Psychotherapy and the realistic scope of health insurance

It has been argued, most recently by Burrell, that psychologists and other nonmedical practitioners who often reject the medical model when applied to psychological disturbances, are hypocritical for accepting health insurance payments for the psychodiagnostic and psychotherapeutic services which they render. This position is based upon faulty logic, conceptual constriction and fusion, ahistoricity, and an apparent lack of concern for certain social realities. Health insurance is a far broader concept than medical insurance and can legitimately cover the services of dentists, physiotherapists, psychologists, and other health care providers.     

The lure of hypocrisy

Why are we susceptible to hypocrisy? Four preconditions for falling prey to hypocrisy are delineated. The reasons for our complex attitude to hypocrisy, both condoning and condemning it, are also explored. Hypocrisy is the false claim to virtue. It always refers to consciously intended deception by a person in a position of trust. Making use of literary examples, the investigation starts with the delineation of three readily apparent preconditions for falling prey to hypocrisy. Idealization of the hypocrite is seen as a defense against a dread of uncertainty on the part of the person who succumbs to hypocrisy. The addition of a third precondition, the force of powerful desire, completes the introduction. A selective review of historical and philosophical studies of hypocrisy over the past twenty-five hundred years situates the problem of the susceptibility to hypocrisy. Application of psychoanalytic formulations and clinical data, principally from the study of patients whose psychoanalysts committed ethical violations, produces a fourth precondition for succumbing to hypocrisy: transference, with a regression from mature trust to a condition of unmodified basic trust.     

The unfriendly agora and secular hypocrisy

This article seeks to commend Professor Trigg on his exposure of the warped thinking and policy‐making concerning religious life and its institutions in the United Kingdom and elsewhere. However, it challenges the view that the problems he has identified are best linked to deep philosophical and metaphysical positions (e.g. relativism, non‐realism and the subjectivity of values). Instead it invites a more piecemeal philosophical approach and supports the call to participate in the agora of discussion and policy‐making despite the secular hostility.     

Punishing hypocrisy: The roles of hypocrisy and moral emotions in deciding culpability and punishment of criminal and civil moral transgressors

Three experiments explored how hypocrisy affects attributions of criminal guilt and the desire to punish hypocritical criminals. Study 1 established that via perceived hypocrisy, a hypocritical criminal was seen as more culpable and was punished more than a non-hypocritical criminal who committed an identical crime. Study 2 expanded on this, showing that negative moral emotions (anger and disgust) mediated the relationships between perceived hypocrisy, criminal guilt, and punishment. Study 3 replicated the emotion finding from Study 2 using new scenarios where group agents were clearly aware of the hypocrisy of their actions, yet acted anyway. Again, perceived hypocrisy worked through moral emotions to affect criminal guilt and punishment. The current studies provide empirical support for theories relating hypocrisy and moral transgressions to moral emotions, also informing the literature on the role of moral emotions in moral reasoning and legal decision making.     

Constructing Nonagency at the Beginning of Psychotherapy: The 10DT model

This study examined how nine clients discursively constructed non-agency in their first session of individual psychotherapy. With open reading and linguistic analysis of the transcribed first sessions, combined with theory-based considerations, we created a model of discursive means for ascribing agentic and non-agentic positions, the 10 Discursive Tools model (10DT). There was large variability in how the tools functioned to create the impression of problematic agency, and the clients could not be classified according to their tool use patterns. The study shows the potential of the 10DT model for the detailed examination of presentations of “not-being-able” produced by psychotherapy clients.     

Self-esteem differences in the effects of hypocrisy induction on behavioral intentions in the health domain

Two studies investigated whether individuals with varying levels of self-esteem respond differently in the hypocrisy paradigm. In the first study, all participants were regular smokers. Those in the hypocrisy condition delivered a speech in front of a camera on the dangers of smoking. The principal dependent measure was the intention to stop smoking. In the second study, participants in the hypocrisy condition wrote a public (personally identifiable) passage about the importance of a healthy lifestyle. The principal dependent measure was the intention to improve one's health behaviors. In both studies, self-esteem scores were positively related to intentions to change behavior in the hypocrisy condition but not in a control condition. The implications of these findings for conceptions of self-esteem and for dissonance theory are discussed.     

Psychoanalytic thinking in primary care: The Tavistock Psychotherapy Consultation model

This paper describes the conceptual underpinnings, structure and operations of a novel service, the City and Hackney Primary Care Psychotherapy Consultation Service – a service set up partly with the aim of addressing the needs of patients who present with ‘medically unexplained symptoms’. As part of the Tavistock and Portman NHS Trust, this service moves its clinical base, staff members and daily work, as well as the foundations of psychoanalytic thinking that define the Trust's work, into the heart of a community, and provides psychoanalytically informed clinical practice and consultation to patients and general practitioners in the City and Hackney, one of London's (and the UK's) most deprived and ethnically diverse boroughs. The authors describe the psychoanalytical underpinnings of the model, the design and structure of the service, patient demographics and preliminary outcome data, as well as an example of consultation work with general practitioners. The authors propose that psychoanalytic applications have a place in primary care and that psychoanalytic thinking can help general practitioners and patients alike, even when the clinical interventions offered are not solely based on psychoanalytic technique or therapeutic approaches. The paper concludes with thoughts about the model, its origins and its future.     

