运用心理咨询的理论技术提高临床医师的医患沟通能力

提高临床医师的医患沟通能力具有重要的意义,是改变当前紧张的医患关系和培养临床医师人文医学执业能力的重要内容,也是生物心理社会医学模式转变的内在要求和重要体现。医患沟通与心理咨询过程中咨询师与来访者之间的沟通具有多方面的共性,这两者都是一种特殊的关系,都需要关注人性、心理学方面的共同理论和技巧以及患者的心理因素对其躯体疾病的影响。医患沟通需要并能够借鉴心理咨询过程中的理论及技能和方法,比如:真诚或表里如一、无条件的积极关注、共情等。     

论Empathy的翻译及其内涵

"共情"(Empathy)是十分重要的心理现象,影响着人们的社会认知和实际的人际交往;共情更是临床心理学中的专业术语,直接关系到医患关系的建立以及治疗和治愈的效果。针对目前国内心理学界对于Empathy的不同理解乃至使用上的混乱,文章从该术语的起源和本义,以及其专业内涵和翻译的意义等方面,提出了独到的见解和主张。     

与情共舞：共情与麻醉医患沟通

麻醉医生所面临的沟通挑战是临床科室中所特有的,将共情应用于麻醉医生临床工作中,可以促进医患情感沟通,改善医患关系,减少医患纠纷。阐述了共情的概念,共情在麻醉医患沟通中的作用以及从术前、术中和术后三个方面探讨了将共情应用于麻醉医生与患者的沟通中。同时就术中的医患沟通从诱导前、麻醉维持中和苏醒期三个方面进行了描述。此外,共情需要麻醉医生和患者的共同参与,可以让医患双方共同获益,让医患之间的情感产生共鸣,让共情与麻醉工作相互交织,使麻醉工作不仅充满科学还充满温情。     

优化医患关系的策略——医护人员主导下的医患互动双向共情

医患关系是整个医学关系中最核心的内容,也是涉及医疗质量和医疗服务水平的关键环节,紧张的医患关系已经成为社会的焦点问题,而共情被认为是构建新型医患关系的有效路径。本文对共情概念的发展史进行梳理,强调最新的四维度共情,并认为共情是医护人员主导的医患互动的、双向的共情,同时对共情的临床意义及四维度概念指导下达成共情的途径进行阐述,以期引起医者的重视,将共情恰当地、有效地应用到临床实践中,从而促进和谐医患关系的构建。     

临床共情研究进展

共情是指站在对方角度思考问题,能认识、理解他人情感情绪的能力.自20世纪60年代起,以美国为主的西方国家开展大量关于共情临床应用的理论研究、实践调查和教育培训,结果显示临床共情的应用对改善医患关系、提高医疗效果、减少医疗纠纷、促进患者康复和增进医生职业成就感等方面都起着重要作用.     

美国医学共情探究及对医学人文教育的启示

医学生共情能力的培育,有助于医生恪守职业操守,升华职业精神,意义重大。近年来,共情在增强医学人文教育、促进医患沟通、提高诊疗效果方面的作用越来越得到认可和重视。美国医学界一直致力于探索共情的本质、临床影响因素及效果。论述了20世纪中期以来美国医学对共情的探究,从认知、情感及行为几个方面深入对共情的理解,希望共情能拉近现代医患之间因为医学科技发展、文化差异等而形成的生疏感,增强医学生的共情教育,构建和谐医患关系。     

共情特质的神经生物学基础

共情特质的个体差异是心理学研究领域中的一个重要主题。近些年来, 研究者开始关注导致人们共情能力高低有别的神经生物学基础问题。研究发现, 不论是情感共情特质还是认知共情特质, 其个体差异均在大脑进行共情反应、脑结构态及静息态功能连接上有所体现。它们共同说明, 人们的共情能力与其具身模仿能力, 情感加工能力及情绪理解能力密切相关。不仅如此, 共情特质也具有高度的可遗传性, 一些基因类型与该能力存在着紧密的关系。在今后的研究中, 需要扩展对共情特质结构的进一步认识, 关注环境和基因在影响共情特质上存在的交互作用, 并努力将理论研究成果应用于共情能力训练和提高的临床实践中。     

以写作模式心理干预技术培养学生医患沟通及临床决策能力

医患沟通和临床决策贯穿医疗过程始终,良好沟通有利于医患信任合作关系建立,临床决策决定医疗效果。心理干预技术如倾听、提问、鼓励、内容反应技术、情感反应技术、解释技术及共情等适合培养医患沟通及相关于人文医学的临床决策能力。本文提出运用心理干预技术培养医患沟通及临床决策能力的写作模式——引导写作、批阅文卷、评析文卷的过程;并论述对这两种能力培养具有独到的意义:可以巩固融会学习知识,促进学生思考,理论联系实际,从而提高实际能力。     

临床共情与叙事能力:将《塔木德》当作文学作品阅读的意义

临床环境中的"治疗潜力"主要依赖于医患之间建立和维持的共情关系。共情关系能让医护人员充分考虑患者的最大利益,并据此做出临床判断和决定,实现"叙事能力"。临床医师分享"文学作品的文本细读心得",并探讨"临床反思性写作"的"叙事医学"模式是培养共情能力的必要途径。近期的实验研究证实这种以文学作品阅读为基础的培养模式在学术界和临床领域都已受到充分肯定。作为一个文学作品,《塔木德》的价值一直被低估。事实上,作为文学作品的源头,它们对"叙事能力"的实现意义重大。通过实践过程中对生命伦理原则的关注,制约叙事医学的局限性已被打破。     

临床共情与护理技术结合:人性化的护理

临床共情是一种能体验患者内心世界的能力,通过患者的言语和非言语表达,觉察和认识患者情感和情绪需求,并对其做出恰当的回应.临床共情具有科学的理论和实践基础,具有缓解患者心理上的痛苦,改善护患关系,促进患者康复等作用.在当今复杂的医疗环境下,务必要重视共情培养,适时运用临床共情.然而,我们强调临床共情的重要作用,并不能忽视护理技术的根本作用,根除躯体上的病变仍有赖于护理技术的有效性.在临床护理实践中,坚持共情与护理技术的有机结合,推进人性化的护理构建.     

Language,politics and dreams: the challenges of building resilience in refugees

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language – the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

Order,disorder, and the absolute: An experiment in dialogue

The first section of this dialogue is excerpted from an edited conversation between Sean Kelly and the late David Bohm, and focuses on the concepts of order, disorder, and the Absolute. The second section explores these concepts in greater depth, with Bohm maintaining the impossibility of absolute knowledge and the fundamental unintelligibility of the concept of disorder, preferring instead to speak of “orders of infinite degree” which emerge out of an “unknown ground.” Kelly responds by proposing the concept of “absolute knowing” as the cognitive process within which the concepts of order and disorder, the known and the Unknown are seen as dialectically related moments of the Absolute as complex whole. The third section is Edgar Morin's response to the preceding dialogue. He begins by outlining his views on the nature and limits of rationality, maintaining, with Bohm, the superiority of the “negative modality” of speaking about “being” or “reality.” In the second part, however, he proposes the notion of nature as “chaosmos,” which he understands as a creative “dialogic” of order, disorder, and organization.