以心理学共情理论应对困境中的医患关系

和谐的医患关系是构建人性化医疗的基础,面对当今医患关系紧张的困境,探索如何应对困境中的医患关系迫在眉睫.共情是心理学的一个概念,阐述了人际互动过程中的一种心理现象,是一种站在对方立场上的思考方式.临床实践中医务人员存在共情缺陷,如易产生共情疲劳、缺乏倾听、缺少尊重等,通过心理学干预技术提高其临床共情能力有利于减少共情缺陷、避免医疗纠纷、协调医患关系.良好的共情能力有助于推进新的合作型医患关系的建设,尤其适合于临床一线的医务工作者.     

The way I make you feel: How relatedness and compassionate goals promote partner’s relationship satisfaction

Research has investigated the role of three basic psychological needs as proposed by Self-Determination Theory – autonomy, competence, and relatedness – in explaining relationship satisfaction. Research has also explored how relatedness specifically increases prosocial motivations in the individual but has not focused on the role of relatedness in shaping partners’ relationship functioning over time. This research takes a dyadic perspective that proposes that relatedness fulfillment fosters compassionate goals, which in turn predict increases in partner’s satisfaction. Forty-five heterosexual dating couples were asked about their relatedness need fulfillment, compassionate goals, and relationship satisfaction. Relationship satisfaction was assessed again four weeks later. Results showed that one’s own relatedness fulfillment, but not one’s partner’s relatedness fulfillment at Time 1 uniquely predicts partner’s increased satisfaction at Time 2, and that this is mediated by one’s own higher compassionate goals. These findings highlight the dyadic importance of having one’s needs met in promoting relationship functioning over time.     

Relationship quality,divorce, and well-being: Findings from a three-year longitudinal study

Recent studies indicate that divorce sometimes is positive for subjective well-being, but we lack knowledge about the circumstances under which this is the case. Further, we lack knowledge about the possible different associations between divorce and life satisfaction (LS) vs. positive affect (PA). The current study is based on the Norwegian Mother and Child Cohort Study (MoBa). Change in LS and PA over a three-year period was examined in women who divorced and women who did not divorce (N > 37,000). Relationship quality and relationship status at follow-up were included in the models. The results indicated that divorce predicted higher LS and PA when initial relationship quality was poor. Furthermore, divorce predicted higher PA for women who, after divorce, reported being in a new romantic relationship. The associations between relationship quality and LS and PA were stronger among not-divorced than divorced women, indicating that relationship quality affects LS and PA.     

Couples' evaluations of fatherhood in different stages of the family life cycle

Fathers' and mothers' views on mothers' satisfaction with paternal behaviour as well as the respective processes of origination were studied in 393 cohabiting couples from three different stages of the family life cycle. Data on paternal competence and the couples' relationship characteristics were included as predictors in multiple regression analyses, and the stages of the family life cycle were taken into account with multigroup regression analyses. Results showed that the mothers were more satisfied with paternal behaviour than the fathers thought the mothers were. Moreover, mothers were satisfied when the fathers were willing to spend time with the child, whereas fathers thought that their partners were satisfied when they were able to establish and maintain a relationship with the child. Couple relationship satisfaction had a consistent impact on fathers' views, whereas it was not relevant to mothers' views unless the oldest child had reached adolescence.     

Factors related to life satisfaction among urban African American adults receiving care at a publicly-funded sexual health clinic

Life satisfaction is linked to premature morbidity and mortality and it may be compromised for individuals living in economically-disadvantaged, urban neighborhoods. The present study explores how behavioral and social-environmental health factors are associated with life satisfaction among a sample of African American young adults. Participants (N = 307, M_age = 26.6 years, 53% male) were recruited from a publicly-funded clinic for a randomized controlled trial (RCT). Data from the baseline assessment of the RCT, which included measures of sleep, depression, anxiety, social support, alcohol and drug use problems, city stress, and life satisfaction, were used for the current study. Correlation analyses assessed bivariate associations between life satisfaction and the demographic and health-related factors. Linear regression using backward elimination determined the best fitting model of factors associated with life satisfaction. Backward elimination resulted in the following variables remaining as significantly associated with life satisfaction: age (b = ?2.40, p = .017), anxiety (b = ?5.32, p < .001), and social support (b = 2.89, p = .004). Feeling rested upon waking also remained in the best fitting model, although this association did not achieve statistical significance (p = .099). The results suggest that African American adults who are younger, less anxious, and report adequate social support are more likely to report satisfaction with life. These findings add to the literature aimed at examining health and social factors impacting the well-being of African Americans living in low-income, urban communities.     

Rejection sensitivity,complaint‐related communication,and relational satisfaction: A mediation analysis

This study examines the links among rejection sensitivity (RS), communication about complaints, and relational satisfaction in intimate relationships. A total of 260 individuals completed an online survey through Amazon Mechanical Turk. RS was positively associated with complaint avoidance and negatively associated with positive politeness and negative politeness when voicing complaints. Furthermore, RS had indirect associations with relational satisfaction, partially mediated through complaint avoidance and positive politeness. The results of this study suggest that communicating complaints openly to one's partner, in concert with positive politeness (i.e., affirming the partner while voicing complaints), may help serve as a buffer against relational dissatisfaction associated with RS.     

