Low-level relationship aggression and couple therapy outcomes.

Increasing evidence supports the efficacy of conjoint therapies that focus on intimate partner violence for couples who engage in mild to moderate physical aggression but want to preserve the relationship and end the aggression. However, there has been no examination of how this population responds to couple therapy that does not have a specific focus on aggression. This lacuna in the research literature is of concern because couples with a history of low-level aggression often seek couple therapy, but couple therapy without a focus on violence is thought to potentially exacerbate aggression. In the current study, the authors examined the efficacy of non-aggression-focused behavioral couple therapy for couples with and without a history of mild physical aggression. One hundred thirty-four couples, 45% of whom had experienced low-level aggression in the year prior to therapy, completed up to 26 sessions of couple therapy and 2 years of follow-up assessments. Results demonstrated no significant differences in relationship and individual outcomes by history of aggression. In addition, couples maintained very low levels of physical aggression during and after treatment and showed reductions in psychological aggression when relationship and individual functioning improved.     

Perception as abduction: turning sensor data into meaningful representation

This article presents a formal theory of robot perception as a form of abduction. The theory pins down the process whereby low-level sensor data is transformed into a symbolic representation of the external world, drawing together aspects such as incompleteness, top-down information flow, active perception, attention, and sensor fusion in a unifying framework. In addition, a number of themes are identified that are common to both the engineer concerned with developing a rigorous theory of perception, such as the one on offer here, and the philosopher of mind who is exercised by questions relating to mental representation and intentionality.     

Prelogical Experience by Edward S. Tauber and Maurice R. Green

Working as director of a group psychotherapy training program in a university medical center, the author has observed many groups in periods of decreased group stability. These situations tend to arise frequently in an academic setting where summer breaks and other school-related holidays may result in extended periods of irregular attendance. Such times appear to be quite stressful to group members and leaders and frequently result in a storm of transferential and/or countertransferential acting out. This may carry over into supervision sessions via the mechanism of the parallel process and these, too, may become stressful, unrewarding, and nonproductive. An attempt to understand such situations and to find better ways of helping trainees deal with them constructively has resulted in the following ideas about group instability. Although these times remain uncomfortable and stressful, they can be managed and used to generate valuable information for the participants that can further the therapeutic process.     

Predicting the Long-Term Effects of Human-Robot Interaction: A Reflection on Responsibility in Medical Robotics

This article addresses prospective and retrospective responsibility issues connected with medical robotics. It will be suggested that extant conceptual and legal frameworks are sufficient to address and properly settle most retrospective responsibility problems arising in connection with injuries caused by robot behaviours (which will be exemplified here by reference to harms occurred in surgical interventions supported by the Da Vinci robot, reported in the scientific literature and in the press). In addition, it will be pointed out that many prospective responsibility issues connected with medical robotics are nothing but well-known robotics engineering problems in disguise, which are routinely addressed by roboticists as part of their research and development activities: for this reason they do not raise particularly novel ethical issues. In contrast with this, it will be pointed out that novel and challenging prospective responsibility issues may emerge in connection with harmful events caused by normal robot behaviours. This point will be illustrated here in connection with the rehabilitation robot Lokomat.     

Why do people change in therapy? A preliminary study

Why do people change in therapy? A preliminary study. This work represents the beginning of a new way to study the processes that can explain the therapeutic change. The method used is the observation and analysis of therapeutic sessions directly recorded and developed inside a behavioural approach. The category system tries to carry out a functional analysis of the therapist-client interaction which enables the identification of learning processes that work in clinical setting and explain success in therapy. Outcomes are provisional but show the utility of this initial trend of investigation to the comprehension of clinical phenomenon. Conclusions also emphasize the importance of associative learning processes on the therapeutic change.     

