基于叙事医学“细读”方法探讨中医医案叙事分析方法

医案作为叙事文本,可进行故事分析与叙事分析。叙事分析结果能够完善故事分析结果。叙事医学提出的细读方法是医学叙事分析方法的集大成者。为增加医案研读结果的完整度,借鉴叙事医学的细读方法,提出了分析医案“框架”、“形式”、“时间”、“情节”、“意愿”的方法,介绍了时间性、独特性、因果关系/偶然性、伦理性、主体间性特征等叙事医学概念对医案分析需求的启发。为了便于记录与规范医案叙事分析的过程,设计了医案叙事分析表。本研究丰富了医案研究方法,扩大了叙事医学细读方法的运用范围。     

Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

Changes in Children's Episodic Narratives Through Long-Term Repeated Recall: Longitudinal Case Studies1

This study aimed to investigate whether a child's narrative of a particular past episode would change in repeated reporting over the long term, and if so, how it would change. To answer these questions, I conducted longitudinal case studies of episodic reports by children every 2–6 months, from their early childhood to the age of 10–15 years. Criteria for inclusion were set in advance; seven episodic narratives meeting these criteria were analyzed. Two types of changes in the narratives were observed, as expected: that of including other information, and that of an event suddenly being reported after no recall for several years. Information from the children's surroundings seemed to be substantially involved in these changes in their episodic narratives. The present results also indicate that mothers' episodic memories are not always reliable and that the schema children have can influence their episodic memories.     

Modelling change in self-narratives and embodied experience: A multicase study and autoethnography

The article documents a multicase study of the researcher’s own clinical work with four clients who each presented with embodied expressions of distress. The researcher practised within a ‘narrative-dialogical’ framework and set out to build theories of therapeutic change. However, a parallel thesis emerged during the project: an autoethnographic account in which the researcher’s uses of supervision, personal therapy, dreams and life events capture data on the ways in which the therapist’s theories of change are modelled in the therapeutic space—with varying degrees of confidence and success. Sessions were audio-recorded and coded for qualitative markers indicating the emergence of novel self-narratives. A reflexive narrative running throughout the work highlights the superordinate role of reflexivity in theory development. Therapeutic change was typified by an evolving internalised map of self and world, with corresponding change in embodied experience. The article highlights techniques deployed by the therapist in highlighting and building upon moments of innovation with the therapeutic process. As an analysis of one therapist’s practice and the experiences of their clients, the study generates theories for ongoing exploration and study. The continuous evolution of change concepts reflects the theory-building work of clinicians in their everyday practice. The study highlights the use of self as research instrument and offers a candid and intimate example of how practitioner research might be structured and delivered.     

A Three‐Domain Personality Analysis of a Mentally Tough Athlete

The current study adopted McAdams' multilayer framework as the basis to develop a psychological portrait of an elite athlete who was identified as being particularly ‘mentally tough’. The aim was to use this single case as an exemplar to demonstrate the utility of McAdams' framework for understanding the complexity of sport performers across three domains of personality: dispositional traits, characteristic adaptations, and narrative identity. We operationalised these domains through the development of specific research questions and, subsequently, the collection and integration of the participant's Big Five traits, personal strivings, coping strategies, and response to a life story interview. The results offered a comprehensive insight into the nature of one athlete's personality that, in turn, informed conceptual perspectives of mental toughness in sport psychology literature and qualitatively supported emerging evidence of the validity of a three‐layer framework in personality psychology. Specifically, the study's design showed how a holistic approach to personality analysis can lead to a more complete psychological representation of competitors in sport, and people generally. It demonstrated how motivational, sociocultural, and meaning‐making aspects of personality can complement a trait profile to achieving a satisfying assessment of the whole person. Copyright © 2017 European Association of Personality Psychology     

Resolution of an impasse at a network meeting: Dialogical sequence analysis of the use of a shared formulation

