The workable here and now and the why of there and then

At an earlier time our work as analysts was easier. We searched for the repressed in order to make constructions that connected the past to the present symptoms. Making these connections conscious, based upon the continuing influence of the Topographic theory, was thought to be the curative factor in psychoanalysis. Freud (1912, 1914) briefly expressed the importance of working in the present but his main focus remained the importance of reconstructing the past. The importance of working in the present started to be fully articulated approximately 30 years ago, and has become a central part of most views on technique. However, it is the contention of this paper that, while there is general agreement on the necessity of working in the here and now, the understanding of what this means or why it is useful runs along parallel lines rather than leading to a central point. Further, it is my impression there is little agreement on the reasons for interpreting the there and then. The idea of a 'workable here and now' is introduced to capture how the here and now might best include the analysand's readiness to synthesize what is offered, while a theory of the necessity for working in the here and now and the there and then is offered.     

预防导尿管相关性感染的临床问题及决策

留置导尿是一项侵袭性操作,易引起尿道黏膜损伤,且留置导尿时间过长,容易引起泌尿系统的逆行感染。为了预防导尿管相关性感染,我们从临床角度讨论是否需要更换一次性尿袋以及更换尿袋的时间,留置导尿尿道外口的清洗,留置导尿膀胱冲洗的必要性及是否应用抗生素,更换导尿管的时间及导尿管的选择等临床问题,为临床人员做该项操作时提供参考,做出正确的临床决策。     

我国临床药学发展史的回顾及展望

临床药学是一门近几十年发展起来的新兴学科,是近年来我国一个备受关注的领域。它的产生及在我国的发展经历了一个曲折的过程,但却是历史发展的必然结果。纵观整个出现发展过程及现状,让我们思考了很多,对其今后的发展以及我们科学的认识事物有很好的启示。     

动脉瘤性蛛网膜下腔出血的临床诊疗决策

探讨动脉瘤性蛛网膜下腔出血的临床诊疗决策。运用循证医学对动脉瘤性蛛网膜下腔出血早期诊断,及时、合理、有效地选择个性化的治疗方案,降低动脉瘤性蛛网膜下腔出血的病残率和死亡率。     

审美的神经机制

审美能力是人类独有的高级功能。本文介绍了审美的认知神经模型, 以及相关研究的实验范式, 对各种刺激材料和任务进行了评价。回顾了近年来脑成像研究的主要进展, ERP和MEG研究证明审美包含发生在不同时段的不同加工阶段, 与审美判断相关的ERP成分为300~400 ms 额中部负成分和440~880 ms 头皮后部晚期正成分。fMRI研究发现与审美相关的主要脑区包括尾状核、框额部皮质和扣带前回。未来研究应进一步区分审美的不同方面的神经机制之间的差别, 扩大刺激材料范围, 更深入地探讨复杂因素, 如文化因素对审美神经机制的影响。     

一种混合型前瞻记忆的干扰效应的神经机制

采用3（任务类型）×2（时段）被试内实验设计,对比一种混合型前瞻记忆（MPM）和基于事件的前瞻记忆（EBPM）在不同时段对进行中任务的干扰效应的神经机制。结果表明,在目标出现的时段,MPM对进行中任务有干扰效应,额区电极最活跃,额区电压最高,而在非目标时段MPM无干扰效应,但刺激出现后200-300ms额区电极较活跃。说明前瞻记忆任务在大脑中可能处于较高的激活状态,额叶灵活地调配意识的不同状态在前瞻记忆加工中参与的程度和时段。     

University psychology clinics in Australia: Their place in professional training

Abstract: There is universal recognition of the need for developmentally appropriate supervised clinical experience in professional psychology training. University clinics were established to provide a bridging function for postgraduate clinical psychology students, assisting the integration of psychological theory and research into real‐world clinical applications and professional identity development. The aim of training in university clinics is to provide opportunities for clinical practice and high‐quality supervision to monitor and shape clinical skills. The experiences gained in external practicum settings complement this initial training but cannot replace it. The recent introduction of Medicare rebates for psychology services has threatened the survival of university clinics because low‐cost psychological treatment is now available from experienced practitioners. This paper provides data on Australian university clinics collected before the introduction of Medicare. Concerted efforts are needed to protect university clinics in order to maintain standards required for accreditation of clinical psychology training programs. The potential impact of the loss of university training clinics is discussed and strategies to ensure their survival are suggested.     

Training clinical psychologists for rural and northern practice: Transforming challenge into opportunity

Abstract: The Rural and Northern Program (R&NP) of the University of Manitoba's Department of Clinical Health Psychology (DCHP) is a unique training and service delivery platform that was developed in response to the scarcity of psychological services in rural and northern areas of the province of Manitoba, Canada. Since 1996 rural and northern‐based psychologists, in conjunction with the faculty based in Winnipeg (Manitoba's largest city) have offered training to two interns and one postdoctoral resident (resident) yearly. The current article discusses the nature of the program, the regions of Manitoba that the program services, and recruitment and retention data. The authors conclude by offering suggestions for creating sustainable rural/northern psychological practice.     

晚期癌症患者治疗决策的思考

现代医疗尚无法治愈所有晚期癌症。现实与期望之间的较大差距,挑战晚期癌症治疗的临床决策。WHO强调为防止资源滥用,应确保抗癌治疗只用于可获益阶段。对于晚期癌症患者的治疗决策,除遵循规矩原则和循证医学证据原则外,还应该遵循尊重患者意愿、社会公平的美德原则。大多数癌症患者需要接受姑息治疗。姑息治疗为患者及家属提供既简便又经济的医疗服务。     

The Teaching Alliance Inventory: Evaluating the student-instructor relationship in clinical and counselling psychology training

The Teaching Alliance Inventory (TAI) was developed to measure the quality of the student-instructor relationship in graduate clinical and counselling psychology classrooms. Based on Bordin's (1983) original concept of the alliance as fundamental to the change process in psychotherapy, we developed the TAI to measure aspects of the classroom relationship that may be fundamental to learning essential skills of counselling and clinical psychology. Factor analysis revealed six subscales, four representing interpersonal variables not evaluated in traditional teaching effectiveness measures. We demonstrated internal consistency and split-half reliability with a large sample of graduate students and described evidence for the scale's face validity and content validity. Construct validity was supported by significant correlations between the TAI and its subscales with an established measure of teaching effectives and its logically related subscales (SEEQ; Marsh, 1987 Marsh, HW. 1987. Students’ evaluations of university teaching: Research findings, methodological issues, and directions for future research. International Journal of Educational Research, 11(Whole Issue 3): 253–288.  [Google Scholar]). The TAI may supplement traditional assessments of instructor quality by providing feedback regarding interpersonal impact in the classroom.