血液肿瘤的基因治疗及伦理学问题

基因治疗是一种新的有希望的抗肿瘤治疗方法。本文首先简述基因治疗发展史,然后介绍目前尝试性用于血液系统肿瘤的反义核酸疗法、抑癌基因疗法、自杀基因疗法以及过继性免疫疗法等基因治疗方法,进一步阐述基因治疗在血液系统肿瘤患者中应用存在的伦理学问题。     

The play's the thing how the essential processes of therapy are seen most clearly in child therapy

Analytic child therapy techniques developed as modifications of techniques from adult psychoanalysis. Child therapy continues to be regarded as an adaptation of adult analysis and to give a central place to the methods and conditions of adult analysis, such as interpretation, in its understanding of how therapy heals. I propose that child therapy is not a modified form of therapy and that the essential processes of therapy are fully present in child therapy. In fact, they often may be seen more clearly there than in adult therapy. I suggest two interrelated processes as the essential ones in all analytic therapy. The first is play. I examine several interrelated aspects of play, specifically as they occur in child therapy. These include the emergence and integration of dissociated self‐states, symbolization, and recognition. The second process I propose as essential in analytic therapy is the renegotiation of self—other relationships through action. This renegotiation is what can help patients become able to play in therapy when they have difficulty doing so. Since I suggest that action is at the heart of analytic therapy, I go on to consider the role of talking in an action therapy. Finally, I explore the dimensions of mutuality in the relationship between child and therapist, including mutual influence and regulation, mutual recognition, and mutual regression. The intersubjective nature of psychotherapy, which is increasingly appreciated in adult analytic therapy but not in child therapy, provides a fertile context for the evolution of play and for the productive renegotiation of self—other relationships.     

Couple and Family Therapy Within the Current Pan-Canadian Context

Canadians take numerous approaches to couple and family therapy due in part to Canada’s diversity of people and geography, as well as the influence of the health care context, a central facet of our national identity. Tracing back to Nathan Epstein, the founder of family therapy in Canada, there continues to be a strong tradition of couple and family therapy within Canada which has international reach. Formal training in family therapy, as well as couple/marital therapy occurs largely outside of the scope of degree granting programs and university settings. The American Association for Marriage and Family Therapy has a strong presence in Canada, with six divisions across the country. Popular models of practice for Canada’s couple and family therapists include cognitive-behavioral therapy, solution-focused therapy, narrative therapy, emotionally-focused therapy, and Bowenian/intergenerational therapy. A growing number of training opportunities are becoming available across Canada, and the practice of couple and family therapy is becoming institutionalized as one of the core competencies for professions such as psychiatry. In this article, we examine the context of family therapy in Canada by examining its history, the unique accreditation standards, qualifications and organizations associated with family therapy, the relationship between couple and family therapy, and future directions for this field of practice.     

Costs of Treating Conduct Disordered Medicaid Youth with and without Family Therapy

This longitudinal, retrospective study investigated the healthcare costs of youth treated for conduct disorder in the Kansas Medicaid system. Along with a comprehensive range of services, youth received in-office individual therapy, in-office family therapy, or in-home family therapy. Data was available for 3753 youth. Overall, 3086 youth received care that included individual therapy (and no family therapy), 503 received in-home family therapy and 164 others received in-office family therapy. Healthcare costs for a period of two and one half years after therapy were available for analysis. The average cost of healthcare for youth receiving no family therapy was $16, 260. For those receiving in-office family therapy, the average cost was $11,116. Youth who received in-office family therapy received $5,144 (32%) less care on average than those receiving only individual therapy. Those who received in-home family therapy averaged $1,622 over the follow-up the period. Those who received in-home family therapy were least expensive of all, averaging at least 85% less than any form of in-office therapy. There does not appear to be an increase in the healthcare cost when family therapy is included in treatment.     

A Current Review of the Behavioral Frame of Reference and Its Application to Occupational Therapy

The historical roots and current trends in behavior therapy and their relationship to psychiatric occupational therapy are reviewed. Key concepts in behavior therapy are defined, case study examples in various psychiatric disorders are cited and examples of applying behavior therapy to occupational therapy are described. Social skills training and a model for developing an occupational therapy program to decrease stress based on the principles of behavior therapy are outlined.     

