as that term is understood by contemporary health professionals. A considerable amount has been written about the potential of creative writing in mental health therapy; the authors of this article provide a brief summary of that literature, then of the concept of ‘recovery’ in a psychology and arts therapy context. There follows a first-hand account by one of the authors of being an arts therapy workshop facilitator in the role of a creative practitioner. This occurred in consultation with, and monitored by, experienced mental health professionals. Life-Writing as ‘Therapeutic’ Life-story or life-writing can be understood in this context as involving more than disclosure or oral expression of a subject’s ‘story’ as in psycho-therapy – life-story is understood as a written, structured narrative. In 2001, Wright and Chung published a review of the literature in which they claimed that writing therapy had been “restimulated by the development of narrative approaches” (278). Pennebaker argues that “catharsis or the venting of emotions” without “cognitive processing” has little therapeutic value and people need to “build a coherent narrative that explains some past experience” in order to benefit from writing” (Pennebaker, Telling Stories 10–11). It is claimed in the Clinical Psychology Review that life-writing has the therapeutic benefits of, for example, “striking physical health and behaviour change” (Esterling et al. 84). The reasons are still unclear, but it is possible that the cognitive and linguistic processing of problematic life-events through narrative writing may help the subject assimilate such problems (Alschuler 113–17). As Pennebaker and Seagal argue in the Journal of Clinical Psychology, the life-writing processallows one to organise and remember events in a coherent fashion while integrating thoughts and feelings ... This gives individuals a sense of predictability and control over their lives. Once an experience has structure and meaning, it would follow that the emotional effects of that experience are more manageable. (1243)It would seem reasonable to suggest that life-writing which constructs a positive recovery narrative can have a positive therapeutic effect, providing a sense of agency, connectedness and creativity, in a similar, integrating manner. Humans typically see their lives as stories. Paul Eakin stresses the link between narrative and identity in both this internal life-story and in outwardly constructed autobiography:narrative is not merely a literary form but a mode of phenomenological and cognitive self-experience, while self – the self of autobiographical discourse - does not necessarily precede its constitution in narrative. (Making Selves 100)So both a self-in-time and a socially viable identity may depend on such narrative. The term ‘dysnarrativia’ has been coined to describe the documented inability to construct self-narrative by those suffering amnesia, autism, severe child abuse or brain damage. The lack of ability to achieve narrative construction seems to be correlated with identity disorders (Eakin, Fictions in Autobiography 124). (For an overview of the current literature on creative and life-writing as therapy see Murphy & Neilsen). What is of particular relevance to university creative writing practitioners/teachers is that there is evidence, for example from Harvard psychiatrist Judith Herman and creative writing academic Vicki Linder, that life-narratives are more therapeutically effective if guided to be written according to fundamental ‘effective writing’ aesthetic conventions – such as having a regard to coherent structure in the narrative, the avoidance of cliché, practising the ‘demonstrate don’t state’ dictum, and writing in one’s own voice, for example. Defining ‘Recovery’There remains debate as to the meaning of recovery in the context of mental health service delivery, but there is agreement that recovery entails significantly more than symptom remission or functional improvement (Liberman & Kopelowicz). In a National Consensus Statement, the Substance Abuse and Mental Health Services Administration (SAMHSA) unit of the US Department of Health and Human Services in 2005 described recovery (in general terms) as being achieved by the enabling of a person with a mental illness to live meaningfully in a chosen community, while also attempting to realize individual potential. ‘Recovery’ as a central concept behind rehabilitation can be understood both as objective recovery – that is, in terms of noting a reduction in objective indicators of illness and disability (such as rates of hospital usage or unemployment) and a greater degree of social functioning – and also as subjective recovery. Subjective recovery can be ascertained by listening closely to what clients themselves have said about their own experiences. It has been pointed out (King, Lloyd & Meehan 2) that there is not always a correspondence between objective indicators of recovery and the subjective, lived experience of recovery. The experience of mental illness is not just one of symptoms and disability but equally importantly one of major challenge to sense of self. Equally, recovery from mental illness is experienced not just in terms of symptoms and disability but also as a recovery of sense of self … Recovery of sense of self and recovery with respect to symptoms and disability may not correspond. (King, Lloyd & Meehan; see also Davidson & Strauss)Symptoms of disability can persist, but a person can have a much stronger sense of self or empowerment – that is still recovery. Illness dislocates the sense of self as part of a community and of a self with skills and abilities. Restoring this sense of empowerment is an aim of arts therapy. To put it another way, recovery is a complex process by which a client with a mental illness develops a sense of identity and agency as a citizen, as distinct from identification with illness and disability and passivity as a ‘patient’. The creative arts have gone well beyond being seen as a diversion for the mentally ill. In a comprehensive UK study of creative arts projects for clients with mental illness, Helen Spandler et al. discovered strong evidence that participation in creative activity promoted a sense of purpose and meaning, and assisted in “rediscovering or rebuilding an identity within and beyond that of someone with mental health difficulties” (795). Recovery is aided by people being motivated to achieve self-confidence through mastery and competence; by learning and achieving goals. Clearly this is where arts therapy could be expected or hoped to be effective. The aim of the pilot study was not to measure ‘creativity’, but whether involvement in what is commonly understood as a creative process (life-writing) can have flow-on benefits in terms of the illness of the workshop participant. The psychologists involved, though more familiar with visual arts therapy (reasonably well-established in Australia – in 2006, the ANZAT began publishing the Australian and New Zealand Journal of Art Therapy), thought creative writing could also be valuable. Preparation for and Delivery of the Workshops I was acutely aware that I had no formal training in delivering a program to clients with mental health illness. I was counselled during several meetings with experienced psychologists and a social worker that the participants in the three workshops over two weeks would largely be people who had degrees of difficulty in living independently, and could well have perceptual problems, could misjudge signals from outside and inside the group, and be on medication that could affect their degree of engagement. Some clients could have impaired concentration and cognition, and a deficit in volition. Participants needed to be free to leave and rejoin the workshops during the afternoon sessions. Attendance might well fall as the workshops progressed. Full ethical clearance was attained though the University of Queensland medical faculty (after detailed description of the content and conduct of the proposed workshops) and consent forms prepared for participants. My original workshop ‘kit’ to be distributed to participants underwent some significant changes as I was counselled and prepared for the workshops. The major adjustment to my usual choice of material and approach was made in view of the advice that recounting traumatic events can have a negative effect on some patients – at least in the short term. For the sake of both the individuals and the group as a whole this was to be avoided. I changed my initial emphasis on encouraging participants to recount their traumatic experiences in a cathartic way (as suggested by the narrative psychology literature), to encouraging them to recount positive narratives from their lives – narratives of ‘recovery’ – as I explain in more detail below. I was also counselled that clients with mental health problems might dwell on retelling their story – their case history – rather than reflecting upon it or using their creative and imaginative ability to shape a life-story that was not a catalogue of their medical history. Some participants did demonstrate a desire to retell their medical history or narrative – including a recurring theme of the difficulty in gaining continuity with one trusted medical professional. I gently guided these participants back to fashioning a different and more creative narrative, with elements of scene creation, description and so on, by my first listening intently to and acknowledging their medical narrative for a few minutes and then suggesting we try to move beyond that. This simple strategy was largely successful; several participants commented explicitly that they were tired of having to retell their medical history to each new health professional they encountered in the hospital system, for example. My principal uncertainty was whether I should conduct the workshops at the same level of complexity that I had in the past with groups of university students or community groups. While in both of those cohorts there will often be some participants with mental health issues, for the most part this possibility does not affect the level or kind of content of material discussed in workshops. However, within this pilot group all had been diagnosed with moderate to severe mental illness, mostly schizophrenia, but also bipolar disorder and acute depression and anxiety disorders. The fact that my credentials were only as a published writer and teacher of creative writing, not as a health professional, was also a strong concern to me. But the clients readily accepted me as someone who knew the difficulty of writing well and getting published. I stressed to them that my primary aim was to teach effective creative writing as an end in itself. That it might be beneficial in health terms was secondary. It was a health professional who introduced me and briefly outlined the research aims of the workshop – including some attempt to measure qualitatively any possible benefits. It was my impression that the participants did not have a diminished sense of my usefulness because I was not a health professional. Their focus was on having the opportunity to practice creative writing and/or participate in a creative group activity. As mentioned above, I had prepared a workshop ‘kit’ for the participants of 15 pages. It contained the usual guidelines for effective writing – extracts from professional writers’ published work (including an extract from my own published work – a matter of equity, since they were allowing me to read their work), and a number of writing exercises (using description, concrete and abstract words, narrative point of view, writing in scenes, show don’t tell). The kit contained extracts from memoirs by Hugh Lunn and Bill Bryson, as well as a descriptive passage from Charles Dickens. An extract from Inga Clendinnen’s 2006 account in Agamemnon’s Kiss: selected essays of her positive