Matthews Model of Clinical Reasoning: A Systematic Approach to Conceptualize Evaluation and Intervention

Clinical reasoning is a complex process required for effective therapeutic encounters. Its development is poorly understood. The clinical reasoning process is placed in a historical context based on the occupational therapy literature. An emerging model of clinical reasoning is proposed. This model of clinical reasoning provides a unique perspective in order to compartmentalize the person, environment, and occupation constructs around the person’s life story, connect it directly to the occupational therapy practice framework, and determine treatment priorities, emphasizing a client-centered perspective. A client-centered model of clinical reasoning supports efforts to provide effective intervention.     

文化疏离感对汉区高校少数民族大学生幸福感的影响机制

为揭示文化疏离感与汉区高校少数民族大学生幸福感的关系,以及压力性生活事件的调节效应和基本心理需要的中介效应,采用文化疏离感量表、压力量表、基本心理需要量表和幸福感问卷对汉区高校少数民族大学生幸福感进行研究。结果显示:(1)文化疏离感会降低汉区高校少数民族大学生幸福感;(2)压力性生活事件对文化疏离感与汉区高校少数民族大学生幸福感的关系具有调节效应;(3)这一调节效应是以基本心理需要为中介变量。因此,文化疏离感对汉区高校少数民族大学生幸福感的影响是有中介的调节效应。     

Evaluative Concerns and Personal Standards Perfectionism: Self-esteem as a Mediator and Moderator of Relations with Personal and Academic Needs and Estimated GPA

We examined the mediational role of self-esteem in the relation between evaluative concerns (EC) and personal standards (PS) perfectionism, and measures of personal concerns, academic concerns, and estimated grade point average (EGPA) in 386 university students. Self-esteem partially mediated the relation between EC perfectionism and students’ personal and academic concerns. EC perfectionism was a weak predictor of EGPA. PS perfectionism was not related to academic concerns. Although PS was associated with personal concerns both directly and indirectly through low levels of self-esteem in women only, these findings did not hold when controlling for EC perfectionism. PS perfectionism had a direct positive relation with EGPA. Neither PS nor EC perfectionism interacted with self-esteem to predict unique variance in personal or academic concerns or EGPA. The results are consistent with our view that a perfectionism dimension that is primarily maladaptive can be distinguished from a dimension that can be adaptive. The implications for research and treatment are considered.

Cancer Genetic Counseling: Communication and Counselees’ Post-Visit Satisfaction,Cognitions, Anxiety,and Needs Fulfillment

Little is known about the relation between communication during cancer genetic counseling and outcome. We assessed associations between counselor-counselee communication and counselee satisfaction, cognitions, anxiety, and fulfillment of major needs, corrected for pre-visit levels as appropriate. In total 171 consecutive new counselees, mainly referred for breast or colon cancer, received pre- and post-visit questionnaires assessing needs/fulfillment, knowledge, perceived control (PPC), anxiety (STAI), and satisfaction. Initial visits were videotaped and counselor eye gaze was recorded. Verbal communication was rated by Roter Interaction Analysis System (RIAS). Asking more medical questions was associated with lower satisfaction levels. Receiving more medical information was related to higher correct knowledge scores, higher reported fulfillment of some needs, and unrelated to perceptions of control. Receiving more psychosocial information and longer counselor eye gaze were related to higher anxiety scores. Longer visits were related to higher correct knowledge scores. Providing medical information appears the most powerful communication aspect to increase counselee satisfaction and address needs. More research is needed on how to address adequately (emotional) needs and increase feelings of control.     