箱庭疗法应用于家庭治疗的理论背景与临床实践

心理咨询与治疗领域出现了整合的趋势,将箱庭疗法应用于家庭治疗是这一趋势下的成功尝试。箱庭疗法应用于家庭治疗的理论背景是家庭治疗与游戏治疗的整合以及箱庭疗法在团体治疗中的应用。箱庭疗法应用于家庭治疗的临床实践包括家庭评估、家庭治疗、夫妻治疗、家庭治疗师督导,这些临床实践的开展为儿童青少年心理咨询与治疗方法的发展提供了有益的启示。     

Toward making progress feedback an effective common factor in couple therapy

Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means to enhance couple therapy outcome, including what measures of therapy progress are most likely to be useful, how to structure feedback to be most useful to therapists, and the likely mediators of the effects of therapy progress feedback. One implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. As a test of this assumption, midtherapy progress was examined as a predictor of final couple therapy outcome in a sample of 134 distressed couples. Either a brief 7- or 32-item assessment of couple therapy progress at midtherapy detected a substantial proportion (46%) of couples who failed to benefit by the end of therapy. Given that failure to benefit from couple therapy is somewhat predictable across the course of therapy, future research should test whether systematic monitoring and feedback of progress could enhance therapy outcome.     

Transference and Countertransference: New Horizons

In this exploratory study one set of patients (n – 50) was randomly assigned to either short-term group therapy or short-term individual therapy. Another set of patients was randomly assigned to either long-term group therapy or long-term individual therapy. All patients were rated prior to therapy on fifteen variables which were believed to be important for psychoanalytically oriented therapy. A comprehensive battery of outcome measures was administered both before and after therapy. Univariate and multivariate analyses were conducted in an effort to discover differential predictors of improvement for group therapy and individual therapy. None of the variables was found to be a significant predictor of improvement in one type of therapy and of nonimprovement in the other type. However, a number of variables were found to be significant predictors of improvement for one type of therapy but not for the other. It is suggested that for a given patient, a pattern of scoring on a number of such variables might tend to favor one type of therapy over another. The authors hope that the present study will serve to encourage further research work on the issue of assisting clinicians in their decisions concerning general and differential prediction of therapy outcome.     

伴骨质疏松的交感神经型颈椎病的临床治疗

为了探讨骨质疏松在交感神经型颈椎病中的作用及临床治疗的方法,对交感神经型颈椎病患者34例,21例同时患骨质疏松症的患者进行研究,观察抗骨质疏松治疗、围领制动及手术治疗的效果。结果显示,13例单纯颈椎病组的抗骨质疏松、围领制动治疗后症状无明显缓解（P〈0．01）,21例伴骨质疏松症组抗骨质疏松、围领制动治疗后症状可缓解（P〈0．05）。因此,骨质疏松是导致交感神经型颈椎病的重要因素,手术治疗的同时抗骨质疏松治疗有良好的效果。     

慢性乙型肝炎抗病毒治疗的策略

抗病毒治疗是慢性乙型肝炎治疗的关键,有效的抗乙型肝炎病毒药物主要有干扰素和核苷（酸）类似物。单药抗病毒治疗可获得较好的疗效,便于监测、管理;联合抗病毒治疗增加抗病毒疗效尚难肯定,更无法避免耐药发生,并可导致多药耐药、增加药物副作用和治疗费用。因此,优选单药进行抗病毒治疗才是目前理想的方案。     

The cost of treating substance use disorders: individual versus family therapy

This study examined the cost of substance use disorders treatment in a large healthcare organization. A survival analysis demonstrated that family therapy utilised the least number of sessions (M = 2.41) when treating substance use disorders followed by individual therapy (M = 3.38) and mixed therapy (M = 6.40). Family therapy was the least costly of the three types, at $124.55 per episode of care for a client, with individual therapy costing $170.22 and mixed therapy $319.55. The ratio of family therapists utilising family therapy was more than three to one compared to other licensed professionals. The percentages of clients coming back for more than one episode of care are fewest for family therapy (8.9%) followed by mixed therapy (9.5%) and individual therapy (12.0%).     

Therapy Process: A Reflective Account from Therapist’s Perspective

A case report is presented providing an account of therapy process and describing the therapist’s reflection on the process of therapy. It draws attention to the course of building hypothesis and clinical formulation, the core nucleus of any therapy. The paper highlights the change in therapy goals in different phases of therapy with the introduction of new information. It also underlines the fact that hypotheses in the formulation need to be constantly updated and checked against the ever changing information as therapy progresses. The importance of single case design is invaluable in the presentation of therapy process as it is more closer to clinical practice then group experimental design. Although attention to therapy process issues is important and there is no dearth of clinical material in India but there are very few published studies reporting therapy process using single case design. In the present paper, an attempt has been made to provide the account of therapy process and to share the reflections on the process of building hypothesis & formulation.     

