Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance

One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from 2 clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. We highlight unique challenges in working with counselors unaccustomed to traditional clinical supervision. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted 1 year following implementation, and interviews with key organization executives and administrators.     

The amygdala but not the hippocampus is involved in pattern separation based on reward value

A total of 32 male Long-Evans rats were tested on a modified version of Flaherty, Turovsky, and Krauss's (1994) anticipatory contrast paradigm to assess pattern separation for reward value. Prior to testing, each rat received either a control, a hippocampal, or an amygdala lesion. In the home cage, each rat was allowed to drink a water solution containing 2% sucrose for 3 min followed by a water solution containing 32% sucrose for 3 min. Across 10 days of testing, the rats in each lesion group showed significantly increased anticipatory discriminability as a function of days. To assess the operation of a pattern separation mechanism, each rat was then tested using the same procedure except the 2% solution was followed by a 16% solution for 10 days and then by an 8% solution for 10 days. Control and hippocampal-lesioned rats continued to show high discriminability when the 2% solution was followed by a 16% solution; however, the amygdala-lesioned rats showed low anticipatory discriminability. On trials where the 2% sucrose solution was followed by an 8% sucrose solution, all groups showed low discriminability scores, suggesting that when two reward values are very similar even control animals are not able to separate the reward values in memory. However, the results of a preference task revealed that all groups can perceptually discriminate between a 2% and an 8% sucrose solution. The data suggest that the amygdala but not the hippocampus is involved in the separation of patterns based on reward value.     

Effing the Ineffable: The Logocentric Fallacy in Argumentation

Words, just because they are words, are not inherently clear. The message they contain becomes clear to those who speak the language and are familiar with the issues and contexts. If the message lacks linguistic clarity the recipient of the message will typically make a query that will bring forth further information intended to clarify. The result might be more words, but it might also involve pointing or drawing, or words that utilize other modes such as references to context, history, and so on. If the ambiguity derives from an inconsistency between, say, words and behaviour, one may look to either mode for clarity. Communication, we must accept, actually occurs in messages, and our ability to transmit information may be limited by any number of factors. When we focus entirely on discursive aspects of communication we limit both the ways in which we receive and ways in which we transmit information. The logocentric fallacy is committed when language, especially in it's most logical guise, is seen to be the only form of rational communication.     

Collective Guilt and Collective Guilt Feelings

Can collectives feel guilt with respect to what they have done? It hasbeen claimed that they cannot. Yet in everyday discourse collectives areoften held to feel guilt, criticized because they do not, and so on.Among other things, this paper considers what such so-called collectiveguilt feelings amount to. If collective guilt feelings are sometimesappropriate, it must be the case that collectives can indeed beguilty. The paper begins with an account of what it is for a collectiveto intend to do something and to act in light of that intention.According to this account, and in senses that are explained, there is acollective that intends to do something if and only if the members of agiven population are jointly committed to intend as a body to do thatthing. A related account of collective belief is also presented. It isthen argued that, depending on the circumstances, a group's action canbe free as opposed to coerced, and that the idea that a collective assuch can be guilty of performing a wrongful act makes sense. The ideathat a group might feel guilt may be rejected because it is assumed thatto feel guilt is to experience a ``pang'' or ``twinge'' of guilt –nothing more and nothing less. Presumably, though, there must becognitions and perhaps behavior involved. In addition, the primacy, eventhe necessity, of ``feeling-sensations'' to feeling guilt in theindividual case has been questioned. Without the presumption that it isalready clear what feeling guilt amounts to, three proposals as to thenature of collective guilt feelings are considered. A ``feeling ofpersonal guilt'' is defined as a feeling of guilt over one's own action.It is argued that it is implausible to construe collective guiltfeelings in terms of members' feelings of personal guilt. ``Membershipguilt feelings'' involve a group member's feeling of guilt over what hisor her group has done. It is argued that such feelings are intelligibleif the member is party to the joint commitment that lies at the base ofthe relevant collective intention and action. However, an account ofcollective guilt in terms of membership guilt feelings is found wanting.Finally, a ``plural subject'' account of collective guilt feelings isarticulated, such that they involve a joint commitment to feel guilt asa body. The parties to a joint commitment of the kind in question may asa result find themselves experiencing ``pangs'' of the kind associatedwith personal and membership guilt feelings. Since these pangs, byhypothesis, arise as a result of the joint commitment to feel guilt as abody, they might be thought of as providing a kind of phenomenology forcollective guilt. Be that as it may, it is argued the plural subjectaccount has much to be said for it.     

Beneficial factors in family discussion groups of a psychiatric day clinic: perceptions by the therapeutic team and the families of the therapeutic process

This paper reports a pilot investigation of the perception of helpful events by the therapeutic team and the families in two family discussion groups (FDGs) of a psychiatric day clinic. All participants of the FDG, including therapists and observers, filled in questionnaires measuring events helpful for the individual, for the family and for the group after each FDG session. The results showed that the therapeutic team and the families diverged in their overall perception of which factors were important in family discussion group therapy. The therapeutic team saw the relational climate and the structural aspects of the group (including group involvement and support from the group), and specific therapeutic interventions as more helpful than the families. The process aspects in the group members (including the experiencing of communality and gaining insight) were, on the other hand, more frequently mentioned by the families than by the therapeutic team. The clinical implications of these findings and suggestions for future research are discussed.