Avoiding Colonizer Positions in the Therapy Room: Some Ideas About the Challenges of Dealing with the Dialectic of Misery and Resources in Families

Some authors have argued that certain acts of family therapists—despite their best intentions—may represent a form of colonizing the family. When acting as a colonizer, a therapist is understood as becoming overly responsible for the family and focusing too strongly on change. In so doing, the therapist disrespects the family's pace, and neglects their own resources for change. This paper aims to highlight the need for therapists to be hypersensitive both to the resources of families entering therapy as well as to the impact of prevailing ideologies on their own positioning in the session. The kind of sensitivity advocated here is dialectical in the sense that every family is understood as having potentials promoting dynamism, happiness, and well-being as well as potentials contributing to stagnation, unhappiness, and misery. In this article, using illustrations from clinical practice, we present some ideas for resisting the tendency by the therapist to assume a colonizing position as a professional solver of problems for families. Our main aim here is to redirect the therapist toward connecting with the family's suffering, as well as with the resource repertoire it has developed for navigating and negotiating its way through life.     

Parental Separation and Children's Behavioral/Emotional Problems: The Impact of Parental Representations and Family Conflict

In this longitudinal study, we examine whether the effect of parental separation on kindergarten children's behavioral/emotional problems varies according to the level of family conflict, and children's parental representations. One hundred and eighty seven children were assessed at ages 5 and 6. Family conflict was assessed using parents' ratings. Children's parental representations were assessed using a story-stem task. A multiinformant approach (parent, teacher, child) was employed to assess children's behavioral/emotional problems. Bivariate results showed that separation, family conflict, and negative parental representations were associated with children's behavioral/emotional problems. However, in multivariate analyses, when controlling for gender and symptoms at age 5, we found that children of separated parents who showed negative parental representations had a significantly greater increase in conduct problems between 5 and 6 than all other children. In terms of emotional symptoms and hyperactivity, symptoms at 5 and (for hyperactivity only) gender were the only predictors for symptoms 1 year later. Our results suggest that kindergarten children's representations of parent-child relationships moderate the impact of parental separation on the development of conduct problems, and underline play and narration as a possible route to access the thoughts and feelings of young children faced with parental separation.     

Identifying early signs of aggression: psychometric properties of the Cardiff infant contentiousness scale

Our aim was to develop an age-appropriate measure of early manifestations of aggression. We constructed a questionnaire about normative developmental milestones into which a set of items measuring infants' use of physical force against people and expressed anger were included. These items comprise the Cardiff Infant Contentiousness Scale (CICS). Evidence for the reliability and validity of the CICS is provided from analyses of a sample of N=310 British infants, assessed at a mean age of 6 months as part of a larger longitudinal study of the development of aggression. The informants' CICS ratings demonstrated reasonable levels of internal consistency and interrater agreement. Informants' ratings were validated by observations of infants' distress in response to restraint in a car seat. Longitudinal analyses revealed that contentiousness was stable over time and that contentiousness at 6 months predicted infants' later use of force with peers. When used in the company of other methods, the simple four-item CICS scale could serve as a useful screen for early manifestations of aggressiveness in human infants.     

论现代临床医学发展的人文走向

我们不能用静止的眼光看待当代的医学。在整个“以人为本”的环境背景和其它因素的影响下,近二十多年以来,现代医学正在开始走出人性冷漠的阴影,出现了一些重要的人文走向,尽管这还只是开始,但无疑给人们以希望和信心。     

The integration of familiarity and recollection information in short-term recognition: modeling speed-accuracy trade-off functions

Dual process models postulate familiarity and recollection as the basis of the recognition process. We investigated the time-course of integration of the two information sources to one recognition judgment in a working memory task. We tested 24 subjects with a response signal variant of the modified Sternberg recognition task (Oberauer, 2001) to isolate the time course of three different probe types indicating different combinations of familiarity and source information. We compared two mathematical models implementing different ways of integrating familiarity and recollection. Within each model, we tested three assumptions about the nature of the familiarity signal, with familiarity having (a) only positive values, indicating similarity of the probe with the memory list, (b) only negative values, indicating novelty, or (c) both positive and negative values. Both models provided good fits to the data. A model combining the outputs of both processes additively (Integration Model) gave an overall better fit to the data than a model based on a continuous familiarity signal and a probabilistic all-or-none recollection process (Dominance Model).     

Neuropsychological Measures that Predict Progression from Mild Cognitive Impairment to Alzheimer's type dementia in Older Adults: a Systematic Review and Meta-Analysis

This study aimed to determine the extent to which cognitive measures can predict progression from mild cognitive impairment (MCI) to Alzheimer’s type dementia (AD), assess the predictive accuracy of different cognitive domain categories, and determine whether accuracy varies as a function of age and length of follow-up. We systematically reviewed and meta-analyzed data from longitudinal studies reporting sensitivity and specificity values for neuropsychological tests to identify individuals with MCI who will develop AD. We searched articles in Medline, Cochrane, EMBASE, PsycINFO, and the Web of Science. Methodological quality was assessed using the STARDem and QUADAS standards. Twenty-eight studies met the eligibility criteria (2365 participants) and reported predictive values from 61 neuropsychological tests with a 31-month mean follow-up. Values were pooled to provide combined accuracy for 14 cognitive domains. Many domains showed very good predictive accuracy with high sensitivity and specificity values (≥ 0.7). Verbal memory measures and many language tests yielded very high predictive accuracy. Other domains (e.g., executive functions, visual memory) showed better specificity than sensitivity. Predictive accuracy was highest when combining memory measures with a small set of other domains or when relying on broad cognitive batteries. Cognitive tests are excellent at predicting MCI individuals who will progress to dementia and should be a critical component of any toolkit intended to identify AD at the pre-dementia stage. Some tasks are remarkable as early indicators, whereas others might be used to suggest imminent progression.     

Splenium development and early spoken language in human infants

The association between developmental trajectories of language‐related white matter fiber pathways from 6 to 24 months of age and individual differences in language production at 24 months of age was investigated. The splenium of the corpus callosum, a fiber pathway projecting through the posterior hub of the default mode network to occipital visual areas, was examined as well as pathways implicated in language function in the mature brain, including the arcuate fasciculi, uncinate fasciculi, and inferior longitudinal fasciculi. The hypothesis that the development of neural circuitry supporting domain‐general orienting skills would relate to later language performance was tested in a large sample of typically developing infants. The present study included 77 infants with diffusion weighted MRI scans at 6, 12 and 24 months and language assessment at 24 months. The rate of change in splenium development varied significantly as a function of language production, such that children with greater change in fractional anisotropy (FA) from 6 to 24 months produced more words at 24 months. Contrary to findings from older children and adults, significant associations between language production and FA in the arcuate, uncinate, or left inferior longitudinal fasciculi were not observed. The current study highlights the importance of tracing brain development trajectories from infancy to fully elucidate emerging brain–behavior associations while also emphasizing the role of the splenium as a key node in the structural network that supports the acquisition of spoken language.     

论医院伦理委员会的建设

医院伦理委员会作为维护医患关系之间权益公平的中介力量,把医学技术与人文关怀结合起来,在医患之间构筑起一种新型的关系,让患者得到细致入微的人本关怀。目前,我国在依法推进、规范医学伦理审查方面仍是空白,所以应尽快对医院伦理委员会的工作性质及作用做出明确的规定,以保障医疗工作更加安全。