On the existential core of professionalism in mental health care

ABSTRACT

Existential issues are at the heart of professional role fulfilment. To defend this thesis, it will first be shown that professional competence not only consists of knowledge and skills, but also includes a second-order capacity which enables the clinician to dose and guide his activities. Secondly, in the way the professional performs his or her role, there is also always something communicated about how the professional relates to his or her role performance. This “indirect” communication is not an undesirable by-product of the communication with the patient, it is intrinsic to the professional role. Thirdly, the shaping of this “self-relatedness” can be conceptualised as the result of an interaction between basic (existential) motives in the professional and the normative appeal of the therapeutic setting. A conceptual model of the professional - patient relationship will be presented that clarifies the different dimensions and relations which are addressed in the three successive steps.     

Adapting Group Therapy to Address Real World Problems: Insights from Groups Offered in the Bahamas

This article presents a cultural adaptation of a group therapeutic approach that is being offered in the Bahamas. “The Family: People Helping People” project was designed as an intervention to improve socialization in New Providence, the Bahamian capital and its most heavily populated city. “The Family” group model offers support and training to improve communication in relationships and to encourage constructive emotional expression. This article will provide an overview of “The Family,” address key elements of this approach that are culturally tailored, and offer clinical examples and note implications for group therapy training. This cultural adaptation offers helpful insights for addressing community problems, such as violence and societal fragmentation, and may inform the development of community-based group interventions in other settings.     

Toward an ecology of student development

A key assumption behind the Cube is that the work of counselors can be more effective as they strive toward the developmental and organizational ends of those dimensions, using whichever methods are appropriate. Blocher fills in some of the detail behind this assumption with his example of life in the elementary school classroom. He posits three subsystems in the classroom ecology. The first he calls “opportunity structure,” the second “support structure,” and the third “reward structure.” The implementation of an ecological approach to student development will require the preparation of a professional with quite different competencies and interests than has been the case. The last section of this issue is addressed to that concern.     

“Beyond Frontiers of Traditional Project Management”: The Concept of “Project Management Second Order (PM-2)” as an Approach of Evolutionary Management

Fundamental changes in sciences offer new perspectives for the management of complexity. Increased complexity in society, economics, and technology requires a new and suitable organization and management. What are the consequences and results for project management? That is the theme of this article. First of all it will given a short introduction to project management, which will be later called “traditional project management” or “project management 1st order (PM-1).” Then, the challenges by the fundamental changes in sciences and the increased complexity in society, economics, and technology will be discussed. It will state that traditional project management cannot solve these challenges. The widespread working-themes and results of the research program “Beyond Frontiers of Traditional Project Management” as an answer to these challenges will be presented at a glance. Subsequently, it will discuss some selected results of the research program:

• The principle-definition and foundation of “Evolution of 1st and 2nd Order.”

• The Evolution of 1st Order and the impact on Project Management methods and processes.

• Evolution of 2nd Order and the Grand Evolutionary Systems Theory (GEST) of E. Laszlo as also the impact on Project Management methods and processes.

• Management of crisis: turn a change to advantage or risk-assurance?

Thereafter, the concept of “Project Management Second Order (PM-2)” is presented as a highlighted result of the research program, as a new paradigm in project management, and as an answer to the challenges, described earlier will be explained in detail. Finally, a real example of transfer evolutionary and self-organizational management principles in a real project life will be demonstrated.     

On Qualifying Religious Literacy: Recent Debates on Higher Education and Religious Studies in Japan

This article describes and analyzes controversies in Japan brought about by an intercollegiate educational project on religion. The project team, consisting of selected members of the Japanese Association for Religious Studies and the Japanese Association for the Study of Religion and Society, has been planning a new system for qualifying undergraduates as “specialists in religious cultures” (shūkyō‐bunkasi). It is anticipated that students with this qualification will be engaged in various occupations that require knowledge of different cultures. The project reflects an increased awareness that the academic study of religion should play a social role and be recognized as worthwhile by the public. This article will focus upon the academic and pedagogical challenges that the project members faced in the process of planning a system to assess and qualify students’ literacy in religious traditions. It will argue that religious literacy involves the dynamic ability to put knowledge into practice as well as to reflect continuously upon previously acquired knowledge.     