Interventions in everyday lives: How clients use psychotherapy outside their sessions

The purpose of psychotherapy is to help clients address and overcome problems troubling them in their everyday lives. Therapy can therefore only work if clients include it in their ongoing lives to deal with their problems. Detailed, systematic research is needed on how clients do so in their everyday lives outside their sessions. A design of exploratory case studies on this topic is presented in this article. The main outcomes of such a case study on family therapy are then laid out in general terms. They highlight how treatment practices and clients’ ordinary everyday practices interact when clients change their everyday lives to overcome their troubles. They also highlight what it involves for clients to accomplish this. It is concluded that we need more research on how to understand intervention; on the interaction between interventions and clients’ conduct of their everyday life; on sessions as a particular, secluded part of clients’ ongoing everyday lives, and on how to consider therapists’ procedures and conduct of sessions accordingly.     

膀胱过度活动症诊治的思考

随着老年人口的增多,膀胱过度活动症的发病率也会逐年升高,但其确切病因不清楚,临床症状不典型,很多患者对这种疾病认识不够,严重影响着患者的生活质量,给患者带来了极大的生理和心理上的困扰。因此,临床工作中应注意发现膀胱过度活动症相关的临床症状,结合完整全面的病史,进行体格检查和相关的辅助检查,及早诊断并给予合理的治疗,提高患者的生活质量。     

针灸防治神经系疾病的适应证及其优势

针灸常被推荐为某些神经系疾病的常规治疗和康复手段,但其适应证和优势是什么?通过考察《神经病学》教材和近10余年来期刊文献。推荐针灸适应证和优势病种计有坐骨神经痛、特发性面神经麻痹等25种,可研究病种有不安腿综合征等47种。中西医有关针灸防治神经系疾病的认识貌“结”而神不“合”。     

Virtual action planning in Parkinson's disease: a control study.

Cognitive planning deficits affect patients with Parkinson's disease (PD) and traditional psychometric tests meet difficulties to evaluate their impact on daily life activities. Virtual reality (VR) may provide a new means of assessment. The objective of this study was firstly to develop a virtual environment (VE) useful to explore planning and secondly to examine the effectiveness of using VR in the assessment of cognitive planning for patients with PD. A virtual supermarket (VS) was designed in which participants carried out a task close to daily activities: a test of shopping list. There were two preliminary sessions to familiarize the participants with the software and the supermarket's layout. Then, during the assessment session, participants completed the task, without any time limitation. Global intellectual efficiency was assessed in order to exclude patients with dementia. Data related to the performance in the VS were recorded. Five patients with PD and five age-matched healthy volunteers, meeting inclusion criteria, constituted our convenience sample. The patients did not perform as well as the control group. In particular, the session's duration and the distance covered were longer. The patients' path is specific with numerous stops, turning around, and hesitancies. Finally, their motivation for further training sessions is aroused. The results underline the potential of using VR in the assessment of cognitive planning in PD. A larger analysis is currently being carried out to confirm and to explore all the outcome measures.     

Working through: in-session processes that promote between-session thoughts and activities

This study examined whether clients' ratings of the working alliance as well as their perception of cognitive-behavioral (CB) and psychodynamic-interpersonal (PI) techniques (delivered by therapists who used both) were associated with clients' intersession processes (i.e., their thoughts about therapy and therapeutic activity between sessions). Seventy-five clients who were currently in therapy at a large university counseling center participated in the current study. Multilevel regression analyses demonstrated that alliance and clients' perceptions of their therapists' use of PI techniques were positively associated with clients' general thoughts about therapy between sessions. Also, stronger alliances were associated with more therapeutic activities between sessions and more positive (and less negative) thoughts about therapy between sessions. In addition, clients at later sessions who described their therapists as using more PI techniques also reported engaging in more therapeutic activities between sessions (after controlling for the variance in the other variables, such as use of CB techniques). Clients' perceptions of their therapists' use of CB techniques in the most recent session were not related to thinking about therapy or therapeutic activities after controlling for the variance in the other variables.     

Therapeutic tasks: what kind of help is sought in psychotherapeutic sessions?

One of the main conditions for a good psychotherapeutic alliance is the agreement on therapeutic tasks and goals. This article explores the kind of help that clients expect from therapeutic sessions. By means of a written questionnaire, the clients of a private psychotherapy center, prior to the sessions, expressed their priorities regarding the work to be carried out in them. The assessment of 873 questionnaires showed that clients prefer to participate in therapeutic work that helps them plan actions, understand what is happening, and assess possibilities for change. Also important are therapeutic tasks that help clients evaluate their own actions, both past and planned. The importance that clients attach to different kinds of help varies above all according to how near they feel to resolving their problems. Nine different kinds of psychotherapeutic tasks are identified, which cover the possible requests a client can make of his/her therapist. This article discusses the clinical application of this model as a basis for planning and classifying psychotherapeutic interventions.     