Hope,religiosity, and subjective well-being

This study explored the relationship between religiosity, hope, and subjective well-being among 430 South African university students (n = 324) and their family members (n = 104) (70.2% female; 88.4% black; 8.4% white). Data were gathered utilising measures of religiosity, hope, satisfaction with life, and affect balance. We applied structural equation modelling to examine both the direct effects of religiosity on hope, as well as the indirect effects of religiosity on life satisfaction and positive and negative affect via hope as mediator. Findings suggest pathway and agency hope to mediate the relationships between religiosity and life satisfaction, positive affect, and negative affect. Specifically, religiosity predicted higher levels of life satisfaction and positive affect, and lower levels of negative affect via agency hope. The results suggest agency hope to mediate the relationship between religiosity and subjective well-being.     

The supervisory alliance: Comparison of measures and implications for a supervision toolkit

Background Clinical supervision lies at the core of the professional development of clinicians providing services within a range of service settings. The supervisory alliance is regarded as the most important construct in effective supervision which underlies the importance of metrics to assess this construct. Aims materials and Method A cross‐sectional self‐report questionnaire design was used to examine clinical supervision constructs. The study used two scales measuring the supervisory alliance (SRQ and SWAI‐T), a scale measuring supervision satisfaction (SSQ) and a scale measuring disclosure (TDS). The questionnaires were administered to 127 clinical psychology trainees who were undertaking a practicum placement. Results Both scales measuring the alliance were positively correlated with satisfaction with supervision and disclosure, with similar sizes of correlation for each alliance scale. There was also a large, positive correlation between the two scales of measuring the alliance. Discussion Both scales were designed for use in supervision and are related to supervision outcome measures in the expected directions. Conclusion The SRQ has some distinct advantages over the SWAI‐T that lend the SRQ to be potentially more useful in clinical and research settings.     

Resolving Ethical Dilemmas in a Tertiary Care Veterinary Specialty Hospital: Adaptation of the Human Clinical Consultation Committee Model

Technological advances in veterinary medicine have produced considerable progress in the diagnosis and treatment of numerous diseases in animals. At the same time, veterinarians, veterinary technicians, and owners of animals face increasingly complex situations that raise questions about goals of care and correct or reasonable courses of action. These dilemmas are frequently controversial and can generate conflicts between clients and health care providers. In many ways they resemble the ethical challenges confronted by human medicine and that spawned the creation of clinical ethics committees as a mechanism to analyze, discuss, and resolve disagreements. The staff of the North Carolina State University Veterinary Hospital, a specialty academic teaching institution, wanted to investigate whether similar success could be achieved in the tertiary care veterinary setting. We discuss the background and rationale for this method, as well as the approach that was taken to create a clinical ethics committee.     

Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review

Background: Testosterone therapy is the predominant treatment for voice masculinization in transgender patients. Although lowering of voice fundamental frequency (f₀) occurs with testosterone therapy, evidence suggests voice and gender identity may not fully align—i.e., voice-gender congruence may not be achieved—with its use.

Aim: This meta-analytic review evaluates the effectiveness of testosterone therapy to masculinize voice in transgender patients.

Methods: Multiple electronic databases were queried (inclusion dates: from database inception up to October 27, 2017) to identify original research on voice masculinization using testosterone therapy. Nineteen articles were included in this meta-analytic review, which followed PRISMA guidelines. In addition to qualitative analyses, random effects proportion meta-analyses were performed on data related to f₀, voice-gender congruence, voice problems, and satisfaction with voice.

Results: A meta-analysis on f₀ data showed after 1 year of testosterone therapy a combined estimate of 21% of participants (95% confidence interval [CI]: 5%–43%; I²: 59.9%) did not achieve cisgender male normative frequencies (f₀ ≤ 131 Hz). Meta-analyses on incomplete voice-gender congruence and voice problems indicated combined estimates of 21% (95% CI: 10%–34%; I²: 0.0%) and 46% (95% CI: 14%–79%; I²: 90.2%), respectively. Regarding incomplete satisfaction with voice, a meta-analysis showed a combined estimate of 16% (95% CI: 7%–28%; I²: 0.0%).

Discussion: We found that not all transgender patients using testosterone therapy to masculinize voice should expect f₀ lowering to cisgender male normative frequencies after 1 year. The vocal transition may involve voice problems for many patients, and some might not achieve voice-gender congruence without additional, voice-specific intervention. Given these findings, a voice evaluation should occur prior to initiating testosterone therapy and involve counseling on expectations for voice. Transgender patients who pursue voice masculinization may need management from laryngology and speech and language therapy to improve voice-gender congruence, mitigate voice problems, and increase satisfaction with voice.