What Can Artificial Intelligence Learn from Wittgenstein＇s On Certainty？.

Meta-philosophically speaking, the philosophy of artificial intelligence （AI） is intended not only to explore the theoretical possibility of building ＂thinking machines,＂ but also to reveal philosophical implications of specific AI approaches. Wittgenstein＇s comments on the analytic/empirical dichotomy may offer inspirations for AI in the second sense. According to his ＂river metaphor＂ in On Certainty, the analytic/empirical boundary should be delimited in a way sensitive to specific contexts of practical reasoning. His proposal seems to suggest that any cognitive modeling project needs to render the system context-sensitive by avoiding representing large amounts of truisms in its cognitive processes, otherwise neither representational compactness nor computational efficiency can be achieved. In this article, different AI approaches （like the Common Sense Law of Inertia approach, the Bayesian approach and the connectionist approach） will be critically evaluated under the afore-mentioned Wittgensteinian criteria, followed by the author＇s own constructive suggestion on what AI needs to try to do in the near future.     

Assessing Specific Effects of Inpatient Group Psychotherapy

Abstract

This article will examine how the psychoanalytic idea of containing can be used in group therapy to form a conceptual bridge such that the group dynamics are not simplistically reduced to individual dynamics, nor that the individual is lost in the “group–as–a–whole” concept. I take the concept of “containing” as versatile in the sense that Bion (1970) meant it to be—that is, the psychological phenomenon of containment is manifest at various system levels: intrapsychic, interpersonal, group, and societal. This article will explore how far this “bridging concept” can be pursued to understand groups theoretically. The article will review various forms of containing, following Bion’s ideas, and in particular a therapeutic, or flexible, form in contrast to rigid and fragile forms.     

Ecclesial Ethics and the Gospel sine glossa: Sacramental Politics and the Love of the World

This article examines the charge that the approach D. Stephen Long identifies as “ecclesial ethics” is a world-denying approach. The article examines typologies that pit world-affirmers against world-deniers, showing how “neo-Augustinians” end up on both sides of this divide, depending on who is constructing the typology. The article argues that these typologies are inaccurate, distorting, and often self-contradictory. It offers an alternative etiology, making a case that “ecclesial ethics” can be understood as a development of the progressive wing of Catholic thought that surfaced in Vatican II. The article examines Giuseppe Dossetti’s advocacy of a Gospel sine glossa at Vatican II, and argues that this type of ethics has deep roots in a Catholic sacramental theology. Finally, the article examines Henri de Lubac’s work as exemplary of such a sacramental theology. The article concludes that the basis of “ecclesial ethics” is a deeply sacramental view of creation being transformed by the grace of God through Jesus Christ.     

Binding,narcissistic pathology and the psychoanalytic process

This article discusses the question of truth claims in psychoanalysis, revolving around the concepts “construction”, “reconstruction”, “historical truth” and “narrative truth”. In Part I of the article, these concepts are discussed in an historical context, in particular, Freud's view, the narrative tradition and some of Bion's ideas. In Part II, an attempt is made to synthesize these concepts. It is argued that the constructed character of the unconscious has to be integrated into the patient's reconstruction of his/her life story. The psychoanalytic project enables the patient to create a new narrative that claims to possess historical validity. It is important in this context not to understand the notion of “history” objectivisticallv as if it were a question of revealing certain objective historical facts. Instead, it is suggested that the connection between the present understanding of the past and the past as it was experienced in the past should be understood as a fusion of horizons. Finally, the necessary function of consciousnesslself-consciousness for the psychoanalytic project of acquiring knowledge about one's unconscious is pointed out.     

Familientherapie

In the field of family therapy besides the emphasis on the autonomy of the different schools (behavioral, psychodynamic, systemic), partly motivated by professional politics, a growing openness for concepts developed in other approaches can be observed. Approaches and results of attachment and affect theory and research find their way into the conceptualization of family processes and family therapy. Processes in the “self” of the therapist are taken into the discussion of therapeutic processes in systemic therapies. Furthermore, new fields of application of family therapy approaches have developed: parents-infant therapy and counseling, therapy of the elder, family medicine and coping with the consequences of the “human genome project”. New research on the empirical validation of relational dynamic concepts and on the evaluation of family therapies show a trend to see the claim for making treatments as short as possible in very relative terms. It is assumed that the family therapeutic approach will become more important in the future.     

