A theory of clinical practice: the cognitive and the narrative

Today the extent of the difference between theoretical models of therapy is under discussion. There have been proposals to abandon such models altogether, or to create others, such as integrative or meta‐ theoretical models. This article proposes, through the analysis of a clinical situation, the possibility of building a theory of practice which could account for most of the aspects of the therapeutic process that remain tacit and implicit. Such a theory could help us explain what concretely happens when a therapist is doing therapy, and also how theoretical models interact with the everyday practice of therapists.     

Some structural considerations in the relationship between M and empathy

After reviewing some of the difficulty around defining empathy, this paper draws attention to three underemphasized structural factors in the empathic tie between self and other. The following distinctions are drawn: (a) empathy vs. fusion with the object: (b) empathy vs. a narcissistic attachment to the object: and (c) empathy vs. an intuitive but fragmented orientation to part-objects. The relationship between Rorschach's M and empathy is reexamined in light of these considerations, and it is concluded that the experience of kinaesthesia on the Rorschach reflects some, but not all, of the components of empathy.     

Bridging between basic theory and clinical practice

This paper articulates and discusses the parts played by different processes and representations in the overall conduct of applied clinical science. It distinguishes two sorts of representation, theories in the science base and bridging representations needed to map from real world behaviour to basic theory and from theory back to the real world. It is then argued that macro-theories of the "normal" human mental architecture could help synthesise basic theoretical accounts of diverse psychopathologies, without recourse to special purpose clinical cognitive theories of particular psychopathologies or even specific symptoms. Using the Interacting Cognitive Subsystems model [Affect, Cognition and Change: Re-modelling Depressive Thought, Lawrence Erlbaum Associates, Hove, 1993], some specific macro-theoretic variables are identified. Concrete illustrations are given of how the essence of quite complex basic theory can be translated into a simpler representational format to help clinicians conceptualise a psychopathological state and pinpoint relevant variables that might be changed by therapeutic interventions. Some suggestions are also offered about how the inevitable problem of complexity in multiple component theories might be directly confronted.     

Analytic practice: Convergences and divergences1

The author discusses current convergences and divergences concerning analytic practice. After presenting a clinical vignette that can be understood differently according to different theoretical approaches, he discusses Wallerstein’s proposal of a common ground in psychoanalysis and suggests that the present state of the art indicates that psychoanalysis is a pluralistic discipline, with different ways of training and practising it, and that the main challenge is to improve our ability to listen to and to learn from different approaches.     

Class in psychodynamic theory,research and practice

Class is a generally neglected topic within the psychotherapeutic and counselling worlds, and has not benefitted from the psychoanalytic and psychodynamic thought arising from contemporary critiques concerning gender, sexuality, and race. The article presents an overview of my researches over many years in an attempt to formulate the different ways in which considerations of class may impinge on practices and theories in the therapeutic professions. I use a clinical vignette to identify class related issues that may arise within the consulting room, and relate these to wider aspects of the intersections of class with therapy and counselling.     

The role and relevance of theory in careers professionalisation and practice

ABSTRACT

A new qualification benchmark, the Qualification and Credit Framework (QCF) Diploma Level 6 in Career Guidance and Development was established in the UK in 2011. This study was conducted to ascertain whether a theoretical nexus is necessary for practice and how this could contribute to the professionalisation of the adult careers sector in England. The study was undertaken with practitioners, all of whom had trained either through the work-based competency route or the academic route. Practitioners were asked to consider their theoretical modalities and how this influenced the embedding of theory within their professional practice. Analysis of survey and case study data revealed that degrees of exposure to theory during initial training affect capacities for theoretical integration during ongoing practice and development.     

Critical reflection in midwifery practice: the protection motivation theory

Background: The aim of this paper is to shed light on the notion of fear and inter-personal working relationships, and to promote safe midwifery practice, by critically reflecting on our practice and being aware of fear appeals and the protection motivation theory (PMT).

Theory: PMT provides a general account of the impact of persuasive communication, emphasising the cognitive processes that mediate behaviour change and questions whether ‘fear appeals’ could influence behaviour. Discussion: It is possible that when a midwife decides on a particular care pathway, she determines the degree and perception of the four elements of the PMT; severity, vulnerability, response-efficacy and self-efficacy. If the midwife decides that both the degree of severity and her perception of vulnerability are high, whereas response and self-efficacy perceptions are low, she will probably decide against her original care pathway. For the PMT to be used safely, an appropriate judgement call is required and is based on full understanding of the situation, effective communication with the multidisciplinary team, full knowledge of the proposed care, and competence and confidence in the proposed care. Conclusion: By critically reflecting on their practice and using the PMT, the author believes that midwives will be able to work in partnership with obstetricians to provide safe and effective care within their sphere of practice and in the absence of fear.     

