Reflexivity in the medical encounter: contributions from post‐modern systemic practice

In this article, I attempt to identify the forms of reflexivity that take place in the medical encounter and the possible contributions that the understanding of reflexivity in systemic thinking can make to medical practice. I start by reviewing some of the literature on the doctor–patient relationship as the necessary foundation to think about and understand reflective practice in medicine. I then argue that, as the medical profession comes under scrutiny from a variety of different individuals and groups, as well as from itself, a process of reconciliation between modern and postmodern thinking, as it has been suggested in the systemic literature, might help get a better grasp of the complex predicament and dilemmas of doctors in modern society. The notion of reflexivity, the ability of any system to critically think about itself by promoting a conversation between the experts and the subject of their expertise is probably the essence of the critical momentum of postmodernism and should be an essential professional attribute for all doctors.     

Change process in systemic therapy: A qualitative investigation

This study addresses the process of therapeutic change in individuals who received systemic therapy. This study is an exploratory qualitative study based on the client's perceptions and therapeutic experiences. The sample included 10 clients who had completed their therapy with systemic therapists. The method used for the collection of the data was semi‐structured interviews (Change Interview; Elliott, Slatick, & Urman, 2001). The interviews were analysed using grounded theory analysis. The results showed that both specific and common factors in therapy function in a co‐occurring mode, hence suggesting a synergy effect between common factors and specific techniques or therapist factors in psychotherapy. The core category ‘experience of therapeutic change, within the secure frame of therapy, is a process of deconstructing and reconstructing the house you live in: Yourself’ emerged based on self‐exploration and self‐discovery and is then discussed in a theoretical constructivist framework. Implications for research on the issue of the process of therapeutic change are discussed.     

Competency,common ground,and challenges: response to the development of systemic therapy competencies for the UK

The recent initiative by the government to delineate the competencies for the delivery of systemic therapies is groundbreaking and represents a fundamental shift with clinical and political implications. In this article the author compares the process and outcomes utilised in the UK with those embarked on in the USA in 2003, culminating in the creation of the marriage and family therapy core competencies by a task force sponsored by the American Association for Marriage and Family Therapy. The development of competencies is just the first step in a development process requiring significant modifications in all of the systems that contribute to the development and delivery of behavioural health services, including clinicians, supervisors, training programmes, regulators and policy‐makers. An elucidation of the challenges faced in the USA is provided as a potential guide to the UK effort.     

Facilitators and barriers to the implementation of motivational interviewing for bullying perpetration in school settings

Bullying is a perplexing and persistent problem with negative consequences for all involved. Schools are assigned considerable responsibility for the management of bullying because of its prevalence amongst youth. Despite considerable efforts over decades to curtail bullying through the use of anti-bullying policies and other school-based interventions, the rates of young people who frequently bully has not decreased significantly. Motivational Interviewing (MI) is a relational and affirming conversational method that strengthens an individual's motivation and commitment to change, overcoming ambivalence toward the problem. The aim of the current study was to provide preliminary insight into the feasibility of incorporating MI into student service repertoires for addressing bullying. Ten staff participants from six secondary schools, who had roles in bullying intervention within their respective schools, were offered training in MI and invited to use and monitor this method in their practice as an intervention for students who perpetrate bullying. Results indicated a number factors which influenced the uptake of MI in schools. Facilitators enabling the use of MI included practitioner's professional background, administrative support, training and implementation of MI. Barriers to the use of MI included time pressure and administrative expectations, school roles and system limitations, and preconceptions and the stigma of bullying.     

Walking versus biofeedback: a comparison of acute interventions for stressed students

Background: High rates of stress-related problems in college students and low utilization of treatment options demonstrate the need for effective stress-reducing interventions that can be self-regulated. This study compared the effect of brief paced-breathing with biofeedback and exercise interventions on heart rate variability, state anxiety and affect. Methods: Students (n?=?32) with high levels of perceived stress completed three 10-min interventions on separate days: paced-breathing with biofeedback (Biofeedback), a self-paced walk (Exercise), and an attention control condition of quiet studying (Quiet Study). Anxiety and affect were measured before (Pre), immediately after (Post0) and 15 mins after (Post15) the intervention. Heart rate variability was measured pre- and post-intervention using electrocardiogram. Results: Biofeedback reduced anxiety more than the exercise condition (Pre to Post0: Biofeedback d?=??0.48, Exercise d?=??0.13). Secondly, Exercise temporarily increased energy (Pre to Post0: d?=?0.67), whereas Biofeedback temporarily increased calmness (Pre to Post0: d?=?0.51). All conditions significantly increased total heart rate variability (p?Conclusions: Biofeedback and Exercise interventions improved emotional states in high-stress college students, but the type of change observed (i.e. energizing, calming or anxiety reducing) depended upon the condition.     