Justice and the market for health insurance

After reviewing some of the insurance-related obstacles to access to health care, some ethical criteria for evaluating proposals aimed at reforming the health insurance marketplace to achieve universal access are developed. The additional reforms needed to eliminate many of the deficiencies in the current health insurance marketplace are discussed. It is suggested that without such substantial reforms some of the other goals such as expanded consumer choice and overall societal health care cost savings may not be effectively promoted.     

Psychotherapy,sin, and mental health

The authors contend that there are important consistencies between the Judeo-Christian tradition and psychotherapy. Empirical findings suggesting a weak correlation between religiosity and mental health are discussed in terms of there being both healthy and unhealthy aspects of religion. The crucial balance may involve the shame engendered via the awareness of sin vs. the assurance of ultimate acceptance or grace. Also discussed are issues that arise when psychiatry and religion seemingly conflict.     

企业为何履行社会责任却落得“伪善”名声?——企业社会责任类型和感知品牌伪善间的关系

2015年中国300强企业慈善捐款达60.03亿元,形成鲜明对照的是,消费者对企业社会责任行为动机的质疑呈整体上升趋势。企业耗费巨资履行社会责任反遭遇感知伪善,无疑与其初衷背道而驰,而现有理论不能充分解释这一现象的原因。自Wagner等学者2009年在营销顶级期刊开启感知品牌伪善相关研究以来,学者多从社会学借鉴感知个体伪善研究中言行不一的分析框架,把企业社会责任单维化,显然不能反映由多样性利益相关者所决定的企业社会责任类型的差异性和复杂性,所以应从利益相关者视角揭示感知品牌伪善的形成机制。根据利益相关者特征划分企业社会责任类型——技术性和公共性,进而引入其中间机制——合法性理论和感知道德资产理论,最终验证企业社会责任类型的交互作用、企业社会责任类型与宣传的交互作用对感知品牌伪善的影响。考虑到企业社会责任的经济和社会双重影响,这一成果将指引企业正确履行社会责任,促进企业和社会良性互动。     

The medical profession and the corporatization of the health sector

This article describes the most important determinant of contemporary American medical practice: the corporatization of the health care delivery system. It argues that there is an urgent need for greater reflection by physicians on the values inherent in profit-based health care and on the implications of such a model of care. Other pressures on the medical profession and several available responses are examined. The article then poses a challenge to the profession to assume a more forthright advocacy for social equity in health care provision.     

The ethics of enforced medical treatment: the balance model

ABSTRACT When is it right to enforce medical treatment on a patient who is refusing that treatment? English law recognises two ethical principles as of paramount importance: the autonomy of the patient; and the consequences of not treating compared with treating. The law, by and large, operates these principles in succession. Thus, in the case of a patient refusing treatment, the law asks first, is the patient competent? Only if the answer is no, are the consequences considered. We criticise the position taken by English law and argue, first, that competence is a graded and not a binary concept, and secondly, that the two ethical principles should be applied not sequentially but at the same time. These two ideas form what we have called the balance model. This model could be used for an empirical study of individuals’ ethical beliefs, and in particular to test the hypothesis that the ethical beliefs of most individuals conform to the balance model rather than to the position taken by English law.     

People's positions regarding social security's health insurance programs: The case of Romania

BackgroundIn Romania, the passage from a culture in which healthcare were freely available to a culture in which people must contribute financially, at least in part, has generated controversies among the population. We examined and mapped the views of people living in Romania regarding social security's health insurance programs.MethodsA convenience sample of 271 adults aged 18–80 who lived in big cities in Romania or in the rural areas around these cities were presented with realistic vignettes that depicted a health insurance program and asked to rate its goodness. The vignettes were created by combining orthogonally the levels of five factors: amount of employers’ contribution to the program, amount of workers’ contribution, extent of coverage of ordinary medical and dental care, extent of coverage of chronic or severe illness, and identity of health insurance recipients.ResultsFive qualitatively different positions were found. They were called Private insurance (8%), Health insurance only for contributors (14%), Health insurance for contributors and for everyone with severe or chronic illness (12%), Health insurance for everyone (29%), and Any insurance program is better than nothing (37%).ConclusionOverall, most participants (78%) favored a health insurance program that would protect all citizens in case of severe or chronic illness or injury, and 66% favored the protection of all citizens in all cases.     

Healing and Psychotherapy: The Pentecostal Tradition

This paper explores the practice of healing in the Pentecostal movement. The practice of healing has a long tradition in Pentecostal practice. The meaning of divine healing and what could be components of a theology of healing are examined. It is important for pastoral counselors, pastors, and chaplains to be aware of the importance of divine healing for Pentecostal clients.