我们时代的境遇——临床诊疗行为中的医患文化冲突

就临床诊疗工作中的医患文化冲突问题,从何谓文化冲突、它的行为表现、文化冲突的原因等方面进行了探讨,从认知、情感、社会心理、环境变迁、价值观多元等社会文化的层面来认识和分析医患之间的复杂关系,并就正确看待和弱化医患文化冲突提出了意见。     

目前医疗执业环境对临床实习带教的影响和对策

现有的医师执业制度和不完善的医疗保障体制使医疗环境复杂化,为临床实习带教带来新的问题和挑战。探索新的教学意识和带教模式是提高临床实习质量的关键。文章分析了目前医疗执业环境对临床实习带教的影响,提出加强带教意识,在建构主义教学理论指导下,应由“教”转为“学”,采用“互动式”教学模式提高临床实习水平。     

伦理导向人力资源管理实践的跨层次作用机制:基于社会情境与社会认知理论

伦理 ¹( ¹ 与组织管理领域的常规做法一致, 本文将伦理与道德看作同义概念, 交替使用。)危机给企业经营带来巨大挑战, 现有文献较多关注微观视角的伦理行为, 缺乏从中观视角对人力资源管理制度开展研究, 导致在实践上无法形成有效的制度化抓手。人力资源管理实践作为中观视角的企业伦理实践之一, 正是针对伦理问题的有效回应。立足于人力资源管理与企业伦理领域的交叉点, 从三个方面构建伦理导向人力资源管理实践的研究框架:(1)基于社会情境理论探讨伦理导向人力资源管理实践对组织伦理绩效的影响机制; (2)基于社会认知理论探讨伦理导向人力资源管理实践对团队伦理建言的跨层次影响机制; (3)基于社会认知理论探讨伦理导向人力资源管理实践对个体伦理建言的跨层次影响机制。研究将丰富人力资源管理理论, 并为企业有效实施伦理导向人力资源管理实践提供启示与帮助。     

A framework and two sketches concerning psychoanalytical training and practice

The author discusses the mode of knowledge production in psychoanalysis based on a reflection on the psychoanalytical education and its relationship to clinical practice. She points out that there is a risk in a form of clinical activity found in our education, which, under the fascination of the analyst's power of operating in the metaphorical domain of words, loses sight of the material dimension of the clinical action. In other words, this form of clinical activity loses sight of the meeting with another human being, of the repertoire of theories and experiences that informs this action and the patient's and the analyst's concrete life situation. The author highlights the role of writing as a privileged way of dealing with the material and immaterial facts that constitute the clinical action and reflects on some of the forces that structure nowadays the reception of knowledge production inside the psychoanalytical field. She uses the notion of 'minor literature', by Franz Kafka, to express the possibility that a live circuit of writings exchanged among psychoanalysts can offer to an interchange of experiences and ideas that is the live expression of the history of the psychoanalytical groups. A clinical session is presented in order to promote considerations about the psychoanalytical education, theory and practice.     

Containment in theory and practice

Abstract

This article selects the term ‘containment’ as a vehicle for an exploration of multi-professional work and communication in the general practice setting. The term was selected because of its widespread use by and relevance to the different professionals who work in general practice. It is sufficiently elastic to be applied to one-to-one work between patients and GPs, counsellors, nurses or complementary therapists, and to a multi-professional teamwork process.

The exploration of the concept in use at Marylebone Health Centre is complicated by the multi-professional nature of the team and then-wide range of belief systems and language groups. In the process of exploring the term, members of the team had to cope with their discovery that it was being used in contradictory ways. They decided that a new and more grounded definition in shared and ordinary (nonprofessional) language was needed, if the term were to become a vehicle for inter-professional collaboration and if unhelpful, anti-task social defences were to be minimised.     

Deconstructing consumer behaviour: theory and practice

This paper challenges the conventional opposition, or distinction, between consumer behaviour theory and practice. This binary dualism, it is argued, is predicated on a simplistic ‘either/or’ logic that ignores the effects theory and practice have on each other. Furthermore, it obscures a hierarchical relationship between academic researchers and marketing practitioners in which basic research is more dominant and privileged than applied research. In response to these criticisms, an alternative ‘both/and’ logic is proposed for exploring the interrelationships between consumer behaviour theory and practice and new social relations among consumer researchers. Copyright © 2001 Henry Stewart Publications.     