Use of nature in a multi-family therapy for Chinese families of adolescents with attention deficit hyperactivity disorder: A photo-elicitation study

This article reports the therapeutic resources in the natural outdoors that were conducive to the therapeutic process in a multi-family therapy (MFT) for enhancing the self-efficacy and collective family efficacy of Chinese families of adolescents with attention deficit hyperactivity disorder (ADHD) in Hong Kong. Photo-elicited interviews with adolescents with ADHD and parent focus groups were employed to explore the participatory experiences of the families. A total of thirteen Chinese families of adolescents (aged 11–15 years) with ADHD participated in this study (fourteen adolescents with ADHD, eight fathers and ten mothers). The present study explored the potential therapeutic resources in the natural outdoors, namely a change in the group environment, spaciousness and darkness. The use of the natural outdoors in MFT proved to be a strategy useful for creating a naturalistic group setting within which family participants can more easily enact changes.     

Secondary school pupils’ views of their school peer counselling for bullying service

Pupils (n=99) from two secondary schools in the UK were interviewed to investigate their views and experiences of the peer counselling for bullying service set up in their school. They were asked about various things concerning (1) the characteristics of the service and service providers that they valued and (2) their reasons for not using the service. Overall, a majority of participants reported a willingness to use this type of service and they identified numerous characteristics that they valued, including peer counsellors with good listening skills who were trustworthy and maintained confidentiality. A noteworthy proportion of participants also wanted the service to provide advice on solving bullying‐related problems. Some barriers to using the service were also identified, including fear of being stigmatised. Responses offered by girls and boys, and by users and non‐users of the service, were compared and several significant differences emerged. The results are discussed in terms of the implications for adults who run this type of service and the peer counsellors who deliver it.     

Electrical safety in the use of biofeedback instruments

Electrical hazards associated with the use of medical apparatus are described with emphasis on biofeedback instruments. Safety standards specify safe current levels for instruments in normal operation; however, the user can take steps to provide back-up protection against hazards caused by component malfunction or breakdown. Measures for protection of patient and operator are outlined, including instrument design considerations and guidelines for the user to follow in order to provide a margin of safety.     

A theory of clinical practice: the cognitive and the narrative

Today the extent of the difference between theoretical models of therapy is under discussion. There have been proposals to abandon such models altogether, or to create others, such as integrative or meta‐ theoretical models. This article proposes, through the analysis of a clinical situation, the possibility of building a theory of practice which could account for most of the aspects of the therapeutic process that remain tacit and implicit. Such a theory could help us explain what concretely happens when a therapist is doing therapy, and also how theoretical models interact with the everyday practice of therapists.     

小学高年级学生创造力的发展：性别差异及学校支持的作用

对203名4年级学生进行3年追踪测试(到6年级),采用多水平分析法考察创造力的发展趋势、性别差异以及教师/同伴支持对创造力发展的影响。结果表明:(1) 4～6年级小学生的流畅性呈线性增长趋势,灵活性和独创性呈非线性增长趋势,初始水平与增长速度呈正相关。(2)女生灵活性和独创性的初始水平高于男生。(3)教师支持正向预测男生灵活性的初始水平,正向预测流畅性的初始水平和独创性的增长速度。(4)教师支持的发展正向预测流畅性的发展。     

学校道德氛围知觉对道德发展影响的教育干预实验

目的 探讨学生的学校道德氛围知觉与其道德发展的关系。方法 采用学校道德氛围知觉问卷、SROM-SF问卷及自编情境故事,对100名中学生进行了干预实验,运用SPSS 15.0对数据进行统计分析。结果 通过干预,学生的学校道德氛围知觉水平有了不同程度的提高;学生对学校道德氛围的知觉水平提高后,其道德判断能力有了显著发展。结论 学生的学校道德氛围知觉影响其道德判断能力的发展。     

Dose response effects of cognitive-behavioral therapy in a school mental health program

ABSTRACT

School mental health (SMH) programs have been shown to be effective in providing evidence-based interventions to underserved youth. However, limitations of SMH programs are that they can entail holiday breaks, typically do not operate through summer, and often require pulling students from class to receive therapy. These limitations suggest that treatment must be expeditious and potent. Although researchers have investigated dose response to treatment, no studies were located that addressed dose response to treatment in SMH programs. The present study addressed this gap by evaluating the dose response to SMH treatment in a sample of 133 adolescents. Adolescents were assessed at baseline, post-treatment, and at multiple time points throughout treatment. An average treatment response of a 26.81-point decrease in Youth Outcome Questionnaire (YOQ-30) score was found across 14 sessions of cognitive-behavioral therapy (CBT). Further, adolescents exhibited reliable change in YOQ-30 score within an average of 2.91 sessions. Finally, it was found that baseline scores on the Depression and Hyperactivity subscales of the Behavior Assessment System for Children, 2nd Edition, along with YOQ-30 score, predicted treatment response. These findings advance our understanding of dose response to CBT in SMH settings, and create opportunities to better inform effective treatment strategies in similar contexts.