Elaborate reflections on a simple manifesto

In an earlier article (^{McFall, 1991}), I urged clinical psychologists to work toward the goal of integrating science and practice and proposed the adoption of a principle and two corollaries aimed at achieving this goal. In general, I argued that all aspects of clinical psychology must be guided by the highest scientific and ethical standards, that clinical practice be limited to empirically supported procedures, and that clinical training be devoted to producing clinical scientists. In the present article, I elaborate and defend these points by offering reflections on a number of submitted questions provoked by the earlier article. I address four major issues: the philosophical foundations for a scientific epistemology, the implications of this epistemology for clinical practice, the implications for clinical training, and the likely impact of adopting this epistemology on the field of clinical psychology.     

THE ORIGINS AND GOVERNANCE OF COMPLEX SOCIAL SYSTEMS

The new science of Complexity explains that limited knowledge prevents societies from predicting and controlling their developments. But Complexity further suggests that nature uses the limits of knowledge to evolve, which turns an apparent obstacle into an opportunity to reevaluate governmental institutions. As in nature, the limits of knowledge lead social systems to evolve by individuating, liberating, and empowering their members. Societies individuate and liberate their members to probe environments and exploit opportunities. Societies empower individuals to globalize their findings which requires constitutionally constraining governmental powers. Societies that respect human rights thus gain selective advantage. Showing that what nature is models what societies ought to be, Complexity may finesse the “naturalistic fallacy” of Hume and Moore.     

Pleasant emotional induction broadens the visual world of young children

These experiments aimed at studying the influence of emotional context on global/local visual processing in children. Children 5 years old, known to present an immature global visual bias, and 8 years old, known to pay attention predominantly to global information, were placed in either a neutral or pleasant emotional context and subsequently presented with a global/local visual judgement task. As with previous findings for adults, both age groups presented a pronounced perceptual bias toward global information following exposure to emotionally pleasant pictures. Interestingly, younger children, who do not present a global bias during the neutral exposure, presented the same preference for global information as older children when exposed to the pleasant context. These findings indicate that emotion may strongly affect visual perception in children, with important implications for educational practice and models of cognition.     

Global dot integration in typically developing children and in Williams Syndrome

Williams Syndrome (WS) is a neurodevelopmental disorder that results in deficits in visuospatial perception and cognition. The dorsal stream vulnerability hypothesis in WS predicts that visual motion processes are more susceptible to damage than visual form processes. We asked WS participants and typically developing children to detect the global structure Glass patterns, under “static” and “dynamic” conditions in order to evaluate this hypothesis. Sequentially presented Glass patterns are coined as dynamic because they induce illusory motion, which is modeled after the interaction between orientation (form) and direction (motion) mechanisms. If the dorsal stream vulnerability holds in WS participants, then they should process real and illusory motion atypically. However, results are consistent with the idea that form and motion integration mechanisms are functionally delayed or attenuated in WS. Form coherence thresholds for both static and dynamic Glass patterns in WS were similar to those of 4–5 year old children, younger than what is predicted by mental age. Dynamic presentation of Glass patterns improved thresholds to the same degree as typical participants. Motion coherence thresholds in WS were similar to those of mental age matches. These data pose constraints on the dorsal vulnerability hypothesis, and refine our understanding of the relationship between form and motion processing in development.     

Private work in public places: Confidentiality and role tensions in a university counselling service

This paper aims to explore issues of confidentiality relating to working with undergraduate and postgraduate students in a university counselling service. The context of a counselling service within our institute of higher education has to be understood in its relationship to academic, administrative and managerial staff, to medical and psychiatric services personnel and to the wide range of other student support and welfare services in the organization whether run by university staff or the students' union. Some reflection will be given to the need for clarity in the range of roles counsellors have to play within the different functions of the university. The client-counselling relationship cannot be seen as a dyad but as a triad or an even more complex constellation of relationships when regarded in an institutional context. The central premise is based on understanding the conscious and unconscious dynamics in the institution and how these impinge on the relationship between client and counsellor in challenging or assuming the confidentiality held by the service. Such boundary issues are identified in consultation and referral, breaking confidentiality, referral of disruptive students, calls for help and holding confidentiality. The case material drawn on to illustrate these five areas is also described in terms of anxieties raised and how these are projected, introjected and contained.

