Understanding,respecting and integrating difference in therapeutic practice

The purpose of this paper is to promote thought and discussion around how and why we treat patients in chosen ways. In the present climate practitioners are required to treat patients following NICE guidelines in which cognitive behavioural therapy (CBT) is the treatment of choice in the majority of diagnoses. This paper raises concerns that this may lead to an homogenization of treatment, loss of invaluable skills and understanding from other treatment approaches, and loss to the patient who may be best cared for by a combination of treatments and approaches, most notably patients presenting with complex pathology. This paper aims to present this as a general principle, and by way of example, will focus on coupling two specific treatment orientations, cognitive behavioural therapy with psychodynamic psychotherapy, with the specific diagnosis of obsessive compulsive disorder (OCD).

Methods: Clinical material is drawn from case studies from practice in secondary adult mental health care services within the NHS. All patients were referred to the psychological services for treatment for OCD and provided with 1:1 therapy with UKCP‐registered therapists. Details have been anonymized by describing fictitious cases re‐constructed from clinical material. A theoretical understanding is included which provides both an overview for integrating treatment for the specific example of OCD and is intended by extension to other diagnoses.

Results: Working with the commonalities of therapeutic approaches, and integrating specific skills of CBT and psychodynamic psychotherapy, appears to offer a viable mode of treatment for cases resistant to single‐orientation therapies.

Conclusions: Coupling the skills of different therapies can be effective in treating complex patients that are referred to the secondary mental health services. Conversely, restricting practice to single orientation therapies can lead to an impoverished care for patients and diminution of invaluable therapeutic skills which may become underused, undervalued and lost in the practice of mental health care within the NHS. Acknowledgement of the skills of others, valuing these and learning from each other can help to avoid the defensive reactions of practitioners, where each may defensively retreat to their corners of specialism. Respecting and sharing skills from different orientations, and acknowledging this in the NICE guidelines, is good for both mental health services and patient care and addresses the concerns raised by practitioners exemplified by Bateman (2000 Bateman, A. 2000. Integration in psychotherapy: An evolving reality in personality disorder.. British Journal of Psychotherapy, 17(2): 147–156.  [Google Scholar], p. 147) that ‘psychotherapy continues to be bedeviled by ideological schisms with practitioners apparently ignoring alternative conceptualizations and potentially superior interventions’.     

Loneliness and social behaviours in a virtual social environment

Feeling lonely motivates people to reconnect with others, but it can also trigger a vicious cycle of cognitions and behaviours that reinforces their loneliness. In this study, we examined the behavioural consequences of loneliness in a virtual social environment. A total of 176 participants navigated a character (protagonist) through a two-dimensional browser game and rated the character's loneliness multiple times during the game. In the first part of the game, another character is introduced as the protagonist's spouse. At one point, the spouse leaves for an undetermined period of time but later returns. Immediately before this separation, higher ascribed loneliness of the protagonist was associated with more frequent interactions with the spouse. After the reunion, however, higher ascribed loneliness was associated with less frequent interactions with the spouse. Ascribed loneliness was not significantly related to the frequency of interactions with others nor to the frequency of solitary activities. These patterns held after controlling for ascribed positive affect. Participants' levels of loneliness were related to the level of ascribed loneliness only when the spouse was present but not when the spouse was absent. In sum, these findings suggest that the conditions that trigger the vicious cycle of loneliness are person- and situation-specific.     

The Evaluation of Psychoanalytical Practice in Stockholm

The authors discuss several surveys that cover the practices of psychoanalysts and psychotherapists in the Stockholm region. They compare these practices with other psychiatrists in both the private and the public sector. In addition, they discuss the results from an attempt towards continuous evaluation of psychoanalytical practices and their treatment standards including an evaluation of the development of individual psychoanalytical processes.     

