Combat-Related Killing: Expanding Evidence-Based Treatments for PTSD

Despite its prevalence, killing in war is an experience that may not fit neatly into existing models of posttraumatic stress disorder (PTSD) and its treatment. The context in which killing occurred may be complex. Furthermore, while killing may certainly be fear based, an individual may have also killed in response to losing someone close and experiencing sadness and anger, as opposed to fear. While evidence-based treatments for PTSD may be a good starting point for killing-related trauma, we argue that existing treatments need to be expanded. Complex killing-related cognitions that may not be anticipated or identified, moral injury, self-forgiveness, and loss are all important issues that arise that may need to be addressed in greater detail. Consequently, we have developed a 6- to 8-session individual treatment module for those impacted by killing in war, expressly designed for use with existing evidence-based treatments for PTSD, currently being validated for use in clinical practice. We see this module as supplementary, rather than as a replacement, building on the skills that veterans have already learned within these treatments. By expanding the types of treatments we offer those who have killed in war, we can ensure that we are providing veterans with comprehensive treatment that takes the complexities of war and its aftermath into account.     

创造力与能力、专长及胜任力关系评述

创造力的实质及其培养问题,一直处于心理学家研究的视野当中。本文试图对创造力与能力、专长及胜任力等相关概念的关系作以简要评述,以期获得对创造力更深刻的理解。     

Creativity and the Clinical Exchange

Using examples from my small c experiences I distinguish between creativity with a big C and small c. I draw analogies between the dialogic interplay of creative artists and their medium and the analyst and his “medium”, the analysand.     

Navigators and Captains: Expertise in Clinical Ethics Consultation

The debate about what constitutes the discipline of ethics and who qualifies as an ethics consultant is linked unavoidably to a debate that is potentiated by the reality of a rapidly changing and high-stakes health care consultation marketplace. Who we are and what we can offer to the moral gesture that is medicine is shaped by our fundamental understanding of the place of expert knowledge in the transformation of social reality. The struggle for self-definition is particularly freighted since clinical ethics consultation aspires to be more than academic contemplation. Two recent books (Ethics Consultation by John La Puma and David Schiedermayer and The Health Care Ethics Consultant: A Practical Guide, edited by Francoise Baylis) exemplify the two most popular but most widely divergent positions on these issues. We argue that while useful, neither book addresses fully the particular and distinct role of the professional ethicist.     

循证医学与临床实践

循证医学是９０ 年代诞生的新兴医学科学。其要点是将临床医学领域的研究结果进行系统、全面的综合评价,为临床医疗实践、科研、卫生决策和医学教育提供可靠的科学证据。在发达国家的运用表明它已经对临床实践产生了重大而深远的影响,并将继续在临床医学领域发挥重要的作用。     

循证医学与临床决策

作为医生每天要面对临床症状体征各异的病人 ,针对其具体情况应用不同诊断方法、提出适合其病情的治疗方案、采取相应的护理措施、对其预后进行分析判断。甚至对所需费用也要作必要考虑。所有上述问题 ,可称之为临床决策。问题的关键是在做出上述决策时 ,其依据是什么 ?医生是惟一拥有决策权的人吗 ?一种正在兴起的医学模式———循证医学对上述问题提出了一种全新的解决模式。循证医学不强调直觉、非系统的临床经验及病理生理学推理作为临床决策的充分依据 ,而更多的强调科学临床研究所取得的证据。循证医学要求医生具备某些新的技能 ,包括…     

Estimating Creativity with a Multiple-Measurement Approach Within Scientific and Artistic Domains

This article presents the structure and the composition of a newly developed multifaceted test battery for the measurement of creativity within scientific and artistic domains. By integrating existing procedures for the evaluation of creativity, the new battery promises to become a comprehensive assessment of creativity, encompassing both domain-general and domain-specific components. In particular, the test battery was designed for the measurement of the 2 main stages of the creative thinking process: ideation and evaluation. The test battery also includes 2 measures of creative achievement and can be used to assess professional levels of creativity in artistic and scientific creativity, as well as everyday creativity. Because creative thinking is not an isolated phenomenon in human behavior, the battery includes the measurement of 2 constructs, intelligence and personality, both of which are highly relevant for creativity. Preliminary results from a vast administration campaign of this test battery are presented.     

The Expertise Question Revisited: Horizontal and Vertical Expertise

This article deals with the developments taking place in the field of family therapy from the expertise perspective, and as an expert practice. This development is looked at as a dialectical movement between two types of expertise, namely vertical and horizontal expertise. This spatial metaphor is put forward as a complementary alternative to the prevailing modern/postmodern debate. A brief account of the development of the study of science and of expertise is provided. The author suggests that the richness of current family therapeutic thinking owes something to both these different modes of expertise, the division not being as exclusive as some postmodernist authors suggest.     

Skill Acquisition and Utilization During Evidence-Based Psychosocial Treatments for Childhood Disruptive Behavior Problems: A Review and Meta-analysis

We review 85 empirical articles published since 2000 that measured the acquisition and/or utilization of parent management skills and/or child cognitive-behavioral skills in the context of an evidence-based treatment (EBT) for childhood behavior problems. Results showed that: (1) there are no standardized measures of skill acquisition or skill utilization that are used across treatments, (2) little is known about predictors, correlates, or outcomes associated with skill acquisition and utilization, and (3) few studies systematically examined techniques to enhance the acquisition and utilization of specific skills. Meta-analytic results from a subset of 68 articles (59 studies) showed an overall treatment–control ES = .31, p < .01 for skill acquisition and ES = .20, p = ns for skill utilization. We recommend that future research focus on the following three areas: (1) development of standardized measures of skill acquisition and utilization from a “common elements” perspective that can used across EBTs; (2) assessment of the predictors, correlates, and outcomes associated with skill acquisition and utilization; and (3) development of innovative interventions to enhance the acquisition and utilization of cognitive-behavioral and parent management skills.     