Comparison of contingent and noncontingent access to therapy dogs during academic tasks in children with autism spectrum disorder

This study compared contingent and noncontingent access to therapy dogs during educational tasks for children with autism spectrum disorder using a multielement design. The experimenters assessed whether initial preference for the dog predicted reinforcer efficacy and how preference changed across time. A higher response rate during contingent dog sessions than baseline sessions occurred for 4 out of 5 participants, suggesting that the dog functioned as a reinforcer. One participant engaged in a high rate of responding in both contingent and noncontingent dog conditions. Preference assessments revealed idiosyncrasies, suggesting that further research is needed into the predictive nature of initial preference assessments with animals as part of the stimulus array. The experimenters also analyzed salivary cortisol before and after sessions to determine if learning about the upcoming interaction with a dog reduced salivary cortisol in children. Cortisol was variable across participants, with only some deriving a potential physiological benefit from expecting to interact with the dog.     

The Reflective Scribe: Encouraging Critical Self-Reflection and Professional Development in Pre-Health Education

Much has been said about the formative process that occurs via the “hidden curriculum” of medical education during which many students experience a disconnect between the professional values espoused within the formal curriculum and the implicit values communicated through interactions with peers and mentors. Less attention, however, has been paid to the formation of the future medical self that takes place during students’ premedical years, a time in which many undergraduate students seek out immersive clinical experiences —such as medical scribing— before applying to medical school. Despite the fact that medical scribes undoubtedly are affected by their clinical experiences, scribes are rarely offered opportunities to reflect on them. The authors contend that the developmental processes of medical scribes, especially those who intend on pursuing a career in the health professions, ought to be supported. This can be achieved, at least in part, through engaging in well-designed reflective sessions with other scribes. Encouraging students to reflect on their experiences can help them make sense of troubling events and give voice to the inconsistencies and value conflicts within medical practice that are so often ignored. The authors describe the development of their new Reflective Scribe program and offer suggestions for future directions.     

Kurz- und Langzeitbehandlung in der Verhaltenstherapie

In Germany, short and long-term psychotherapy are the two established forms for providing basic outpatient cognitive behavior therapy. The goal of the current study is to describe and discuss empirical evidence for these two structural forms; therefore, results from randomized controlled trials are presented and their implications related to the optimal number of therapy sessions are described. Furthermore, important results of naturalistic process outcome research are outlined. Additionally, the individual needs of patients for specific numbers of sessions are described based on data from the Association of Statutory Health Insurance Physicians. The results of randomized controlled trials generally showed strong empirical evidence for the efficacy of short-term cognitive behavior therapy of 7–20 sessions in patients with simple diagnoses; however, there is less empirical evidence in relation to the general efficacy and differential indications for long-term behavior therapy. These study results are supported by data from 200,000 patients receiving outpatient treatment in the German healthcare system. In two thirds of these patients, less than 25 sessions were sufficient to achieve subjectively adequate clinical improvement; however, approximately 10?% of the patients needed more than 60 therapy sessions. Empirical evidence concerning outcomes of long-term therapy with such a high number of sessions is scarce. Future research should address this research gap in order to identify empirically-based individual adaptation rules concerning the optimal number of treatment sessions in long-term therapy.     

Family sessions as part of child psychological assessment: goals, techniques, clinical utility, and therapeutic value

Including a family session in a child assessment can significantly advance the assessor's and parents' understanding of the child's problems and enhance the likelihood that parents will follow through on recommendations after the assessment. A family session allows the assessor to observe the child in the family context, test systemic hypotheses, better understand the meaning of individual test results, and try out possible interventions. A family session may also help parents see systemic aspects of their child's problems, help the child feel less blamed, foster positive experiences among family members, and offer the family a glimpse of family therapy. We describe methods and techniques for structuring family sessions and offer guidance on preparing for and conducting such sessions depending on one's case conceptualization. Detailed case examples illustrate each technique and demonstrate the immediate and subsequent impact of family sessions as well as their therapeutic value. We also address common clinical and pragmatic issues.     

