Clinical Ethics: Theory Or Practice?

This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual patients as well as the moral parameters of swift and urgent medical action in the face of limited supportive information.     

Phenomenologizing with A Hammer: Theory or Practice?

As a contribution towards clearing the ground for a new phenomenological evaluation of the essence of science, in this paper I present a critique of Heidegger's argument in Being and Time for the priority of Zuhandenheit to Vorhandenheit. I argue that Heidegger's notion of presence-at-hand is incoherent, conflating Husserl and Descartes, and that this general analysis has serious phenomenological flaws. Contrary to Heidegger, I maintain that there is a form of exploratory, theoretical activity including causal inquiry which is prior to the type of practical activity entailed by readiness-to-hand. Consideration of this exploratory activity points us in the direction of an alternate conception of the genesis and essence of theory.     

Cognitive Behaviour Therapy for Children and Adolescents: Can Attachment Theory Contribute to Its Efficacy?

Meta-analyses consistently demonstrate that cognitive behaviour therapy (CBT) provides effective evidence-based treatment for children and adolescents with emotional and behaviour problems. Also consistent across meta-analyses is the observation that CBT treatment effects are often medium in size. This observation has instigated a search for factors that could help explain the limited treatment effects and that could be focused upon to enhance CBT treatment outcomes. The current qualitative review focuses on the parent–child attachment relationship as one factor that could be relevant to enhance CBT treatment effects. This review first acknowledges reasons why CBT has historically not been attracted to attachment theory and its postulates. Second, recent evidence is examined to evaluate whether attachment can be approached from a cognitive schema perspective. Subsequently, research is described showing how restoring attachment relationships could result in large treatment effects. Finally, this evidence is integrated in a model of attachment assessment and intervention that might be compatible with CBT. In sum, this review suggests that restoring trust in insecure parent–child attachment relationships can be integrated within CBT and could contribute to its treatment outcomes.     

The Violence in Our Schools: What Can a Psychoanalytically Informed Approach Contribute?

In the first part of the overview the author draws on the papers in this issue to support the argument that school violence is but one form of social violence with which modern life confronts us. Without modeling from the top down, it is hard to imagine how viable programs for violence prevention in schools can be developed and implemented. Coercion is the rule within most social systems, with the exception of families where secure attachments dominate. In secure organizations social influence is exercised in a framework dominated by an awareness of the mental states, concerns, thoughts, and feelings of individuals within the system—that is, a capacity for mentalization. The creation of a peaceful learning environment requires enhancement of the child's consciousness of his or her own awareness of others' awareness of him/her. In the second part of the overview the author questions whether all violence is understandable in these ways or in any way at all. He suggests for reconsideration the classical psychoanalytic notion of threat as a manifestation of a destructive drive. He speculates that violence may occur in two ways and for two reasons which are often conflated and confused. A psychoanalytic theory of this second type of violence is briefly outlined.     

Does Depression Affect Clinical Practice?

Abstract

While recent autobiographical accounts of women psychotherapists with depressive illnesses have provided vivid and compelling portraits of therapists' experiences in therapy (e.g., Jamison, 1995; Manning, 1995), further research is needed to clarify the impact that depression and its treatment have upon both collegial relationships and clinical practice. A subset of the membership of the Association for Women in Psychology (AWP) was surveyed concerning therapists' experiences with depression and its treatment. Of 220 respondents, 76% reported some form of depressive illness. Eighty-five percent of respondents indicated that they participated in personal therapy. When evaluating their clinical work, respondents reported both positive and negative consequences resulting from their depression. While some respondents noted improvement in collegial relationships, many felt judged and avoided.     

Participatory Teaching Methods in Theory and in Practice: The Schools Council ‘Careers’ Project in School

The Schools Council Careers Education and Guidance Project is discussed with particular reference to its use in school. The purpose is to focus attention on the likelihood of school-based constraints on careers education, which it is argued can best be uncovered through an ‘illuminative’ model of evaluation. Such an ‘illuminative’ approach is applied to the implementation of the project's pedagogy, which laid particular stress on pupil participation in lessons as a means of operationalising a more general concern with the development of autonomy. In practice, school lessons diverged considerably from the project's ideal. Factors responsible for the transformation are proposed, and their significance as barriers to this type of pedagogy is discussed.     

Does Reintegration Stress Contribute to Suicidal Ideation Among Returning Veterans Seeking PTSD Treatment?

Although posttraumatic stress disorder (PTSD) and other psychiatric symptoms are well‐established risk factors for suicidal ideation among returning veterans, less attention has been paid to whether the stress of reintegrating into civilian society contributes to suicidal ideation. Utilizing a sample of 232 returning veterans (95% male, mean age = 33.63 years) seeking PTSD treatment, this study tested whether reintegration difficulties contribute to suicidal ideation over and above the influence of PTSD symptoms, depression symptoms, and potential substance misuse. Logistic regressions indicated that reintegration stress had a unique effect on suicidal ideation over and above PTSD and depression symptoms. Reintegration stress interacted with substance misuse to predict suicidal ideation, such that the effect of reintegration stress on suicidal ideation was much larger for those with potential substance misuse. Exploratory analyses also examined which types of reintegration difficulties were associated with suicidal ideation, and found that difficulty maintaining military friendships, difficulty getting along with relatives, difficulty feeling like you belong in civilian society, and difficulty finding meaning/purpose in life were all significantly associated with suicidal ideation, beyond the effects of psychiatric symptoms and potential substance misuse. Findings highlight the importance of addressing reintegration stress for the prevention of suicide among returning veterans. Implications for treatment are discussed.     

Enhancing Quality of Practice Through Theory of Change‐Based Evaluation: Science or Practice?