interaction with fellow cancer patients (a narrative with the underlying theme of recovery) was also valuable for the participants. I stressed to the group that this material was very similar to that used with beginning writers among university students. I described the importance of life-writing as follows: Life-writing is simply telling a story from your life and perhaps musing or commenting on it at the same time. When you write a short account of something chosen from your life, you are making a pattern, using your memory, using your powers of description – you are being creative. You are being a story-teller. And story-telling is one very important thing that makes us humans different from all other animals – and it is a way in which we find a lot of meaning in our lives.My central advice in the kit was: “Just try to be as honest as you can – and to remember as well as you can … being honest and direct is both the best and the easiest way to write memoir”. The only major difference between my approach with these clients and that with a university class was in the selection of possible topics offered. In keeping with the advice of the psychologists who were experts in the theory of ‘recovery’, the topics were predominantly positive, though one or two topics gave the opportunity to recount and/or explore a negative experience if the participant wanted to do so: A time when I was able to help another personA time when I realised what really mattered in lifeA time when I overcame a major difficultyA time when I felt part of a group or teamA time when I knew what I wanted to do with my lifeA time when someone recognised a talent or quality of mineA time I did something that I was proud of A time when I learned something important to meA memorable time when I lived in a certain house or suburbA story that begins: “Looking back, I now understand that …”The group expressed satisfaction with these topics, though they had the usual writing students’ difficulty in choosing the one that best suited them. In the first two workshops we worked our way through the kit; in the third workshop, two weeks later, each participant read their own work to the group and received feedback from their peers and me. The feedback was encouraged to be positive and constructive, and the group spontaneously adopted a positive reinforcement approach, applauding each piece of writing. Workshop DynamicsThe venue for the workshops was a suburban house in the Logan area of Brisbane used as a drop-in centre for those with mental illness, and the majority of the participants would be familiar with it. It had a large, breezy deck on which a round-table configuration of seating was arranged. This veranda-type setting was sheltered enough to enable all to be heard easily and formal enough to emphasise a learning event was taking place; but it was also open enough to encourage a relaxed atmosphere. The week before the first workshop I visited the house to have lunch with a number of the participants. This gave me a sense of some of the participants’ personalities and degree of engagement, the way they related to each other, and in turn enabled them to begin to have some familiarity with me and ask questions. As a novice at working with this kind of client, I found this experience extremely valuable, especially as it suggested that a relatively high degree of communication and cognition would be possible, and it reduced the anxiety I had about pitching the workshops at an appropriate level. In the course of the first workshop, the most initially sceptical workshop participant ended up being the most engaged contributor. A highly intelligent woman, she felt it would be too upsetting to write about negative events, but ultimately wrote a very effective piece about the empowerment she gained from caring for a stray cat and locating the owner. Her narrative also expressed her realisation that the pet was partly a replacement for spending time with her son, who lived interstate. Another strong participant previously had written a book-length narrative of her years of misdiagnoses and trauma in the hospital system before coming under the care of her present health professionals. The participant who had the least literacy skills was accepted by the group as an equal and after a while contributed enthusiastically. Though he refused to sign the consent form at the outset, he asked to do so at the close of the first afternoon. The workshop was comprised of clients from two health provider organisations; at first the two groups tended to speak with those they already knew (as in any such situation in the broader community), but by the third workshop a sense of larger group identity was being manifested in their comments, as they spoke of what ‘the group’ would like in the future – such as their work being published in some form. It was clear that, as in a university setting, part of the beneficial effect of the workshops came from group and face to face interaction. It would be more difficult to have this dimension of benefit achieved via a web-based version of the workshops, though a chat room scenario would presumably go some way towards establishing a group feeling. Web-based delivery would certainly suit participants who lacked mobility or who lived in the regions. Clearly the Internet is a vital social networking tool, and an Internet-based version of the workshops could well be attempted in the future. My own previous experience of community digital storytelling workshops (Neilsen, Digital Storytelling as Life-writing) suggests that a high degree of technical proficiency can not be expected across such a cohort; but with adequate technical support, a program (the usual short, self-written script, recorded voice-over and still images scanned from the participants’ photo albums, etc) could make digital storytelling a further dimension of therapeutic life-writing for clients with mental illness. One of the most useful teaching techniques in a class room setting is the judicious use of humour – to create a sense of sharing a perspective, and simply to make material more entertaining. I tested the waters at the outset by referring to the mental health worker sitting in the background, and declaring (with some comic exaggeration) my concern that if I didn’t run the workshop well he would report adversely on me. There was general laughter and this expression of my vulnerability seemed to defuse anxiety on the part of some participants. As the workshop progressed I found I could use both humorous extracts of life-writing and ad hoc comic comments (never at the expense of a participant) as freely as in a university class. Participants made some droll comments in the overall context of encouraging one another in their contributions, both oral and written. Only one participant exhibited some temporary distress during one of the workshops. I was allowing another participant the freedom to digress from the main topic and the participant beside me displayed agitation and sharply demanded we get back to the point. I apologised and acknowledged I had not stayed as focused as I should and returned to the topic. I suspect I had a fortunate first experience of such arts therapy workshops – and that this was largely due to the voluntary nature of the study and that most of the participants brought a prior positive experience of the workshop scenario, and prior interest in creative writing, to the workshops. Outcomes A significantly positive outcome was that only one of the nine participants missed a session (through ill-health) and none left during workshops. The workshops tended to proceed longer than the three hours allotted on each occasion. Post-workshop interviews were conducted by a psychologist with the participants. Detailed data is not available yet – but there was a clear indication by almost all participants that they felt the workshops were beneficial and that they would like to participate in further workshops. All but one agreed to have their life-writing included in a newsletter produced by one of the sponsors of the workshops. The positive reception of the workshops by the participants has encouraged planning to be undertaken for a wide-ranging longitudinal study by means of a significant number of workshops in both life-writing and visual arts in more than one city, conducted by a team of health professionals and creative practitioners – this time with sophisticated measurement instruments to gauge the effectiveness of art therapy in aiding ‘recovery’. Small as the workshop group was, the pilot study seems to validate previous research in the UK and US as we have summarised above. The indications are that significant elements of recovery (in particular, feelings of enhanced agency and creativity), can be achieved by life-writing workshops that are guided by creative practitioners; and that it is the process of narrative construction within life-writing that engages with or enhances a sense of self and identity. NoteWe are indebted, in making the summary of the concept of ‘recovery’ in health science terms, to work in progress by the following research team: Robert King, Tom O'Brien and Claire Edwards (School of Medicine, University of Queensland), Margot Schofield and Patricia Fenner (School of Public Health, Latrobe University). We are also grateful for the generous assistance of both this group and Seiji Humphries from the Richmond Queensland Fellowship, in providing preparation for the workshops. ReferencesAlschuler, Mari. “Lifestories – Biography and Autobiography as Healing Tools for Adults with Mental Illness.” Journal of Poetry Therapy 11.2 (1997): 113–17.Davidson, Larry and John Strauss. “Sense of Self in Recovery from Severe Mental Illness.” British Journal of Medical Psychology 65 (1992): 31–45.Eakin, Paul. Fictions in Autobiography: Studies of the Art of Self-Invention. Princeton: Princeton UP, 1985.———. How Our Lives Become Stories: Making Selves. Ithaca: Cornell UP, 1999.Esterling, B.A., L. L’Abate., E.J. Murray, and J.W. Pennebaker. “Empirical Foundations for Writing in Prevention and Psychotherapy: Mental and Physical Health Outcomes.” Clinical Psychology Review 19.1 (1999): 79–96.Herman, Judith. Trauma and Recovery: The Aftermath of Violence - from Domestic Abuse to Political Terror. New York: Basic Books, 1992.King, Robert, Chris Lloyd, and Tom Meehan. Handbook of Psychosocial Rehabilitation. Oxford: Blackwell Publishing, 2007.Liberman, Robert, and Alex Kopelowicz. “Recovery from Schizophrenia: A Criterion-Based Definition.” In Ralph, R., and P. Corrigan (eds). Recovery in Mental Illness: Broadening Our Understanding of Wellness. Washington, DC: APA, 2005.Linder, Vicki. “The Tale of two Bethanies: Trauma in the Creative Writing Classroom.” New Writing: The International Journal for the Practice and Theory of Creative Writing 1.1 (2004): 6–14Murphy, Ffion, and Philip Neilsen. “Recuperating Writers – and Writing: The Potential of Writing Therapy.” TEXT 12.1 (Apr. 2008). ‹http://www.textjournal.com.au/april08/murphy_neilsen.htm›.Neilsen, Philip. “Digital Storytelling as Life-Writing: Self-Construction, Therapeutic Effect, Textual Analysis Leading to an Enabling ‘Aesthetic’ for the Community Voice.” ‹http://www.speculation2005.qut.edu.au/papers/Neilsen.pdf›.Pennebaker, James W., and Janel D. Seagal. “Forming a Story: The Health Benefits of Narrative.” Journal of Clinical Psychology, 55.10 (1999): 1243–54.Pennebaker, James W. “Telling Stories: The Health Benefits of Narrative.” Literature and Medicine 19.1 (2000): 3–18.Spandler, H., J. Secker, L. Kent, S. Hacking, and J. Shenton. “Catching Life: The Contribution of Arts Initiatives to ‘Recovery’ Approaches in Mental Health.” Journal of Psychiatric and Mental Health Nursing 14.8 (2007): 791–799.Wright, Jeannie, and Man Cheung Chung. “Mastery or Mystery? Therapeutic Writing: A Review of the Literature.” British Journal of Guidance and Counselling, 29.3 (2001): 277–91.