Within the service client and counsellor contract to work together. It is made clear that counselling is a professional relationship with agreed boundaries and a commitment to confidentiality. This is crucial to the working relationship and is a means of providing the client with both safety and privacy. Any limitation on the degree of confidentiality offered may reduce the usefulness of counselling. Bound by his or her professional code of ethics the counsellor will reach an agreement with the client at the outset about the extent of confidentiality they are offering, take care not to disclose information given in confidence and, when possible, be able to negotiate any change in agreement with the client.

Exceptional circumstances which may occur and give rise to the counsellor's decision to break the confidentiality formerly agreed between him or herself and the client are those which give grounds for believing the client will cause serious harm to others or themselves or have harm caused to them. Reference will be made to the role of consultant supervision in such situations and how any breaking of confidentiality can best be minimized. Attention will be given to the relevant ethical codes to which counsellors adhere and the issues of confidentiality within the legal process as well as whether the requirements of providing counselling services for students in higher education impel us, logically and practically, towards certain policies in regard to boundaries.     

On integrity

This paper argues that, rather than statutory registration, it is the personal integrity of the individual practitioner that will best safeguard the interest of the client and ultimately the image and reputation of the counselling/psychotherapy profession within society. An attempt is made to define integrity as an absolute moral component of the personality and to consider its significance to the therapeutic relationship. Trust, too, is considered as a vital factor in this relationship. As well as the integrity of the individual practitioner, the integrity of the psychotherapy profession as a whole is considered with particular regard to its considerable reliance on the production of theory for its sense of self worth, as opposed to its efficacy as a therapeutic enterprise.     

Book Review: Managing Mental Health in the Community: Chaos and Containment

Abstract

The British Association of Counselling first introduced a Code of Ethics and Practice for Counsellors in 1984. It has subse-quendy been revised three times. The codes have to be sufficiently broad to be accepted by the membership of BAC, who come from a wide range of theoretical backgrounds. Inevitably this means that the codes do not satisfy everyone nor do they resolve all ethical dilemmas. This paper focuses on sections of the codes which are unsatisfactory, or inadequate for psychodynamic counsellors. It also looks at the influence of psychodynamic counsellors in changes to the clauses on sexual exploitation. Finally the absence of any mention of dual and multiple relationships is discussed.     

Cosmopolitan ethics and global legalism

This article analyses the legal and ethical dimensions of the wide gap between commitments to universal human rights and the reality of their widespread and systematic abuse, particularly as related to poverty and inequality. The argument put forward is that, properly conceived, global legalism, that is, the quest to apply the rule of law across and among states and societies, and cosmopolitan ethics, both support restricting harms imposed on weak and vulnerable individuals worldwide by an unjust institutional order. Therefore, those who have tended to value either a global rule of law or cosmopolitan ethics independently have good reason to pursue their requirements together. The article also considers the problem of legalism and cosmopolitanism being used by powerful agents in global politics to enhance their prerogatives and their freedoms from legal and ethical restraints.     

Switching between global and local scopes of attention is resisted near the hands

Recently, several changes in perception, attention, and visual working memory have been reported when stimuli are near to compared to far from the hands, suggesting that such stimuli receive enhanced scrutiny. A mechanism that inhibits the disengagement of attention from objects near the hands, thus forcing a more thorough inspection, has been proposed to underlie such effects. Up until now, this possibility has been tested only in a limited number of tasks. In the present study we examined whether changes in one's global or local attentional scope are similarly affected by hand proximity. Participants analysed stimuli according to either their global shape or the shape of their constituent local elements while holding their hands near to or far from the stimuli. Switches between global and local processing were markedly slower near the hands, reflecting an attentional mechanism that compels an observer to more fully evaluate objects near their hands by inhibiting changes in attentional scope. Such a mechanism may be responsible for some of the changes observed in other tasks, and reveals the special status conferred to objects near the hands.     

Quelques réflexions sur l’incidence des valeurs éthiques sur le choix technique des interventions psychothérapeutiques

If we consider the evolution in the patterns of psychopathology during the 20th century, we discover the evolution of ethical values implicit in the theory and their implications as far as our technical choices are concerned. The therapeutic relationship is asymmetrical, not only because of different role positions but also because of an inherent power differential. The therapist is consciously recognized as occupying a superior role because of his or her professional status and at the unconscious level, too, through transfer and projection of different fantasies. Being in charge of the therapeutic process carries with it the professional responsibility for handling this asymmetry. The therapist's theoretical and technical decisions in this regard reflect his or her ideology about power and how it should be used to establish the therapeutic alliance.