Three modes of psychotherapy and their requisite core skills

The field of psychotherapy suffers from the lack of an integrative meta‐perspective on the large variety of existing psychotherapies and on the therapeutic skills involved. In the present paper, it is suggested that the development of a more comprehensive view of this field may be facilitated if we differentiate between three modes of psychotherapy, which require different therapeutic core skills: (a) an educational mode, which requires teaching skills; (b) a reparative mode, which requires analytic‐conceptualising skills to identify some kind of disordered functioning, in combination with specific relational‐technical skills to repair this dysfunction; and (c) a developmental mode, which involves engaging in a therapeutic relationship with patients to facilitate their personal growth, and which requires non‐directivity skills. In addition, some therapeutic skills (e.g., awareness and communication skills) may be more or less important in all modes of treatment. Concrete manifestations of the three different modes of psychotherapy are discussed in terms of five different theoretical perspectives on psychotherapy: the common factors, the humanistic‐experiential mindfulness cognitive‐behavioural (CBT) and psychodynamic perspective. The common factors model is criticised as being insufficient in several respects. Finally, it is argued that if personal therapeutic skills are essential to the effects of psychotherapy, then empirical research on psychotherapy needs to be re‐oriented towards a person‐oriented study of therapist skills in action, in the context of a study of the interaction between therapist and patient.     

Withholding and Withdrawing Life-Sustaining Treatment: Ethically Equivalent?

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment.     

Factors associated with physical spousal abuse of women during pregnancy in Bangladesh

CONTEXT: Violence toward pregnant women is a gross violation of human rights with adverse health consequences for the woman and potentially for her fetus; however, few studies have examined factors associated with such abuse in developing countries or with population-based data. METHODS: A sample of 2,553 ever-pregnant women aged 15-49 from one urban and one rural site in Bangladesh were surveyed in 2001 as part of a World Health Organization multicountry study. Multilevel logistic regression analysis was used to examine factors associated with physical spousal abuse of women during pregnancy. RESULTS: Urban and rural women whose mother or mother-in-law had experienced physical spousal abuse had increased odds of experiencing abuse during pregnancy (odds ratios, 2.1-3.4); increased spousal communication was negatively associated with the outcome in both settings (0.6 and 0.7). Among urban women, being older than 19, having a husband with more than 10 years of education and being from certain higher income quartiles were negatively associated with abuse (0.2-0.5); living in a community highly concerned about crime was positively associated with abuse (1.1). Among rural women, being able to depend on natal family support in a crisis was negatively associated with abuse (0.5); being in a marriage that involved dowry demands and being Muslim were positively associated with abuse (1.8 and 3.6, respectively). CONCLUSIONS: The message that a family history of spousal violence increases a daughter's risk of such abuse should be widely communicated. Further research is needed to determine whether increased couple communication reduces the likelihood of violence or whether absence of violence leads to increased couple communication.     

Eye movements during the reading of compound words and the influence of lexeme meaning

We examined the use of lexeme meaning during the processing of spatially unified bilexemic compound words by manipulating both the location and the word frequency of the lexeme that primarily defined the meaning of a compound (i.e., the dominant lexeme). The semantically dominant and nondominant lexemes occupied either the beginning or the ending compound word location, and the beginning and ending lexemes could be either high- or low-frequency words. Three tasks were used--lexical decision, naming, and sentence reading--all of which focused on the effects of lexeme frequency as a function of lexeme dominance. The results revealed a larger word frequency effect for the dominant lexeme in all three tasks. Eye movements during sentence reading further revealed larger word frequency effects for the dominant lexeme via several oculomotor motor measures, including the duration of the first fixation on a compound word. These findings favor theoretical conceptions in which the use of lexeme meaning is an integral part of the compound recognition process.     