The study describes the resolution of an impasse at a network meeting during clinical child neurological assessment procedure, analysed by dialogical sequence analysis (DSA) a micro-analytic method for analysing utterances. The two earlier studies of the project describe how a DSA-based case conceptualisation can be used to assess change in the dyadic interaction between neuropsychologist and parent. This study applies the same formulation to analyse group level interaction at the network meeting. The case of a four-year-old girl was selected from a database of videotaped and transcribed child neurological team assessment processes. A repetitive problematic pattern was clearly manifested between parents and the child. At an early stage of the assessment, the neuropsychologist formulated and shared with the parents a clinical formulation of the pattern, summarised as the controlling/coercive parents to the rebellious child. In the earlier studies, microanalysis using DSA confirmed the accuracy of the neuropsychologist’s initial formulation, which she had used in the encounters with the parents. This study traces how she made use of it to address a re-enactment of the problematic pattern, now between the parents and professionals at the network meeting. The analysis of the phases of the conflict resolution by using DSA suggests that the impasse represented a re-enactment of the role positions of coercion and rebelliousness. The use of the original formulation at the meeting helped the conflicting parties to reach an observing stance to the pattern and a more empathic attitude to each other. The micro-analytic methodology by DSA used in this study allows to show the therapeutic potential of the network meeting and also how the development of an empathic stance is manifested in the discourse content.     

Meaning-making and resilience: case studies of a multifaceted process

Explanations of meaning-making generally prioritise intrapersonal processes. Although making meaning is an intrapersonal process, it is also strongly influenced by person-context interactions and cultural positioning. Nevertheless, the meaning-making literature has paid scant attention to how such interactivity and positioning shape meaning-making. In this article, we highlight the compound character of resilience-promoting meaning-making. To this end, we recount the instrumental cases of Ntando's and Sipho's resilience. The accounts of these black South African students’ positive adjustment to adversity richly illustrate how their lived experiences of a social ecology stimulated multifaceted meaning-making processes. In particular, Ntando's and Sipho's interpersonal experiences and Africentric worldviews gave rise to and/or moderated positive re-appraisal, revisioned goals, purposeful direction, application of spiritual beliefs, identification of benefits, sense-making and reflective problem-solving. Although both their stories drive an understanding of meaning-making as a helix-like process with inter-, intrapersonal and cultural strands, the differences in their accounts of meaning-making stimulate the need for deeper exploration into the complexity of resilience-promoting meaning-making processes.     

Depression and resilience mediate the relationship between traumatic life events and ill physical health: results from a population study

We set out to investigate the mediating roles of depression, resilience, smoking, and alcohol use, in the relationship between potentially traumatic life events and objective and subjective, physical and mental health in a single study. A face-to-face, population-based survey was conducted in Hong Kong (N = 1147). Information on health conditions and traumatic life events was obtained, and participants completed measures of subjective physical and mental health, depression, and resilience. Smoking and drinking were not significant mediators of the relationship between life events and both objective and subjective health. Depressive symptomatology was found to mediate the relationship between life threatening illness and subjective physical health, the relationship between abuse (physical and sexual) and subjective mental health, and the relationship between the death of a parent/partner and subjective mental health. Resilience was found to mediate the relationships between multiple traumatic life events and subjective physical and mental health. Our results indicate that psychological factors rather than biological are important mediators of the relationship between life events exposure and health. Our findings provide evidence that depressive symptomatology has a mediating role only in the case of specific potentially traumatic life events and that resilience is only a critical factor in the face of exposure to multiple traumatic events, rather than single events. Our results also indicate that behavioural factors, such as smoking and drinking, are not significant mediators of the relationship between life events and health.     

叙事医学在临床研究中的应用进展

叙事医学的概念自问世以来,在国内外均得到快速发展。对采用叙事医学进行干预的临床研究进行综述,以期为广大临床医护工作者开展有关叙事医学的临床对照研究提供参考。现有叙事医学涉足的领域包括了叙事医学教育、叙事医学文学、叙事医学临床实践等方面,在叙事医学临床实践方面集中在叙事病历、叙事故事的建立,并通过叙事干预实现其医疗目的。叙事医学干预不同于传统的医学干预,将叙事医学作为干预措施进行的对照研究相对有限。     

Like a Fish Out of Water: Reconsidering Disaster Recovery and the Role of Place and Social Capital in Community Disaster Resilience

