Physician and patient communication training in primary care: effects on participation and satisfaction

OBJECTIVE: To assess the effects of a communication skills training program for physicians and patients. DESIGN: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). MAIN OUTCOME MEASURES: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. RESULTS: The following significant (p < .05) effects emerged: physician training improved patients' satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians' counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians' sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians' satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. CONCLUSION: Implications for improving physician-patient relationship outcomes through communication skills training are discussed.     

Mirror mirror on the ward: who is the unfairest of them all? Reflections on reflective practice groups in acute psychiatric settings

Consultant psychiatrists in medical psychotherapy, adult psychotherapists, child and adolescent psychotherapists and clinical psychologists increasingly complement their direct therapeutic activity with applications of their psychotherapeutic thinking in acute mental health work through facilitating reflective practice groups for staff working in mental health teams. The authors offer their reflections on facilitating National Health Service reflective practice groups using the metaphor of a mirrored dialogue between patient and professional, and professional and institution as a basis for informing the development of reflective practice for colleagues. Their reflections are based on working on three acute in-patient wards, in a crisis resolution team and in community mental health teams. They describe the practicalities of setting up and facilitating reflective practice groups, and offer insights into some of the issues that arise in reflective practice groups. They conclude that these groups are mutually beneficial in forging links between psychotherapy professionals and professionals working in other disciplines and areas of mental health. Facilitating these groups often requires a challenging adaptation of technique, which will not suit all psychotherapists, as well as a wider understanding of organisational dynamics and the interplay between clinicians and management.     

Escaping the Dark Side of Curiosity

Curiosity as a clinical entity has been a neglected subject in the psychoanalytic literature. Freud never addressed the issue of curiosity systematically. His interest was in trying to account for children's sexual questioning. Nevertheless, hinderance to internal curiosity—this is to say, that which intimidates and abates the appetite for an exploration of one's motives—is part and parcel of psychoanalytic inquiry. And, arguably, there is no greater clinical challenge for the analyst than trying to treat an analysand who appears to lack an interest in the underlying causes of his unhappiness. The problem of impeded self-inquiry is usually exacerbated in people with more serious emotional disturbances. My position here is that in studying the conditions that mitigate against curiosity in a seriously disturbed patient, we gain access to an enlarged version of the curiosity problems of our less disturbed patients. Here I interpret my clinical impressions about problems with curiosity with ideas from the writings of Martin Buber and Albert Camus.     

Reading Plays to Enhance Professional Development

Writing in a narrative style, the authors describe the continuing education model of the Red Well Theater Group. The model combines a study group format with a play reading performance module to enhance the professional development of the Group’s members and their audiences of colleagues. The educational goals are to: 1) didactically study the principles and practice of group therapy; 2) theatrically illuminate concepts, relational themes, and small group dynamics relevant to group therapy; 3) experientially deepen therapist empathy for the challenge of being in a group; and 4) provide a vitalizing experience in support of therapist well-being. As an example of this model in action, the authors elaborate their experience preparing The Great God Pan, by Amy Herzog, for presentation at the 2014 American Group Psychotherapy Association (AGPA) Annual Meeting.     

The emergence of homegrown stereotypes

Homegrown stereotypes are generalizations that groups develop about their own typical characteristics. They are a distinct class of in-group stereotypes in the contexts and processes that give rise to them, as well as in their consequences for individual group members. The authors develop the concept of homegrown stereotypes and locate the origins of these stereotypes in self-presentation processes. They discuss the accuracy of these stereotypes and consider their similarities to and differences from a number of related phenomena. An examination of homegrown stereotypes highlights the importance of taking into account the impact of in-group, as well as intergroup, dynamics on the production of stereotypes.     

