Clinical Guidelines for Working With Stepfamilies: What Family,Couple, Individual,and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence‐informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world‐wide. As a result many clinicians rely on their training in first‐time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first‐time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex‐spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three‐level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family‐of‐Origin. The article describes some “easy wrong turns” for well‐meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.     

Disrupted narrative and narrative symbol

In this article a specific type of narrative, which often appears in analytic sessions, is discussed. It is characterized by a seemingly ordinary, everyday topic and by a peculiar disruption of the narrative flow. The threefold structure of this type of narrative is described, along with its main characteristics. One element of this type of narrative is very similar to symbolic content or complex symbolic structures, e.g. dreams, the sort of material that can be used for the purpose of interpretation. The similarities as well as the differences are elaborated in the article. Thanks to the observed general structure and ‘symbolic’ nature of some parts of the narrative, it is easy to notice some of the unconscious elements, which are not familiar to the patient's ego, and to make an interpretation. Because these elements are close to the threshold of consciousness, the patient willingly accepts an interpretation based on them. This is especially true for patients whose dominant function is thinking. A temporary, working name for this type of narrative is proposed in the article: ‘disrupted narrative’ ? and for its disruptive part ‘narrative symbol’.     

On matters of mind and body: regarding Descartes

In this paper the author considers Descartes’ place in current thinking about the mind‐body dilemma. The premise here is that in the history of ideas, the questions posed can be as significant as the answers acquired. Descartes’ paramount question was ‘How do we determine certainty?’ and his pursuit of an answer led to cogito ergo sum. His discovery simultaneously raised the question whether mind is separate from or unified with the body. Some who currently hold that brain and subjectivity are unified contend that the philosopher ‘split’ mind from body and refer to ‘Descartes’ error’. This paper puts forward that Descartes’ detractors fail to recognise Descartes’ contribution to Western thought, which was to introduce the Enlightenment and to give a place to human subjectivity. Added to this, evidence from Descartes’ correspondence with Princess Elisabeth of Bohemia supports the conclusion that Descartes did in fact believe in the unity of mind and body although he could not reconcile this rationally with the certainty from personal experience that they were separate substances. In this Descartes was engaged in just the same dilemma as that of current thinkers and researchers, a conflict which still is yet to be resolved.     

Who is my Jung? Memories,Reflections, Prospects

The author describes his personal and professional journey in relation to the subject of the AJA 40^th anniversary conference, ‘Who is my Jung?’ The first part of the paper covers his early life and his attempt to bring together two opposing parts within him: valuation of a scientific approach, and an interest in the inner world, dreams and the paranormal. Discussion of his professional life follows, including his relationship with Gerhard Adler, past problems and splits within the Jungian community and the author's attempts to heal these. The value of both remembering and forgetting is questioned. This leads onto ideas that bring value and meaning to his work and life, and which bridge the inner divisions he felt in his early life: notably Jung's focus on applying scientific theory to the mystery of the psyche, his relational attitude (exemplified by the dialectical process and his interest in countertransference) and his theory of synchronicity. Recent discussion in Jungian writing has questioned the nature of synchronistic experiences and explored how they may emerge naturally from complex systems. The paper ends the author's continuing journey with two personal vignettes describing how meaning may emerge from the unconscious.     

Outside‐In: Jung's myth of interiority ambiguated. Or ‐ Knowing me,Knowing Jung – ahah!

Given his lifelong battle against one‐sidedness Jung's persistent prioritising of the ‘inner life’ over the ‘outer’ can seem problematic. The question is raised as to whether an approach that seems to verge uncomfortably close to solipsism can sometimes render Jung blind to the intuition that psychic life is constituted by an on‐going interplay between inner and outer, self and other (an intuition that he himself sometimes articulated so brilliantly). The ‘ambiguation’ of Jung's work offers an opportunity to confront this problem by utilising a critical dynamic that is consistent with Jung's psychological insights.     

The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS’ origins in everyday clinical practice. The authors contend that PCOMS represents “both/and,” providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time‐honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized.     

Attachment Versus Differentiation: The Contemporary Couple Therapy Debate

This paper reviews the current debate between differentiation and attachment in treating couples through exploring the tenets of crucible therapy (Schnarch, 1991) and emotionally focused couple therapy (Johnson, 2004). We provide a review of the two theories—as well as the two “pure form” example models—and explore the debate in light of the integrative movement in couple and family therapy (Lebow, 2014). We also examine points of convergence of the two theories and models, and provide clinicians and researchers with an enhanced understanding of their divergent positions. Both differentiation and attachment are developmental theories that highlight the human experience of balancing individuality and connection in adulthood. The two models converge in terms of metaconcepts that pervade their respective theories and approach. Both models capitalize on the depth and importance of the therapeutic relationship, and provide rich case conceptualization and processes of therapy. However, they substantially differ in terms of how they view the fundamental aspects of adult development, have vastly divergent approaches to how a therapist intervenes in the room, and different ideas of how a healthy couple should function. In light of the deep polarization of the two models, points of integration—particularly between the broader theories of attachment and differentiation—are offered for therapists to consider.     

对影响病人满意度相关因素的医学伦理思考

设计调查问卷对深圳某基层医院实施病人满意度调查及相关因素的医学伦理分析。结果显示病人满意度不高,门急诊病人的总满意度明显低于住院病人;病人对服务态度、就医环境和诊疗费用等都较不满意。其中医院未能遵循及时、准确、有效、择优和自主原则是主要影响因素。     

Elaboration et validation de tests de jugement situationnel comme outil de sélection professionnelle : guide méthodologique

Current views in personnel selection recognize the necessity for situational judgements tests (SJT) which are closed to the real work context of companies. The SJTs have also become a popular selection tool across Europe. SJTs are attractive because they show good validity, positive applicants reactions and can be cost effective to test large group of applicants at once. The aim of this paper is to describe a structured methodology for the elaboration of such test. Each stage is illustrated by examples and psychometrics validation issues are discussed.     

The Shift from Monologue to Dialogue in a Couple Therapy Session: Dialogical Investigation of Change from the Therapists’ Point of View

As part of a larger research project on couple therapy for depression, this qualitative case study examines the nature of dialogue. Drawing on Bakhtinian concepts, the investigation shows how the conversation shifts from a monologue to dialogue. Among the findings are: first, the process of listening is integral to the transforming experience. That is, the careful listening of the therapist can evoke new voices, just as the experience of one of the partners’ “listening in” to the conversation between the other partner and the therapist can create movement and new trajectories. The latter is a qualitative difference between dialogic therapy with a couple and that with an individual. Second, the therapist not only acts as creative listener, but as the dialogue unfolds, actively contributes to meaning‐making. Third, the study upholds having a team of researchers as a polyphonic forum and the usefulness of Bakhtinian concepts in clinical research on dialogue in multi‐actor sessions.