Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.     

Possession and Applicability of Signature Character Strengths: What Is Essential for Well-Being,Work Engagement,and Burnout?

Signature character strengths can foster health-related outcomes in work and private life, thus being particularly important for endangered occupational groups like physicians. However, situational circumstances need to allow character strengths demonstration (applicability) first to enable their application. Therefore, this study addresses the role of (1) applicability of signature character strengths in work and private life beyond their possession and (2) relationships with well-being, work engagement, and burnout dimensions (emotional exhaustion, depersonalization, and reduced personal accomplishment). Hospital physicians (N = 274) completed an online survey examining their signature character strengths and applicability, well-being, work engagement, and burnout dimensions. The top-five individual signature character strengths were fairness, honesty, judgment, kindness, and love. Hierarchical multiple linear regressions revealed that the possession as well as the applicability of signature character strengths was important in work and private life, but to different degrees. Possessing fairness, honesty, or kindness indicated significant positive relations with subjective well-being, whereas judgment and kindness seemed to negatively interact with reduced personal accomplishment. Hospital physicians’ applicability of fairness, honesty, judgment, and love was particularly essential for their psychological well-being and work engagement, whereas the applicability of fairness (reduced personal accomplishment) and judgment (emotional exhaustion, depersonalization) at work interacted negatively with the respective outcomes. Therefore, creating awareness for individual signature character strengths as well as providing applicability in hospitals and private life could be a promising approach to improve physicians’ well-being and consequently patient care as well as the performance of the health-care system in general.

     

Psychometric Characteristics of the German Values in Action Inventory of Strengths 120-Item Short Form

The original Values in Action Inventory of Strengths (VIA-IS) is an international 240 item validated self-report questionnaire measuring character strengths. A validated and reliable English 120-item short form (VIA-120) is available. However, there is limited information about the psychometric properties of the German VIA-120. This article addresses this gap and reports the reliability, validity and comparability of the German VIA-120 with the German VIA-240 version. Two independent samples were recruited: a general population sample (N = 1073, Sample 1) and a sample consisting of medical students and physicians (N = 685, Sample 2). Internal consistency of the VIA-120-scales ranged from α = .58 (modesty) to α = .87 (spirituality) in Sample 1 and α = .63 (honesty) to α = .90 (spirituality) in Sample 2. Intercorrelations between the scales of the 120-item version and the original 240-Items version (Sample 1) ranged from r = .52 (hope) to r = .89 (prudence). Criterion validity with the Satisfaction with Life Scale (SWLS) and the Brief Inventory of Thriving (BIT) was demonstrated. The comparison of the factor structure between the original and the short form showed a good convergence (Tucker’s Phi .93–.99 Sample 1, .95–.98 Sample 2). Overall, the German VIA-120 was reliable, showed good convergence with the German VIA-240 and thus presents a similar level of validity for the assessment of character strengths. This study provides the first indication that the VIA 120 short form is comparable regarding the validity and reliability of the original VIA 240-item version indicating its potential to be used in large scale research studies.

     

The Knowledge Argument and Objectivity

In this paper I argue that Frank Jackson’s Knowledge Argument is better considered not as an argument against physicalism, but as an argument that objective theories must be incomplete. I argue that despite the apparent diversity of responses to the knowledge argument, they all boil down to a response according to which genuine epistemic gains are made when an individual has an experience. I call this the acquaintance response. I then argue that this response violates an intuitive stricture on the objectivity of theories. Therefore, the knowledge argument does show that objective theories cannot provide a complete understanding of the world. The result, however, is that both objective dualism and objective physicalism are refuted by the argument. In the end it is suggested that the notion of “subjective physicalism” is one that should be pursued.     

How Wittgenstein Defeated Russell’s Multiple Relation Theory of Judgment

In 1913 Wittgenstein raised an objection to Russell’s multiple relation theory of judgment that eventually led Russell to abandon his theory. As he put it in the Tractatus, the objection was that “the correct explanation of the form of the proposition, ‘A makes the judgement p’, must show that it is impossible for a judgement to be a piece of nonsense. (Russell’s theory does not satisfy this requirement,” (5.5422). This objection has been widely interpreted to concern type restrictions on the constituents of judgment. I argue that this interpretation is mistaken and that Wittgenstein’s objection is in fact a form of the problem of the unity of the proposition.     

THE USE OF REBT PRINCIPLES AND PRACTICES IN LEADERSHIP TRAINING AND DEVELOPMENT

Training, coaching, and consulting with people in leadership roles can be a primary consulting function for clinicians. In this paper, the authors describe their model of leadership, and what they believe to be the central personality or character components of leadership necessary for producing extraordinary results. Throughout they will show where and how REBT skills can make a significant contribution.     

Explication Defended

How can formal methods be applied to philosophical problems that involve informal concepts of ordinary language? Carnap answered this question by describing a methodology that he called “explication." Strawson objected that explication changes the subject and does not address the original philosophical problem; this paper shows that Carnap’s response to that objection was inadequate and offers a better response. More recent criticisms of explication by Boniolo and Eagle are shown to rest on misunderstandings of the nature of explication. It is concluded that explication is an appropriate methodology for formal philosophy.