The autobiographical documentary film “18q – a valuable life”, is one attempt to redefine the place of disability in contemporary western society. My work presents some key moments in my life and that of my family since the birth of my youngest child, Allycia in 1995. Allycia was born with a rare genetic condition affecting the 18th chromosome resulting in her experiencing the world somewhat differently to the rest of the family. The condition, which manifests in a myriad of ways with varying levels of severity, affects individuals’ physical and intellectual development (Chromosome 18, n. pag.). While the film outlines the condition and Allycia’s medical history, the work is primarily concerned with the experiences of the family and offering an alternate story of disability as “other”. Drawing on Rosemarie Garland Thomson’s notion of shape structuring story ("Shape") and Margrit Shildrick’s discussion of becoming vulnerable as theoretical foundations, I reflect on how the making of the film has challenged my previously held views about disability and ultimately about myself. The Film & Disability “18q – a valuable life” introduces a new, previously “invisible” shape in the form of bodies coded as Chromosome 18 to the screen. The initial impulse to make the film was driven by a need to provide a media presence for a rare genetic condition known collectively as Chromosome 18 (Chromosome 18, n. pag.) where previously there was none. This impulse was fuelled by a desire to tell a different story, our story; a story about what life can be like when a child with intellectual and physical impairment is born into one’s family. This different story is, in Garland Thompson’s terms, one that “insists that shape structures story” (114) and endeavours to contribute to recasting disability “as an occasion for exuberant flourishing” (Garland Thompson 114). The categorisation and depiction of people with disability in western society’s media have been scrutinised by many writers including Mitchell and Snyder ("Representations"; "Visual"), Oliver and Norden who point out that negatively charged stereotypical representations of the disabled continue to proliferate in the mediasphere. Englandkennedy for example examines the portrayal of the new disability classification Attention Deficit Disorder and is highly critical of its representation in programs such as The Simpsons (1989-2008) and films such as Pecker (1998). She asserts, “few media representations of ADD exist and most are inaccurate; they reflect and reinforce social concerns and negative stereotypes” (117) to the detriment of the condition being better understood by their audiences. However, Englandkennedy also identifies the positive possibilities for informed media representations that offer new models and stories about disability, citing works such as Children of a Lesser God (1986) and The Bone Collector (1999) as examples of shifts in fictional story telling modes. There are also shifts in recent documentary films such as My Flesh and Blood (2004), Tarnation (2003) and Murderball (2005) which provide insightful, powerful and engaging stories about disability. I suggest however that they still rely upon the stereotypical modes identified by numerous disability studies scholars. For example, Darke’s (n. pag.) heroic mother figure and disabled outsider and victim are depicted in the extreme in My Flesh and Blood and Tarnation respectively, whilst Murderball, as powerful as it is, still constructs disability as “something” to be overcome and is celebrated via the character construction of the “super-crip” (Englandkennedy 99). These stories are vital and insightful developments in challenging and re-shaping the many stigmas associated with disability, but they remain, for the most part, inaccessible to me in terms of my place in the world as a person parenting a little girl with physical and intellectual impairment. Able to Live The opening of the film features footage of my two older children Adam and Kristina, as “normal”, active children. These idyllic images are interrupted by an image of me by Allycia’s bedside where, as an infant, she is attached to life saving machines. She is at once “othered” to her active, healthy siblings. Her survival was reliant, and remains so, albeit to a much lesser extent, upon the intrusion of machines, administering of medication and the intervention of strangers. The prospect of her dying rendered me powerless, vulnerable; I lacked the means to sustain her life. To hand over my child to strangers, knowing they would carve her tiny chest open, suspend the beating of her already frail heart and attempt to repair it, was to surrender to the unknown without guarantees; the only surety being she would cease to be if I did not. Allycia survived surgery. This triumph however, was recast in the shadow of abnormality as outlined in the film when genetic screening of her DNA revealed she had been born with a rare genetic abnormality coded as 18q23 deletion. This information meant she was missing a part of her eighteenth chromosome and the literature available at that time (in 1997) gave little cause for hope – she was physically and intellectually retarded. This news, delivered to me by a genetic counsellor, was coupled with advice to ensure my daughter enjoyed “quality of life”. The words, “rare genetic abnormality” and “retarded” succeeded in effectively “othering” Allycia to me, to my other two children and the general population. My knowledge and experience with people with genetic abnormalities was minimal and synonymous with loss, sadness, suffering and sacrifice and had little to do with quality of life. She was frail and I was confronted with the loss of a “normal” child that would surely result in the “loss” of my own life when framed within this bleak, imagined life that lay before me; her disability, her otherness, her vulnerability signalled my own. As unpalatable as it is for me to use the word monstrous with reference to my daughter, Shildrick’s work, aligning the disabled experience with the monstrous and the possibility of becoming via a refiguring of vulnerability, resonates somewhat with my encounter with my vulnerable self. Schildrick proposes that “any being who traverses the liminal spaces that evade classification takes on the potential to confound normative identity” (6). As Allycia’s mother, I find Shildrick’s assertion that the monstrous “remains excessive of any category, it always claims us, always touches us and implicates us in its own becoming” (6) is particularly pertinent. This is not to say that Schildrick’s notion of the monstrous is an unproblematic one. Indeed Kaul reminds us that: to identify disabled bodies too closely with the monstrous seems to risk leaving us out of universal, as well as particular, experience, entirely in the figurative. (11) Schildrick’s notion of the universality of vulnerability however is implicit in her reference to that which confounds and disturbs us, and it is an important one. Clearly Allycia’s arrival has claimed me, touched me; I am intimately implicated in her becoming. I could not have anticipated however the degree to which she has been intertwined with my own becoming. Her arrival, in retrospect crystallised for me Shildrick’s proposition that “we are already without boundaries, already vulnerable” (6). The film does not shy away from the difficulties confronting Allycia and my family and other members of the chromosome 18 community. I have attempted however to portray our environment and culture as contributing factors and challenge the myth of medicine as a perfect science or answer to the myriad of challenges of navigating life with a disability in contemporary society. This was a difficult undertaking as I did not want the work to degenerate into one that was reliant on blame or continued in the construction of people with disability as victims. I have been mindful of balancing the sometimes painful reality of our lives with those moments that have brought us a sense of accomplishment or delight. Part of the delight of our lives is exemplified when my sister Julie articulates the difference in Allycia’s experiences as compared to her own nine year old daughter, Lydia. Julie succeeds in valorising Allycia’s freedom to be herself by juxtaposing her own daughter’s preoccupation with “what others think” and her level of self consciousness in social contexts. Julie also highlights Lydia’s awareness of Allycia’s difference, via narration over footage of Lydia assisting Allycia, and asserts that this role of becoming a helper is a positive attribute for Lydia’s development. Able to Laugh Including humour in the film was a vital ingredient in the reframing of disability in our lives and is employed as a device to enhance the accessibility of the text to an audience. The film is quite dialogue driven in furnishing background knowledge and runs the risk at times, when characters reveal some of their more painful experiences, of degenerating into a tale of despair. Humour acts as device to lift the overall mood of the film. The humour is in part structured by my failures and incompetence – particularly in reference to my command (or rather lack) of public transport both in Australia and overseas. While the events depicted did occur – my missing a ferry and losing our way in the United States – their inclusion in the film is used as a device to show me, as the able bodied person; the adult ‘able’ mother, with flaws and all. This deliberate act endeavours to re-shape the “heroic mother” stereotype. A wistful form of humour also emerges when my vulnerability becomes apparent in a sequence where I break down and cry, feeling the burden in that moment of the first eleven years of Allycia’s life. Here Allycia as carer emerges as she uses our favourite toy to interrupt my crying, succeeding in turning my tears into a gentle smile. Her maturity and ability to connect with my sadness and the need to make me feel better are apparent and serve to challenge the status of intellectual impairment as burden. This sequence also served to help me laugh at myself in quite a different way after spending many hours confronted with the many faces that are mine during the editing process. I experienced a great deal of discomfort in front of the camera due to feelings of self-consciousness and being on display. That discomfort paled into insignificance when I then had to watch myself on the monitor and triggered a parallel journey alongside the making of the film