In this paper we draw on the findings of a critical, multi-sited ethnographic study of two rural communities affected by a wildfire in British Columbia, Canada to examine the salience of place, identity, and social capital to the disaster recovery process and community disaster resilience. We argue that a reconfiguration of disaster recovery is required that more meaningfully considers the role of place in the disaster recovery process and opens up the space for a more reflective and intentional consideration of the disorientation and disruption associated with disasters and our organized response to that disorientation. We describe a social-psychological process, reorientation, in which affected individuals and communities navigate the psychological, social and emotional responses to the symbolic and material changes to social and geographic place that result from the fire's destruction. The reorientation process emphasizes the critical importance of place not only as an orienting framework in recovery but also as the ground upon which social capital and community disaster resilience are built. This approach to understanding and responding to the disorientation of disasters has implications for community psychologists and other service providers engaged in supporting disaster survivors. This includes the need to consider the complex dynamic of contextual and cultural factors that influence the disaster recovery process.     

案例教学的医学伦理学再造

我国医学伦理学采用案例教学法已经有二十余年的历史了。在此期间,案例教学得到了一定的发展,却也受到了诸多因素的限制。当前,中国医学伦理学的案例教学朝哪里去、怎么去等一系列新的问题摆在我们面前,这些问题必须依赖于加强我国医学伦理学软件环境的建设并对案例教学进行医学伦理学的再造方能加以解决。     

The Dawning of a Thought and the Role of Play and Trauma

A critical scrutiny of Freud's case the Rat Man elucidates the implications of the built-in contradictions that Freud made while evolving the psychoanalytic method. By comparing the published case of the Rat Man with Freud's private notes we get access to two different perspectives. Wishing to mould a clinical situation that would confirm his theories and uphold the image of the psychoanalyst as an authority figure, Freud was partly blind to some irrational distortions in how he perceived the interaction between the patient and himself. Contradictory explicit and unconscious “theories” and the emergence of a more modern understanding of transference, which includes inter-subjective dimensions, are expounded.     

11岁选择性缄默症女孩的箱庭治疗个案研究

采用箱庭疗法对11岁选择性缄默症女孩进行心理治疗的小M研究.经过18次个体箱庭和4次家庭箱庭治疗,来访者的箱庭作品由贫瘠、单调逐渐向丰富、多样转化,由孤立、静止走向开放、动态,自我力量逐步增强.来访者的学校适应、亲子关系也发生了积极改变.箱庭治疗使来访者的内心世界由创伤走向治愈.     

A Microanalytic Case Study of the Utilization of ‘Solution-Focused Problem Talk’ in Solution-Focused Brief Therapy

Abstract

Solution-focused therapy (SFBT) is a popular therapeutic approach among family therapists. However, disputes about SFBT still arise, especially on problems. This study examines the function of problem talk in SFBT by using a microanalytic case study method. As a result, three categories were found: Eliciting, clarifying, and acknowledging problems. The problem talks initiated by the SF therapist showed a pattern associated with the solution talk and served as preliminary steps to be connected to the following solution talks. The results indicate that solution building is constructed not only through solution talk, but also through ‘solution-focused problem talk.’     

Extending the temporal range of psychometric prediction by optimal linear filtering of mental test scores

Incorporating temporal decline in predictive validity into mental testing theory is outlined. Starting from multivariate regression of criterion on repeated measurements, an analytic extension results in a weighting function for repeated measurements, replacing the beta weights. Besides optimizing, the procedure permits an evaluation of any particular prognosis setting: In cases of exponentially declining predictive validity, prognostic range can be extended if concurrent validity is nonperfect by optimal weighting (predictive filtering) of repeated measurements. Considerable gain in prognostic range over the traditional approach can be achieved if predictive validity declines concavely downwards.This work was supported by grant Dr 58/3 from Deutsche Forschungsgemeinschaft.     

Some effects of external circumstances on the inner experience of two child patients

This paper describes the research findings that formed part of a professional doctorate in Child Psychoanalytic Psychotherapy. It explores the impact of unresolved mourning following parental death in early adolescence on subsequent adolescent development. Via reference to a single case study, it describes emergent and overlapping themes related both to the bereavement process and adolescent development, and links the themes with psychoanalytic theoretical research in both adolescent development and bereavement. It considers how these themes changed over the course of an intensive psychotherapeutic treatment.