A Sociological View of the Counselor's Role: A Dilemma and a Solution

The school counselors struggle for role identity still continues. The counselor's commitment to counseling pupils is being questioned by those with a sociological view of the counselor's role. Several writers suggest that the counselor's role be changed so that the counselor will function as a “cultural architect” or “social engineer.” The main thesis of this article is that the facilitation of human potentiality calls for a complementary approach to the resolution of school and pupil problems and not the diminution and prostitution of one role for another. It is proposed that a new position be created in our schools—that of a school sociologist.     

On the Spot Ethical Decision-Making in CBRN (Chemical,Biological, Radiological or Nuclear Event) Response

First responders to chemical, biological, radiological, or nuclear (CBRN) events face decisions having significant human consequences. Some operational decisions are supported by standard operating procedures, yet these may not suffice for ethical decisions. Responders will be forced to weigh their options, factoring-in contextual peculiarities; they will require guidance on how they can approach novel (indeed unique) ethical problems: they need strategies for “on the spot” ethical decision making. The primary aim of this paper is to examine how first responders should approach on the spot ethical decision-making amid the stress and uncertainty of a CBRN event. Drawing on the long-term professional CBRN experience of one of the authors, this paper sets out a series of practical ethical dilemmas potentially arising in the context of a large-scale chemical incident. We propose a broadly consequentialist approach to on the spot ethical decision-making, but one which incorporates ethical values and rights as “side-constraints”.     

Batman in the Classroom: Academic Philosophy and “… and Philosophy”

Though the interaction of philosophy with pop culture has so far mostly taken the form of books for nonphilosophers that use various shows and movies as sources of examples to illustrate “traditional” philosophical issues, this article contends that serious engagement with the informal philosophical discussions expressed in popular entertainments constitutes a kind of “ethnophilosophy” and should be considered an important part of the discipline. Our disciplinary responsibility for maintaining and considering the history of philosophy ought to include even the philosophical conversations that occur outside the academy; however unlike “proper” philosophy this material may be, it nonetheless represents engagement—sometimes substantial engagement—with the same issues that concern those of us who are considered “professional” philosophers, and thus is legitimately of interest to us.     

Utilitarianism and the Evolution of Ecological Ethics

R.M. Hare’s two-level utilitarianism provides a useful framework for understanding the evolution of codes of professional ethics. From a Harean perspective, the codes reflect both the fact that members of various professions face special kinds of ethically charged situations in the normal course of their work, and the need for people in special roles to acquire various habits of thought and action. This highlights the role of virtue in professional ethics and provides guidance to professional societies when considering modifications to their codes. From a Harean perspective, a professional society should ask both “Are there kinds of situations that members of this profession will normally encounter which members of other professions and/or the general public will not?” and “What habits of thought and action would it be good for individuals encountering such situations to have?”     

Der biopsychosoziale Krankheitsbegriff in der Praxis

Many of the recent approaches in diagnostics and therapy, e. g. the behavioral medicine, consider themselves as “holistic” or “multidimensional”. By closer consideration, however, it turns out, that while more or less referring back to the system-theoretically founded “bio-psycho-social model” (Engel, Weiner et al.) its implications are not taken seriously in practice. Presenting a concrete work project (“simultaneous diagnostics”) we will show, how to implement this (theoretically potent) bio-psycho-social conception of disease in clinical practice. It can be clearly seen, that it cannot replace the conventional reductional approach of medicine which focusses on the examination of single processes and structures under simplified conditions. On the contrary, such reductionism remains indispensable, because to be able to grasp any higher (more complex) structure one has to know its elements. Comprehensive explanation of phenomena, however, is not possible in a reductionist way. Therefore, the bio-psycho-social disease model in its operationalization is not a new way of medicine, rather an expanded approach to diagnostical and therapeutic issues.     