as I continued to view myself over time. Those images showing my distress, my face contorted with tears as I struggled to maintain control made me cry for quite a while afterwards. I felt a strange empathy for myself – as if viewing someone else’s pain although it was mine, simultaneously the same and other. Chris Sarra’s “notion of a common core otherness as constituting the essence of human being” is one that resonates closely with these aspects. Sarra reinterprets Bhaskar (5) arguing that “we should regard the same as a tiny ripple on the sea of otherness”, enabling us “to enshrine the right to be other” capturing “something of the wonder and strangeness of being” (5). Over time I have become used to seeing these images and have laughed at myself. I believe becoming accustomed to seeing myself, aging as I have during these years, has been a useful process. I have become "more" comfortable with seeing that face, my face in another time. In essence I have been required to sit with my own vulnerabilities and have gained a deeper acceptance of my own fragility and in a sense, my own mortality. This idea of becoming “used to”, and more accepting of the images I was previously uncomfortable with has given me a renewed hope for our community in particular, the disability community in general. My experience I believe indicates the potential for us, as we become more visible, to be accepted in our difference. Critical to this is the need for us to be seen in the fullness of human experience, including our capacity to experience laughter and love and the delight these experiences bring to our lives and those around us. These experiences are captured exquisitely when Allycia sees her newfound chromosome 18 friends, Martin and Kathryn kissing one another. She reacts in much the same way I expect other little girls might in a similar situation. She is simultaneously “grossed out” and intrigued, much to our delight. It is a lovely spontaneous moment that says much in the space of a minute about Martin and Kathryn, and about Allycia’s and my relationship. For me there is a beauty, there is honesty and there is transparency. Able to Love My desire for this film is similar to Garland Thomson’s desire for her writing to “provide access to some elements of my community to both disabled and non disabled audiences alike” (122). I felt part of the key to making the film “work” was ensuring it remained accessible to as wide an audience as possible and began with a naive optimism that the film could defy stereotypical story lines. I discovered this accessibility I desired was reliant upon the traditions of storytelling; language, the construction of character and the telling of a journey demanded an engagement in ways we collectively identify and understand (Campbell). I found our lives at times, became stereotypical. I had moments of feeling like a victim; Allycia as a dancer could well be perceived as a “supercrip” and the very act of making a film about my daughter could be viewed as a heroic one. The process resulted in my surrendering to working within a framework that relies upon, all too often, character construction that is stereotypical. I felt despondent many times upon realising the emergence of these in the work, but held onto the belief that something new could be shown by exposing “two narrative currents which are seldom included in the usual stories we tell about disability: sexuality and community” (Garland Thompson 114). The take on sexuality is a gentle one, concerned with emerging ideologies surrounding sexuality in our community. This is a new phenomenon in terms of the “place” of sexuality and intimacy within our community. One of our parents featured in the film makes this clear when he explains that the community is watching a new romance blossom “with interest” (18q) and that this is a new experience for us as a whole. In focussing on sexuality, my intention is to provoke discussion about perceptions surrounding people categorised as intellectually impaired and their capacity to love and build intimate relationships and the possibilities this presents for the chromosome 18 community. The theme of community features significantly in the film as audiences become privy to conferences attended by, in one instance, 300 people. My intention here is to “make our mark”. There has been no significant filmic presence of Chromosome 18. The condition is rare, but when those affected by it are gathered together, a significantly “bigger picture” of is presented where previously there was none. The community is a significant support network for families and is concerned with becoming empowered by knowledge, care and advocacy. The transcendence of global and cultural boundaries becomes apparent in the film as these differences become diminished in light of our greater need to connect with each others’ experiences in life as, or with, people born with genetic difference. The film highlights the supportive, educated and joyful “shape” of our community. In presenting our community I hope too that western society’s preoccupation with normativity and ableism (Goggin) is effectively challenged. In presenting a version of life that “destabilises the system and points up its inadequacy as a model of existential relations”, I am also demonstrating what Shildrick calls “unreflected excess, that which is other than the same” (105). The most significant shift for me has been to refigure my ideas about Allycia as an adult. When I was given her medical prognosis I believed she would be my responsibility for the rest of my life. I did not hold a lot of hope for the future and could not have possibly entertained the idea that she may live independently or heaven forbid, she may enter into an intimate adult relationship; such was my experience with the physically and intellectually impaired. Thankfully I have progressed. This progression has been, in part, due to attending a Chromosome 18 conference in Boston in 2007 where we met Kathryn and Martin, a young couple in the early stages of building a relationship. This is a new phenomenon in our community. Kathryn and Martin were born with chromosome 18 deletions. Meeting them and their families has signalled new possibilities for our children and their opportunities and their right to explore intimate adult relationships. Their relationship has given me confidence to proceed with an open mind regarding Allycia’s adulthood and sexuality. Conclusion The very act of making the film was one that would inevitably render me vulnerable. Placing myself before the camera has given me a new perspective on vulnerability as a state that simultaneously disempowers and empowers me. I could argue this process has given me a better understanding of Allycia’s place in the world, but to do this is to deny our differences. Instead I believe the experience has given me a renewed perspective in embracing our differences and has also enabled me to see how much we are alike. My understanding of myself as both “able” and “othered”, and the ensuing recognition of, and encounter with, my vulnerable self have in some measure, come as a result of being continually confronted with images of myself in the editing process. But more than this, reflecting upon the years since Allycia’s birth I have come to a more intimate understanding and acceptance of myself as a consequence of knowing Allycia. Whereas my experience has been a matter of will, Allycia’s contribution is in the fact that she simply is. These experiences have given me renewed hope of acceptance of people of difference - that over time we as a society may become used to seeing the different face and the different behaviours that often accompany the experience of people living with genetic difference. References Bhaskar, R. Dialectic: The Pulse of Freedom. London: Verso, 1993. Campbell, J. The Hero's Journey: Joseph Campbell on His Life and Work. California: New World Library, 2003 Caouette, J. Tarnation. Dir. J. Caouette. DVD. 2004. Chromosome 18. "Chromosome 18 Research & Registry Society." 2008. 3 March 2008 ‹http://www.chromosome18.org/›. Darke, P. "The Cinematic Construction of Physical Disability as Identified through the Application of the Social Model of Disability to Six Indicative Films Made since 1970: A Day In The Death of Joe Egg (1970), The Raging Moon (1970), The Elephant Man (1980), Whose Life Is It Anyway? (1981), Duet for One (1987) and My Left Foot (1989)." 1999. 10 Feb. 2006 ‹http://www.darke.info/›. Englandkennedy, E. “Media Representations of Attention Deficit Disorder: Portrayals of Cultural Skepticism in Popular Media.” Journal of Popular Culture 41.1 (2008): 91-118. Garland Thomson, R. “Shape Structures Story: Fresh and Feisty Stories about Disability.” Narrative 15.1 (2007): 113-123. –––. Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature. New York: Columbia Univ. Press, 1997. Goggin, G. Division One: Bodies of Knowledge. 2002. 10 Feb. 2006 ‹http://adt.library.qut.edu.au/adt-qut/uploads/approved/adt-QUT20041123.160628/public/02whole.pdf›. Groening, M. The Simpsons. 20th Century Fox Television. 1989-2008. Iacone, J. The Bone Collector. Dir. P. Noyce. DVD. Columbia Pictures Corporation, 1999. Karsh, J. My Flesh and Blood. DVD. San Francisco: Chaiken Films, 2004. Kaul, K. Figuring Disability in Disability Studies: Theory, Policy and Practice. Toronto: York University, 2003. Medoff, M. Children of a Lesser God. Dir. R. Haines. Paramount Pictures, 1986. Mitchell, D. T., and S. L. Snyder. "Representation and Its Discontents: The Uneasy Home of Disability in Literature and Film." In Handbook of Disability Studies, eds. G. L. Albrecht, K. D. Seelman, and M. Bury. Thousand Oaks, CA: Sage, 2001. 195-218. –––. “The Visual Foucauldian: Institutional Coercion and Surveillance in Frederick Wiseman's Multi-Handicapped Documentary Series.” Journal of Medical Humanities 24.3 (2003): 291. Norden, M.F. The Cinema of Isolation. New Brunswick: Rutgers University Press, 1994 Oliver, M. The Politics of Disablement. The Disability Archive UK. University of Leeds, 1990. 3 April 2005 ‹http://www.leeds.ac.uk/disability-studies/archiveuk/Oliver/p%20of%20d%20oliver4.pdf›. Rubin, H. A., and D. A. Shapiro. Murderball. DVD. Paramount Pictures, 2005. Sarra, C. Chris Sarra & The Other. Unpublished manuscript, 2005. Shildrick, M. Embodying the Monster: Encounters with the Vulnerable Self. London: Sage, 2002.Wain, Veronica. 18q – A Valuable Life. Prod. V. Wain. 2008. Waters, J. Pecker. Videocassette. Polar Entertainment, 1998.