儿童阅读与心理理论间的关系

阅读与心理理论(theory of mind, ToM)在儿童发展过程中都发挥着重要的作用,梳理文献发现两者可能存在双向促进作用。儿童通过与家长或老师的共享阅读,启动联合注意,使用心理状态术语进行对话,进一步根据社会想象力,模拟社会互动,从而促进儿童心理理论发展。另一方面,在阅读过程中,心理理论能够助力儿童从宏观的阅读观的建立、元认知阅读策略的使用、故事情境模型的构建,到微观具体的短语、句子、语篇和多文本的理解等能力的提高,这些证据揭示了心理理论可以从多方面促进儿童阅读能力的发展。进一步的神经生理证据发现,阅读和心理理论这两个过程的神经活动是有一定重叠的。由此推测,两者可能具备潜在的双向促进关系。未来需要更深入和长期的纵向追踪研究为两者的关系提供丰富的实证证据。此外,还应进行更多中国的低龄儿童的研究。随着科技的发展和线上课程的盛行,也应更多关注多媒体内容阅读对儿童心理理论的影响。     

Uses and abuses of theory: a group analytic perspective

Group therapy occupies a curious and ambiguous status in the overall mental health field: groups are recognized and marginalized, sought after and avoided, respected and dismissed as second best to individual therapy. Groups are now practised widely in many services, probably because of the pressure of referrals and increased concern about funding, but even then have a secondary status. The under-recognition of both the value and complexity of groups seems to parallel the problems of theory which are part of the group psychotherapeutic culture. Rather than attempt a comprehensive theory of groups in this article, I intend to present some of the problems about theory and its link to practice, focusing particularly on the ambivalence about groups that I see as a continuing concern. I do so from a position which values theory, seeing in theory the container of understanding which guides psychotherapeutic practice. I do not identify with a critical position which rejects theory. This position recognizes fully the risks and dangers of over-theorizing, the potential to distort human contact through a rigid adherence to theory; however, I write in the spirit of appreciating theory thoughtfully applied as without theory, our work might be impoverished and even impeded.     

Axiomatic world theory: An overview the general theory of evolution in brief

The world, its many subsystems and all their theories, starting with logic, can be reduced to two related functions: a combinatorial system generator and a hamiltonian system organizer. These can be derived, in turn, from an Axiom of Lawfulness, the expansion being guided by pseudo‐category and pseudo‐functor analysis to produce an axiomatic theory of the world or general theory of evolution. Specifically, world evolution is generated by a constrained combinatorial world generator, F:G_(X), deduced from two related axioms: I. The Axiom of World Lawfulness and II. The Axiom of World Constraint Constants, c = c₁, c₂, of primordial physical combinatee (substance), c₁, and physical combinator (motion), c₂.

Axiom I postulates a lawful analysis by an analyzer adhering to appropriate coordinate systems, CS, of a lawful analysand obeying a conservation law, X = X. The analysand consists of a base combinatee (the set and elements), X = {x₁, x₂,… x_n}, and a base combinator, namely, the universal Boolean operator, NOR = NOT + OR. Base combinatee and combinator both have attributes of quantity combinatorially generated by NOR operating on the universal number, 1, and of quality generated by NOR operating on the universal dimensions, MLT (mass, length, time), including the null sets.

Axiom II fixes the base constants, c, = c₁, c₂, thereby converting X to material substance using c₁ and NOR to material motion using c₂. This comprehensive, quality and quantity‐competent foundational science is called Universal Combinatorics. Its elements comprise the logical alphabet or metavector, A = {c, 1, MLT; X, NOR}, where c is obtained from the remaining terms. These give: (1) the attributive pseudo‐functor, F = P_(c,1,MLT), where P is the power set of the indicated attributes, and (2) the logic generator, G_(X), where G = NOR_(NOR). F then maps G_(X) into world evolution, F:G_(X) → world evolution, as follows:

Expanding the abstract generator, F₁:G,_(x), with world constants eliminated, i.e., c = 0, generates Universal Grammar consisting of (1) the substantive content of the abstract science chain running from linguistic grammar to mathematics and logic and (2) a comprehensive epistemology equivalent to an explicit theory of the strategic aspects of the scientific method, including a universal hamiltonian theory structure informally related to a mathematical category. The four epistemological theorems are:

1. I. The Combinatorial System Generator, F:G_(X), (read as “The attributive functor, F, maps the logic generator, G_(X), into world theory” or “The world is an attributive combinatorial function of logic").

