Clinical pragmatism: a method of moral problem solving

This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in moral problem solving are discussed.     

African Americans and Consultation

This article reviews key issues related to racial minorities working as consultants, provides an analysis of possible impediments to successful consultation by stage of the process, and provides examples of how majority consultants can provide support for this underrepresented group in the field. Implications for training are discussed.     

Journal Reviews

Journal of Child Psychotherapy Samuels , Andrew (ed.). (1996). ‘Symposium: post-Jungian thought,’The Psychoanalytic Review Schwartz -Salant , Nathan . ‘On the interactive field as analytic object’. In The Interactive Field in Analysis, Vol 1. Chiron Clinical Series Jacobs , Theodore J. ‘On therapeutic interventions in the analysis of certain “unana-lyzable” patients’. Contemporary Psychoanalysis Guntrip , Harry . ‘My experience of analysis with Fairbairn and Winnicott. (How complete a result does psychoanalytic therapy achieve?)’. First published in The International Review of Psycho-Analysis Padel , John . ‘The case of Harry Guntrip’. Markillie , Ronald . ‘Some personal recollections and impressions of Harry Guntrip.’ Published together in The International Journal of Psycho-Analysis Plaut , F. ‘Analytiker als Minorität’. [Analysts as a minority]. Analytische Psychologic Samuels , Andrew ‘The politics of transformation/the transformation of polities’, International Journal of Psychotherapy     

Presence and absence through the mirror of transference: a model of the transcendent function

The workings of the transcendent function are explored through the development of a model of psychical process which is founded on the symbolism of the mirror. The model consists in a three-dimensional psychical manifold comprising apperceptive, reflective, and subjective axes. A fourth, temporal axis is implicit in the process character of the model. A fifth, affective axis is not discussed. The model is used to enhance understanding of both failed and successful transcendent functioning. Parallels with modes of initiation are developed. The transference role of the therapist is explored.     

CLASSWIDE PEER TUTORING: AN INTEGRATION STRATEGY TO IMPROVE READING SKILLS AND PROMOTE PEER INTERACTIONS AMONG STUDENTS WITH AUTISM AND GENERAL EDUCATION PEERS

A multiple baseline design across subjects with a reversal was used to examine the effects of classwide peer tutoring relative to traditional reading instruction on reading skills and social interaction time for 3 high-functioning students with autism and their typical peers in integrated, general education classrooms. Traditional reading instruction consisted largely of teacher-led instruction with individual student participation and seat work. Classwide peer tutoring consisted of 25 to 30 min of well-specified instruction in which tutor—learner pairs worked together on a classwide basis on reading fluency and comprehension skills. All students participated in 15- to 20-min unstructured free-time activities immediately following reading instruction. Results of reading assessments demonstrated that classwide peer tutoring increased reading fluency and correct responses to reading comprehension questions for students with autism and their peers. The procedure further increased the total duration of free-time social interactions for students with autism and typical peers, with individual variation in performance.     

REDUCING ESCAPE BEHAVIOR AND INCREASING TASK COMPLETION WITH FUNCTIONAL COMMUNICATION TRAINING,EXTINCTION AND RESPONSE CHAINING

The effects of functional communication training, extinction, and response chaining on 3 subjects' escape-maintained aberrant behavior were evaluated using a multielement design. Functional communication training consisted of teaching subjects a verbal response that was functionally equivalent to their aberrant behavior. Subjects initially were allowed to escape from a task contingent on the trained verbal response. In subsequent treatment phases, escape was contingent on the trained verbal response plus the completion of the specified number of steps in the task (response chaining). The number of steps was increased until a subject completed the task to obtain a break. Results showed that the treatment reduced rates of aberrant behavior and that the chaining procedure was effective in decreasing the availability of escape.     

Mass traumatic terror in Oklahoma City and the phases of adaptational coping,part I: Possible effects of intentional injury/harm on victims' post-traumatic responses

The bombing in Oklahoma City shook the entire nation from “sea to shining sea.” This tremendous collective sensation was made even worse when available evidence revealed that this act of terrorism had not been committed by some terrorist from the Middle East but one from Middle America. The blast stunned the nation's sense of collective safety, while it raised serious questions about our ability as a nation to manage violence, and the profound feelings of discontent and narcissistic injuries among distressed Americans. Was it this failure to address chronic discontents that led to this tragedy of mass violence? These larger sociocultural and political issues are being debated in public and private forums throughout the nation, an activity that is likely to continue for some time to come. As these issues are debated in the public arena, victims' levels of psychological distress are expected to rise, as they attempt to process the traumatic shock in their minds and bodies. Specifically, this article has two parts and focuses on acute and post-acute psychophysiological traumatic stress responses in victims, as well as issues pertaining to assessment, prevention, and treatment. Part I addresses the nature of disasters, with a special emphasis on the victim's subjective evaluation (meaning) of the reality of a catastrophe caused by intentional human strategy. The article, additionally, discusses issues of epidemiology of stress reactions, post-traumatic stress disorder, co-morbidity, risk factors, and assessment and diagnostic considerations. Part II, to be published in the next of issue of the Journal, will focus on issues of prevention as well as post-disaster intervention. Prevention of chronic post-traumatic stress disorder after the Oklahoma City bombing is a critical objective by debriefers and mental health professionals. A proposed four-phase model called “self-efficacy adaptational coping” will be presented in Phase II as well. The present article is probably the first major discussion on the traumatic effects of the blast on individuals, families, and the communities of Oklahoma City, and the first to offer some broad guidelines to intervention. Since it predates future empirical studies, the author relies on his almost 20 years of experience in the field of traumatic stress, and on a review and integration of pertinent disaster outcome studies in the national and international literature.