Dialogue in a learning process: problematization of gender and gender equality in higher education

The overall aim with the study was to describe the knowledge building that was developed in a group of students who were trained nurses enrolled in a Swedish higher education programme. With a point of departure in an interactive research approach, the authors applied the dialogue seminar as method and pedagogical model. When the students in close to practice talks, shared their thoughts about how gender and gender equality could be experienced and understood, the dialogue seminar became useable. At the analysis of the stories which the students shared at the dialogue seminars, it became clear that most of the students had an ambivalent approach to gender equality. When they reflected on gender relations, they brought out the hierarchical and separate gender relations which they experienced as existing within healthcare. Furthermore, their professional lives seemed to be embedded in gender-related practices. An important conclusion is that the students’ reflections oscillated between critical reflection on conditions and critical reflection on processes within their own practice in healthcare. Another finding was that the students’ reflections in dialogue form became important in a learning process, not least in the light of that gender relations and gender equality only to a limited degree had been included in their nurse’s education at the basic level.     

A Practice-Specificity-Based Model of Arousal for Achieving Peak Performance

The authors propose a practice-specificity-based model of arousal for achieving peak performance. The study included 37 healthy male physical education students whom they randomly assigned to a high-arousal (n = 19) or low-arousal group (n = 18). To manipulate participants' level of arousal, the authors used motivational techniques. They used heart rate and the Sport Competition Anxiety Test (R. Martens, 1977) to measure the level of arousal that participants achieved. At the determined and given arousal state, the 2 groups performed the task (basketball free throws) for 18 sessions. Both groups performed a retention test at the 2 arousal levels immediately after the last exercise session, in the posttest, and after 10 days. Results showed that both groups learned the task similarly and achieved their peak performance at their experienced arousal level. When tested at an arousal level that differed from the one that they experienced throughout practice sessions, participants' performance had deteriorated significantly. Performance of the task seemed to have integrated with the arousal level of the participants during the task learning. The findings of this study suggest a practice-specificity-based explanation for achieving peak performance.     

Identity and oppression: differential responses to an in-between status

Oppression operates at various levels, with varying degrees of negativity, and groups respond in markedly different ways. In this paper, the in-between status of the colored South African group is used to illustrate issues of identity and oppression under the Apartheid system—and differing ways in which oppression was experienced and used. The colored group had many social advantages over Blacks, but were also used to oppress that group. Habituation, accommodation, and relative advantage were identified as dynamics within the broader context of power and privilege that contributed to cultural and psychological marginality and status ambivalence of the coloreds. These processes must be understood within the historical, social, and political context of the community. What is evident from the data is that groups and individuals can take up various positions along a continuum of oppressor—oppressed, depending upon the contexts, time, and social and legal relationships involved in their interactions.     

The spiritual dynamics of chronic post traumatic stress disorder

Although there have been numerous articles and books written about Post Traumatic Stress Disorder (PTSD), relatively little has been written about the spiritual dynamics of this disorder. The authors of this article suggest that the spiritual components of PTSD should be addressed in treatment because they may have profound impact on chronic PTSD patients. A framework for treatment involving eight Rs—Risking and Revealing, Responding and Releasing, Reflecting and Reconciling, and Resurrecting and Rebuilding—is described.J. LeBron McBride, Ph.D. is Coordinator of Behavioral Science and a licensed Marriage and Family Therapist at the Georgia Baptist Family Practice Residency Program in Morrow, Georgia. Gloria Armstrong, M.Div., M.A. is licensed as a Marriage and Family Therapist and Professional Counselor and works at the Pastoral Institute in Columbus, Georgia.     

In the Shadows of the Twin Towers: Muslim Immigrant Women's Voices Emerge

The senseless attacks of September 11 left marks of sadness on us all. In a focus group, seven young women immigrants of the Muslim faith shared incidents and reflections on the special effects the attacks left on them. Their discussions shed light on important issues and dynamics in their lives, counteracting stereotypes of them as passive or uneducated. In addition, sources of stress, primarily from discrimination and media stereotyping, were discussed. From their insights, the authors offer recommendations to help feminists raise awareness about, and acculturate to, these women in their quest to achieve without losing their culture.     