The hypnotic use of language — a Heideggerian interpretation

Abstract

This paper shows that Heidegger's theory of language has implications for our understanding of hypnosis. A Heideggerian interpretation of samples of trance inductions brings to light the fact that the hypnotic use of language differs from the everyday language in two major dimensions: in hypnosis, language “call” things into being, thus becoming “something more than a simple, practical means of communicating with others and a means of controlling nature” and in hypnosis, humans enter into a reversed relationship with language, a relationship in which it is language, rather than the hypnotist, that “speaks.”     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

The role of attitudes towards the targets of behaviour in predicting and informing prenatal testing choices

Research considering the role of attitudes in prenatal testing choices has commonly focused on the relationship between the attitude towards undergoing testing and actual testing behaviour. In contrast, this study focused on the relationship between testing behaviour and attitudes towards the targets of the behaviour (in this case people with Down syndrome (DS) and having a baby with DS). A cross-sectional, prospective survey of 197 pregnant women measured attitudes towards the targets of prenatal testing along with intentions to use screening and diagnostic testing, and the termination of an affected pregnancy. Screening uptake was established via patient records. Although attitudes towards DS and having a baby with DS were significantly associated with screening uptake and testing and termination intentions, unfavourable attitudes were better than favourable ones at predicting these outcomes. For example, in the quartile of women with the ‘most favourable’ attitude towards people with DS 67% used screening although only 8% said they would terminate an affected pregnancy. Qualitative data suggested that not all women considered personal attitudes towards DS to be relevant to their screening decisions. This finding has implications for the way in which informed choice is currently understood and measured in the prenatal testing context.     

A psychobiographical analysis of Dambudzo Marechera's personal development through his writings

This study applied psychobiography to explore the personal development of Zimbabwean novelist Dambudzo Marechera – and particularly focus on psychological disintegration. For the evidence, we examined primary and secondary works on his life history with special attention to his literary works. Findings indicate that his early writings were autobiographical in nature, chronicling lived poverty, war and violence experiences. Later writings were somehow surrealistic and unstructured, marking a culmination of significant personal disintegration that started in early childhood. Other ancillary biographical evidence suggests self-perceptions as a cult-like figure, and what appears to be a limited social interest.     

Uncertainty in ethical consumer choice: a conceptual model

The market place has seen significant growth in the demand for ‘ethical’ products and services. Yet, consumers often experience knowledge, evaluation and choice uncertainties in decision‐making processes, particularly in relation to products such as ethical clothing. The authors explore this pertinent form of consumer uncertainty through three qualitative studies of ethical consumers that examine their approaches to clothing consumption. In‐depth interviews and focus groups confirm uncertainty arises; the results also identify the causes and consequences of consumer uncertainty in this context. The causes of uncertainty pertain to issues surrounding complexity, ambiguity, conflict and credibility that give rise to uncertainties that result in delaying purchase decisions, compromising beliefs and negative emotions. This study contributes to literature by offering a holistic understanding of the challenges facing consumers when making ethical choices. Copyright © 2013 John Wiley & Sons, Ltd.     

Does Perceived Realism Really Matter in Media Effects?

Memory, perceived realism, and emotional responses to documentary and fictional film excerpts were investigated experimentally using adult participants. Documentary stimuli were perceived as more factual than their fiction counterparts at both semantic and syntactic levels. However, contrary to expectations, memory for visual and verbal information and the intensity of emotional reactions were greater overall for fiction films. Films whose content corresponded to well-known social themes and film genres also had a greater influence on memory and emotions. In general, it appears that perceived factuality does not have as compelling an influence on adults as it does on younger viewers. Results are interpreted in terms of the differences between cinematic attributes of documentary and fiction films and between the cognitive processes activated by these two film genres and by different themes.     

Modality exclusivity norms for 400 nouns: The relationship between perceptual experience and surface word form

We present modality exclusivity norms for 400 randomly selected noun concepts, for which participants provided perceptual strength ratings across five sensory modalities (i.e., hearing, taste, touch, smell, and vision). A comparison with previous norms showed that noun concepts are more multimodal than adjective concepts, as nouns tend to subsume multiple adjectival property concepts (e.g., perceptual experience of the concept baby involves auditory, haptic, olfactory, and visual properties, and hence leads to multimodal perceptual strength). To show the value of these norms, we then used them to test a prediction of the sound symbolism hypothesis: Analysis revealed a systematic relationship between strength of perceptual experience in the referent concept and surface word form, such that distinctive perceptual experience tends to attract distinctive lexical labels. In other words, modality-specific norms of perceptual strength are useful for exploring not just the nature of grounded concepts, but also the nature of form–meaning relationships. These norms will be of benefit to those interested in the representational nature of concepts, the roles of perceptual information in word processing and in grounded cognition more generally, and the relationship between form and meaning in language development and evolution.