Stress in Clinical Psychology Trainees: Current Research Status and Future Directions

The purpose of this article is to present the current status of the literature related to stress in clinical psychology trainees (CPTs), and to offer research directions for investigating stress in this population and ways to enhance self‐care in these individuals. The following conclusions emerge from the review: (1) CPTs are vulnerable to elevated stress; (2) undue stress can negatively impact CPTs' personal and professional functioning and, in turn, result in less than optimal standards of care for clients; (3) there is a dearth of studies on stress in this population and no published intervention studies; (4) incorporating self‐care strategies into clinical psychology training is recommended; and (5) “third‐wave” cognitive behaviour therapy stress management interventions have been efficacious in comparable populations. In view of the potential costs of elevated stress to trainees themselves and their clients, research on stress and stress management in this population is of a high priority. Broad research agendas are proposed for these two domains. Modifications to clinical training programmes to reduce trainee stress are required and should be evidence‐based and systematically revaluated.     

Clinical Psychology Students’ Experiences of a Pilot Objective Structured Clinical Examination

There is a need to improve methods used to assess students’ clinical skills in postgraduate clinical psychology training, but research into the use of new competency‐based assessments are sparse. The current study examines the potential application of the objective structured clinical examination (OSCE) to clinical psychology training. Commonly used in medical training, the OSCE requires students to demonstrate clinical skills across a number of standardised stations with trained actors playing the part of patients. A pilot OSCE was conducted with nine students from a psychology doctoral program. Participants completed a brief student feedback questionnaire and attended a focus group after the OSCE. They also completed the State–Trait Anxiety Inventory before and after the OSCE. The results showed that students viewed the OSCE as a valid, realistic, and fair assessment method. They reported high levels of anxiety during the OSCE but noted that the OSCE was a positive learning experience. These results suggest that OSCEs should be considered in clinical psychology training programs for the assessment of clinical competence. Further evaluations of the validity and reliability of the clinical psychology OSCE using a larger sample size are required. Other limitations and implications of the study are discussed.     

Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT-SP) via Video Telehealth: A Case Example During the COVID-19 Outbreak

Although veterans living in remote/rural areas are at elevated risk for suicide, there is very little research specific to treating suicidal veterans who present with barriers to in-person care. The current study aims to examine the delivery of brief cognitive-behavioral therapy for suicide prevention (BCBT-SP) via Clinical Video Telehealth (CVT) to the home of a veteran discharged from the psychiatric inpatient unit after a recent suicide attempt. Preliminary data on acceptability, feasibility, and changes in symptoms were gathered. The veteran received treatment during the 2020 COVID-19 outbreak and additional adaptations were made accordingly. The veteran did not engage in any suicidal behavior during the course of treatment, and suicidal ideation, depression, and anxiety decreased as treatment progressed. The results provide initial support for the feasibility of BCBT-SP via CVT to the home.     

Bion's Notes on memory and desire – its initial clinical reception in the United States: A note on archival material

While Bion's 1967 memory and desire paper reflected a crucial episode in his clinical thinking during his epistemological period, it was also central to his evolution as a Kleinian psychoanalyst who worked with seriously disturbed adult patients. The author explicates and contextualizes these claims with a new archival document, the Los Angeles Seminars delivered by Bion in April 1967, and the full‐length version of Notes on memory and desire. Bion here instigated a radical departure from years of theory‐laden work when he made his clinical work and ideas accessible to a new audience of American Freudian analysts. While this new group was keenly interested to hear about Bion's clinical technique with both borderline and psychotic patients, there were varied reactions to Bion's ideas on the technical implications of the analyst's abandonment of memory and desire. Both the Los Angeles Seminars and Notes elicited responses ranging from bewilderment, admiration to skepticism amongst his audience of listeners and readers. These materials also however allow for a more complete and systematic presentation of important ideas about analytic technique – and while his ideas in this domain have been long valued and known by many psychoanalysts, this contribution stresses the crucial aspect of the reception of his ideas about technique in a particular American context. American analysts gained a much more explicit idea of how Bion worked analytically, how he listened, formulated interpretations and factored in the analyst's listening receptivity in the here‐and‐now. The author concludes with a consideration of the importance of Bion's American reception in 1967.     