This paper describes the evaluation component of Partnerships for Success (PfS), a comprehensive community effort designed to address youth development issues. The evaluation component is referred to as theory of change-based evaluation. The author considers the implications of applying community practice tools such as theory of change-based evaluation to the current conceptualization of community science. More specifically, the author argues that the current conceptualization of community science pays scant attention to community practice. This paper concludes by suggesting that the current conceptualization of community science be modified to recognize the importance of community practice as an equal aspiration for community psychologists.     

Practice Effects in Bimanual Force Control: Does Age Matter?

ABSTRACT

The authors examined age-related differences in fine motor control during a bimanual coordination task. The task required the modulation of fingertip forces in the precision grip according to a visually presented sinusoidal antiphase pattern (force range 2–12 N; frequency 0.2 Hz). Thirty-four right-handed participants of three age groups (young, early middle-aged, and late middle-aged) practiced 30 trials of the task. Accuracy and variability of relative timing and relative forces at minima and maxima of the sine wave were analyzed for hand–hand and hand–stimulus couplings and compared between age groups. Analysis showed for relative timing and force weaker hand–hand than hand–stimulus coupling as well as lower accuracy and higher variability for minima as compared to maxima. Further, we analyzed practice effects by comparing the first and last trials and characterized the course of practice by detecting the transition of a steeper to a shallower acquisition slope for the different age groups. Late middle-aged participants demonstrated poorer performance than both other groups for all parameters. All groups improved performance to a similar amount. However, an age-related difference in acquisition strategy is visible. Late middle-aged participants seemed to have focused on improvement of force amplitude, whereas young and early middle-aged focused on timing.     

Companion Animal Ethics: A Special Area of Moral Theory and Practice?

Considerations of ethical questions regarding pets should take into account the nature of human-pet relationships, in particular the uniquely combined features of mutual companionship, quasi-family-membership, proximity, direct contact, privacy, dependence, and partiality. The approaches to ethical questions about pets should overlap with those of animal ethics and family ethics (and, for veterinary issues, with healthcare ethics), and so need not represent an isolated field of enquiry, but rather the intersection of those more established fields. This intersection, and the questions of how we treat our pets, present several unique concerns and approaches for focused examination.     

Student’s Self-Efficacy in Reading – Connecting Theory to Practice

Abstract

Literacy learning has focused on skills over affective dimensions, such as self-efficacy, since the beginning of the 21^st century. Self-efficacy is the belief in one’s abilities to accomplish desired outcomes. What is less well known is how teachers provide effective literacy instruction linked to the affective dimension of development. How can we nurture students’ self-efficacy while bolstering their reading skills? This article highlights Bandura’s seminal research and related scholarly findings on the critical tenets of self-efficacy within literacy teaching and learning. Contextualized in today’s diverse educational environments, practical implementations connecting elements of self-efficacy to literacy instructional practices serve as a resource for K-12 teachers, specialists, and administrators alike.     

Advances Toward Evidence-Based Practice: Where to From Here?

Evidence-based practice has a long history; however, attempts to bridge the gap between science and practice have been only partially effective and much work remains to be done. Part of the problem has been the unilateral approach associated with dissemination of research findings to clinical practitioners. In this special series, Goldfried and colleagues (2014--this issue) suggest a two-way bridge, in which practitioners are afforded the opportunity to disseminate their rich clinical experiences to researchers as well. In this manner, a more collaborative working relationship is espoused. Surveys of practitioners on the use of CBT procedures in the treatment of panic disorder, social anxiety disorder, and generalized anxiety disorder are described. The findings are reviewed and limitations associated with the surveys are noted. Finally, future directions are suggested for rapprochement, hopefully resulting in a greater synthesis of research and practice.     

How Much Jungian Theory Is There in My Practice?

This non-clinical paper consists of the author's subjective and personal value judgements on theory and practice. He discusses nine topics: I) What is analysis and why do people seek therapy? 2) Dangers of reification and hypostatizing: reinforcement of narcissistic defences and schizoid unrelatedness. 3) The problems of archetypal psychology and amplification. 4) The cultural and political aspects of the unconscious psyche, and the value of studying the philosophical background to the psychodynamic approach. 5) Criticism of the classical Jungian over-emphasis of the intrapsychic at the expense of the interpersonal. 6) Psychosomatic healing through experience and interpretation of psychosomatic identity in the transference/countertrans-ference; idea of the ‘animating body’. 7) Dangers of theoretical hndamentalism and crusading among Jungian schools: envy and intolerance. 8) The need for the analyst to have enough good objects. 9) An acknowledgement of theoretical influences other than Jung on the author's practice; although Jung's ideas facilitate a personal pluralism - the spirit of Jung.     

From Theory to Practice: One Agency’s Experience with Implementing an Evidence-Based Model

As evidence-based practice is becoming integrated into children’s mental health services as a means of improving outcomes for children and youth with severe behavioral and emotional problems, therapeutic foster care (TFC; a specialized treatment approach for such youth) is one of few community-based programs considered to be evidence-based. “Together Facing the Challenge” (TFTC) which was tested in a randomized trial of TFC has been identified as an evidence-based model. We describe the experiences reported by one of the agencies that participated in our study and how they have incorporated TFTC into their on-going practice. We highlight key implementation strategies, challenges faced, and lessons learned as the agency moved forward towards full implementation of TFTC.     

Is Smoking Detrimental to Effective Supervision?

This paper examines the relationship between the smoking hehavior of supervisors and the effectiveness ratings attributed to them by their subordinates on 5 leadership eflectiveness measures. A sample of 3.422 assessments revealed that supervisors who smoke were rated lower than were nonsmoking supervisors. The findings suggest that smoking tobacco is associated with lower supervisory effectiveness, as perceived by subordinates. The causes for such lower ratings are attributed to bias against smokers in the workplace. actual performance differences, or both.