启蒙式沟通

无过错纠纷在所有医疗纠纷中占比过半,原因在于医患沟通的失误,本质在于医患双方知识结构和社会阅历存在巨大差异.其危害性大于医疗事故,容易导致医患两个群体间的情绪对立.本文结合临床实际提出“启蒙式沟通”是杜绝此类纠纷的有效方法,并阐述了常用的实施方式.     

Reclaiming Communication

This article focuses on the history of the ecumenical discussion on communication, as reflected in the assemblies of the World Council of Churches (WCC). It examines, in particular, the communication statements that emerged from the WCC assemblies in Uppsala in 1968 and in Vancouver in 1983, as well as the more tentative moves at the Harare assembly of 1998 to develop an understanding of communication as an integral part of an “ecumenical space.” The article goes on to argue that the changing perspectives manifested at these assemblies, each 15 years apart, were linked to changing paradigms of social and theological reflection that were themselves the product of economic and political transformation. Finally, the article considers how the insights gained can be brought to bear on the challenges presented by digital transformation.     

Communication in Infancy

The ability to communicate, to share information about intentions, thoughts, and feelings with others and with one's self, is a unique and necessary capacity of humans. In this paper, I summarize a large body of research and observation that helps to explain the development of communication in infancy. Babies are “bathed” in the chatter of their mothers. This provides infants and toddlers entry into the symbolic realm when a full range of communication—preverbal, gestural, imagistic, and the syntactic and metaphoric use of language—is gradually developed and integrated.     

Stepfamily Communication Strengths

This study used systems theory to examine the communication strategies that differentiate “strong” stepfamilies from stepfamilies having more difficulty, inductively deriving a composite of stepfamily “communication strengths.” A total of 90 in‐depth interviews were conducted with stepparents, parents, and stepchildren from 30 stepfamilies. The stepfamilies, regardless of their strength, faced 7 primary challenges in their development: “feeling caught,” regulating boundaries with a noncustodial family, ambiguity of parental roles, “traumatic bonding,” vying for resources, discrepancies in conflict management styles, and building solidarity as a family unit. However, the communicative tactics used to manage them differed according to the strength of the stepfamily. In general, strong stepfamilies reported using everyday talk, more openness, spending time together as a family, communicating clear rules and boundaries, engaging in family problem solving, promoting a positive image of the noncustodial parent, and more consistency in perceptions about the severity of their problems. Implications for appropriate boundary integration in stepfamilies are discussed.     

Primary Process Communication

An unorthodox view of the function of primary process is presented with a view to enlarge, rather than diminish Freudian assumptions. One of the basic tenets of Freudian hypothesis was the supposed lack of influence of outside experience upon primary process functions. Yet we see demonstrated on a daily basis that primary process cognition is at work in any human interaction or experience. The mental structures of the self in interaction with the nonself is constantly monitored, added to, or subtracted from during contact with others. It is a prereflective mode that does not immediately rise into awareness. We give meaning to all interactions without necessarily reflecting upon them or even clarifying them to ourselves. Without allowing for such meaning to be integrated, we would lose or misinterpret large portions of our daily interactions. Flaws in communication occur every day and are demonstrable particularly in therapy when therapists are not attuned to their patients' emotional needs. It is demonstrated that nonverbal avoidance behavior of disturbed infants is the precursor for disturbed object relations of adults. Therefore, it makes no sense to interpret unconscious meanings—there are none. The difficulty lies in the inter-subjective realm and serves defensive modes. However, if patients present an inauthentic self, it is often difficult to decide if one is indeed in the presence of such a maimed self. The therapist's countertransference aids in detecting inaulhenticity. Ever-present, unconscious meaning analysis must be brought into consciousness by the therapist in order to further the therapeutic process.