The Effect of Expectations on Intention to Persist in Therapy

ABSTRACT

Little is known about the impact of expectations on persistence in couple and family therapy. A better understanding of the factors that contribute to persistence in therapy is key to understanding therapeutic dropout. We report results of a secondary grounded theory analysis of individual, couple, and family therapy clients' therapy expectations and their intention to persist in therapy. Participants were 19 clients of MFTs. Results indicate that clients carry expectations about the therapist, therapy process, duration, and outcome. Positive disconfirmation (Tambling & Johnson, 2010) of negative expectations contributed to therapy persistence.     

慢性乙型肝炎治疗目标及策略解析

慢性乙型肝炎治疗的目标是最大限度地长期持续抑制或清除乙肝病毒,减轻肝细胞炎症坏死及其所致的肝纤维化,延缓疾病进展,减少肝硬化、原发性肝细胞癌及其并发症的发生。治疗措施包括核苷类似物抗病毒治疗;干扰素抗病毒治疗;免疫调节治疗;抗炎治疗和抗纤维化治疗,其中抗病毒治疗是关键。     

ABSTRACTS OF LITERATURE

This theoretical essay offers a critique of individual psychotherapy versus the advantages of family therapy. Theories of family pathology, models, techniques, and indications, are reviewed and the relationship of family therapy to behavior therapy, multiple-impact therapy, home visits, crisis therapy, network therapy, and multiple-family group therapy are discussed.     

Intensive specialised multi-family therapy for multi-stressed families: Therapeutic alliance as predictor for effectiveness

The effectiveness of intense specialised multi-family therapy (ISMFT) for 111 multi-stressed families, and the therapeutic alliance as a possible predictor of outcome, were examined. A repeated measures design was used, where changes in all ISMFT phases (preparation, multi-family therapy and follow-up) were assessed and compared for both mothers and fathers. Evidence was found for improved family functioning after the therapy period, which was maintained at 3 months follow-up, although the multi-stressed families still functioned in the problematic range. The therapy did however not decrease parenting stress, or did so only temporarily. Observations of the therapeutic alliance with the System for Observing Family Therapy Alliances (SOFTA) scales indicated that high therapist engagement was related to positive therapy outcomes, both at the start of therapy and later. High family engagement also predicted therapy effectiveness, but only at the start of therapy. The present study shows that solution-focused multi-family therapy at least seems to provide the first step in alleviating problems in multi-stressed families.     

Thematic review of family therapy journals in 2004

In this paper the principal English-language family therapy journals published in 2004 are reviewed under the following headings: evidence-based practice, common factors in effective therapy, innovations in family therapy, innovations in couples therapy, training, gender, diversity, international developments, terrorism, and historical transitions.     

心理治疗两种范式的对立及其整合

心理治疗有两种不同的范式:科学主义治疗范式和人文主义治疗范式。前者主要由行为疗法和认知—行为疗法的诸种治疗形式所构成;后者则包括当事人中心疗法、存在疗法等。两种范式在人性观、心理诊断、治疗关系、治疗方法和治疗目的等方面存在着明显的对立。对此进行分析,并提出两者整合的构思,以期裨益于心理治疗实践。     

Reflections on Kenneth Gergen’s Contributions to Family Therapy

Kenneth Gergen has made significant contributions to family therapy. This article highlights selected contributions and specifically discusses his idea of therapy as relational recovery, including the importance he places on a client??s developing relational skills that they can put into action in their everyday lives outside the therapy room. In response to this idea of therapy as relational recovery, the article presents the concept of therapy as a dialogically-structured activity in which transformation whether in meaning, understanding, thought or action is inevitable, inherent and unpredictable. Client feedback on after therapy session transformation partially illustrates this concept.     

中国传统情绪疗法及其应用

系统地探讨了中国传统情绪疗法：情志相胜疗法,相反情绪疗法,激情刺激疗法,与感觉刺激有关的情绪疗法,与别人有关的情绪疗法,顺情从欲疗法,抑情顺理疗法,移情易性疗法,情志导引疗法,七情合参疗法。这些中国传统心理疗法在现代仍有实用价值。