The phenomenon of vulnerability in clinical encounters

After a brief, personal reflection on Aron Gurwitsch’s life and his many influences on my career, I devote this lecture to some of the central themes of a phenomenology of medicine. Its core is the clinical encounter, which displays a certain structure I term the asymmetry of power (physician) and vulnerability (patient, family)—a complex contextual imbalance characterized by multiple points of view, hence points for reflective entrance. These are then interpreted phenomenologically in terms of epoché and reduction (practical distantiation), evidence, reflection, and other related themes. I conclude with a suggestion about “the fundamental method” of phenomenology, free fantasy variation. This paper was delivered as The Aron Gurwitsch Memorial Lecture, October 21, 2005, co-sponsored by The Center for Advanced Research in Phenomenology and the Society for Phenomenology and Existential Philosophy, Salt Lake City, Utah. It is based on a number of articles, chapters and books I have written over the past several decades (see especially 2000, pp. 123–140; 1995b, pp. 147–168).     

儒家伦理讨论中的六大概念问题

关于儒家伦理问题的讨论一直是中国哲学史界与伦理学界的一个热门话题,许多学者都抱着真挚的热情与善良的意愿努力开掘儒家传统伦理思想中的精微意蕴,并力图为现实生活与社会提供某种可资借鉴的范本。应当说其中的不少工作都有着深刻的理论价值和一定的现实意义,但也不能不看到,在讨论中有不少关涉核心问题的概念显得比较模糊甚或混乱,主要有伦理与德性、实践与思想、当然与可能、大众与精英、他律与自律、早期(先秦)儒家与后期(宋明)儒家等。对这些不同的概念做一辨析和梳理,将有利于关于儒家伦理问题的讨论在更深入和更精确的层面上进行。     

An Empirical Evaluation of Millon's Dimensional Polarities

LASTPAGE study investigated the theoretical consistency for Millon's dimensional polarities (T. Millon &; R. D. Davis, 1996; T. A. Widiger, 1999) by administering the Millon Index of Personality Styles (MIPS; T. Millon, 1994) and Millon Clinical Multiaxial Inventory-III (MCMI-III; T. Millon, 1997) to 50 university counseling center students. Data were analyzed by correlating the MIPS polarity dimension scales with the personality disorder scales of the MCMI-III. Findings suggested more inconsistencies than consistencies with the underlying theoretical model. The greatest discrepancies were found for the expected relationships between the polarity dimensions and the narcissistic and compulsive scales, and to a lesser degree, the schizoid, avoidant, schizotypal, and negativistic scales. Discussion concerned how these divergencies might best be understood in light of Millon's conceptualization of Axis II disorders.     

女大学生心理健康的测试与培养

本研究抽选198名在校女大学生,采用SCL-90临床症状精神量表测试。结果表明女大学生在人际关系、情绪等方面比正常成人分值略高;课题组通过设计多种心理训练活动,力图培养女大学生的良好心理健康,并为此已有初步成绩。     

Intimacies: An Integrative Multicultural Framework for Couple Therapy

Implicitly or explicitly, our ideas about intimacy are the most fundamental notions giving direction to the process of couple therapy. Yet, as a field, we have spent little time conceptualizing intimacy and even less time considering the diversity of priorities and meanings couples bring to our offices. In Part One, Varieties of Intimacy, I describe a kaleidoscope of contexts—socio‐historical, cultural, gender, life cycle, and developmental—that inform our ideas and expectations for intimacy in couples’ relationships. I highlight different spheres in which intimacy may take place such as the emotional, sexual, intellectual, or familial. I propose a starting point in which the therapist, in a collaborative manner, helps the partners articulate their yearnings and priorities in order to negotiate a shared vision. In Part Two, Conceptualizing Intimacy, I suggest an experiential definition that gives room for each partner's subjective meanings, yet consider diverse relational processes that may need to be addressed for a resilient ebb and flow of intimate experiences. In Part Three , Sexual Intimacy, I outline conditions in which sex is more likely to be experienced as intimate rather than nonintimate. Finally, in Part Four, I describe Therapeutic Principles to guide the therapist in taking couples from reactivity to dialogue to negotiations of intimacy. The integrative framework proposed here discourages monolithic a priori notions of intimacy and highlights instead: nuanced meanings, relational processes to be considered differentially, present and past emotional blocks, and a flexible clinical approach to foster conditions for the creation and resilience of intimate experiences.     