Responsibility frames in media coverage describe the mediated attribution of responsibility for causes and remedies (treatments, solutions) for health issues, mostly differentiating between individual and societal responsibility. Field of application/theoretical foundation: Media coverage of health topics, public opinion formation, attribution of responsibility, framing studies, social media on health issues Example studies: Gollust & Lantz (2009); Kim & Willis (2007); O’Hara & Smith (2007); Stefanik-Sidener (2013); Yoo & Kim (2012); Zhang & Jin (2015) Information on Kim & Willis, 2007 Authors: Sei-Hill Kim, Leigh Anne Willis Health topic: Obesity Research questions: How have the media presented the causes and solutions for obesity? Have certain causes and solutions appeared more often than others? How has media coverage of causal and solution responsibility changed over the years? Have mentions of certain causes and solutions increased or decreased? Object of analysis: Newspaper and television news data containing “obesity” or “obese” appearing in the headline, lead paragraphs, or index terms; articles published in The New York Times, The Washington Post, Chicago Sun-Times, The San Francisco Chronicle, The Houston Chronicle, and USA Today; news transcripts on obesity from three television networks (ABC, CBS, NBC); after conducting a systematic sampling, n = 300 articles and n = 200 transcripts were analyzed Time frame of analysis: January 1995 to August 2004 Info about variables Variables: Variables included attributions of causal and treatment responsibility, cause or treatment option was coded as ‘‘not present’’ (0) or ‘‘present’’ (1). Level of analysis: News article respectively tv transcript Causal responsibility Solution responsibility Personal causes (Scott’s pi= .81) Unhealthy diet: Consuming too much food, consuming too much unhealthy food, addictive or emotional eating. Sedentary lifestyle: Lack of exercise, Lack of physical activities. Genetic conditions: Genetic=biological factors that may produce obesity (e.g., imbalance of hunger hormones that may stimulate appetite). Others: E.g., poor adult role models. Personal solutions (Scott’s pi= .74) Healthy diet: Consuming less food, consuming healthy food. Physically activities: More exercise and physical activities. Medical treatments: Medications (e.g., diet pills), surgical treatments of obesity (e.g., gastric bypass, gastric stapling). Others: E.g., working with a support group, talking to a counselor, parents as role models. Societal causes (Scott’s pi= .86) The food industry: Obesity-promoting foods (fast=junk food), super-sizing, large increase in fast=junk food restaurants, other aggressive marketing promotions. Schools & education: Unhealthy foods in school cafeterias, lack of physical activity programs at schools, lack of public education about healthy eating and lifestyle. Socioeconomic factors: Low-income families may not be able to afford healthy food, exercise equipment, or a gym membership. They may be too busy to prepare their own healthy food. Others: E.g., automobile-oriented society (e.g., drive-thru stores and restaurants, big-box stores), unsafe community (crime, traffic, accident), and limited opportunities for outdoor activities. Societal solutions (Scott’s pi= .81) Regulations of the food industry: Regulating obesity-promoting foods, super-sizing, vending machines, and other aggressive marketing promotions, taxing unhealthy food. Changes in schools & education: Healthier food in school cafeteria, more physical activity programs at schools, more public education. Socioeconomic changes: Narrowing income gap, healthy food should be more affordable and available, more affordable exercise. Others: E.g., less automobile-oriented and more walking-oriented society (less drive-thru stores and restaurants, less big-box stores), safer community, and more opportunities for outdoor activities. Information on Stefanik-Sidener, 2013 Author: Kelsey Stefanik-Sidener Health topic: Diabetes Research questions: What was the dominant frame used in news stories about diabetes? What were the most common cause and solution frames used for each type of diabetes? Object of analysis: Diabetes coverage in the New York Times (N = 239) Time frame of analysis: 2000 to 2010 Info about variables Variables: The articles were coded for the presence of three types of frames for both causes of and solutions to diabetes, respectively: behavioral, societal, or medical, frames were not mutually exclusive Level of analysis: News article General cause frame (Krippendorff’s Alpha= .96) General solution frame (Krippendorff’s Alpha= .64) Behavioral causal frame Poor diet, lack of physical activity, or other individual-level issues Personal solutions Improving one’s diet or increasing activity levels Societal cause frames Poor food environments, car-centered culture, poor nutrition in schools, or other broad problems Societal solution frames Improving access to healthy foods, increasing nutrition education, or other public policy/societal-level solutions Medical cause frames Family history, genetics, age Medical solution frames Blood sugar control, medication, or surgery Information on Yoo & Kim, 2012 Authors: Jina H. Yoo, Junghyun Kim Health topic: obesity Research questions: What typifications (i.e., causal claims and solution claims) have been made in videos on YouTube with regard to the obesity issue? How do these typifications vary among different types of media formats on YouTube? Object of analysis: YouTube was searched with the keywords “obesity” and “obese” on 5 March 2010 and owing to capacity limits, the number of available videos was limited to 1,000 per each keyword; after a systematic random sampling and excluding irrelevant videos, total sample of N = 417 YouTube videos was analyzed Time frame of analysis: 2000 to 2010 Info about variables Variables: articles were coded for the presence of causal claims and solution typifications, behavioral, biological, and systematic causal factors on obesity being causal claims and behavioral solution, medical or pharmacological solution and systematic solution Reliability: Intercoder reliability was calculated for each category, and average intercoder reliability coefficient was .89. The Cohen’s kappa coefficient for each variable ranged between .77 and 1.00 Level of analysis: each whole video, including all of the video’s visual, audio, and text presentation Causal claims for obesity Solution typifications for obesity Behavioral causal claim Obesity is due to the individual’s lifestyle choices, including lack of exercise, wrong diet, lack of willpower and self-control, etc. Behavioral solution Improving one’s diet or increasing activity levels Biological causal claim Obesity is due to genetic or hormonal problems Medical or pharmacological solution To use diet pills or have a gastric bypass surgery as a means of treating obesity. Systematic causal claim Obesity is based on environmental influences and policy choices, including detrimental practices of corporations and government, such as the fast food industry’s marketing practices, school cafeterias’ unhealthy foods, inadequate or inaccurate information about food and nutrition, etc. Systematic solution A societal level of obesity treatment, such as implementing obesity-related policies, banning fast food marketing, removing vending machines from school, etc. Information on Zhang & Jin, 2015 Authors: Yuan Zhang, Yan Jin Health topic: Depression Research question: Do cultural values and organizational restraints shape the responsibility frames for health issues? Object of analysis: US (n = 228) and Chinese (n = 224) newspaper coverage on depression, including New York Times and USA Today, Philadelphia Inquirer, Houston Chronicle, Star Tribune and Denver Post; Chinese newspapers were not further specified, except for People’s Daily and Beijing Daily Time frame of analysis: 2000 to 2012 Info about variables Variables: News framing of causal and problem-solving responsibilities was measured at individual and societal levels, with individual-level and society-level causes and solutions. Each cause and solution included four subcategories which were measured nominally as 0 (absent) or 1 (present). Reliability: For the US data, a pretest in which two coders both coded a randomly selected 10% of the sample yielded Pearson’s r of 0.737 (p < 0.001) for individual causes, 0.862 (p < 0.001) for societal causes, 0.790 (p < 0.001) for individual solutions, and 0.907 (p < 0.001) for societal solutions. For the Chinese data, a pretest in which two bilingual coders both coded a randomly selected 10% of the sample yielded Pearson’s r of 0.861 (p < 0.001) for individual causes, 0.893 (p < 0.001) for societal causes, 0.807 (p < 0.001) for individual solutions, and 0.899 (p < 0.001) Level of analysis: Article Variables & operational definitions: In the appendix References Gollust, S. E., & Lantz, P. M. (2009). Communicating population health: Print news media coverage of type 2 diabetes. Social Science & Medicine (1982), 69(7), 1091–1098. https://doi.org/10.1016/j.socscimed.2009.07.009 Kim, S.?H., & Willis, A. (2007). Talking about obesity: News framing of who is responsible for causing and fixing the problem. Journal of Health Communication, 12(4), 359–376. https://doi.org/10.1080/10810730701326051 O’Hara, S. K., & Smith, K. C. (2007). Presentation of eating disorders in the news media: What are the implications for patient diagnosis and treatment? Patient Education and Counseling, 68(1), 43–51. https://doi.org/10.1016/j.pec.2007.04.006 Stefanik-Sidener, K. (2013). Nature, nurture, or that fast food hamburger: Media framing of diabetes in the New York Times from 2000 to 2010. Health Communication, 28(4), 351–358. https://doi.org/10.1080/10410236.2012.688187 Yoo, J. H., & Kim, J. (2012). Obesity in the new media: a content analysis of obesity videos on YouTube. Health Communication, 27(1), 86–97. https://doi.org/10.1080/10410236.2011.569003 Zhang, Y., & Jin, Y. (2015). Who's responsible for depression? The Journal of International Communication, 21(2), 204–225. https://doi.org/10.1080/13216597.2015.1052532 Zhang, Y., & Jin, Y. (2015). Who's responsible for depression? Journal of International Communication, 21(2), 204–225.