Clinical Expertise in Cognitive Behavioural Therapy: Definition and Pathways to Acquisition

Evidence-Based Practice is premised on current research evidence, patient factors, and clinical expertise. The definition of clinical expertise has been the most contentious, primarily owing to the ambiguity of the construct. However, attempts have been made by the American Psychological Association to outline standards of clinical competence required for psychologists, irrespective of theoretical orientation, and the Improving Access to Psychological Therapies program in the UK has recently outlined a framework for therapist competences in cognitive behavioural therapy (CBT) in particular. This paper aims to review these recent conceptual developments in defining competence and addresses current training programs and certification standards that aim to ensure that CBT therapists acquire these standards of competence.     

Implementation in a Changing Landscape: Provider Experiences During Rapid Scaling of Use of Evidence-Based Treatments

This study examined 133 service providers’ perspectives on a rapid shift to mandated evidence-based treatment delivery, utilizing an inductive coding process to capture themes present in their qualitative feedback. The majority of provider comments were negatively valenced, but attitudes varied considerably across response categories: comments regarding practice context and support were nearly uniformly negative, while comments regarding treatment fit and therapeutic consequences were more balanced. Treatment fit was the most commonly cited category; the fit to therapist (e.g., ease of use) subcategory was predominantly positive in contrast with the fit to client (e.g., flexibility) subcategory, which was predominantly negative. Results illustrate the intended and unintended consequences of large-scale implementation efforts on community providers, and may aid implementation researchers and system decision makers optimize the conditions under which community providers are asked to implement evidence-based treatment.     

Creativity, Pathology, and Family Structure: A Cybernetic Metaphor

This paper describes a cybernetic metaphor as a novel paradigm for family theory, linking aspects of cybernetic epistemology as described by Bateson ( 1 ) with the tropes, major figures of speech, as defined by the linguist Jakobson ( 25 ). Jakobson describes two operations characteristic of all human discourse at many levels of organization and abstraction: the metaphoric, linking by similarity; and the metonymic, linking by contiguity.
A cybernetic metaphor suggests a view of individuals as adaptive systems able to transform novelty into expectations ( 49 ) in one of two ways and thereby maintain a relationship with their context. Those who encounter contexts characterized by "dissonances" in structure and basic premises would adopt the metaphoric mode by finding similarities in apparent differences and thus learn to link separate domains. Those learning to orient themselves in a context of consistent basic premises and structure would adopt the metonymic mode, linking by temporal or spacial contiguity within an implicit assumed whole. Clinical examples and the literature on the families of symptomatic and creative individuals will be used as illustrations of this process of learning communicative modes.     

Expertise, Evaluative Motivation, and the Structure of Citizens' Ideological Commitments

Political psychologists have typically argued that ideological commitments are structured in a bipolar fashion, where a positive evaluation of conservative objects implies a negative evaluation of liberal objects (and vice versa). Individual differences in conformity to this pattern are usually attributed to an ability-related variable, i.e., political expertise . Departing from this strict focus on ability, this study examines the hypotheses that an important motivational variable—the need to evaluate , or the desire to form opinions of objects as "good" or "bad"—would (1) predict deviations from ideological bipolarity, even controlling for expertise; and (2) moderate the relationship between expertise and deviations from bipolarity. Data from two national surveys provided evidence for these hypotheses and indicated that the results extended to deviations from bipolarity in evaluations of presidential candidates and political parties.     

Transmuted Expertise: How Technical Non-Experts Can Assess Experts and Expertise

To become an expert in a technical domain means acquiring the tacit knowledge pertaining to the relevant domain of expertise, at least, according to the programme known as “Studies of Expertise and Experience” (SEE). We know only one way to acquire tacit knowledge and that is through some form of sustained social contact with the group that has it. Those who do not have such contact cannot acquire the expertise needed to make technical judgments. They can, however, use social expertise to judge between experts or expert claims. Where social expertise is used to make technical judgments we refer to it as “transmuted expertise”. The various kinds of transmuted expertise are described and analysed.     

Clinical Expertise: A Preliminary Attempt to Clarify Its Core Elements

The recent emphasis on evidence-based practice revolves around an integration of three domains: client characteristics, relevant research, and clinical expertise. Unfortunately, most reports focus on the examination of current research, while few guidelines exist for clarifying or developing expertise in clinical psychology. Although expertise is more advanced than competence, basic clinical competence can set the foundation for the development of more sophisticated skills. It is best to strive for narrow domains of expertise instead of global ratings of a professional as an “expert”. Five criteria are proposed for evaluating, developing, and maintaining clinical expertise: (1) the professional must possess a terminal degree in the field, (2) the professional has accumulated multiple years of clinical experience in the direct provision of clinical assessment, psychological testing, or psychological treatment, (3) the professional has attained advanced credentials in a specific area of psychology, (4) the professional is visible in the professional community at a national level, and (5) the professional has demonstrated evidence of superior clinical skills in a specific application of psychology. Together, these five criteria help to objectify the evaluation and cultivation of clinical expertise in psychology. Because each criterion is weak and flawed if used alone, it is recommended that multiple criteria are used in combination to define clinical expertise.     

循证医学与临床诊断学教育改革

探讨在临床诊断学教育中,导入循证医学的理念和方法,改变传统的经验医学教育模式,实现教学相长.以期提高医学生的理论知识水平和临床技能,提高临床实践能力,培养具有临床循证思维和创新思维的新一代医学人才.