"It's led me astray": How Cognitive Behavioural Therapists experience personal therapy in clinical practice

Personal therapy is considered to be an essential component of most psychotherapeutic training programmes. However, it remains peripheral to cognitive behavioural therapy (CBT) training courses. We present a subsection of results from a qualitative study that examines how CBT therapists use personal therapy in their clinical practice. Seven CBT therapists who have undergone personal therapy were interviewed. Participants were asked about how they used personal therapy in their clinical practice and their accounts were analysed using interpretative phenomenological analysis (IPA) to identify common themes. This article presents the results of the first master theme, “Personal therapy creates conflict”, which explores a paradox that arises between personal therapy and CBT clinical practice; participants suggest that personal therapy equips them with therapeutic tools that paradoxically hinder their capacity to practice a standardised protocol‐led CBT. Results show that participants found personal therapy created considerable internal conflict, where their use of technical evidence‐based treatment protocols as practitioners was experienced in tension with the relationally oriented therapy they had received as clients. We discuss results in the context of Gabriel Marcel's philosophical insights on the dehumanising effects of technology on human relationships. We conclude with a brief consideration of the current political climate that increasingly privileges short‐term technical solutions to psychological distress.     

What do clinical supervision research reviews tell us? Surveying the last 25 years

What do clinical supervision research reviews across the last 25 years tell us? That question is subsequently examined. Based on database and literature searches, 20 reviews appearing from 1995 through 2019 were identified for survey examination; consistencies, inconsistencies and other defining features were determined across reviews; and the survey findings and their implications are considered. Primary findings are as follows: (a) ‘proof’ for supervision appears to be more ‘proof by association’ than otherwise, being primarily a product of ex post facto, cross‐sectional, correlational study; (b) evidence supporting supervision impact of any type is weak at best, especially so for worker and client outcomes; (c) supervision models generally lack empirical foundation; (d) evidence‐based supervision appears to be more a hope and dream than supervision‐based reality at present; and (e) the primary methodological problems that plagued supervision research in the 1990s are still all too frequent in modern research. Some questions to entertain about supervision going forward, and some remedies for improving its research, are proposed.     

Clinical Ethics: Theory Or Practice?

This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual patients as well as the moral parameters of swift and urgent medical action in the face of limited supportive information.     

举证责任倒置与临床实践中证据的思考

医疗纠纷的举证责任倒置对医疗患双方产生广泛而深远的影响,也使医学与法律产生了碰撞,这就要求医务工作者在临床实践中既要为患者服务又要做到每个临床决策都必须有章可循,有法可依,有据可查以维护自己的合法权益,正确认识举证责任倒置的要求和掌握在临床实践中遵循证据的方法以避免陷入越来越多的医疗纠纷。     

Priming Effects on Cooperative Behavior in Social Dilemmas: Considering the Prime and the Person

We test whether people with a relatively more intrinsic vs. extrinsic value orientation (RIEVO) are particularly likely to enact cooperative behavior in resource dilemmas when they are primed with relatedness goals. In Study 1, high RIEVO participants primed with relatedness exhibited more restrained fishing behavior in a resource dilemma than their unprimed counterparts or participants low in RIEVO. Study 2 replicated this effect and further showed that the prime must signal the possibility of satisfying a valued goal (relatedness satisfaction) in order to elicit the value-consistent behavior. We discuss these results in the context of recent process models of goal priming, and also discuss how these findings contribute to our understanding of cooperative behavior and the predictive power of value constructs more broadly.     

DEVELOPMENT OF THE PARENT‐CHILD PLAY SCALE FOR USE IN CHILDREN WITH FEEDING DISORDERS

The Parent‐Child Play Scale was developed as a scale that complements the Parent‐Child Feeding Scale, created by I. Chatoor et al. (1997), to evaluate mother–infant/toddler interactions in two different caregiving contexts of a young child's everyday life, specifically play and feeding. This Play Scale can be used with infants and toddlers ranging in age from 1 month to 3 years and provides reliable global ratings of mother–child interactions during 10 min of videotaped free‐play in a laboratory setting. The scale consists of 32 mother and infant/toddler interactive behaviors which are rated by trained observers from videotaped observations. Four subscales are derived: Dyadic Reciprocity, Maternal Unresponsiveness to Infant's/Toddler's Cues, Dyadic Conflict, and Maternal Intrusiveness. Construct validity and interrater and test‐retest reliability of the Play Scale have been demonstrated. This Play Scale discriminates between children with and without feeding disorders as well as between children with different subtypes of feeding disorders as defined by the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0–3R) (Feeding Disorder of State Regulation, Feeding Disorder of Caregiver‐Infant Reciprocity, and Infantile Anorexia). It can be used for research or clinical practice in the diagnosis and treatment of early feeding problems, to assess the pervasiveness of mother–infant/toddler difficulties and to monitor changes following therapy.     

现代临床治疗中如何理解“医者仁心”？

作为具有中国文化特色的一项医学伦理原则,“医者仁心”在现代医学实践中得到普遍提倡。在现代临床治疗中理解“医者仁心”,需要将其本义置于现代学术语境中加以解读,揭示其现代意义和实际价值。现代临床治疗中的“医者仁心”体现为“用心关爱”“用心思考”“用心体验”三重境界,其面临的挑战主要来自临床治疗中检测的“物化”倾向、经济利益驱动、过度的工具理性和医患之间信息不对称。培育现代临床治疗中的“医者仁心”需要通过医学人文教育、继续教育、制度激励和营造相应的舆论氛围,造就新时代的“大医精诚”。

     

Code of ethics: Day-to-day applications

The following article was originally presented as a workshop at the 1992 NSGC Annual Education Conference. It was the first in a series of programs designed to fulfill the educational component of the Board of Directors' charge to the Ethics Subcommittee of the interpretation, education and application of the Code of Ethics. Applications of the Code to actual problems experienced by genetic counselors are presented. The Code is shown to be a practical guide in the areas of confidentiality and patient advocacy. Because the Committee has received several communications regarding sexual harassment, the need for addressing this issue seemed particularly timely. The third scenario presents a more general discussion regarding this topic.     

Testing Clinical Intuitions About Barriers to Improvement in Cognitive-Behavioral Therapy for Panic Disorder

Although clinical intuitions influence psychotherapeutic practice and are a rich source of novel hypotheses for research, many remain to be empirically tested. This study evaluates whether clinicians’ beliefs about barriers to progress in cognitive-behavioral therapy (CBT) for panic disorder are supported by data. Data from a randomized-controlled trial comparing CBT to panic-focused psychodynamic psychotherapy (PFPP) for adults with primary panic disorder (N = 161) were used to evaluate 15 factors endorsed by clinicians as impediments to CBT in a recent survey. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Hierarchical linear modeling revealed that none of the perceived barriers were predictive of poor outcome. Contrary to clinicians’ intuitions, dissociation during panic attacks was associated with greater symptomatic improvement in both treatment arms (β = ?0.69, p < .05), above the effect of established predictors. Moderation analyses revealed that when patients had PTSD diagnosed with the Anxiety Disorders Interview Schedule (β = 1.71, p < .05) or less severe panic disorder (β = 0.45, p = .04), they changed more rapidly in CBT than in PFPP. Overall, clinician agreement was inversely related to the strength of a predictor (r = ?.24, p = .39). Although clinical intuitions can be useful as clinical and empirical signals, such beliefs should be critically examined before informing practice. Dialogue between academics and clinicians might be enhanced through research that incorporates input from front-line practitioners.