An elderly man of my acquaintance once told me that there was nothing much to recommend living beyond 90. Things have changed over the past two decades, however. These days all he'd need is a touch of Viagra, an attitude reorientation, a little bit of manifesting and he'd be feeling as fit as, as, well … as a man in his 60s. Had he been around now, as a knowledgeable nonagenarian, he need not have mourned the passing of the years. Instead, he could have concentrated on becoming daily younger. As Second Youth so blithely trumpets: "In your youth, your mind, body and spirit are capable of great recuperative powers but, as you get older, you believe that those powers diminish. Not true! As long as you have a will -- and a method -- to improve your life, you will find the power to make it happen." Lacking the method? Look no longer… Books entitled RealAge: Are You as Young as You Can Be? (Roizen 1999) appear at the top of the New York Times best seller list, arguing that some 70-year olds can have the health profile of average 44-year olds within three years of making the right choices. (www.RealAge.com) This is the book's manifesto: The whole point of RealAge is to promote old age. Healthy, vibrant and young old age. RealAge shows you how you can live at eighty with all the energy and vigor of a fifty-five year old, how you can be the ninety year old who still lives on your own, travels and forcefully expresses feisty opinions -- the person who leaves the 'kids' marveling, 'How does she do it?' Having respect for old age means wanting to end the suffering that so often goes along with it. No one wants to be bedridden, afflicted with heart disease, or undergoing cancer treatment. Everyone wants to be able to do all the things he or she has always done and more. [Italics, gendered language, original] (Roizen 1999, p. 10) This website-supported best seller is part of a burgeoning industry which includes Cassel and Vallasi (1999) The Practical Guide to Aging: What Everyone Needs to Know, and Perls and Silver (1999) Living to 100: Lessons in Living to Your Maximum Potential at Any Age. "‘People have gotten old before, but never this many people and never this many people with such a high level of education … [boomers] will become obsessed with health and prevention of all the infirmities that accompany aging’ predicts Russell." (Wetzstein 1999, citing Russell.) The hypothesis put forward by Russell, by Wetzstein (1999) and by others, is that this is an 'age and stage' issue. It represents a new generational perspective reflective of the mindset and the life experience of the post mid-1940s 'baby boomer'. This website-supported best seller is part of a burgeoning industry which includes Cassel and Vallasi (1999) The Practical Guide to Aging: What Everyone Needs to Know, and Perls and Silver (1999) Living to 100: Lessons in Living to Your Maximum Potential at Any Age. "‘People have gotten old before, but never this many people and never this many people with such a high level of education … [boomers] will become obsessed with health and prevention of all the infirmities that accompany aging’ predicts Russell." (Wetzstein 1999, citing Russell.) The hypothesis put forward by Russell, by Wetzstein (1999) and by others, is that this is an 'age and stage' issue. It represents a new generational perspective reflective of the mindset and the life experience of the post mid-1940s 'baby boomer'. Boomers refuse to see 40 as middle aged (Wetzstein 1999), and would perish the thought that the Rolling Stones would ever retire. They define 50s as ‘Second youth’. (Gabriel & Molli 1995) They continue to participate in adventure and encounter holidays and subscribe to complementary health care regimes and new age approaches to daily life. They sign up for www.lovinguniversity.net and marvel at how much younger 43-yr old founder Susan Bradley looks on her website than in a recent Who Weekly (2001, p. 71). This baby boomer refusal to age has manifested itself widely in general and specialist consumer magazines, in broadcast TV and radio shows concentrating on good health and super-fitness, and in other elements of popular culture. Even given the hype, however, this new perspective might have long-term beneficial health/medical effects. The aging of the boomer generation may not be accurately predictable from the data collected from other generations with other mindsets. The back cover of Second Youth proclaims: "Desperate and aging far too fast she staked everything on discovering a natural source of Young Women's Hormones. Now, her triumph gives you thirty extra years of Second Youth. Age moved backwards for this woman. Just as it can -- this very month -- for you". (Gabriel & Molli 1995, back cover) Did someone mention snake oil? Or Bluebeard? Coupled with an optimism that allows them to forecast health and happiness into double-digit decades, however, boomers have a demonstrable suspicion of conventional medical ‘authority’ and a willingness to do their own research on health topics of interest. According to Mycek (1999) "In 1998, the [US] bill for homeopathic remedies (chiropractic and massage therapy, vitamins, yoga, herbal remedies, hypnosis, acupuncture) exceeded the total gross domestic product of all [US] hospitals put together." For boomers, a greater emphasis on health is not going to mean more of the same health care products, delivered in the same way. It is going to mean doing things differently. But is this a healthy way for us to look at aging and (shall we mention the word) death? Is our desire/burning commitment to remain indefinitely young and healthy in some way 'sick'? It is eminently reasonable to hypothesise -- as many people approaching their 'middle years' do -- that baby boomers are aiming to reinvent the aging process. (Dychtwald, 1999) The past quarter century has seen the burgeoning growth of preventative/health promotion and complementary health promoting services including nutritionists, naturopaths, chiropractors, rebalancers, meditation teachers, physiotherapists, counsellors and life coaches. The oldest members of the richest, best informed, most numerous generation in history are turning 55. The boomers (born from 1946--1960) can't put off for any longer the fact that -- chronologically -- they are approaching middle age. But what does this mean to a generation with many members who would rather be dead than old? Does the denial of chronological age, and the espousal of 'physiological age' (the premise upon which the RealAge philosophy and empire is built) represent a sick fantasy to avoid accepting our mortality? Baby boomers are a specific, much researched, sociocultural phenomenon. Their aim is to move beyond actuarial projections to re-write expectations of aging. From the self-help movement to the success of the potency drug Viagra, there is ample evidence that boomers have plans and expectations for their own aging processes that differ radically from those adopted by their parents. People born into the prosperity and plenty of the early post-WWII years often police their health attitudes and behaviours in proactive ways. These patterns are likely to impact upon their health profiles in the future and to influence the creation of services tailored to meet different hopes, fears and expectations. Who says Cher can't look young forever? Most health care planning is based on actuarial data that examines past events and extrapolates from these events into the future. However, this is not likely to result in a valid prediction of the health and aging patterns of the boomer generation. Graham May is a futurologist. He suggests that (May 2000), in anticipating the future, we are attempting either to foresee it, to manage it, or to create it. The philosophical distinctions between these perspectives provide different rationales for those who wish to influence the future. Attempts to foresee, or predict, the future – for example by extrapolating trends – presuppose that in some very particular ways the future already exists and/or is closely related to the forces evident in the present and the past. Managing the present with the future in mind accepts that present actions and decisions influence the future, and suggests that the future does not exist and is capable of being influenced by our current choices. The creation of the future – through techniques such as ‘creative visioning’ – works on the basis that once situations that do not exist have been imagined they can be brought into existence. These three approaches, separately and in parallel, offer ways of negotiating the uncertainty and essential unpredictability of the future, and of longevity and fitness. The longevity and second youth approach combines the idea of managing the future and envisioning it: 'the manifestation' approach. Baby boomers have already created a different future for our society. They are credited with re-writing the institutions of marriage (via de factos, divorce, blended families, single parents, older pregnancies); marketing (psychodemographics rather than age, sex, socioeconomic status); religion (the decline of the Church and the rise of new age philosophies, faith healing, angels on demand); education (just-in-time learning, lifelong learning); work practices -- and health. The boomers are also rewriting what aging means for them, and to them. Using popular culture starting points, such as Second Youth and RealAge, it seems that a major boomer project of the next twenty years is working to defy/turn back the aging clock. This project is invested with the hopes, fears, dreams and expectations of millions of citizens in western societies. Boomers are practical, however, as well as ‘just in time’ and they know that a belief that they can do it is half the battle. Let's assume that although many boomers are already fitter and healthier than any generation before them at their age, others may be intending to ‘make a break’ for fitness as an early priority of their retirement. Boomers may also expect their retirement years to be years of health and plenty, and they seem to indicate that they're prepared actively to work with these goals in mind. However, not all will be successful in beating their biology. How do boomers expect to manage their own chronic ailments in the future: arthritis, failing hearing and sight, late onset diabetes, heart disease, incontinence, dementia etc? Will the stem cell implants solve all foreseeable problems? Excluding alternative and complementary medical strategies, the health care industry is one of the biggest sectors of the economy representing 8% GDP (and rising). As indicated by its growing place in popular culture, health is also a hobby, pastime and pleasure – and the contemporary obsession with health is … sick. Although the social advantage to be conferred by living as healthily as possible, and as well as possible, is self-evident, it may require a level of selfishness and self-absorption unparalleled in human history. More to the point, however, this approach to getting older brings problems of its own. Firstly, it is built on a fear of aging, and a wish to deny the aging process