The effect of contingent reinforcement on target variables in outpatient psychotherapy for depression: a successful and unsuccessful case using functional analytic psychotherapy

The current study investigated a behavior-analytic treatment, functional analytic psychotherapy (FAP), for outpatient depression utilizing two single-subject A/A+B designs. The baseline condition was cognitive behavioral therapy. Results demonstrated treatment success in 1 client after the addition of FAP and treatment failure in the 2nd. This study highlights the challenges in measuring treatment progress and outcome idiographically in this population.     

Creative Writing as a Medical Instrument

Listening and responding to patients’ stories for over 20 years as an emergency physician has strengthened my appreciation for the many ways that the skills and principles drawn from writing fiction double as necessary clinical skills. The best medicine doesn’t work on the wrong story, and the stories patients tell sometimes feel like first drafts—vital and fragile works-in-progress. Increasingly complex health challenges compounded by social, financial, and psychological burdens make for stories that are difficult to articulate and comprehend. In this essay, I argue that healthcare providers need to think like creative writers and the skills and sensitivities necessary to story construction deserve a vital space in medical education. A thorough understanding of story anatomy and the imaginative flexibility to work stories into open spaces serve as antidotes to the reductive nature of clinical decision making and have implications as patient safety and risk management strategies. The examples that I have selected demonstrate how thinking like a creative writer functions at the bedside, providing tools for clinical excellence and empathy. This approach asks that we re-imagine the importance of story in clinical care: from a vehicle to a diagnosis to its place as a critical destination.     

On the Edge: Exploring the End of the Analytic Hour

The final moments of the analytic hour are a repetitive reenactment whose symbolic meaning can be both a challenge and an opportunity. Each member of the analytic dyad is vulnerable to the revival of deprivation and loss that is introduced by the end of the hour, and each will handle the experience in a unique way. When this cocreated moment occurs in the absence of awareness, there can be avoidance and enactment. When it occurs in the context of shared understanding, the analytic pair is free to intensify, play with, and confront the limitations and inevitabilities of life that are revived again and again when we approach and reach the end. Integrating theoretical perspectives on mourning, attachment, and self-states, along with clinical vignettes, the paper will show how existential questions are present in many of our analytic encounters. As we help our clients negotiate this moment, we too may acknowledge aspects of ourselves that can intensify our awareness, and facilitate our therapeutic effectiveness. Our capacity to explore this important edge of analytic space with our patients can help them to live and to love and can enrich our work if we can be open to its multifaceted meaning.     

Shaping Medical Students' Attitudes Toward Ethically Important Aspects of Clinical Research: Results of a Randomized,Controlled Educational Intervention

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics.     

How Loving are You Willing to Be? Empathic Interpretations of Fallibility,Capability, and Luck in Psychotherapy

This article addresses possibilities for more empathic interpretations in the clinical situation. Using both clinical case material and mythical allegories, the author, a psychotherapist and philosopher, considers the interrelated themes of human capability, fallibility, luck, and compassion within the context of clinical circumstances, especially in relation to intractable compulsive disorders. While addressing the implications of deterministic and indeterministic assumptions regarding human nature, the author attempts to show how human capability is subject to fallibility and how both are dependent on the workings of luck. Clinical material is then used to elucidate and illustrate more empathic ways of relating both to patients in particular and our fellow human beings in general. A new interpretive framework is also introduced to facilitate and to suggest ways to more compassionately understand, interpret, and respond to patients' own struggles for well being.     

Attention to distinguishing features in object recognition

This study advances the hypothesis that, in the course of object recognition, attention is directed to distinguishing features: visual information that is diagnostic of object identity in a specific context. In five experiments, observers performed an object categorization task involving drawings of fish (Experiments 1–4) and photographs of natural sea animals (Experiment 5). Allocation of attention to distinguishing and non-distinguishing features was examined using primed-matching (Experiment 1) and visual probe (Experiments 2, 4, 5) methods, and manipulated by spatial precuing (Experiment 3). Converging results indicated that in performing the object categorization task, attention was allocated to the distinguishing features in a context-dependent manner, and that such allocation facilitated performance. Based on the view that object recognition, like categorization, is essentially a process of discrimination between probable alternatives, the implications of the findings for the role of attention to distinguishing features in object recognition are discussed.