Multidisciplinary teamwork in primary care: The role of the counsellor

Since other professionals have joined doctor and nurse to form multidisciplinary working groups, primary health care teams have made efforts, more or less successfully, to work together. This paper views the primary health care team as a medium-sized, multidisciplinary, family-like organization with very specific characteristics. Full of promise as a synergistic body, nevertheless the team frequently struggles with difficult and even self-destructive dynamics. The structures, problems and values of teamworking in this specialized context are examined, with particular attention given to ways in which the practice counsellor can support and encourage team working. Suggestions are offered regarding how primary health care teams might move towards a more team-oriented approach.     

Emotion and ethics: An inter-(en)active approach

In this paper, we start exploring the affective and ethical dimension of what De Jaegher and Di Paolo (Phenomenology and the Cognitive Sciences, 6:485–507, 2007) have called ‘participatory sense-making’. In the first part, we distinguish various ways in which we are, and feel, affectively inter-connected in interpersonal encounters. In the second part, we discuss the ethical character of this affective inter-connectedness, as well as the implications that taking an ‘inter-(en)active approach’ has for ethical theory itself.     

Beyond you and I: role play and reflection-in-action in communication training

This article will explore the development of communication training within nurse training. Beginning by outlining current thinking around this practice, it then discusses Schön’s notion of reflective practice and its frequently cited relevance to nursing before pointing out some of its limitations. In particular, it looks at the limitations of the individual being able to critically reflect on their self within a broader social context. Drawing on the theories of Habermas and Bourdieu, it suggests that encouraging a greater awareness of one’s own social context, and hence of one’s own subject position, would develop a deeper awareness of other potential perspectives and a better ability to listen to patients. Finally, it argues for the use of role play in assisting nurses to gain such awareness, particularly in difficult clinical situations such as end-of-life care.     

An investigation of the matrix training approach to teach social play skills

Matrix training is a conceptual model inspired by the generative learning approach to program development. This investigation used matrix training to facilitate a generative repertoire of two‐component solitary and social play skills in a child diagnosed with autism and cerebral palsy. Play‐related actions and corresponding toys were aligned on perpendicular axes of a standard matrix. The learner was trained on the skills that intersected along the diagonal of the matrix. The learner acquired both appropriate solitary and social play skills. The participant also began requesting items from a peer despite not having been directly trained to do so. The untrained combinations accounted for 86% of the matrix responses acquired.     

Empathy and feedback processing in active and observational learning

The feedback-related negativity (FRN) and the P300 have been related to the processing of one’s own and other individuals’ feedback during both active and observational learning. The aim of the present study was to elucidate the role of trait-empathic responding with regard to the modulation of the neural correlates of observational learning in particular. Thirty-four healthy participants completed an active and an observational learning task. On both tasks, the participants’ aim was to maximize their monetary gain by choosing from two stimuli the one that showed the higher probability of reward. Participants gained insight into the stimulus–reward contingencies according to monetary feedback presented after they had made an active choice or by observing the choices of a virtual partner. Participants showed a general improvement in learning performance on both learning tasks. P200, FRN, and P300 amplitudes were larger during active, as compared with observational, learning. Furthermore, nonreward elicited a significantly more negative FRN than did reward in the active learning task, while only a trend was observed for observational learning. Distinct subcomponents of trait cognitive empathy were related to poorer performance and smaller P300 amplitudes for observational learning only. Taken together, both the learning performance and event-related potentials during observational learning are affected by different aspects of trait cognitive empathy, and certain types of observational learning may actually be disrupted by a higher tendency to understand and adopt other people’s perspectives.     

Measuring symbolic play style in infancy: a methodological approach.

Researchers have examined symbolic play style as a qualitative variable distinguishing two groups of children: patterners and dramatists. We have conceptualized style not as a typology of children but as reflecting dimensions of difference between children which are amenable to quantitative analysis. For the construct of style to be invoked, it must be measurable by many variables, it must be observable over time, and it ought to be demonstrably independent of general developmental level. Fifteen boys and 15 girls were each seen twice, once at 21 months of age and again 6 weeks later. The Session 2 pattern of correlations among hypothesized dramatist measures was not entirely consistent with that observed at Session 1; however, three measures, narrative vocalizations, spontaneous play, and elicited-appropriate play were primary dramatist measures at both sessions.     