Professional Journeys of International Medical Graduates in Quebec: Recognition,Uphill Battles,or Career Change

In Quebec and Canada, immigration policies are designed to attract “the best and the brightest.” Once migration occurs, however, the “brain waste” is challenging. This research focuses on the professional trajectories of international medical graduates (IMG) who migrate to Quebec. The main goal is to understand why certain individuals of a similar occupational group can easily access the doctoral profession while others cannot. Following a qualitative approach, and stemming from IMGs’ perspectives, this article explores the interplay of economic, social, and symbolic resources in a context of highly fragmented institutional resources and protectionism. We are critical of the individual-centered approaches that ignore social norms and constraints. If migrants are free to choose their paths and manner of integration, the “human capital” approach is limited in explaining the heterogeneous pathways within the same professional group. The current structure for professional recognition places unusual constraints on IMGs, whereby some encounter more obstacles than others. The “battle” for professional recognition takes shape in a highly competitive context, one which—although presented as a neutral process—is underlain with ideological, relational, and subjective currents.     

Thinking,Doing, and the Ethics of Family Therapy

In this article, we examine how family therapists develop their capacity to make ethical decisions in clinical practice. We present an approach to clinical ethics that builds upon, and integrates the central features of, professional training and development in family therapy itself. We also explore the similarities and differences between the theoretical, top-down approach of bioethics, with its emphasis on “principled decision making,” and the clinical, pragmatic, bottom-up approach discussed here.     

GENOCIDAL MUTATION AND THE CHALLENGE OF DEFINITION

Abstract: The optimum definition of the term “genocide” has been hotly contested almost since the term was coined. Definitional boundaries determine which acts are covered and excluded and thus to a great extent which cases will benefit from international attention, intervention, prosecution, and reparation. The extensive legal, political, and scholarly discussions prior to this article have typically (1) assumed “genocide” to be a fixed social object and attempted to define it as precisely as possible or (2) assumed the need for a fixed convention and sought to stipulate the range of events that should be denoted by the term. Even if its meaning is a matter of convention, however, “genocide” is not a fixed object but varies by context and evolves in methods and forms over time. In fact, as relevant laws, legal interpretations, and political commitments develop, so do would‐be perpetrators modify what genocide is in order to avoid political and legal consequences. This article advances an approach to a definition of “genocide” that allows even legal definitions to keep pace with this evolutionary process.     

Navigating Bioethical Waters: Two Pilot Projects in Problem-Based Learning for Future Bioscience and Biotechnology Professionals

We believe that the professional responsibility of bioscience and biotechnology professionals includes a social responsibility to contribute to the resolution of ethically fraught policy problems generated by their work. It follows that educators have a professional responsibility to prepare future professionals to discharge this responsibility. This essay discusses two pilot projects in ethics pedagogy focused on particularly challenging policy problems, which we call “fractious problems”. The projects aimed to advance future professionals’ acquisition of “fractious problem navigational” skills, a set of skills designed to enable broad and deep understanding of fractious problems and the design of good policy resolutions for them. A secondary objective was to enhance future professionals’ motivation to apply these skills to help their communities resolve these problems. The projects employed “problem based learning” courses to advance these learning objectives. A new assessment instrument, “Skills for Science/Engineering Ethics Test” (SkillSET), was designed and administered to measure the success of the courses in doing so. This essay first discusses the rationale for the pilot projects, and then describes the design of the pilot courses and presents the results of our assessment using SkillSET in the first pilot project and the revised SkillSET 2.0 in the second pilot project. The essay concludes with discussion of observations and results.     

Learning As Support For Organizational Innovation: Possibilities And Limitations

Abstract

The present article tells an intervention story where two collectives, from business and academia, came together to address a business problem through collaborative action research. Among other things, the project created new ways of learning and therefore, knowing about the “business problem.” The author argues that in order to talk about an organizational intervention in a learning context, it was helpful to focus observation at the level of practice, in this case the different learning practices brought to the project by the organization and the research group. The “scientific narrative” focuses on how the two practices interacted. The present story's plot revolves around the following questions: What happens when one collective—used to a particular style of learning—decides to engage with another collective with a different approach to learning and what are the consequences for organizational innovation?