The social epidemiologic concept of fundamental cause

The goal of research in social epidemiology is not simply conceptual clarification or theoretical understanding, but more importantly it is to contribute to, and enhance the health of populations (and so, too, the people who constitute those populations). Undoubtedly, understanding how various individual risk factors such as smoking and obesity affect the health of people does contribute to this goal. However, what is distinctive of much on-going work in social epidemiology is the view that analyses making use of individual-level variables is not enough. In the spirit of Durkheim and Weber, S. Leonard Syme makes this point by writing that just “as bad water and food may be harmful to our health, unhealthful forces in our society may be detrimental to our capacity to make choices and to form opinions” conducive to health and well-being. Advocates of upstream (distal) causes of adverse health outcomes propose to identify the most important of these “unhealthful forces” as the fundamental causes of adverse health outcomes. However, without a clear, theoretically precise and well-grounded understanding of the characteristics of fundamental causes, there is little hope in applying the statistical tools of the health sciences to hypotheses about fundamental causes, their outcomes, and policies intended to enhance the health of populations. This paper begins the process of characterizing the social epidemiological concept of fundamental cause in a theoretically respectable and robust way.

Thinking and Working Relationally: Interviewing and Constructing Hypotheses to Create Compassionate Understanding

In the initial interviews of family therapy sessions, the therapist faces the challenge of obtaining and organizing the information that is most relevant toward understanding the essential concerns that families and couples bring to therapy. This article describes the process of clinical interviewing and case conceptualization used in training family therapists at the Ackerman Institute for the Family. This approach helps the therapist bring forward, and organize, specific information into relational hypotheses, or systemic‐relational conceptualizations, that allow both family members and the therapist to understand presenting problems within their relational contexts. While always provisional, relational hypotheses help anchor the therapist in a systemic‐relational frame and provide a conceptual through‐line to guide the ongoing work of the therapy. The process of interviewing and the construction of clear and complex conceptualizations of presenting problems are illustrated through case examples.     

Couple and Family Treatments: Study Quality and Level of Evidence

This paper examines the application of the guidelines for evidence‐based treatments in family therapy developed by Sexton and collaborators to a set of treatment models. These guidelines classify the models using criteria that take into account the distinctive features of couple and family treatments. A two‐step approach was taken: (1) The quality of each of the studies supporting the treatment models was assessed according to a list of ad hoc core criteria; (2) the level of evidence of each treatment model was determined using the guidelines. To reflect the stages of empirical validation present in the literature, nine models were selected: three models each with high, moderate, and low levels of empirical validation, determined by the number of randomized clinical trials (RCTs). The quality ratings highlighted the strengths and limitations of each of the studies that provided evidence backing the treatment models. The classification by level of evidence indicated that four of the models were level III, “evidence‐based” treatments; one was a level II, “evidence‐informed treatment with promising preliminary evidence‐based results”; and four were level I, “evidence‐informed” treatments. Using the guidelines helped identify treatments that are solid in terms of not only the number of RCTs but also the quality of the evidence supporting the efficacy of a given treatment. From a research perspective, this analysis highlighted areas to be addressed before some models can move up to a higher level of evidence. From a clinical perspective, the guidelines can help identify the models whose studies have produced clinically relevant results.     

Current issues and new direction in Psychology and Health: Epidemiology and health psychology – please bridge the gap

Epidemiology has and continues to play a vital role in furthering our understanding of risks for disease development. Large scale studies provide the necessary statistical power to identify biological and environmental factors associated with disease onset and severity. However, association does not confirm causality and in theoretical terms, epidemiology is somewhat limited. In this editorial, we argue that bringing together the methodological strengths of epidemiology with the theoretical rigour of psychology enables researchers to go beyond risk-finding and develop causative [or explanatory] models of disease development which pave the way for directed, evidence-based interventions to improve health.     