‘Heart-talk:’ Considering the Role of the Heart in Therapy as Evidenced in the Quran and Medical Research

The emphasis on scientific approaches and evidence-based therapy has been a key force in developing and refining existing models of therapy. While this has been unquestioningly invaluable, it has similarly restricted the development and so implementation of those models that do not lend themselves easily to current research methodology, since the lack of evidence-practice research means they are not considered as ‘legitimate’ therapeutic practice. That the mind and body have an inter-dependent relationship is readily evidenced in numerous religious texts, but the lack of acknowledgement of that relationship in contemporary therapeutic approaches means that patients are not able to benefit from its use in sessions. Ironically, it is current developments in medical research that have discovered the reality around this relationship that have enabled such models to be further explore within an accepted context of evidence-based practice. This paper highlights the relationship between the heart and brain function as evidenced with brief reference to Quranic verses and medical (namely, neurocardiological) research. Further, it raises questions around the implications of this information for therapists working in both physical and mental health. The concept of ‘heart talk’ is an extension of the term ‘heart brain’ coined by Dr Armour (Professor of Pharmacology) in 1991 and is suggestive of its use in the world of psychological therapy. It relates to those cognitions which patients suggest come ‘from the heart’ which though previously dismissed are now suggestive of having some scientific basis and are potentially a legitimate source of information in understanding patients experiences.     

Medical Family Therapy for a Woman with End-stage Crohn's Disease and Her Son

Medical family therapy grew out of the experiences of family therapists working with other professionals to provide comprehensive, integrated healthcare for patients (McDaniel, Hepworth, & Doherty, 1992). This is the story of one such patient, her son, and those of us who were the three primary participants on her treatment team. To provide an account that comes closest to the experience itself, we have taken quotes from videotaped sessions and electronic mail communications that occurred throughout the course of therapy. Each provider tells part of the story in his or her own voice. The commentary is provided by Susan McDaniel.     

A comparison of attachment outcomes in enactment-based versus therapist-centered therapy process modalities in couple therapy

Attachment issues are viewed by many therapists as lying at the heart of couple distress. It is critical to empirically validate therapy processes that facilitate couples in responding to each other's attachment needs. This study examined enactments as a therapy process and change mechanism to promote secure attachment in couple therapy. Sixteen couples were randomly assigned to 1 of 2 experimental groups--1 group received 3 therapist-centered sessions followed by 3 enactment-based sessions, and a second group received 3 enactment-based sessions followed by 3 therapist-centered sessions. To measure between-session and within-session change, each spouse completed presession and postsession measures of attachment security each week. Results showed that couples who received enactment-based sessions first reported greater increases in attachment security than those receiving therapist-centered sessions first. These same couples continued to show improvement after switching to the therapist-centered sessions. Conversely, couples who received therapist-centered sessions first did not increase attachment after switching to enactment-based sessions. For wives, enactment-based sessions produced the greatest improvement in attachment, yet both therapy process modalities led to some improvement. Conversely, for husbands, attachment improved only when they received enactment-based sessions first. Enactment-based sessions may therefore be more important for husbands than wives. Overall, with some qualification it appears that enactment-based therapy process may improve attachment more than a therapist-centered process. These observed trends and findings are generally consistent with previous research supporting use of enactments in couple therapy.     

A cognitive architecture that combines internal simulation with a global workspace

This paper proposes a brain-inspired cognitive architecture that incorporates approximations to the concepts of consciousness, imagination, and emotion. To emulate the empirically established cognitive efficacy of conscious as opposed to non-conscious information processing in the mammalian brain, the architecture adopts a model of information flow from global workspace theory. Cognitive functions such as anticipation and planning are realised through internal simulation of interaction with the environment. Action selection, in both actual and internally simulated interaction with the environment, is mediated by affect. An implementation of the architecture is described which is based on weightless neurons and is used to control a simulated robot.