Transfer effects between moral dilemmas: A causal model theory

Evaluations of analogous situations are an important source for our moral intuitions. A puzzling recent set of findings in experiments exploring transfer effects between intuitions about moral dilemmas has demonstrated a striking asymmetry. Transfer often occurred with a specific ordering of moral dilemmas, but not when the sequence was reversed. In this article we present a new theory of transfer between moral intuitions that focuses on two components of moral dilemmas, namely their causal structure and their default evaluations. According to this theory, transfer effects are expected when the causal models underlying the considered dilemmas allow for a mapping of the highlighted aspect of the first scenario onto the causal structure of the second dilemma, and when the default evaluations of the two dilemmas substantially differ. The theory’s key predictions for the occurrence and the direction of transfer effects between two moral dilemmas are tested in five experiments with various variants of moral dilemmas from different domains. A sixth experiment tests the predictions of the theory for how the target action in the moral dilemmas is represented.     

When to cooperate and when to compete: Emotional intelligence in interpersonal decision-making

This study examined the relationship between emotional intelligence (EI), assessed with an ability test, and interpersonal decision-making using the Prisoner’s Dilemma Game (PDG). Previous research found that individuals who self-report high EI tend to cooperate more than others in the Prisoner’s Dilemma. We relativize these findings by showing that individuals scoring high on an ability measure of EI choose effective strategies to deal with three different PDG conditions during real interactions. This suggests that emotionally intelligent individuals are not rigidly predisposed to cooperate regardless of others’ behavior. Instead, EI is associated with the capacity to respond flexibly to others’ strategies and to the interaction context in order to maximize long-term gains – even when this means competing rather than cooperating.     

13例脐尿管囊肿的诊断分析

脐尿管囊肿是一种少见畸形,为探讨其病因、临床表现及诊治方法,对2010年1月～2013年12月于我院诊断为脐尿管囊肿的13例患者进行回顾性分析。结果显示,脐尿管囊肿主要发现于男性患儿,可表现为腹痛、脐部或膀胱不适等合并症,常伴有发热,也可无明显临床表现,由单纯查体发现。B超和CT是推荐检查方法,确诊需依靠组织病理学检查。手术切除是治疗该病的首选方法,临床效果满意。随着技术的发展,治疗脐尿管囊肿可优先选择腹腔镜切除术。     

培养临床医学专业学位研究生系统思维能力的途径和方法

系统思维是20世纪中期以后发展起来的一种新型思维,它与传统还原论思维根本不同,强调立足于事物整体来认识和处理问题,注重揭示事物内部机制以及环境对整体的作用和影响。我国临床医学专业学位研究生的培养应该纳入这种现代思维方式,使其善于应用系统思维来指导诊断和治疗,并应用在医学科研中。这不仅有利于提高其服务广大患者的能力,而且有利于提高其临床医学科研能力,从而提高临床研究生的整体素质。     

临床共情与护理技术结合：人性化的护理

临床共情是一种能体验患者内心世界的能力,通过患者的言语和非言语表达,觉察和认识患者情感和情绪需求,并对其做出恰当的回应.临床共情具有科学的理论和实践基础,具有缓解患者心理上的痛苦,改善护患关系,促进患者康复等作用.在当今复杂的医疗环境下,务必要重视共情培养,适时运用临床共情.然而,我们强调临床共情的重要作用,并不能忽视护理技术的根本作用,根除躯体上的病变仍有赖于护理技术的有效性.在临床护理实践中,坚持共情与护理技术的有机结合,推进人性化的护理构建.