An exploration of the mechanisms of change following an integrated group intervention for stuttering,as perceived by school-aged children who stutter (CWS)

PurposeTo explore the process of change and role of resilience following an integrated group intervention for children who stutter (CWS).MethodUsing an exploratory multiple case study design, this research sought to identify the most significant changes perceived by seven participants following therapy, the mechanisms of change, and the role of resilience in the process of change. Quantitative measurements of resilience were combined with qualitative analysis of semi-structured interviews.ResultsThematic analysis of qualitative data showed that cognitive and emotional change was a key driver for therapeutic change, enabled by the shared experience of the group and a positive therapeutic environment. These changes were generalised into clients’ real-world experiences, facilitated by their support network. Quantitative data demonstrated a statistically reliable positive change in overall Resiliency scores for four participants and reduced impact of stuttering scores on OASES-S for all participants, maintained at 12 month follow-up.ConclusionsThis study demonstrates the importance of adopting an integrated approach in therapy for CWS, which incorporates Cognitive Behavioural Therapy (CBT) as a key component, to facilitate change and build resilience. These results are unique to this cohort of CWS and further investigation into the use of CBT and the process of change may be warranted.Educational ObjectivesThe reader will be able to (1) describe the integrated intervention used in this study (2) define the most significant change following therapy for the participants involved (3) summarise the key factors that facilitated change during the therapy process (as perceived by the participants).     

青少年感恩、基本心理需要与病理性网络使用的关系

采用青少年感恩量表、基本心理需要量表和病理性网络使用问卷对760名中学生进行调查,考察了中国文化背景下青少年感恩与病理性网络使用的关系,以及基本心理需要的能力需要、关系需要和自主需要的三大成分在其中的链式中介效应。结果表明:(1)青少年感恩与病理性网络使用显著负相关;(2)基本心理需要三大成分在感恩与病理性网络使用之间具有链式中介作用,即感恩既直接促进青少年自主需要的满足,也通过促进能力需要和关系需要的满足间接增进其自主需要的满足,进而减少病理性网络使用。     

Developing comprehensive,individualized community-based services for children and youth with emotional and behavior disorders: Direct service providers' perspectives

Increased attention to the plight of children and youth with emotional or behavioral disorders (EBD) and their families has led to innovations in the manner in which these individuals are served. Two such innovations have been the development of public systems of comprehensive, community-based care and individualized wraparound services. This study was part of one community's attempt to merge these two innovations and provide individualized wraparound services to children and youth with EBD through the auspices of public agencies. Direct service providers were surveyed to gather their input into how such services could best be developed and implemented. The survey focused on existing barriers to providing services and specific service priorities for system development. Methods and results are presented. Implications for the local system and future research needs are discussed.     

员工感知被信任影响工作投入的心理机制：维度差异及理论比较

领导－员工之间的信任是工作场所中宝贵的资源,但有关领导对员工的信任及其作用机制的研究相对缺乏。以423名企业员工为被试,通过问卷调查法从被信任方角度考察了员工感知被信任对工作投入的影响及其机制,并比较了三种主导解释理论的相对有效性。结果显示：感知被信任与工作投入正相关,但其具体作用机制有赖于感知被信任的不同维度;相对于不确定管理理论和认知评估理论,社会交换理论更能有效解释感知被信任与工作投入的关系。     

The Suffocation of Marriage: Climbing Mount Maslow Without Enough Oxygen

This article distills insights from historical, sociological, and psychological perspectives on marriage to develop the suffocation model of marriage in America. According to this model, contemporary Americans are asking their marriage to help them fulfill different sets of goals than in the past. Whereas they ask their marriage to help them fulfill their physiological and safety needs much less than in the past, they ask it to help them fulfill their esteem and self-actualization needs much more than in the past. Asking the marriage to help them fulfill the latter, higher level needs typically requires sufficient investment of time and psychological resources to ensure that the two spouses develop a deep bond and profound insight into each other's essential qualities. Although some spouses are investing sufficient resources—and reaping the marital and psychological benefits of doing so—most are not. Indeed, they are, on average, investing less than in the past. As a result, mean levels of marital quality and personal well-being are declining over time. According to the suffocation model, spouses who are struggling with an imbalance between what they are asking from their marriage and what they are investing in it have several promising options for corrective action: intervening to optimize their available resources, increasing their investment of resources in the marriage, and asking less of the marriage in terms of facilitating the fulfillment of spouses’ higher needs. Discussion explores the implications of the suffocation model for understanding dating and courtship, sociodemographic variation, and marriage beyond American's borders.