Teacher feedback during active learning: Current practices in primary schools

Background. Feedback is one of the most powerful tools, which teachers can use to enhance student learning. It appears difficult for teachers to give qualitatively good feedback, especially during active learning. In this context, teachers should provide facilitative feedback that is focused on the development of meta‐cognition and social learning. Aims. The purpose of the present study is to contribute to the existing knowledge about feedback and to give directions to improve teacher feedback in the context of active learning. Sample. The participants comprised 32 teachers who practiced active learning in the domain of environmental studies in the sixth, seventh, or eighth grade of 13 Dutch primary schools. A total of 1,465 teacher–student interactions were examined. Methods. Video observations were made of active learning lessons in the domain of environmental studies. A category system was developed based on the literature and empirical data. Teacher–student interactions were assessed using this system. Results. About half of the teacher–student interactions contained feedback. This feedback was usually focused on the tasks that were being performed by the students and on the ways in which these tasks were processed. Only 5% of the feedback was explicitly related to a learning goal. In their feedback, the teachers were directing (rather than facilitating) the learning processes. Conclusions. During active learning, feedback on meta‐cognition and social learning is important. Feedback should be explicitly related to learning goals. In practice, these kinds of feedback appear to be scarce. Therefore, giving feedback during active learning seems to be an important topic for teachers’ professional development.     

Enhancing transfer of training: using role-play to foster teamwork in the cockpit

Role-plays serve a unique purpose in providing practice and feedback for aircrew team development training in the classroom. When compared with other training strategies, role-play provides targeted practice and feedback of specific behaviors at low cost, with the trade-off being the amount of fidelity it provides. This article presents guidelines for designing role-plays to elicit crew resource management (CRM) behaviors and providing feedback to trainees on their performance. Through careful design procedures, a role-play exercise can provide both targeted practice and feedback and serve a useful purpose in the overall training design of a CRM training program.     

An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping.

A new approach to the rehabilitation of movement, based primarily on the principles of operant conditioning, was derived from research with deafferented monkeys. The analysis suggests that a certain proportion of excess motor disability after certain types of injury involves a learned suppression of movement and may be termed learned nonuse. Learned nonuse can be overcome by changing the contingencies of reinforcement so that they strongly favor use of an affected upper extremity in the chronic postinjury situation. The techniques employed here involved 2 weeks of restricting movement of the opposite (unaffected) extremity and training of the affected limb. Initial work with humans has been with chronic stroke patients for whom the approach has yielded large improvements in motor ability and functional independence. We report here preliminary data suggesting that shaping with verbal feedback further enhances the motor recovery.     

Repurposing process measures to train psychotherapists: Training outcomes using a new approach

Aims: First, this paper presents the rationale for a novel approach to training counsellors in which measures for psychotherapy process research are taught to students before moving on to teaching basic empathic reflections and interventions. The rationale for this is that client process measures can be re‐purposed to help orient and sensitise trainees to key in‐session moments. Second, we present a training outcome study that assesses the effectiveness of this approach. Method: Using an experiential‐integrative therapy approach, a 13‐week training program was used to teach psychotherapy skills and process research measures to22 clinical graduate students taken from two cohorts. As part of the course, trainees conducted several single sessions with volunteer clients on four separate occasions. Training outcomes were measured using both trainee and client reports. Results: Compared to baseline, therapists reported significant and steady gains (all p's<.05) in session management, reducing their anxious self‐awareness, and in improved sense of self‐efficacy, with the latter having the largest effect (partial Eta Sq.=.381). Discussion: While the findings provide some support for a new training strategy, a dismantling design is needed next to more closely examine the process‐measure approach to training.     

The role of processes and contents in human memory: An item response theory approach

This study investigated the specificities and communalities of visuospatial and verbal memory contents, as well as short-term memory and working memory (STM and WM) processes with the use of Rasch models as an alternative to the previous studies based on the classical test theory. A sample of 547 undergraduate students executed four computerised tasks, each consisting of verbal-numeric WM, visuospatial WM, verbal-numeric STM, and visuospatial STM content. Confirmatory factor analyses indicated that visuospatial and verbal-numeric memory are distinct, but correlated variables. Findings also support a domain-general view of WM capacity distinct from domain-specific storage. With the use of Rasch models, our results confirm previous experimental, psychometric, and neuropsychological studies, highlighting that memory span tasks can be divided into separate subsystems for content and processes. This study also shows that better results are obtained when models with person parameter estimates (provided from Rasch models) are adopted, rather than summed raw scores.     

Organizational media choice in performance feedback: a multifaceted approach

This study was designed to examine media choice in performance feedback, an organizational communication process that has been overlooked in the literature. Specifically, we adopted a multifaceted approach and examined how contextual variables in feedback, variables identified from media choice theories, and individual differences in media perception influenced selection of a medium to communicate performance information. A policy‐capturing survey was administered to 178 full‐time employees in Hong Kong. Participants read feedback scenarios and provided media preference ratings of face‐to‐face, telephone, electronic mail, and written communication. Results showed that the three facets jointly influenced media choice. Given that communication quality is partly determined by the medium selected, the present work sheds light on the understanding of initiation process in performance feedback.     

