Ethical Considerations of Screening and Early Intervention for Clinical High-Risk Psychosis

Research on individuals at clinical high risk for psychological and physical disorders has grown exponentially in recent years, with a variety of new screening tools and early intervention techniques being implemented. One recent example is Attenuated Psychosis Syndrome, a diagnosis for individuals who are at clinical high risk for psychosis, which was recently included in Section III of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Given the focus on prevention at early stages, at-risk individuals will continue to be a topic of significance not only in psychosis research but also in other illnesses. This document provides a comprehensive summary of the ethical dilemmas that clinicians or researchers may encounter in this domain, and possible actions consistent with the current Canadian Code of Ethics for Psychologists. We use clinical high risk for psychosis and the Canadian Code of Ethics for Psychologists as a way to illuminate these ethical issues; however, application to other jurisdictions and disciplines, as well as other high-risk populations, is also of relevance.     

Proneness for exercise,cognitive and psychophysiological consequences of action observation

ObjectivesPhysical exercise has benefits that go beyond health and well-being, namely in cognitive, motor and psychophysiological areas. The discovery of a shared neural network between action observation and execution (Action-Observation Network) led us to hypothesize that watching human motor action might improve cognitive and motor aspects of performance and proneness for exercise.Design/MethodsSixty participants viewed a Motor (M) (n = 30) or a Non-Motor (NM) (n = 30) movie with strong or weak content of motoric features of human action, respectively. Performance in d2 Attention test, Fitts' Motor task, and a Proneness for Exercise Visual Analog Scale was assessed before and after movie visualization, in a cross-sectional study. Psychophysiological measures were recorded throughout the experiment.ResultsOur results demonstrate an increase in proneness for exercise, and greater improvement in attention-related cognitive aspects in the M group. The aforementioned benefits of action observation did not modulate motor performance. A mental effort deployment was associated to the decrease in heart rate variability after visualization of the NM movie. This was not conducive to attention channeling on task performance. Conversely, M movie observation seemed to be associated to a cognitive load release, affording attention deployment for the resolution of the subsequent tasks.ConclusionsIt seems that some benefits associated to physical practice can result from the mere visualization of movies with human motor action content. These are the improvement in attention-related cognitive skills associated to psychophysiological changes that support a disengagement from mental effort. Crucially, the observation of exercise behavior seems to be a key factor for exercise adherence.     

Experiences of Countertransference: Reports of Clinical Psychology Students

While historically linked with psychoanalysis, countertransference is recognised as an important component of the experience of therapists, regardless of the therapeutic modality. This study considers the implications of this for the training of psychologists. Fifty‐five clinical psychology trainees from four university training programmes completed an anonymous questionnaire that collected written reports of countertransference experiences, ratings of confidence in managing these responses, and supervision in this regard. The reports were analysed using a process of thematic analysis. Several themes emerged including a desire to protect or rescue clients, feeling criticised or controlled by clients, feeling helpless, and feeling disengaged. Trainees varied in their reports of awareness of countertransference and the regularity of supervision in this regard. The majority reported a lack of confidence in managing their responses, and all reported interest in learning about countertransference. The implications for reflective practice in postgraduate psychology training are discussed.     

Entering the Sacred: Using Motivational Interviewing to Address Spirituality in Counseling

Despite the salience of spirituality in the lives of many clients, counselors are often hesitant to explore spiritual issues in counseling, largely out of a valid concern of imposing values on the client. Motivational interviewing provides a framework within which a counselor can both assess spirituality and facilitate client exploration of spiritual issues without fear of imposing values.     

What's not being said? Recollections of nondisclosure in clinical supervision while in training

The aim of this qualitative study was to retrospectively examine nondisclosure in individual supervision while in training. Interviews were conducted with supervisees two years post-qualification. Specific nondisclosures were examined and reasons for these nondisclosures were explored. Six in-depth semi-structured interviews were conducted and data analysis drew on Consensual Qualitative Research. The findings revealed four categories relating to: (i) the nature of the difficulty; (ii) reasons for nondisclosure; (iii) the supervisory relationship; and (iv) facilitative factors. The quality of the supervisory relationship was a significant element in nondisclosure. A key recommendation was that role induction for supervisees should be incorporated into training programmes to assist supervisees in learning how to use supervision more effectively. Limitations of the study and further research are provided in light of current findings.     

Not starting psychotherapy is more often initiated by the therapist than the patient

The phenomenon of not starting psychotherapy is seldom investigated. The present study of psychotherapy in the Swedish mental health services differentiates between patients applying for and being offered psychotherapy but choosing not to start (n = 69), patients recommended to receive no treatment, another type of treatment or treatment at another clinic (n = 133), and therapy starters (n = 1294). After the initial assessment, nearly twice as many patients did not start based on the therapist’s decision than on the patient’s. Cases of not starting psychotherapy decided by the therapist were more frequent among patients whose occupational status was less stable, presented a danger to others, had lower levels of initial therapeutic alliance, and by therapists with lower levels of psychotherapy training and those at less structured and more unstable clinics. Patients choosing not to start therapy had lower levels of mental ill-health than both starters and therapist-initiated nonstarters. The most frequently presented reason for a patient-initiated decision to not start therapy was “patient wished another treatment or therapist,” whereas the most common therapist-initiated reason was “recommended or referred to another treatment or clinic”.     

借助巴林特小组培训模式提高临床护理质量

通过对巴林特小组培训模式的认识和理解,并将之运用于临床护理研究,使护理人员在处理护患关系中形成新的视角和更具分析性的思考方式,从而能够更深刻地意识到自身对于患者的影响,提高换位思考的敏感性,以便更好地理解和帮助患者;同时还能促进护理人员的心理健康和减少其工作中存在的护患矛盾。这不仅可以提高患者的治疗效果和生活质量,而且还可以提升护理人员自身的职业素养。因此,巴林特小组培训模式对于实现临床护理优质服务具有重要的现实意义。     

病例报告与临床科研思维

病例报告属于描述性研究方法,是通过记录非同寻常的临床现象,可能揭示新病种、特殊机制、新疗法等,为临床工作经验介绍、总结的初步形式。在医学科学探索的历程中,病例报告拥有特殊的地位和曾经的辉煌,目前仍是医学研究的一种重要体裁。"一个好的病例报告就是一个有教育意义的好故事",一个不同寻常的现象,可能是一个新的病种、一个特殊的机制或一种特殊的组织病变或生理功能紊乱所致。一篇好的病例报告为临床医生和科研工作者提供直接生动的第一手临床资料,能促进临床医生和医学生热爱临床工作,养成面对难题、独立思考、追根朔源、发现与解决问题的能力,值得重视。     

临床医学中人性化医疗的非显性误区辨析

随着现代医疗技术的迅猛发展,人们在享受高新技术提供服务的同时,却对临床医学存在的非人性化趋势提出越来越多的质疑,因此,需要对医学目的和价值进行重新审视。本文阐述了人性化医疗中存在的某些非显性误区,这是医学人文削减的主要内在原因,面对技术与人文之间的矛盾关系,出路在于医疗技术的人性化方向,赋予非人性化手段以人性化关怀,在探索人性化的医疗手段中实现医疗的人性化复兴。