La gestion de la souffrance par le psychologue clinicien. Étude des impacts et des stratégies de coping

We focus in this study on strategies used by clinical psychologists to cope with their own or patient psychological distress in the framework of help relationship. A self-administered form was sent to listings of professionals by e-mail. The sample is made of 187 French clinical psychologists. To cope with patients’ suffering, psychologists use mostly avoidance coping style. And the strategies they prefer are “supervision”, “personal therapy” and “speaking with colleagues” (problem focused coping strategies). To cope with their own distress, which has a lot of negative impacts on help relationship, psychologists have most frequently a problem focused coping style but their favourite strategy is to “lighten their schedules”. And almost a quarter of the sample presents a significant level of distress. In conclusion, results show that psychological distress management by psychologists is an important question with a lot of ethical questions.     

Measuring psychotherapy outcomes in routine practice: Examining Slovak versions of three commonly used outcome instruments

This study examined the Slovak mutations of three outcome measures for routine practice i.e. the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), the Outcome Questionnaire – 45 (OQ-45), the Outcome Rating Scale (ORS), and one control measure the Symptom Checklist 10 Revised (SCL-10R), with regard to their concordance or differences in outcome classification of pre-post change, when used by the same patients and when the criteria used for establishing recovery and improvement status are based on the same sample. Method: Non-clinical (252) and clinical (202) samples were used for the standardisation of all instruments. A portion of the clinical participants (N?=?140) completed all measures at the end of their treatment. Results: The CORE-OM, and the SCL-10R indicated a higher number of recovered and improved clients. With regard to the pre-post differences as expressed in the effect size, the CORE-OM showed the highest pre-post difference (pre-post effect size .98), followed by the ORS (.87), the SCL-10R (.83) and finally with the OQ-45 (.69). Conclusion: Even very similar instruments developed on the basis of similar theoretical conceptualisations and empirical findings may report different pre-post outcomes.     

Offering a ‘therapeutic presence’ in schools and education settings

Abstract

In this essay I present the clinical work with a client that I have been working with for 9 months now. The essay is divided into sections, each one indicative of one phase of the counselling relationship. In each of them I present the therapeutic process (my client's and myself) by highlighting some newly-acquired psychodynamic concepts, sharing some difficulties encountered, the learning gained though supervision and the progress of the client.     

Theology and Epidemiology as Complementary Perspectives on Aging

ABSTRACT

The religiousness of individuals and communities can be effective resources for healthcare practitioners serving older Americans. Such effectiveness can be more fully realized if theology and epidemiology are recognized as complementary ways of understanding aging and health. The ways in which theologians and epidemiologists can be complementary consist of the different modalities of hope they engender, the different types of preferential recollection they exercise, and the different stages of life they address. The complementarity of theology and epidemiology is dependent upon a spiritual but not supernatural conception of the relationship between religion and health.     

Can voicing conflict within experiential learning groups facilitate connection? building and developing effective multi-disciplinary team-working skills

In the UK, Clinical Psychologists (CPs) work in a variety of settings within the National Health Service (NHS), often within Multi-Disciplinary Teams (MDTs). Problem-Based Learning (PBL) within CP training at the University of Hertfordshire (UH) offers unique opportunities to combine scientist-practitioner and reflective-practitioner models to learn about group dynamics from the personal experience of working within an experiential learning group.

Further, given Trainees work three days per week on placement within MDTs in the NHS, the learning gained within a ‘safer’ PBL context can be utilised within these clinical settings. For two years, Trainees at UH have to work in small PBL groups with five or six members learning to work together to achieve a goal (four assessed presentations) negotiating their own personal and professional journey, as well as a group journey. Consequently, PBL offers trainees opportunities to learn (1) how individuals work within a group; (2) how personal experiences influence this process; (3) how others influence them and are influenced by them; and (4) how a group of diverse individuals conceptualise, understand and convey case vignettes to an audience. Within these groups, many Trainees learn to speak out, reflect, listen attentively, empathise, validate and accept diverse experiences. Further, when differences dominate they often learn to negotiate these, finding a way to maintain effective team working in order to complete the presentation. Focusing on the conflict that can occur within (any) group, this paper explores themes from the reflective narratives of six trainees: parallels and differences between MDTs and PBL groups, striving for and achieving authenticity; and conflict as a ‘swear’ word. We conclude that exploring the role PBL can play in training individuals to work effectively in teams may be of benefit within the training of other professional groups.