2. II. The Hamiltonian System Operating Theorem, h (an abstract theory‐category structure).

3. III. The System Stability Theorem, PI?, where PI is the extremal Performance Index or controlling law.

4. IV. The Intersystem Abstraction Ranking Theorem given by the Attributive Functor/ Function, F.

F₂ admits the world constants, c > 0, to materialize the grammar generator, G_(X), to an homologous concrete Euler combinatorial physical wave generator, namely, the superstring equation of quantum theory, E_(NI) = A(σ,τ), where E is the permutational function, NI, is the set of nonintegers and the solution is the dual amplitude, σ,τ. Expanding generates the elementary particles of nonadaptive physics and, by inference, the substantive content of Universal Physics consisting of three additional primary systems comprising the world, where a primary system is defined as one having a distinct but derivative extremal controlling law:

1. I. Nonadaptive physics and chemistry (harmonic hamiltonian wave systems) : Minimize Action, subject to conservation constraints.

2. II. Adaptive physics or biology (membrane bound duplicating polymer‐copolymer hamiltonian systems) : Maximize Survival, subject to energy constraints.

3. III. Sentient physics or sociopsychology (neuromatrix hamiltonian systems) : Maximize subjective Happiness, subject to survival constraints and

4. IV. Representational physics or language (a symbolic combinatorial routine): Maximizes the Information Gain, subject to happiness constraints.

The world can then be viewed as a perpetual superfluid computer implicitly using the epistemology of Axiom I as a world program to process the physical data base, c > 0, of Axiom II into world evolution. After evolving through Systems I and II, mankind, i.e., System III, evolves as an internal metacomputer which makes the combinatorial program explicit and uses it to put all four primary systems in standard hamiltonian theory (pseudo‐category) format and terminology. This can be viewed as a generalization of the Darwinian variation‐and‐selection theme in which combinatorial‐variation is recursively hamiltonian‐selected thereby incrementing world logic and logic constraints on successive primary systems. Because Universal Physics and Universal Grammar are functor‐related homologous concrete and abstract combinatorial pseudocategories, related by a pseudo‐functor, thus, differing only in the presence and absence, respectively, of the World Constants, c ≥ 0, they constitute, ipso facto, Universal Science (Formal Philosophy, World Evolution, World Unification, Explicit Theory of Everything, ETOE, or Axiomatic World Theory).

QED: Because intricate verified predictions, ranging from particles to personality types, mental disorders, political parties and the abstract sciences, result from a system which is merely expanding to fill its possibility set, it is concluded that the world is lawful and that this means it is an object deterministic but not fully analytically determinable combinatorial system. In the object domain, the world is system‐number complete at four. Dually, in the analytical codomain, understanding of it is approximately complete, as measured by a world information gain function. Hence, the dualistic, analysand‐analyzer world program is finite and has dualistic completion criteria, as required of an involuted program.     

医学院校教学医院临床实践教学的现状与对策

国家赋予医学院校教学医院救死扶伤和教书育人的两个职能,它在现行医疗体制改革的情况下与病人的维权发生了激烈的碰撞,临床实践教学出现了滑坡现象.在分析了医学院校教学医院临床实践教学现状的基础上,作者试从制定相应法规,保障临床实践教学;践行行医准则,尊重病人权利等几个方面进行了阐述,以期保证医学院校教学医院临床实践教学的质量.     

Some Thoughts on Supervision

Quite often we have the experience that adolescents do not accept an offer of treatment, in spite of the fact that they feel miserable. Or, that they do start in treatment and then change their minds and break off contact. The author reflects about factors and conditions contributing to these analytic failures. He discusses elements of analytic method, setting, neutral position, analytic relationship, and how the frames are put under pressure in work with adolescents. He thereafter presents some vignettes and examples of analytic work, where intuitive interventions and interpretations appear against a background of ordinary psychoanalytic method. For the analyst, these interventions can feel unexpected, incidental, like ideas out of the blue. On second thoughts, we may sometimes be able to trace and understand how these intuitions are based on non-conscious processes, like counter-transference feelings, an understanding of the patient still unclear and unarticulated for the analyst or perhaps a last desperate attempt to reach the patient and get in contact at a decisive or critical moment. Finally, the author reflects on the double face of psychoanalysis: both a contemplated, carefully described and systematic method and a craft with elements of intuition, creativity and, sometimes, inspiration.