Positive mental health,positive affect and suicide ideation

Background/ObjectivePositive mental health (PMH) has been shown to confer resilience against suicide ideation. However, the mechanisms underlying the positive effect of PMH on suicide ideation/behavior are largely unknown. The current study aimed to determine whether positive affect mediates the association between PMH and suicide ideation.MethodA total of 150 adult outpatients (65.3%; female; age: M(SD)=37.79(13.50), range:18–77) completed measures on PMH, positive and negative affect, as well as suicide ideation. Data were collected using self-report questionnaires. Linear hierarchical regression analysis was used to analyze the data. Positive affect was considered to mediate the association between positive mental health and suicide ideation.ResultsWhile positive affect fully mediated the significant negative association between PMH and suicide ideation, negative affect did not reveal to be a significant mediator of this relationship.ConclusionsThe protective influence of PMH against suicide ideation is due to heightened positive affect: If positive mental health translates into positive affect, then suicide ideation becomes less likely.     

Practice and forgetting effects on vocabulary memory: an activation-based model of the spacing effect

An experiment was performed to investigate the effects of practice and spacing on retention of Japanese–English vocabulary paired associates. The relative benefit of spacing increased with increased practice and with longer retention intervals. Data were fitted with an activation-based memory model, which proposes that each time an item is practiced it receives an increment of strength but that these increments decay as a power function of time. The rate of decay for each presentation depended on the activation at the time of the presentation. This mechanism limits long-term benefits from further practice at higher levels of activation and produces the spacing effect and its observed interactions with practice and retention interval. The model was compared with another model of the spacing effect (Raaijmakers, 2003) and was fit to some results from the literature on spacing and memory.     

Variable solutions to the same problem: aberrant practice effects in object naming by three aphasic patients

Although deficits in confrontation naming are a common consequence of damage to the language areas of the left cerebral hemisphere, some patients with aphasia show relatively good naming ability. We measured effects of repeated practice on naming latencies for a set of pictured objects by three aphasic patients with near-normal naming ability and by neurologically intact young and older adults. While the non-injured participants showed a systematic reduction in overall mean latencies and reduced trial-to-trial latency variability, the aphasic patients did not. Examination of the latency distributions suggests that successful naming by aphasic patients may come about by different underlying operations.     

Acceptance and commitment therapy: model, processes and outcomes

The present article presents and reviews the model of psychopathology and treatment underlying Acceptance and Commitment Therapy (ACT). ACT is unusual in that it is linked to a comprehensive active basic research program on the nature of human language and cognition (Relational Frame Theory), echoing back to an earlier era of behavior therapy in which clinical treatments were consciously based on basic behavioral principles. The evidence from correlational, component, process of change, and outcome comparisons relevant to the model are broadly supportive, but the literature is not mature and many questions have not yet been examined. What evidence is available suggests that ACT works through different processes than active treatment comparisons, including traditional Cognitive-Behavior Therapy (CBT). There are not enough well-controlled studies to conclude that ACT is generally more effective than other active treatments across the range of problems examined, but so far the data are promising.     

The role of input and output modality pairings in dual-task performance: evidence for content-dependent central interference

Recent debate regarding dual-task performance has focused on whether costs result from limitations in central capacity, and whether central operations can be performed in parallel. While these questions are controversial, the dominant models of dual-task performance share the assumption that central operations are generic--that is, their interactions are independent of stimulus and response modalities. To examine these issues, we conducted a series of dual-task experiments with different input and output modality pairings. One condition combined a visual-manual task with an auditory-vocal task, and the other condition reversed the input-output pairings, combining a visual-vocal task with an auditory-manual task. Input/output modality pairings proved to be a key factor; throughout practice, dual-task costs were generally more than twice as large with visual-vocal/auditory-manual tasks than with the opposite arrangement of modalities (Experiments 1 and 2). These differences could be explained neither by competition for peripheral resources nor by differences in single-task response times (Experiment 3). Moreover, the persistent dual-task costs did not appear to stem from a central bottleneck. Contrary to the dominant models of dual-task performance, we propose that central interference between tasks depends not just on the duration of central operations, nor just strategic adaptation, but also on the content of those operations. Implications for structural and strategic accounts of dual-task interference are discussed.