Interpreting imaginative play in child psychotherapy: Towards a phenomenological hermeneutic approach

Abstract

Despite renewed interest and technical advances in play therapy with children, its theoretical basis remains weak. A phenomenological hermeneutic approach to play therapy offers a philosophically grounded theoretical understanding of the meaning of children's expressions through imaginative play in a therapeutic context. Drawing upon Gadamer's ontological concept of play and Ricoeur's theory of interpretation, a child's imaginative play is seen as a text that calls for interpretation. The understanding and interpretation of imaginative play in play therapy is illustrated by means of a case vignette of a young physically abused child.     

Self-images play a causal role in social phobia

Patients with social phobia often experience negative self-images in social situations. The current study investigated whether negative self-images have a causal role in maintaining social phobia. Patients with social phobia participated twice in a conversation with a stranger, once whilst holding their usual negative self-image in mind and once whilst holding a less negative (control) self-image in mind, with order counterbalanced across participants. Compared to the control image condition, when participants held the negative image in mind they experienced greater anxiety, rated their anxiety symptoms as being more visible, and rated their performance as poorer. An assessor who did not know which image was being held also rated participants' anxiety as more evident and their behaviour as less positive when the negative image was being held in mind. Finally, when participant and assessor ratings were compared, participants underestimated their performance and overestimated the visibility of their anxiety to a significantly greater extent in the negative imagery condition. Taken together, these results support the hypothesis that negative self-imagery has a causal role in maintaining social phobia.     

Blindsight: the role of feedforward and feedback corticocortical connections

When human subjects suffer from a lesion to the primary visual cortex, they lose all visual percepts in the region of space that corresponds to the site of the lesion. However, they are still capable of responding to stimuli in this region when asked to 'guess' or to execute forced-choice motor commands related to these stimuli. This phenomenon, termed blindsight, is still only partly understood. Here, the possible roles of feedforward and feedback corticocortical connections in the visual brain in the understanding of blindsight are reviewed. What emerges is substantial evidence in favor of the theory that unconscious visuo-motor transformations, as in blindsight, may be executed in an entirely feedforward processing cycle, while visual awareness is critically dependent on feedback connections to the primary visual cortex.     

Appearance feedback in intimate relationships: The role of self-verification and self-enhancement

To better understand how body image operates within the context of intimate relationships, we investigated women's responses to appearance feedback from an intimate partner. Participants (N = 192) imagined receiving feedback from their partner that was either consistent with their own appearance self-view (i.e., self-verifying), more positive (i.e., self-enhancing), or less positive (i.e., devaluing), and then provided their affective and cognitive reactions. As expected, women's perceptions of their own appearance moderated their reactions. Women with more negative self-views felt happier with enhancing feedback, but thought that it meant their partner understood them less well. They also felt less happy when they received verifying feedback, but felt more understood by their partners. Thus, women with body image dissatisfaction may find themselves stuck in the “cognitive-affective crossfire” reacting ambivalently whether their partner enhances their appearance or confirms their negative self-views. Further examination of partners’ actual feedback is needed.     

Relationship between implicit false belief understanding and role play: Longitudinal study

Pretend play is one of the earliest forms of children’s imagination. While social pretend play (role play) may facilitate the development of theory of mind – including false belief understanding – theoretically, the reverse may be true; theory of mind may facilitate the development of role play. To clarify this relationship, the present longitudinal study examined whether toddler’s implicit understanding of false beliefs predicted their role play during preschool years. We examined 18-month-old toddlers’ looking time in an implicit false-belief task (Time 1). When the children were 4/5 years old (Time 2), children’s parents answered a questionnaire on their child’s engagement in role play, such as playing with an imaginary companion and impersonating an imagined character. Toddlers’ looking time in the false-belief task at Time 1 predicted impersonation scores at Time 2. The results suggest that early theory of mind skills can facilitate children’s role play.     

Training in family psychology: a competencies-based approach

After providing an overview of the family psychology landscape and the competencies-based movement in professional psychology, attention is paid to eight family-specific competencies in the following areas: the application of scientific knowledge to practice, psychological assessment, psychological intervention, consultation and interprofessional collaboration, supervision, professional development, ethics and legal issues, and individual and cultural diversity. Effective strategies for providing family-focused education and training to psychology trainees at the doctoral, internship, and postdoctoral levels and to psychologists through continuing professional education in these core competency domains are provided.