Biobank research and the right to privacy

What is privacy? What does privacy mean in relation to biobanking, in what way do the participants have an interest in privacy, (why) is there a right to privacy, and how should the privacy issue be regulated when it comes to biobank research? A relational view of privacy is argued for in this article, which takes as its basis a general discussion of several concepts of privacy and attempts at grounding privacy rights. In promoting and protecting the rights that participants in biobank research might have to privacy, it is argued that their interests should be related to the specific context of the provision and reception of health care that participation in biobank research is connected with. Rather than just granting participants an exclusive right to or ownership of their health information, which must be waived in order to make biobank research possible, the privacy aspect of health information should be viewed in light of the moral rights and duties that accompany any involvement in a research based system of health services.     

BROGAARD'S MORAL CONTEXTUALISM

Brogaard's non-indexical version of moral contextualism has two related problems. It is unable to account for the function of truth-governed assertoric moral discourse, since it leaves two (semantically clearheaded) disputants without any incentive to resolve seemingly contradictory moral claims. The moral contextualist could explain why people do feel such an incentive by ascribing false beliefs about the semantic workings of their own language. But, secondly, this leaves Brogaard's moral contextualism looking weaker than a Mackie-style invariantist error theory about morals. The latter is equally non-objectivist, but less revisionist, since it takes the semantics of moral discourse at face value, and can also explain all of Brogaard's other linguistic evidence.     

Ingroup bias in the minimal group paradigm shown by three‐person groups with high or low state self‐esteem

From social identity theory a negative relation between self‐esteem and ingroup bias can be deducted. Much research has been done to test this proposition and largely failed to confirm this relation. Unlike many existing studies, we conducted an experiment in which (a) self‐esteem is not conceived as a trait entity but much more situation‐specific, (b) the self‐esteem manipulation is not relative to the outgroup, and (c) the measure of intergroup differentiation is unrelated to the self‐esteem manipulation. We categorised our participants into two arbitrary minimal groups (Klee or Kandinsky fans) and afterwards formed homogeneous three‐person groups (all persons were either Klee or Kandinsky fans). We manipulated the state self‐esteem of these real groups by giving them positive or negative feedback concerning their performance in a problem‐solving task. Afterwards, all groups distributed money to ingroup and outgroup members via Tajfel distribution matrices. Low state self‐esteem groups were found to exhibit stronger ingroup bias than high state self‐esteem groups overall, although the variability of intergroup discrimination was larger in the low state self‐esteem groups, pointing to more heterogeneous reactions to low state self‐esteem. Copyright © 2002 John Wiley & Sons, Ltd.     

Implicit Learning in Aging: Extant Patterns and New Directions

Research suggests that the striatum plays an important role in implicit learning (IL). The striatum exhibits marked age-related morphological and neurochemical losses. Yet, behavioral studies suggest that IL is generally well preserved in old age, and that age-related differences emerge only when highly complex IL tasks are used. In this review, we integrate behavioral and neuroimaging evidence on IL in aging. We suggest that relative stability of IL in old age may reflect neural reorganization that compensates for age-related losses in striatal functions. Specifically, there may be an age-related increase in reliance on extrastriatal regions (e.g., medial-temporal, frontal) during IL. This reorganization of function may be beneficial under less taxing performance conditions, but not when task demands become more challenging.     

Stability of Typical Patterns of Subjective Well-Being in Middle-Aged Swedish Women

Typical patterns of general subjective well-being (SWB) were searched for in a representative longitudinal sample of Swedish women (N = 272) at age 43 and 49. Cluster analysis at each age separately resulted in a six-cluster solution at both ages. The two solutions were similar, indicating structural stability across 6 years. Five of the six clusters also showed significant individual stability. Among these clusters, a generalized positive typical pattern and two generalized negative typical patterns were found, one characterized by very high negative affect and one characterized by very low global life satisfaction. A cluster characterized by above average positive and negative affect was also found as well as one characterized by low positive affect. A strong relationship was found between membership in an extreme cluster and the values in certain SWB-related variables, supporting the validity of the typical patterns found. Further, it was shown that cluster membership contributed to the prediction of some validation variables above the prediction achieved by using only SWB components entered as continuous variables, suggesting the presence of interactions and nonlinearities in the SWB area.