Caring and the Graduate Student: A Phenomenological Study

Given the increasing numbers of adult learners on university campuses, both as undergraduates and graduates, an understanding of adult learning processes is relevant—indeed essential—to the university's response to this student group. While educators have attempted to understand learners in terms of developmental stages, learning styles, and contextual factors, less attention has focused on the dynamics of helping relationships that attend learning or the importance of caring in the learning process. The purpose of this phenomenological study was to explore and explicate the experience of caring as it relates to graduate education from the perspective of the graduate student. The connection between caring relationships and learning was confirmed. Seven components of the caring were identified. Implications for the university center on attention to relationship skills and the creation of a campus community in which caring relationships are encouraged and nurtured.     

In the belly of the beast: traumatic countertransference

The authors discuss their work together in a consultation process. One author led many groups that were created to facilitate recovery for persons directly impacted by the terrorist attacks on September 11, 2001; the other acted as consultant to the therapist/leader. The leader was a resident of New York City at the time of the attacks; the consultant lived in a distant Midwestern city and the two had never met prior to the work. They describe their experience of working together and the role of this collaboration in the lives of the leader and the groups. Well aware that little exists in the literature about groups led by leaders having experienced the same trauma as group members, the authors pay special attention to the countertransference that each underwent and raise questions about the effects of that on the group process.     

Treatment contracts in long-term groups with alcoholic outpatients: A group case study

This paper describes the process of treatment contracting in a long-term group with alcoholic outpatients — relating the contracting process to the dynamics of the group and to the total treatment context. The material presented highlights the ways in which the contracting process (in particular, grappling with the issue of who should set the terms of the contract) may serve as a model for helping group members better understand and cope with problems in assertiueness and limit setting.     

Anchor Point Selection: Scale Alignment Based on an Inequality Criterion

For detecting differential item functioning (DIF) between two or more groups of test takers in the Rasch model, their item parameters need to be placed on the same scale. Typically this is done by means of choosing a set of so-called anchor items based on statistical tests or heuristics. Here the authors suggest an alternative strategy: By means of an inequality criterion from economics, the Gini Index, the item parameters are shifted to an optimal position where the item parameter estimates of the groups best overlap. Several toy examples, extensive simulation studies, and two empirical application examples are presented to illustrate the properties of the Gini Index as an anchor point selection criterion and compare its properties to those of the criterion used in the alignment approach of Asparouhov and Muthén. In particular, the authors show that—in addition to the globally optimal position for the anchor point—the criterion plot contains valuable additional information and may help discover unaccounted DIF-inducing multidimensionality. They further provide mathematical results that enable an efficient sparse grid optimization and make it feasible to extend the approach, for example, to multiple group scenarios.     

Catechists' conceptions of their catechetical learning environments

In ‘A Typology of Catechetical Learning Environments’ (2014), De Kock presented a typology for describing different types of catechetical practices. The typology serves as a theoretical framework for empirically investigating the effects of catechetical practices in church communities. This current article investigates, on the basis of interviews with catechists, whether the types of catechetical learning environments drawn from the typology are reflected in catechists' conceptions of their catechetical practices. It concludes that the stipulated categories are only partially reflected in the conceptions of learning goals at which respondents aim, as well as in the role divisions between catechumens and the catechist. Moreover, the types of learning environments drawn from the typology are not clearly reflected in catechists' own reflections on their catechetical practices. Implications for both the professional practice of catechesis and for further research are suggested.     

The power of causal beliefs and conflicting evidence on causal judgments and decision making

In two experiments, we investigated the relative impact of causal beliefs and empirical evidence on both decision making and causal judgments, and whether this relative impact could be altered by previous experience. Participants had to decide which of two alternatives would attain a higher outcome on the basis of four cues. After completing the decision task, they were asked to estimate to what extent each cue was a reliable cause of the outcome. Participants were provided with instructions that causally related two of the cues to the outcome, whereas they received neutral information about the other two cues. Two of the four cues—a causal and a neutral cue—had high validity and were both generative. The remaining two cues had low validity, and were generative in Experiment 1, but almost not related to the outcome in Experiment 2. Selected groups of participants in both experiments received pre-training with either causal or neutral cues, or no pre-training was provided. Results revealed that the impact of causal beliefs and empirical evidence depends on both the experienced pre-training and cue validity. When all cues were generative and participants received pre-training with causal cues, they mostly relied on their causal beliefs, whereas they relied on empirical evidence when they received pre-training with neutral cues. In contrast, when some of the cues were almost not related to the outcome, participants’ responses were primarily influenced by validity and—to a lesser extent—by causal beliefs. In either case, however, the influence of causal beliefs was higher in causal judgments than in decision making. While current theoretical approaches in causal learning focus either on the effect of causal beliefs or empirical evidence, the present research shows that both factors are required to explain the flexibility involved in human inferences.     

