The Nature of Client Agency Prior to Therapy: A Qualitative Study on Clients’ Narratives

Client agency is considered a crucial contributor to good treatment outcome. Recent studies, however, differ strongly in how they conceptualise and investigate agency. The current study explores the nature of client agency in ten clients’ pre-treatment interviews. Applying Consensual Qualitative Research, we constructed three overarching categories, subdivided into 14 sub-categories capturing both between- and within-person differences in agency before therapy. We found that all participants oscillated between the experience of a lack of grip on problems on the one hand and noticing their involvement in the problem and taking action on the other. These results present a dynamic conceptualisation of client agency. This allows us to ask pertinent questions for both future research and clinical practice.     

Decomposition of multivariate utility functions in non-additive expected utility theory

In expected utility many results have been derived that give necessary and/or sufficient conditions for a multivariate utility function to be decomposable into lower-dimensional functions. In particular, multilinear, multiplicative and additive decompositions have been widely discussed. These utility functions can be more easily assessed in practical situations. In this paper we present a theory of decomposition in the context of nonadditive expected utility such as anticipated utility or Choquet expected utility. We show that many of the results used in conventional expected utility carry over to these more general frameworks. If preferences over lotteries depend only on the marginal probability distributions, then in expected utility the utility function is additively decomposable. We show that in anticipated utility the marginality condition implies not only that the utility function is additively decomposable but also that the distortion function is the identity function. We further demonstrate that a decision maker who is bivariate risk neutral has a utility function that is additively decomposable and a distortion function q for which q(½) = ½.     

Cooperative social coordination and aggression: Sex and strain differences in the effects of housing on gonadectomized rats with hormone replacement

Laboratory rats were used to investigate sex and strain differences in the effects of aggression on a cooperative behavior in which pairs learn to coordinate shuttling in a rectangular chamber. The level of aggression was manipulated by comparing males and females of the aggressive S3 strain and a less aggressive Sprague-Dawley-derived strain and by housing same-sex partners either together or individually (eight groups, n = 7 pairs per group). Hormone levels were stabilized by gonadectomy and daily injections of the appropriate sex hormone. The only serious coordination deficits were in individually housed males, associated with violent fighting and an extreme dominance/subordinance relationship that was not observed in females. All other groups readily learned and performed the coordination, with evidence that low and moderate levels of aggression could facilitate coordination by evoking species-typical behaviors that increased proximity, synchrony, and differentiation within pairs. The discussion focused on models of affiliative behavior in the study of aggression and the compatibility between moderate levels of aggression and cooperation.     

No indication that the ego depletion manipulation can affect insight: a comment on DeCaro and Van Stockum (2018)

Abstract

Recently, DeCaro and Van Stockum have suggested that ego depletion following intensive self-control can improve insight problem-solving; this finding was interpreted in terms of insight relying on decreased control over attention and memory. However, DeCaro and Van Stockum used three variants of the single matchstick arithmetic problem. Experiment 1 involved low sample and non-standard problem application, while the more powered Experiment 2 yielded a surprisingly low solution rate. These facts made both studies problematic and called for their replication. In the two present studies, the DeCaro and Van Stockum ego-depletion manipulation and their matchstick problems were administered to a total of 316 people. Furthermore, various other insight problems, subjective ratings of insight experience, analytical problems and executive control tests were applied. The key result was that no reliable effect of ego depletion could be found for any of these measures.     

Response styles in affect ratings: making a mountain out of a molehill

Ratings of affect words are the most commonly used method to assess pleasant affect (PA) and unpleasant affect (UA). The reliance on self-reports would be problematic if affect ratings were heavily influenced by response styles. Several recent publications have indeed suggested (a) that the influence of response styles on affect ratings is pervasive, (b) that this influence can be controlled by variations of the response format using multitrait-multimethod models, and (c) the discriminant validity of PA and UA is spurious. In this article, we examined the evidence for these claims. We demonstrate that (a) response styles have a negligible effect on affect ratings, (b) multiple response formats produce the same results as a single response format, and (c) the discriminant validity of PA and UA is not a method artifact. Rather, evidence against discriminant validity is due to the use of inappropriate response formats that respondents interpreted as bipolar scales.     

The relevance of Rawls' principle of justice for research on cognitively impaired patients

An ethical conflict arises when we must performresearch in the interest of future patients,but that this may occasionally injure theinterests of today's patients.In the case of cognitively impaired persons, thequestion arises whether it is compatible withhumane healthcare not only to treat, but alsoto use these patients for research purposes.Some bioethicists and theologians haveformulated a general duty of solidarity, alsopertaining to cognitively impaired persons, as ajustification for research on these persons. Ifone examines this thesis from the theory ofjustice according to John Rawls, it is revealedthat such a duty of solidarity cannotnecessarily be extrapolated from Rawls'conception of justice. This is at least true ofRawls' difference principle, because accordingto the difference principle only those measuresare justifiable which serve the interest of therespective least well off. Those measures whichwould engender additional injury for the leastwell off could not be balanced by any utilityaccording to Rawls.However, John Rawls' difference principleis subordinate to the first principle,which is that each person has an equalright to the most extensive basic libertycompatible with the same liberty for others.These primary goods are determined by thefreedom and integrity of the person.This integrity of decisionally impaired personswould be in danger if one would abstain fromresearch and thus forego the increase inknowledge related to their disease. Thus onecould conclude, at least from Rawls' firstprinciple, that society must take on a duty toguarantee the degrees of freedom forcognitively impaired persons and thus alsosupport the efforts for their healing.     

The use of genetic test information in insurance: The argument from indistinguishability reconsidered

In the bioethical literature, discrimination in insurance on the basis of genetic risk factors detected by genetic testing has been defended and opposed on various ethical grounds. One important argument in favour of the practice is offered by those who believe that it is not possible to distinguish between genetic and non-genetic information, at least not for practical policy purposes such as insurance decision-making. According to the argument from indistinguishability, the use of genetic test information for insurance purposes should be permitted, because genetic test information is no different from non-genetic medical information in any relevant respect, therefore it would be inconsistent to prohibit the former whilst permitting the latter. This paper discusses and defends this argument and suggests a new, more tenable foundation.     

Ministry to the chronic hemodialysis patient

The beginning point of ministry to those persons suffering from renal failure and turning to hemodialysis in order to sustain life is a sensitive understanding of the total dialysis experience. The minister or chaplain who visits a hemodialysis unit only occasionally will be more effective in bringing his skills to the task by understanding the unique dynamics of the physical, emotional and spiritual adjustment of those who depend on this relatively new therapy. The specific elements of this ministry in terms of those closely involved, professional care givers, families, and patients, are discussed with attention to the factors that tend to make ministry to the hemodialysis patient unique.This article is the result of a one-year chaplain residency at the Veterans Administration Hospital in Nashville, Tennessee, in partial fulfillment of clinical requirements for the D. Min. degree in Pastoral Theology and Counseling at the Divinity School, Vanderbilt University, Nashville, Tennessee.