Developing a critically reflexive practice for art therapists using external perceptions of art therapy

This critical inquiry explored external perceptions of art therapy. By focusing on the organizational contexts and structures that art therapy practices are typically situated within, the purpose of the study was to understand: How the values that art therapists intrinsically hold within practice transmitted, translated, and interpreted by other mental health professionals. To gain rich and detailed views, nine mental health professionals were interviewed. Through analysis of the findings, a critically reflexive form of practice was developed to assist art therapists in substantiating their role, while strengthening a team mentality to provide better services to their clients. Study implications involve the need to further explore how art therapists can develop professionally, as well as expand on strategies for how art therapy can be further valued within mental health systems.     

Does the philosophy of medicine exist?

There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine.Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the philosophy of medicine, this is not enough to establish that consensus exists as to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field.     

Awakening from Descartes' nightmare: On the love of ambiguity in phenomenological approaches to education

This paper is an exploration of the Cartesian paradigms of clarity and univocity and how these inform contemporary educational theory and practice. Phenomenology is discussed as a way of disrupting Descartes' visions of clarity and distinctness as paradigms of knowledge and as a return of inquiry to life as it is actually lived. Analogical discourse is examined as a way of giving a voice to this sort of inquiry. Heidegger's notions of inquiry as obedience and thanksgiving are discussed.     

Affordances can invite behavior: Reconsidering the relationship between affordances and agency

The concept of agency has been central to ecological approaches to psychology. Gibson, one of the founders of this movement, made room for this concept by arguing against the mechanistic conceptions in psychology. In his view, the environment is not a collection of causes that pushes the animal around, but consist of action possibilities, which he coined affordances. In making their way in the world, animals regulate their behavior with respect to these possibilities. Reed later developed this ecological conception of agency, following Gibson in conceiving of affordances as action possibilities. However, drawing upon industrial design, architecture, and phenomenology, we argue that affordances are not mere action possibilities but that they can also invite behavior. We suggest a mutualist perspective on invitations, suggesting that they depend on the animal-environment relationship in multiple dimensions. The implications of this new conception of affordances for the ecological account of agency are explored.     

Word use of outpatients with a personality disorder and concurrent or previous major depressive disorder

In a recent study, Rude, Gortner, and Pennebaker (2004) found word use to be related to depression and vulnerability to depression in the essays of college students. We sought to replicate and extend these findings in a clinical sample. Written essays of 304 psychiatric outpatients with a personality disorder and a mixed psychiatric profile on DSM-IV axis-I and 108 healthy controls were examined with word count software. Data on the tendency to be discrepant about the current self compared to a more ideal self were also gathered. We found that psychiatric outpatients in general used more words referring to the self and negative emotion words and fewer positive emotion words, compared to healthy controls. However, word-use proved unrelated to depression specifically. Actual-ideal self discrepancies were related to patient status and to current depression. Contrary to our hypothesis, these discrepancies did not correlate with the use of words referring to the self. We conclude that the negative content and self-focus of written essays and high levels of discrepancy reflect a negative thinking style that is common to a range of psychiatric disorders rather than being specific to depression.     

Everyday dynamics in generalized social and political trust

We applied the traits as density distributions of states approach to generalized expectations of trustworthiness, namely, social trust and trust in politicians. Using an experience sampling study (N = 47), we assessed state social trust and trust in politicians four times a day for 2 weeks. Within-person variability was found to be low but meaningful as it was predicted by variations in affect, interactional trust, and prior experiences. There was high stability in interindividual differences in the mean levels of state trustworthiness expectations and in the levels of within-person variability. Our study provides a comprehensive understanding of stability and variability in generalized expectations of trustworthiness and indicates broad applicability of the traits as density distributions of states approach.     

Moral Philosophers as Ethical Engineers: Limits of Moral Philosophy and a Pragmatist Alternative

Ever since Kant, moral philosophers have been more or less animated by the mission of discovering inescapable law‐like rules that would provide a binding justification for morality. Recently, however, many have started to question (a) whether this is possible and (b) what, after all, this project could achieve. An alternative vision of the task of moral philosophy starts from the pragmatist idea that philosophizing begins and ends in human experiencing. It leads to a view where morality is seen as a “social technology” that aims to make living together possible, and strengthens people's capability to live a good life within a society. The role of moral philosophy is, accordingly, to develop our moral tools further. Moral philosophers become ethical engineers who use their expertise in ethical topics to criticize existing “moral technology” and construct new concepts, tools, and theories that better answer the current challenges for living a good life.     

The explicit and implicit dance in psychoanalytic change

How the implicit/non-declarative and explicit/declarative cognitive domains interact is centrally important in the consideration of effecting change within the psychoanalytic arena. Stern et al. (1998) declare that long-lasting change occurs in the domain of implicit relational knowledge. In the view of this author, the implicit and explicit domains are intricately intertwined in an interactive dance within a psychoanalytic process. The author views that a spirit of inquiry (Lichtenberg, Lachmann & Fosshage 2002) serves as the foundation of the psychoanalytic process. Analyst and patient strive to explore, understand and communicate and, thereby, create a 'spirit' of interaction that contributes, through gradual incremental learning, to new implicit relational knowledge. This spirit, as part of the implicit relational interaction, is a cornerstone of the analytic relationship. The 'inquiry' more directly brings explicit/declarative processing to the foreground in the joint attempt to explore and understand. The spirit of inquiry in the psychoanalytic arena highlights both the autobiographical scenarios of the explicit memory system and the mental models of the implicit memory system as each contributes to a sense of self, other, and self with other. This process facilitates the extrication and suspension of the old models, so that new models based on current relational experience can be gradually integrated into both memory systems for lasting change.     

The Multilevel Relationships of HIV‐Related Stigma to Child and Caregiver Mental Health among HIV‐Affected Households in South Africa

HIV/AIDS‐related (HAR) stigma is still a prevalent problem in Sub‐Saharan Africa, and has been found to be related to mental health of HIV‐positive individuals. However, no studies in the Sub‐Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV‐negative, HIV‐affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra‐individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community‐representative sample of 508 HIV‐affected households nested within 24 communities in KwaZulu‐Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual‐level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV‐affected adults; and that community‐level HAR stigma significantly predicts both individual‐level mental health outcomes (anxiety) among HIV‐affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV‐affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.