The Psychosocial Impact of Undergoing Prophylactic Total Gastrectomy (PTG) to Manage the Risk of Hereditary Diffuse Gastric Cancer (HDGC)

Individuals identified as at high risk of developing Hereditary Diffuse Gastric Cancer (HDGC) are advised to undergo prophylactic surgery - have their stomach removed - in their early twenties. Research with (older) cancer patients who undergo gastrectomy for curative reasons suggests that gastric resection has a number of physical and psychosocial sequelae. Because it is difficult to extrapolate the findings of studies of older cancer patients to younger healthy patients who are considering prophylactic total gastrectomy (PTG), the aim of this qualitative interview study was to determine the psychosocial implications of undergoing prophylactic surgery to manage genetic risk. Fourteen men and 13 women from the UK’s Familial Gastric Cancer study who had undergone PTG were invited to participate in qualitative interviews. Most reported that undergoing surgery and convalescence was easier than anticipated. There was evidence that age affected experiences of PTG, with younger patients tending to report faster recovery times and more transient aftereffects. All saw the benefits of risk reduction as outweighing the costs of surgery. Surgery was described as having a range of physical impacts (disrupted appetite, weight loss, fatigue, GI symptoms) that had related psychological, social and economic implications. Those considering PTG need to be aware that its impact on quality of life is difficult to predict and negative sequelae may be ongoing for some individuals.     

Learning in the brain–computer interface: insights about degrees of freedom and degeneracy from a landscape model of motor learning

In this paper, we examine the role of degrees of freedom and their degeneracy in learning in the brain–computer interface paradigm. Though the traditional notion of degrees of freedom in motor learning gave emphasis to muscle and joint activity, the broader concept of dimensions of behavior is relevant to brain–computer interface learning where there is no muscle activity. The role of degeneracy in the dimensions of brain activity is proposed to enhance learning through robustness to stability loss and adaptability in the search for new stable states. Principles for the application of augmented information for learning to coordinate and control the degenerate degrees of freedom in the brain–computer interface are outlined.     

The emergence of new intentions in subjective experience: A social/personal constructionist and relational understanding

As part of the larger project to revision vocational psychology for a new era, a process referred to as the emergence of new intentions in subjective experience is defined and described. It is proposed that this process is central to the ongoing construction and reconstruction of lives in the changing landscape of the times. Following an elaboration of the meaning of emergence of new intentions in subjective experience through comparison to related constructs and theories, a social/personal constructionist and relational understanding of this process is developed. The article concludes by addressing implications for vocational psychology practice.     

Reform of statistical inference in psychology: the case of memory & cognition.

Geoffrey Loftus, Editor of Memory & Cognition from 1994 to 1997, strongly encouraged presentation of figures with error bars and avoidance of null hypothesis significance testing (NHST). The authors examined 696 Memory & Cognition articles published before, during, and after the Loftus editorship. Use of figures with bars increased to 47% under Loftus's editorship and then declined. Bars were rarely used for interpretation, and NHST remained almost universal. Analysis of 309 articles in other psychology journals confirmed that Loftus's influence was most evident in the articles he accepted for publication, but was otherwise limited. An e-mail survey of authors of papers accepted by Loftus revealed some support for his policy, but allegiance to traditional practices as well. Reform of psychologists' statistical practices would require more than editorial encouragement.     

Where to look first for an explanation of induction with uncertain categories

Recent research has examined how people predict unobserved features of an object when its category membership is ambiguous. The debate has focused on whether predictions are based solely on information from the most likely category, or whether information from other possible categories is also used. In the present experiment, we compared these category-based approaches with feature conjunction reasoning, where predictions are based on a comparison among exemplars (rather than categories) that share features with a target object. Reasoning strategies were assessed by examining patterns of feature prediction and by using an eye gaze measure of attention during induction. The main findings were (1) the majority of participants used feature conjunction rather than categorical strategies, (2) people predominantly gazed at the exemplars that were most similar to the target object, and (3) although people gazed most at the most probable category to which an object could belong, they also attended to other plausible category alternatives during induction. These findings question the extent to which category-based reasoning is used for induction when category membership is uncertain.     

A Video Life-world Approach to Consultation Practice: The Relevance of a Socio-Phenomenological Approach

This article discusses the [development and] use of a video life-world schema to explore alternative orientations to the shared health consultation. It is anticipated that this schema can be used by practitioners and consumers alike to understand the dynamics of videoed health consultations, the role of the participants within it and the potential to consciously alter the outcome by altering behaviour during the process of interaction. The study examines health consultation participation and develops an interpretative method of analysis that includes image elicitation (via videos), phenomenology (to identify the components of the analytic framework), narrative (to depict the stories of interactions) and a reflexive mode (to develop shared meaning through a conceptual framework for analysis). The analytic framework is derived from a life-world conception of human mutual shared interaction which is presented here as a novel approach to understanding patient-centred care. The video materials used in this study were derived from consultations in a Walk-in Centre (WiC) in East London. The conceptual framework produced through the process of video analysis is comprised of different combinations of movement, knowledge and emotional conversations that are used to classify objective or engaged WiC health care interactions. The videoed interactions organise along an active or passive, facilitative or directive typical situation continuum illustrating different kinds of textual approaches to practice that are in tension or harmony. The schema demonstrates how practitioners and consumers interact to produce these outcomes and indicates the potential for both consumers and practitioners to be educated to develop practice dynamics that support patient-centred care and impact on health outcomes.     

Klinische Supervision

Clinical supervision is of central significance within different phases of training and is seen as a central part of adequate psychotherapy. Based upon different definitions and models of supervision, this article reviews clinically relevant results of psychotherapy research dealing with issues of supervision. Although the significance of supervision for the quality of psychotherapeutic treatment is sometimes still critically discussed, the amount of evidence for their positive effects increases. The review shows a number of current research deficits that should be compensated in the future.     

‘A baptism of fire’: A qualitative investigation of a trainee counsellor's experience at the start of training

Background: Belief in the effectiveness of professional counselling and psychotherapy training is widespread and generally unquestioned. Few studies have attempted to understand the changes experienced by trainees, or identified which aspects of professional training programmes assist them in the process of becoming therapists. Aims: to investigate how a trainee counsellor changes at the start of training, and to identify which aspects of a professional counsellor training programme were helpful in instigating and supporting change. Method: the experience of one trainee counsellor, Margaret, was captured through three semi-structured interviews conducted at the beginning, middle and end of her first term. The data were subjected to systematic qualitative analysis. Findings: Margaret experienced significant change during her first term. Each interview revealed a different phase of her development. The core categories were: becoming something new (week 3); growth in therapeutic confidence (week 6); surviving ‘stressful involvement’ through supervision (week 11). Experiential learning, in particular group supervision, was helpful throughout. The presence of real clients was identified as the main driver for change. Conclusion: The findings were found to be consistent with a number of other studies, which suggest that training is potentially painful because of the emotional demands it places on trainees, particularly at the start of practice. Consequently trainees require opportunities for experiential learning, peer support and supportive supervision to assist them in their development, but most importantly, given that supportive supervision can only minimise the harm of stressful involvement (Orlinsky & Ronnestad, 2005), they need early positive experiences with clients.