which may become more desperate as the years (and they will) take their toll. Far from increasing the pleasure and satisfaction of 'a good age' this dynamic, operating over the decades, is as likely to build frustration, depression and a sense of powerlessness. As a (breast) cancer patient once told me: 'It's bad enough having cancer without everyone else thinking it's my fault for not having a positive enough attitude!' Aging is going to happen -- will we go with the flow - or end up like King Canute, with wet feet, trying to turn back the tide? Secondly, this perspective is counter-productive in fetishising a numerical age. When we're so focused on chronological age, biological age and the celebrating of our first, second and third 'year younger' parties (with fruit and water, please) we're not coming to terms with what's real for us in our ecological niche. Humanity is comprised of sentient, vertebrate, mammals. Far better to know our life cycle, and plan our lives to fit within it, than to pretend it can be revered. Much better to accept that we can be a very fit seventy year old (or a very unfit seventy year old) than to persuade ourselves that 'That's just my chronology, my real age is 44.' I'm sure we'll all be able to tell the difference… If anyone seriously believed the hype of living 26 years younger, you'd have to feel more than sorry for them. You'd have to suspect that maybe, even if they were blissfully unaware of it, they're a little bit sick. I gather that there's a Centre for Positive Aging recently started up in Perth: that's something altogether healthier References Cassel, C. and Vallasi, G. The Practical Guide to Aging: What Everyone Needs to Know. New York: New York University Press, 1999. Dychtwald, K. 'Age power': how the new-old will transform medicine in the 21st century, Geriatrics, vol. 54, no. 12, 1999, 22—7. Gabriel, V. and Molli, J. Second Youth, Melbourne: Bookman Press, 1995. May, G. Worldviews, assumptions and typologies of the future, Journal of Future Studies, vol. 5, no. 2, November, 2000, 37—51 Mycek, S. We’re not in Kansas anymore, Trustee, vol. 52, no. 8, 1999, 20—4 Perls, T. and Silver, M. Living to 100: Lessons in Living to Your Maximum Potential at Any Age, New York: Basic Books, 1999. Roizen, M. RealAge: Are You as Young as You Can Be? London: Thorsons, 1999 Wetzstein, C. Boomers’ new quest: to be forever young, Insight on the News, vol. 15, no. 24, 28th June, 1999, 40 Who Weekly Love is in the air, no. 474, 2 April, 2001, 71

As the distinction between disclosure-fuelled celebrity and lasting fame becomes difficult to discern, the “based on a true story” label has gained a particular traction among readers and viewers. This is despite much public approbation and private angst sometimes resulting from such disclosure as “little in the law or in society protects people from the consequences of others’ revelations about them” (Smith 537). Even fiction writers can stray into difficult ethical and artistic territory when they disclose the private facts of real lives—that is, recognisably biographical information—in their work, with autoethnographic fiction where authors base their fiction on their own lives (Davis and Ellis) not immune as this often discloses others’ stories (Ellis) as well. F. Scott Fitzgerald famously counselled writers to take their subjects from life and, moreover, to look to the singular, specific life, although this then had to be abstracted: “Begin with an individual, and before you know it, you find that you have created a type; begin with a type, and you find that you have created—nothing” (139). One of the problems when assessing fiction through this lens, however, is that, although many writers are inspired in their work by an actual life, event or historical period, the resulting work is usually ultimately guided by literary concerns—what writers often term the quest for aesthetic truth—rather than historical accuracy (Owen et al. 2008). In contrast, a biography is, and continues to be, by definition, an accurate account of a real persons’ life. Despite postmodern assertions regarding the relativity of truth and decades of investigation into the incorporation of fiction into biography, other non-fiction texts and research narratives (see, for instance: Wyatt), many biographers attest to still feeling irrevocably tied to the factual evidence in a way that novelists and the scriptors of biographically-based fictional television drama, movies and theatrical pieces do not (Wolpert; Murphy; Inglis). To cite a recent example, Louis Nowra’s Ice takes the life of nineteenth-century self-made entrepreneur and politician Malcolm McEacharn as its base, but never aspires to be classified as creative nonfiction, history or biography. The history in a historical novel is thus often, and legitimately, skewed or sidelined in order to achieve the most satisfying work of art, although some have argued that fiction may uniquely represent the real, as it is able to “play […] in the gap between the narratives of history and the actualities of the past” (Nelson n.p.). Fiction and non-fictional forms are, moreover, increasingly intermingling and intertwining in content and intent. The ugly word “faction” was an attempt to suggest that the two could simply be elided but, acknowledging wide-ranging debates about whether literature can represent the complexities of life with any accuracy and post-structuralist assertions that the idea of any absolute truth is outmoded, contemporary authors play with, and across, these boundaries, creating hybrid texts that consciously slide between invention and disclosure, but which publishers, critics and readers continue to define firmly as either fiction or biography. This dancing between forms is not particularly new. A striking example was Marion Halligan’s 2001 novel The Fog Garden which opens with a personal essay about the then recent death of her own much-loved husband. This had been previously published as an autobiographical memoir, “Cathedral of Love,” and again in an essay collection as “Lapping.” The protagonist of the novel is a recently widowed writer named Clare, but the inclusion of Halligan’s essay, together with the book’s marketing campaign which made much of the author’s own sadness, encourages readers to read the novel as a disclosure of the author’s own personal experience. This is despite Halligan’s attempt to keep the two separate: “Clare isn’t me. She’s like me. Some of her experience, terrors, have been mine. Some haven’t” (Fog Garden 9). In such acts of disclosure and denial, fiction and non-fiction can interrogate, test and even create each other, however quite vicious criticism can result when readers feel the boundaries demarking the two are breached. This is most common when authors admit to some dishonesty in terms of self-disclosure as can be seen, for instance, in the furore surrounding highly inflated and even wholly fabricated memoirs such as James Frey’s A Million Little Pieces, Margaret B. Jones’s Love and Consequences and Misha Defonseca’s A Mémoire of the Holocaust Years. Related problems and anxieties arise when authors move beyond incorporating and disclosing the facts of their own lives in memoir or (autobiographical) fiction, to using the lives of others in this way. Daphne Patai sums up the difference: “A person telling her life story is, in a sense, offering up her self for her own and her listener’s scrutiny […] Whether we should appropriate another’s life in this way becomes a legitimate question” (24–5). While this is difficult but seemingly manageable for non-fiction writers because of their foundational reliance on evidence, this anxiety escalates for fiction writers. This seems particularly extreme in relation to how audience expectations and prior knowledge of actual events can shape perceptions and interpretations of the resulting work, even when those events are changed and the work is declared to be one of fiction. I have discussed elsewhere, for instance, the difficult terrain of crafting fiction from well-known criminal cases (Brien, “Based on a True Story”). The reception of such work shows how difficult it is to dissociate creative product from its source material once the public and media has made this connection, no matter how distant that finished product may be from the original facts.As the field of biography continues to evolve for writers, critics and theorists, a study of one key text at a moment in that evolution—Jill Shearer’s play Georgia and its reliance on disclosing the life of artist Georgia O’Keeffe for its content and dramatic power—reveals not only some of the challenges and opportunities this close relationship offers to the writers and readers of life stories, but also the pitfalls of attempting to dissemble regarding artistic intention. This award-winning play has been staged a number of times in the past decade but has attracted little critical attention. Yet, when I attended a performance of Georgia at La Boite Theatre in Brisbane in 1999, I was moved by the production and admiring of Shearer’s writing which was, I told anyone who would listen, a powerfully dramatic interpretation of O’Keeffe’s life, one of my favourite artists. A full decade on, aspects of the work and its performance still resonate through my thinking. Author of more than twenty plays performed throughout Australia and New Zealand as well as on Broadway, Shearer was then (and is) one of Australia’s leading playwrights, and I judged Georgia to be a major, mature work: clear, challenging and confident. Reading the Currency Press script a year or so after seeing the play reinforced for me how distinctive and successful a piece of theatre Shearer had created utilising a literary technique which has been described elsewhere as fictionalised biography—biography which utilises fictional forms in its presentation but stays as close to the historical record as conventional biography (Brien, The Case of Mary Dean).The published version of the script indeed acknowledges on its title page that Georgia is “inspired by the later life of the American artist Georgia O’Keeffe” (Shearer). The back cover blurb begins with a quote attributed to O’Keeffe and then describes the content of the play entirely in terms of biographical detail: The great American artist Georgia O’Keeffe is physically, emotionally and artistically debilitated by her failing eyesight. Living amidst the Navajo spiritual landscape in her desert home in New Mexico, she becomes prey to the ghosts of her past. Her solitude is broken by Juan, a young potter, whose curious influence on her life remains until her death at 98 (Georgia back cover). This short text ends by unequivocally reinforcing the relation between the play and the artist’s life: “Georgia is a passionate play that explores with sensitivity and wry humour the contradictions and the paradoxes of the life of Georgia O’Keeffe” (Georgia back cover). These few lines of plot synopsis actually contain a surprisingly large number of facts regarding O’Keeffe’s later life. After the death of her husband (the photographer and modern art impresario Alfred Steiglitz whose