Religion and health in Mexican Americans

The relationship between religion and health was investigated using data from a three-generation study of mexican Americans. Two measures of religion—religious institution attendance and self-rated religiosity—were correlated with a number of functional health indicators, including self-rated health, activity restriction owing to health, bed disability days, physician utilization, worry over health, a physical symptoms scale, and a depression scale. In addition, prevalence rates were calculated for several major chronic diseases. Many significant associations obtained, as well as an inverse relationship between self-rated religiosity and hypertension. These findings are interpreted in light of the literature on religious attendance and health and on religion and aging.This research was supportive by Grant No. AG04170 of the National Institute on Aging. The authors wish to acknowledge the assistance of Laura Ray in teh programming phase of the data analysis.     

Conditional discrimination learning: A critique and amplification

Carter and Werner recently reviewed the literature on conditional discrimination learning by pigeons, which consists of studies of matching-to-sample and oddity-from-sample. They also discussed three models of such learning: the “multiple-rule” model (learning of stimulus-specific relations), the “configuration” model, and the “single-rule” model (concept learning). Although their treatment of the multiple-rule model, which seems most applicable to the pigeon data, is generally excellent, their discussion of the other two models is incomplete and sometimes inaccurate. Potential problems of terminology are discussed in the present paper, as are additional lines of research that deserve consideration by those interested in further work in this area. The issue of response versus stimulus selection (configuration versus compound-cue learning) is discussed in connection with the configuration model. Particular attention is given to Carter and Werner's criticism of the application, in studies with other species, of the learning set procedure in testing for single-rule learning. Some of the important related issues are: the bias for improvement on new problems in a series, the adequacy of a multiple-rule model to explain learning set formation, and evidence in favor of the single-rule model, at least in primates. Consideration of these additional contributions to the study of conditional discrimination learning emphasizes the usefulness of this task in the comparative study of cognitive processes.     

Riddles in serial murder: A synthesis

This article blends the conclusions of four former law enforcement personnel who have investigated and apprehended serial killers, with pertinent principles derived primarily from the field of psychoanalysis. The four—John Douglas, Roy Hazelwood, Robert Keppel, and Robert Ressler—have written extensively about their investigations of serial killers. In their writings, they have answered many questions about the personality development of serial killers while leaving other questions only partially answered. This article expands the answers to three fundamental questions: What is the origin of the dynamics of serial killing? Why is the aggressive drive so singularly powerful and persistent in serial killers? Why is it that serial killers often reveal their identities to the police? In answering these three riddles, the contributions of four emotional pillars in the personality of killers are emphasized. The pillars include emotional hunger, anxiety and aggression, eroticism, and conscience structure. At times, these pillars merge and drive murderous behavior but the pillars lack the integration needed for healthy personality development. This synthesis offers a fuller understanding of the psychodynamics involved in serial killings.     

The Semantics of Anchoring

Previous research has demonstrated that judgmental anchoring effects—the assimilation of a numeric estimate to a previously considered standard—are semantic in nature. They result because the semantic knowledge about the target object that is activated during the comparison with the anchor influences the absolute judgment. In addition to this semantic influence, the numeric anchor value itself may also yield an effect under specific conditions. The present research was designed to examine the relative strength of both mechanisms and explore their boundary conditions. Studies 1 and 2 demonstrate that semantic anchoring effects are more potent than purely numeric effects. Study 3 further suggests that purely numeric effects only operate if accessible semantic knowledge is inapplicable to the critical judgment so that semantic influences are incapacitated. The implications of these findings are discussed from the perspective of an integrative model which differentiates between two stages of anchoring. Whereas purely numeric influences appear to be limited to the stage of anchor selection, the actual comparison with the target involves more elaborate semantic processes.