The Client Is the Most Important Common Factor: Clients' Self-Healing Capacities and Psychotherapy

I first briefly review the dodo bird verdict and suggest that we should be responding to it by looking for a new way to conceptualize how therapy works. Then I describe the dominant medical or treatment model of psychotherapy and how it puts the client in the position of a dependent variable who is operated on by supposedly potent therapeutic techniques. Next I argue that the data do not fit with this model. An alternative model is that the client is the most important common factor and that it is clients' self-healing capacities which make therapy work. I then argue that therapy has two phases—the involvement phase and the learning phase—and that the involvement phase is the most important. I next review the five learning opportunities provided by therapy. Finally, I argue that a relational model of therapy focused on consultation, collaboration, and dialogue is better than a treatment model.     

Managing one's body using self-management techniques: practicing autonomy

This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come to rely on measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy.     

社会因素对剖宫产率的影响

近二三十年来,剖宫产率在世界范围内不断升高。究其原因,除了医学因素外,社会因素起着重要作用,从社会经济发展,社会科学文化水平、社会习俗观念、法律、医疗道德、国家计划生育政策、医学教育等多个角度分析了社会因素对剖宫产率的影响,并就如何发挥社会因素的积极作用,消除和避免其消极作用,使剖部率维持在合理的范围内进行了讨论。     

The Meaning vs. The Medical Model in the Empirically Supported Treatment Program: A Consideration of The Empirical Evidence

A review of the debate on the Empirically Supported Treatment Program is presented. It is argued that underlying the specifics of the debate are fundamentally incompatible paradigms: a meaning vs. a medical model. The findings from two gold standard multi-site studies are reviewed to conclude that the control condition meets requirements for an empirically supported treatment. The empirical finding of the failure of clinical training to improve treatment outcomes is explained by the focus on rational factors in training. It is recommended that training of therapists focus on enhancing experiential capacity rather than mastery of manualized treatment approaches.     

MMPI-2 subgroups in a sample of chronic pain patients

MMPI-2 scores of 307 female and 161 male chronic pain patients were analyzed by gender using a multivariate clustering method. Two subgroups were found for both sexes replicating previous results. The major subgroup corresponded to the classical "Conversion V" and the minor corresponded to the "Generally elevated" profile. The results also indicated a satisfactory internal consistency and a high discriminant validity of the Swedish version of the MMPI-2.     

Chronic Fatigue Syndrome: The Need for Subtypes

Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians, and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed, and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity, and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains.     

The Association of American Medical Colleges and the Association of Medical School Psychologists: Finding Psychology’s Place in Academic Medicine

This paper highlights the role of the Association of Medical School Psychologists (AMSP) as a bridge between academic medicine and psychology. AMSP’s affiliation with Division 12 of the American Psychological Association is discussed, but the primary focus is AMSP’s affiliation with the Association of American Medical Colleges (AAMC) and the AAMC’s Council of Academic Societies (CAS). The history, structure, activities, and goals of AAMC and CAS are examined. AMSP’s affiliation with AAMC is important for psychologists in medical schools and academic medical centers, and for psychology in general, because AAMC is the major voice of academic medicine in the US. AAMC activities affect medical education at all levels, as well as research and health services at academic medical centers, and health care policy at the national level. AMSP’s dual affiliation with AAMC’s CAS and APA’s Society of Clinical Psychology will increase psychology’s visibility and influence in academic medical centers and enhance the two-way flow of ideas and information between academic medicine and psychology.     

The Family Impact of Pain Scale: Preliminary Validation

A new questionnaire, the Family Impact of Pain Scale (FIPS), was designed in order to assess the effects of chronic pain on the significant other and family of the chronic pain patient. The FIPS is a 10-item self-report questionnaire examining the effect of pain on domestic duties, social functioning and communication within the family. It was administered to 177 chronic pain patients in two different samples to investigate its psychometric properties. Internal reliability (α = .94) and test–retest reliability (r = 0.79) were high. Exploratory factor analysis suggested a two-factor solution, relating to physical limitations and difficulties with communication. Construct validity was confirmed by significant Pearson correlations with pain intensity, pain distress, mood and the use of pain coping skills (r = −0.22–0.74, all at p < .05). Outcome data also showed that the measure is sensitive to the effects of a cognitive behavioural pain management intervention.