ghost is a central character in the play), O’Keeffe did indeed relocate permanently to Abiquiú in New Mexico. In 1971, aged 84, she was suffering from an irreversible degenerative disease, had lost her central vision and stopped painting. One autumn day in 1973, Juan Hamilton, a young potter, appeared at her adobe house looking for work. She hired him and he became her lover, closest confidante and business manager until her death at 98. These facts form not only the background story but also much of the riveting content for Georgia which, as the published script’s introduction states, takes as its central themes: “the dilemma of the artist as a an older woman; her yearning to create against the fear of failing artistic powers; her mental strength and vulnerability; her sexuality in the face of physical deterioration; her need for companionship and the paradoxical love of solitude” (Rider vii). These issues are not only those which art historians identify as animating the O’Keeffe’s later life and painting, but ones which are discussed at length in many of the biographies of the artist published from 1980 to 2007 (see, for instance: Arrowsmith and West; Berry; Calloway and Bry; Castro; Drohojowska-Philp; Eisler; Eldredge; Harris; Hogrefe; Lisle; Peters; Reily; Robinson).Despite this clear focus on disclosing aspects of O’Keeffe’s life, both the director’s and playwright’s notes prefacing the published script declare firmly that Georgia is fiction, not biography. While accepting that these statements may be related to copyright and privacy concerns, the stridency of the denials of the biography label with its implied intention of disclosing the facts of a life, are worthy of analysis. Although noting that Georgia is “about the American artist Georgia O’Keeffe”, director of the La Boite production Sue Rider asserts that not only that the play moves “beyond the biographical” (vii) but, a few pages later, that it is “thankfully not biography” (xii). This is despite Rider’s own underscoring of the connection to O’Keeffe by setting up an exhibition of the artist’s work adjacent to the theatre. Shearer, whose research acknowledgments include a number of works about O’Keeffe, is even more overtly strident in her denial of any biographical links stating that her characters, “this Juan, Anna Marie and Dorothy Norman are a work of dramatic fiction, as is the play, and should be taken as such” (xiii).Yet, set against a reading of the biographies of the artist, including those written in the intervening decade, Georgia clearly and remarkably accurately discloses the tensions and contradictions of O’Keeffe’s life. It also draws on a significant amount of documented biographical data to enhance the dramatic power of what is disclosed by the play for audiences with this knowledge. The play does work as a coherent narrative for a viewer without any prior knowledge of O’Keeffe’s life, but the meaning of the dramatic action is enhanced by any biographical knowledge the audience possesses. In this way, the play’s act of disclosure is reinforced by this externally held knowledge. Although O’Keeffe’s oeuvre is less well known and much anecdotal detail about her life is not as familiar for Australian viewers as for those in the artist’s homeland, Shearer writes for an international as well as an Australian audience, and the program and adjacent exhibition for the Brisbane performance included biographical information. It is also worth noting that large slabs of biographical detail are also omitted from the play. These omissions to disclosure include O’Keeffe’s early life from her birth in 1887 in Wisconsin to her studies in Chicago and New York from 1904 to 1908, as well as her work as a commercial artist and art teacher in Texas and other Southern American states from 1912 to 1916. It is from this moment in 1916, however, that the play (although opening in 1946) constructs O’Keeffe’s life right through to her death in 1986 by utilising such literary devices as flashbacks, dream sequences and verbal and visual references.An indication of the level of accuracy of the play as biographical disclosure can be ascertained by unpacking the few lines of opening stage directions, “The Steiglitz’s suite in the old mid-range Shelton Hotel, New York, 1946 ... Georgia, 59, in black, enters, dragging a coffin” (1). In 1946, when O’Keeffe was indeed aged 59, Steiglitz died. The couple had lived part of every year at the Shelton Towers Hotel at 525 Lexington Avenue (now the New York Marriott East Side), a moderately priced hotel made famous by its depiction in O’Keeffe’s paintings and Steiglitz’s photographs. When Stieglitz suffered a cerebral thrombosis, O’Keeffe was spending the summer in New Mexico, but she returned to New York where her husband died on 13 July. This level of biographical accuracy continues throughout Georgia. Halfway through the first page “Anita, 52” enters. This character represents Anita Pollitzer, artist, critic and O’Keeffe’s lifelong friend. The publication of her biography of O’Keeffe, A Woman on Paper, and Georgia’s disapproval of this, is discussed in the play, as are their letters, which were collected and published in 1990 as Lovingly, Georgia (Gibiore). Anita’s first lines in the play after greeting her friend refer to this substantial correspondence: “You write beautifully. I always tell people: “I have a friend who writes the most beautiful letters” (1). In the play, as in life, it is Anita who introduces O’Keeffe’s work to Stieglitz who is, in turn, accurately described as: “Gallery owner. Two Nine One, Fifth Avenue. Leader of the New York avant-garde, the first to bring in the European moderns” (6). The play also chronicles how (unknown to O’Keeffe) Steiglitz exhibited the drawings Pollitzer gave him under the incorrect name, a scene which continues with Steiglitz persuading Georgia to allow her drawings to remain in his gallery (as he did in life) and ends with a reference to his famous photographs of her hands and nude form. Although the action of a substantial amount of real time is collapsed into a few dramatic minutes and, without doubt, the dialogue is invented, this invention achieves the level of aesthetic truth aimed for by many contemporary biographers (Jones)—as can be assessed when referring back to the accepted biographical account. What actually appears to have happened was that, in the autumn 1915, while teaching art in South Carolina, O’Keeffe was working on a series of abstract charcoal drawings that are now recognised as among the most innovative in American art of that time. She mailed some of these drawings to Pollitzer, who showed them Steiglitz, who exhibited ten of them in April 1916, O’Keeffe only learning of this through an acquaintance. O’Keeffe, who had first visited 291 in 1908 but never spoken to Stieglitz, held his critical opinion in high regard, and although confronting him over not seeking her permission and citing her name incorrectly, eventually agreed to let her drawings hang (Harris). Despite Shearer’s denial, the other characters in Georgia are also largely biographical sketches. Her “Anna Marie”, who never appears in the play but is spoken of, is Juan’s wife (in real life Anna Marie Hamilton), and “Dorothy Norman” is the character who has an affair with Steiglitz—the discovery of which leads to Georgia’s nervous breakdown in the play. In life, while O’Keeffe was in New Mexico, Stieglitz became involved with the much younger Norman who was, he claimed, only his gallery assistant. When O’Keeffe discovered Norman posing nude for her husband (this is vividly imagined in Georgia), O’Keeffe moved out of the Shelton and suffered from the depression that led to her nervous breakdown. “ Juan,” who ages from 26 to 39 in the play, represents the potter Juan Hamilton who encouraged the nearly blind O’Keeffe to paint again. In the biographical record there is much conjecture about Hamilton’s motives, and Shearer sensitively portrays her interpretation of this liaison and the difficult territory of sexual desire between a man and a much older woman, as she also too discloses the complex relationship between O’Keeffe and the much older Steiglitz.This complexity is described through the action of the play, but its disclosure is best appreciated if the biographical data is known. There are also a number of moments of biographical disclosure in the play that can only be fully understood with biographical knowledge in hand. For instance, Juan refers to Georgia’s paintings as “Beautiful, sexy flowers [... especially] the calla lilies” (24). All attending the play are aware (from the exhibition, program and technical aspects of the production) that, in life, O’Keeffe was famous for her flower paintings. However, knowing that these had brought her fame and fortune early in her career with, in 1928, a work titled Calla Lily selling for U.S. $25,000, then an enormous sum for any living American artist, adds to the meaning of this line in the play. Conversely, the significant level of biographical disclosure throughout Georgia does not diminish, in any way, the power or integrity of Shearer’s play as a literary work. Universal literary (and biographical) themes—love, desire and betrayal—animate Georgia; Steiglitz’s spirit haunts Georgia years after his death and much of the play’s dramatic energy is generated by her passion for both her dead husband and her younger lover, with some of her hopeless desire sublimated through her relationship with Juan. Nadia Wheatley reads such a relationship between invention and disclosure in terms of myth—relating how, in the process of writing her biography of Charmain Clift, she came to see Clift and her husband George Johnson take on a larger significance than their individual lives: “They were archetypes; ourselves writ large; experimenters who could test and try things for us; legendary figures through whom we could live vicariously” (5). In this, Wheatley finds that “while myth has no real beginning or end, it also does not bother itself with cause and effect. Nor does it worry about contradictions. Parallel tellings are vital to the fabric” (5). In contrast with both Rider and Shearer’s insistence that Georgia was “not biography”, it could be posited that (at least part of) Georgia’s power arises from the creation of such mythic value, and expressly through its nuanced disclosure of the relevant factual (biographical) elements in parallel to the development of its dramatic (invented) elements. Alongside this, accepting Georgia as such a form of biographical disclosure would mean that as well as a superbly inventive creative work, the highly original insights Shearer offers to the mass of O’Keeffe biography—something of an American industry—could be celebrated, rather than excused or denied. ReferencesArrowsmith, Alexandra, and Thomas West, eds. Georgia O’Keeffe & Alfred Stieglitz: Two Lives—A Conversation in Paintings and Photographs. Washington DC: HarperCollins and Calloway Editions, and The Phillips Collection, 1992.Berry, Michael. Georgia O’Keeffe. New York: Chelsea House, 1988.Brien, Donna Lee. 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