病患的意义：从体验到概念的蜕变过程

美国哲学家S.K.图姆斯基于本人罹患的播散性或多发性硬化症的直接经验,阐述了关于病患意义构成及其变化四个层次的观点,这是他对梅洛-庞蒂身体现象学思想的具体化和当下化的应用。通过对这四个层次观点的梳理(感觉经验层次、患病的体验层次、疾病的认识层次、疾病状态的认识层次),认为研究病患意义具有极大的临床价值:即了解和读懂患者赋予病患的各种意义,将有助于改变目前临床医学问诊将患者的体验转变为医学概念术语的蜕变过程,有助于改善医患关系,并且对医学诊断和治疗目标带来深刻的影响。     

Psychiatric Disorders in Clinical Genetics I: Addressing Family Histories of Psychiatric Illness

This is the first article of a two-part professional development series addressing genetic counseling for personal and family histories of psychiatric disorders. It is based on an Educational Breakout Session presented by the Psychiatric Special Interest Group of the National Society of Genetic Counselors at the 2006 Annual Education Conference. This article examines issues that arise in addressing family histories of psychiatric illness, while the second article in the series considers the generation and provision of individualized recurrence risks for psychiatric disorders. In this article we discuss the importance of managing uncertainty for affected individuals and their close family members who have been referred to genetics for a number of different indications. We then use four simulated cases to make recommendations about the scope and timing of discussions related to the psychiatric family history.     

Psychological wellbeing and quality of life in amyotrophic lateral sclerosis: A review

Amyotrophic lateral sclerosis is a fatal neurodegenerative disease with a progressive and rapid course that, so far, cannot be stopped or reversed. The psychological impact of the disease is huge, on both patients and caregivers. This review summarizes studies that have investigated quality of life, depression, anxiety, pain, spiritual and existential issues, hope, and hopelessness in the ALS field, with attention to both patients and their caregivers. Psychological support and the possible role of psychologists in the ALS field are also discussed.     

Response to Difficult Patients in Group Analysis: The Personification of I:A/M

The author focuses on the application of Hopper's proposal of an additional basic assumption (I:A/M) using a model of clinicians' theories: bridging theory, psychological theory, and clinical theory (Michels, 1999). This paper will describe the potential for advances in understanding particular group formations seen in clinical practice and other settings.     

Outcomes in a System of Care for Youths with Emotional and Behavioral Disorders: An Examination of Differential Change Across Clinical Profiles

We assessed the utility of an empirically-derived classification system for youths with emotional and behavioral disorders in a system of care with a strong representation of juvenile delinquents. Eighty-seven youths served in a system of care were categorized by variables related to past history, current behavioral functioning, and current psychological functioning into four clinical clusters. We evaluated preliminary clinical outcomes after six months of interagency involvement for youths within each cluster and across the four clusters. Results indicated that youths in different clusters improved significantly in need-specific areas. Trends in our data indicated differential change in clinical outcomes across clusters. We discuss our findings within the context of emerging outcomes of youths involved in comprehensive community-based programs and consider implications for outcome research, treatment of juvenile delinquents, and mental health policy.     

Group psychodynamic counselling with final-year undergraduates in clinical psychology: A clinical methodology to reinforce academic identity and psychological well-being

Educational institutions should ensure that students develop a professional identity, as well as safeguarding their well-being and activating awareness and change processes. The aim of this study was to assess the efficacy of group psychodynamic counselling as a means of reinforcing academic identity – considered the forerunner of professional identity – and psychological well-being in a group of final-year undergraduates studying clinical psychology. Thirty-three final-year-students of clinical psychology who participated in six group psychodynamic counselling sessions were compared with sixteen final-year students of clinical psychology who had never participated in an intervention of this kind. The results suggested that group psychodynamic counselling made students feel more capable of managing their lives and more open to new experiences as well as encouraging them to perceive their relationships as more positive and satisfying, to believe that their life is meaningful, and to achieve greater self-acceptance. The in-depth exploration also prompted students to consider their commitment to their choice of career. Group psychodynamic counselling also reinforced students’ educational choice, as the likelihood of students becoming less committed to this choice was reduced after the intervention. Thus, the study confirmed the efficacy of group psychodynamic counselling as a means of reinforcing both academic identity and promoting well-being and demonstrated that it is a tool clinical psychologists and university teachers could use to activate self-reflection and change within educational settings.     

The Bottoming‐Out Experience and the Turning Point: A Phenomenology of the Cognitive Shift From Drinker to Nondrinker

The bottoming‐out experience (BOE) is commonly considered the catalyst to sobriety. A phenomenological study was conducted to gain an understanding about this occurrence for alcoholics. Results indicated two distinct experiences: the BOE and the turning point.     

