The words we work with that work on us: clinical paradigm and cumulative relational trauma

This paper addresses a gap between analytic clinical theory and practice which emerges when examining the words we work with via textual and narrative research of case histories. Both subject matter and methodology fit with the remit of conceptual research in psychoanalysis, currently ranging from inductive to nomothetical approaches. Research of clinical language reveals an implicit account of human nature and the world which undergirds clinical practice. Based in the critical philosophy of the previous century, this is termed clinical paradigm. Such implicit views are induced rather than explicitly taught during analytic training, and need to be spelled out in order to become available to discourse and difference of opinion. Textual research shows these implicit pre‐clinical attitudes to be inherently pessimistic and thus too similar to the views of self and others found in cumulative relational trauma. Moreover, clinical accounts tend to normalize subtly antagonistic forms of relating, recently recognised as micro‐trauma. Importantly, this contravenes the agapic orientation of our theories and ethics. Paradigmatic reflection as a form of professional individuation addresses this gap. This includes a more optimistic outlook which can be traced through the philosophical implications of quantum theory.     

Exercise Training for Persons with Alzheimer's Disease and Caregivers: A Review of Dyadic Exercise Interventions

Alzheimer's disease (AD) is the most common form of dementia and the prevalence will increase dramatically in the next decades. Although exercise has shown benefits for people with dementia due to AD as well as their caregivers, the impact of a dyadic exercise intervention including both groups as study participants remains to be determined. The authors review the current clinical evidence for dyadic exercise interventions, which are exercise regimens applied to both the person with dementia and the caregiver. A total of 4 controlled trials were reviewed. This review shows that dyadic exercise interventions are feasible and may produce a positive effect on functional independence and caregiver burden. However, there was insufficient evidence to support a benefit of dyadic exercise intervention on cognitive performance and on behavioral and neuropsychiatric symptoms in participants with dementia due to AD. A dyadic exercise intervention improves functional independence and caregiver burden. However, there is a need for well-designed randomized controlled clinical trials to confirm these benefits and to investigate several important points such as the effects of a dyadic exercise intervention on cognitive and noncognitive outcomes of AD, the optimal intensity of exercise training, and the cost effectiveness of such a program.     

Practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugee clients

The present study is the first study undertaken in Australia that seeks to explore practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugees. We used thematic analysis to analyse extracts of interviews that were conducted with nine professionals who worked therapeutically with asylum seekers and refugees and had experience of participating in individual and peer supervision. The findings of the study suggest that supervision encouraged practitioners to develop multicultural awareness and explore therapeutic ways of working that are compatible with their clients’ frame. In addition, supervision provided the context in which practitioners explored the impact of the asylum legislative framework on their clinical work and reflected upon their feelings of powerlessness and political impotence. Implications for practice that derive from supervisory needs of practitioners who work with asylum seekers and refugees are explored.     

Facilitating supervisees’ developing competence through supervisory conversation

Research on assessing supervisees’ professional development (PD) has been primarily focused on formal end-point, summative evaluations. Little attention has been given to the role that routine supervisory conversations play in formative PD evaluations. This study takes a situated/dialogical approach to explore how PD evaluations are locally proposed, recognized, transacted, and conversationally accomplished in the conversations of actual supervision practice. Informed by ethnomethodology, we discursively analyzed episodes of supervisory sessions selected by supervisory dyads, which they regarded as significant to the supervisee’s PD. We describe and exemplify five conversational Practices by which supervisory dyads brought about shared evaluations vis-à-vis the supervisee’s PD, through supervisory conversations.     

Implicit racial bias and epistemic pessimism

Implicit bias results from living in a society structured by race. Tamar Gendler has drawn attention to several epistemic costs of implicit bias and concludes that paying some costs is unavoidable. In this paper, we reconstruct Gendler’s argument and argue that the epistemic costs she highlights can be avoided. Though epistemic agents encode discriminatory information from the environment, not all encoded information is activated. Agents can construct local epistemic environments that do not activate biasing representations, effectively avoiding the consequences of activation. We conclude that changing our local environments provides a way to avoid paying implicit bias’s epistemic costs.     

Dynamic accountability in clinical training and supervision: Three orienting ideals

Despite the growing interest on making clinical practice accountable, research on how specific components of professional competence are relevant in actual training/supervision practice is as yet unspecified. This study explores this dynamic aspect of professional supervision. Three supervisory dyads, composed by an experienced supervisor and a doctoral counseling psychology student were used in the study. A qualitative, ethnomethodology-informed design was used to discursively analyze 16 significant episodes (SEs) in actual supervision meetings. This was complemented by 16 follow-up interviews. Three interpretative repertoires – ‘ideals’ – influencing participants’ accounting practices were identified: efficacy, responsiveness, and authenticity. The article discusses how structural (competency-based) and dynamic (practice-based) approaches to accountability can be combined to guide the appraisal of relevant professional competencies.     

Reliability, diagnostic efficiency, and validity of the Millon adolescent clinical inventory: examination of selected scales in psychiatrically hospitalized adolescents

This study examined the internal consistency, diagnostic efficiency, and validity of selected scales of the Millon adolescent clinical inventory (MACI; Millon et al., Manual for the Millon Adolescent Clinical Inventory, National Computer Systems, Minneapolis, MN, 1993). 241 psychiatrically hospitalized adolescents were administered the MACI and a battery of established self-report measures and a multidisciplinary team independently assigned DSM-IV psychiatric diagnoses at the time of discharge. The internal consistency of MACI scales ranged from 0.71 to 0.93. Conditional probabilities (sensitivity, specificity, positive predictive power, and negative predictive power) were calculated for selected disorders using independently generated clinical diagnoses as the standard. The diagnostic efficiencies for the selected scales were variable, with adequate performance for predicting classes of diagnoses but not for specific diagnoses. The MACI showed good criterion validity for most disorders, with participants with a clinical diagnosis having a significantly higher corresponding MACI scale score than participants not assigned that diagnosis. Concurrent validity, tested by correlating MACI scale scores with those of relevant, validated measures, was generally good. The MACI appears to be a psychometrically sound self-report instrument and appears valuable as a screening instrument for many problems found in adolescent psychiatric inpatients.     

Clinical Implications and Methodological Challenges in the Study of the Neuropsychological Correlates of Cannabis,Stimulant, and Opioid Abuse

Chronic consumption of several drugs of abuse (cannabis, stimulants, opioids) has been associated with the presence of neuropsychological impairments in a broad range of functions. Nevertheless, in recent years neuropsychological research on substance abuse has focused on the study of impairments in the executive functions linked to the prefrontal cortex and their influence on the personality, cognitions, and behaviors of the substance abusers. The aim of our review is, first, to summarize the main neuropsychological impairments shown by classic studies, as well as these new discoveries in executive functioning; second, to consider the mediating role of neuropsychological status on treatment outcomes and analyze the impact of these impairments in clinical practice with drug addicts; and third, to review the principal methodological challenges associated with research in the field of the neuropsychology of substance abuse. We also highlight the convenience of intervening in those functions most relevant to the abusers' persistence in consumption and risk of relapse.