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.     

Lateralized Changes in Regional Cerebral Blood Flow during Performance of Verbal and Facial Recognition Tasks: Correlations with Performance and “Effort”

Functional neuroimaging has been used to investigate neural substrates of mnemonic processes, and cerebral blood flow (CBF) measures have been sensitive to activation with memory tasks. Studies of memory with two-dimensional¹³³Xenon clearance techniques found that word and face recognition tasks produced contralateral CBF changes in mid-temporal cortical regions. This study replicated the activation paradigm, expanding to the three-dimensional resolution of positron emission tomography (PET). Word and face recognition, and a control baseline task were administered to 19 healthy right-handed volunteers (11 men, 8 women) during successive 10 min PET¹⁵O-water measures of CBF. Quantitative CBF rates were calculated with the arterial input function and the equilibrium model. Redistributions of blood flow were compared across tasks using both absolute and relative (region/whole brain) CBF.Replicating the¹³³Xenon clearance findings, CBF was “appropriately” lateralized during task performance (left–right for words > left–right for faces) in the mid-temporal region. Contrary to predictions, the recognition tasks did not activate expected mesolimbic or prefrontal areas. The task-induced CBF changes also correlated with performance. Bilateral CBF in mid-temporal and parahippocampal gyrus regions of interest correlated with the ability to correctly identify word targets (sensitivity). Left-lateralized CBF in the amygdala and hippocampus correlated with better word sensitivity as well as specificity (ability to correctly reject foils). Complementally, right-lateralized CBF in the parahippocampal gyrus correlated with better face specificity performance. In addition, left-lateralized CBF in the amygdala and right-lateralized CBF in the parahippocampal gyrus and hippocampus correlated with “mental effort” indices (task performance relative to basal ability) for word and face memory tasks, respectively. Thus, whereas this recognition task showed the expected lateralized increase in the mid-temporal region and not in frontal and limbic areas, lateralized activation in some of these areas was associated with better performance. Exploratory analyses on other regions showed lateralized changes in one additional temporal region, the occipital-temporal, and several limbic regions.     

Reading performance and general cognitive ability in twins with reading difficulties and control pairs

The etiology of the observed relationship between general cognitive ability and reading performance was investigated by analyzing data from samples of twin pairs tested in the Colorado Learning Disabilities Research Center. Bivariate phenotypic and genetic structural equation models were fitted to data from 486 twin pairs selected for reading deficits (276 identical and 210 same-sex fraternal) and 314 control pairs (195 identical and 119 same-sex fraternal). Subtests of the Peabody Individual Achievement test (Reading Recognition, Reading Comprehension, and Spelling) were used as measures of reading performance, and verbal and performance IQ scores from the Wechsler Intelligence Scale for Children-Revised (WISC-R) or Wechsler Adult Intelligence Scale-Revised (WAIS-R) were used as indices of general cognitive ability. The results of these confirmatory factor analyses indicate that shared environmental influences do not contribute significantly to covariation between general cognitive ability and reading performance. In contrast, genetic influences contribute substantially to the relationship between the two latent factors. Moreover, the genetic and phenotypic variances of reading performance in the proband group are larger than those in controls, whereas both the genetic and phenotypic correlations between reading performance and general cognitive ability are lower in probands. These results are consistent with recent reports that reading disability may be caused by one or more genes with major effects.     

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.     

The nature and treatment of social phobia in youth

A small proportion of children and adolescents experience a debilitating level of social anxiety, known as social phobia. Initially, we consider the phenomenology and aetiology of social phobia in children and adolescents. A number of age-sensitive assessment instruments or tools are briefly considered: a diagnostic interview, selj-report instruments, behavioural observations, cognitive assessment, self-monitoring and psychophysiological recording. We explore cognitive-behavioural strategies that have been found to be useful in the management of social phobia. Although there is much research support for the efficacy of cognitive-behavioural strategies for adults with social phobia, it is emphasized that controlled evaluations have yet to be undertaken with socially phobic youngsters.     

Socialization in an International Context

The globalization of the world economy, the widespread expansion of corporations into overseas markets and the increased use of expatriate and repatriate job assignments have all fundamentally changed the context in which organizational socialization now takes place. This article examines the distinctive socialization issues made salient by this organizational context change. The paper reviews existing theoretical and empirical research, provides hypotheses to guide future socialization research in this area and discusses the implications of an international context for the management of organizational socialization programmes.     

Should the behavioral sciences become more pragmatic? The case for functional contextualism in research on human behavior

Although societal need for behavioral science research is enormous, current research practices seem to be inefficient vehicles for producing knowledge that guides practical action. Many of our most popular theories provide little direct guidance for application. They focus on the development of models of the relationships among organismic events such as attitudes, self-efficacy expectations, and behavior, but pay little or no attention to the contextual influences on behavior. Such research is in keeping with a long-standing mechanistic tradition in psychology. We propose a version of contextualism as an alternative paradigm for the behavioral sciences. According to this paradigm, theories and research are evaluated in terms of their contribution to the prediction and influence of behavior. Basic research organized to pursue this goal has a direct bearing on how behavioral phenomena can be changed for practical purposes. Conversely, applied research contributes to basic understanding of the determinants of psychological phenomena.     

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.