走向整合的智力研究 ——Demetriou的经验结构式认知发展理论述评

基于经验结构式认知发展理论的智力结构包含环境指向系统、超认知系统和加工系统三个层次。环境指向系统用于表征和加工不同领域的信息,加工系统是个体加工信息的操作平台,超认知系统负责监控和调节其他两个系统的认识活动。三个层次的发展既具有各自的特点又相互影响。因此,该理论指出智力结构的发展是一个动态平衡过程,存在三种发展变化模式：自下而上、自上而下和平行变化。智力结构层次内和层次间的发展都要遵循四种变化的机制。该理论作为整合型智力理论有自己的优势,但在概念使用、超认知概念的提出以及执行功能在结构中定位等问题有待商榷     

Eating disorders in the course of life: A qualitative approach to vital change

Eating disorders (EDs) have become one of the biggest mental-health problems in the last decades, especially among youth and women. The present study aims to analyse the suitability of Prochaska and DiClemente’s Transtheoretical Model of Change when applied to the living experiences of people diagnosed with ED and their carers. For this purpose, we applied a narrative biographic approach to the ways in which people face their problems and vital development in the ED domain. Through the narrative analysis of these autobiographies, we aimed to study the patients’ own notions of ‘change’, ‘problem’ and ‘vital trajectory’. We focused on five autobiographic interviews of persons diagnosed as ED (four women and a man). The analysis yields three discourses which organize and give sense to our participants’ vital transitions: a discourse of functional adaptation to events and experiences; one that pays attention to random events and people entering your life; and one that has the personal initiative and agency of an individual agent at its core. It also illuminates particular ways of understanding determination, contemplation and pre-contemplation. These ways of understanding change are shown to extend the possible ways of thinking about people’s lives and ED patients’ perspectives.     

From mimesis to agency: Clinical steps in the work of psychic two‐ness1

In this paper, through the study of the clinical process of a girl starting treatment at the age of 3 years 10 months, who was thought of as a dummy by her family and who came for consultation when the assumed genetic aetiology was questioned, the authors build upon Tustin's contributions on the context of togetherness and the crisis of two‐ness, and upon Eugenio and Renata Gaddini's on the precursor object. The mimetic phenomena enacted with an older brother and at the kindergarten are found to result from cumulative trauma at her contacting a loving but mind–blind mother. After an initial stage of transference autism, enactment in the session of the traumatic situation was the first step in surmounting her autistic pseudo–stupidity. Mimetic transference dynamics took place principally at the level of the gaze, leading to the unfolding of the work of two–ness to a differentiation from the analyst as psychic breast, on the road to symbol formation and personal agency.     

A Return to “The Clinic” for Community Psychology: Lessons from a Clinical Ethnography in Urban American Indian Behavioral Health

Community psychology (CP) abandoned the clinic and disengaged from movements for community mental health (CMH) to escape clinical convention and pursue growing aspirations as an independent field of context‐oriented, community‐engaged, and values‐driven research and action. In doing so, however, CP positioned itself on the sidelines of influential contemporary movements that promote potentially harmful, reductionist biomedical narratives in mental health. We advocate for a return to the clinic—the seat of institutional power in mental health—using critical clinic‐based inquiry to open sites for clinical‐community dialogue that can instigate transformative change locally and nationally. To inform such works within the collaborative and emancipatory traditions of CP, we detail a recently completed clinical ethnography and offer “lessons learned” regarding challenges likely to re‐emerge in similar efforts. Conducted with an urban American Indian community behavioral health clinic, this ethnography examined how culture and culture concepts (e.g., cultural competence) shaped clinical practice with socio‐political implications for American Indian peoples and the pursuit of transformative change in CMH. Lessons learned identify exceptional clinicians versed in ecological thinking and contextualist discourses of human suffering as ideal partners for this work; encourage intense contextualization and constraining critique to areas of mutual interest; and support relational approaches to clinic collaborations.     

Partnerships with Psychiatry and Other Clinical Disciplines: A Key to Psychology's Success in U.S. Medical Schools

This paper describes the growth of psychology in medical schools and the distribution of psychologists across medical school departments. The Association of American Medical Colleges (AAMC) and American Psychological Association (APA) use different data collection approaches that reflect their different missions. AAMC focuses solely on medical school faculty, whereas APA tries to reach all psychologists working in academic health centers (AHCs). The number of psychologists in medical school settings has increased, largely due to their research expertise; but psychologists also contribute through teaching and clinical service. Psychologists hold appointments in wide variety of medical school departments, which has been a key factor in their success. Through partnership and interdisciplinary collaboration with a wide range of academic physicians, psychologists have gained increased support, become valued members of the AHC and medical school communities, and can rise to leadership positions in medical schools.